Urinary Incontinence Questions
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- 1.________ oxybutin is associated with __________ published rates of dry mouth and constipation but the incidence of skin reaction to patch is ~15%.
- A.
Topical; lowest
- B.
IV; lowest
- C.
Topical; highest
- D.
IV; highest
- 2.________ is better with ________ formulations especially in patients who are already taking multiple daily medications.
- A.
Compliance; once daily
- B.
Tolerance; twice daily
- C.
Efficacy; once daily
- D.
Efficacy; three times daily
- 3.Which of the following statements is false?
- A.
Major age-related changes in the bladder include increased involuntary contractions
- B.
Urinary incontinence can be attributed to detrusor overactivity alone
- C.
Diminished detrusor contractile strength is a major age-related change
- D.
Urethral closure pressure decreases with age
- 4.In women, mechanical urethral obstruction is usually due to:
- A.
Pelvic organ prolapse
- B.
Prior surgery
- C.
Prostate disease
- D.
A and B only
- 5.The major age-related changes in bladder pathophysiology include:
- A.
Decreased involuntary contractions
- B.
Increased voided volume
- C.
Decreased detrusor contractile strength
- D.
All of the above
- 6.The major age-related changes in urethral pathophysiology
- A.
Increased urethral closing pressure
- B.
The number but NOT density of striated fibers decreases
- C.
Prostate-induced mechanical urethral obstruction is common in females
- D.
None of the above
- 7.Which is not a predominate factor in drug selection?
- A.
Differences in the incidence of ADEs
- B.
Formulation and manufacturer of the drug
- C.
Avoidance of ADEs to which the patient may be susceptible
- D.
Additional patient-based issues that may complicate the use of the drug
- 8.Which agent is currently available as a generic medication?
- A.
Oxybutynin
- B.
Solifenacin
- C.
Darifenacin
- D.
Fesoterodine
- 9.Drug selection for urinary incontinence is primarily based on which of the following:
- A.
Incidences of ADE’s
- B.
Oxybutynin is always the primary choice
- C.
There is no difference between drug choices
- D.
Patient age
- 10.Which of the following adverse effects of anti-muscarinics is incorrect:
- A.
Dry mouth
- B.
Constipation
- C.
Alopecia
- D.
Altered cognition
- 11.Older populations tend to have all of the following characteristics that lead to urinary incontinence EXCEPT:
- A.
Smaller voided volumes
- B.
Higher urine flow rate
- C.
Smaller bladder capacity
- D.
Increased post-voiding residual volume
- 12.Possible causes in women that cause a decrease in urethral closure pressure includes all of the following except:
- A.
Alterations in the mucosal and submucosal layers
- B.
Alterations in smooth muscle membranes
- C.
Decreased vascular density
- D.
Decreased blood flow
- 13.
- A.
Alpha –Blockers and 5-ARI’s used in men with LUT symptoms from BPH are not very effective in reducing UI or urgency
- B.
Anticholinergic drugs are neither less efficacious nor significantly more likely to cause urinary retention
- C.
Desmopressin acetate is inappropriate for nocturia in older persons because of the risk of hyponatremic
- D.
Amitriptyline has robust evidence of efficacy and is supported by its anticholinergic effects
- 14.The correct brand name match for the following generics (tolterodine, solifenacin, darifenacin and fesoterodine) in order are:
- A.
Detrol, Vesicare, Enablex, Toviaz
- B.
Sanctura, Vesicare, Toviaz, Enablex
- C.
Detrol, Enablex, Toviaz, Vesicare
- D.
Sanctura, Oxytrol, Enablex, Evista
- 15.Which pharmalogical intervention below do you think would be the BEST treatment of urinary incontinence?
- A.
Estrogen
- B.
Duloxetine
- C.
Amitriptyline
- D.
Oxybutynin
- 16.Solitenacin and darifenacin act primarily by:
- A.
Increasing bladder capacity
- B.
Acting at the level of the sacral cord to facilitate sphincter contraction
- C.
Ablating detursor overactivity
- D.
Facilitate sphincter contraction through smooth muscle α-1A receptors
- 17.
- A.
Tolterodine
- B.
Darifenacin
- C.
Oxybutynin
- D.
Fesoterodine
- 18.Which of the antimuscarinic agents is not metabolized by CYP450 enzymes?
- A.
Solifenacin
- B.
Trospium
- C.
Oxybutynin
- D.
Fesoterodine
- 19.Which of the following may improve urinary incontinence?
- A.
Correcting comorbid disease states
- B.
Correcting functional impairments
- C.
Optimizing medication therapy
- D.
All of the above
- 20.Which of the following is not associated with UI in elderly patients?
- A.
Elderly patients are at risk for developing adverse effects of UI medications
- B.
Etiology is usually a specific condition of the lower urinary tract
- C.
Concurrent medications should be considered for the cause of UI
- D.
UI is associated with an increase in fall risk
- 21.The major age related changes in the bladder include the following EXCEPT?
- A.
Detrusor overactivity
- B.
Diminished detrusor contractile strength
- C.
Increased number and density of striated and smooth muscle
- D.
Small bladder capacity
- 22.What is a possible cause of decreased urethral closure pressure?
- A.
Increased vascular density and blood flow
- B.
Diminished detrusor contractile strength
- C.
Alterations in the mucosal and submucosal layers
- D.
"ultra-close abutments" in smooth muscle cells to facilitate
- 23.Urethral closure pressure decreases with ____________.
- A.
Gender
- B.
Age
- C.
Physical activity
- D.
Caffeine
- 24.Which of these is NOT a major age related related change in the bladder?
- A.
Increased involuntary contractions
- B.
Detrusor overactivity
- C.
Decreased involuntary contractions
- D.
Diminished detrusor contractile strength
- 25.Which of the following about bladder biopsies from older person with normal urodynamic tests is correct?
- A.
Elevated caveolae
- B.
“dense bands” in smooth muscle membranes
- C.
Tight spaces between muscle cells
- D.
None of the above
- 26.Which of the following antimuscarinic agents is NOT metabolized by CYP450?
- A.
Trospium
- B.
Darifenacin
- C.
Oxybutinin
- D.
Solifenacin
- 27.Which of the following UI therapies had the lowest tolerance for dry mouth?
- A.
Tolterodine
- B.
Oxybutynin
- C.
Darifenacin
- D.
Solifenacin
- 28.Which of the following UI therapies has been shown to be the most efficacious?
- A.
Oxybutynin
- B.
Tolterodine
- C.
Solifenacin
- D.
There is no difference in efficacy among UI therapies
- 29.What type of leakage is characterized by an increase in intra-abdominal pressure and is associated with impaired urethral sphincter support?
- A.
Urge UI
- B.
Stress UI
- C.
Explosive UI
- D.
Bladder UI
- 30.Which of the following medication class is not associated with causing or worsening incontinence?
- A.
NSAIDS
- B.
Estrogens
- C.
Statins
- D.
TCAs
- 31.Which of the following agents with an indication for stress UI does NOT have robust evidence?
- A.
Duloxetine
- B.
Oxybutynin
- C.
Tolterodine
- D.
Darifenacin
- 32.Which one of the following statements are FALSE about antimuscarinic:
- A.
All antimuscarinics are metabolized by CYP-450 enzymes
- B.
During antimuscarinic therapy with older adults a major drug related ADE of concern is cognitive impairment
- C.
Currently there is insufficient evidence that one agent with in this class is "safer" for all older patients
- D.
Agents within this class prescribed for UI may be associated with drug-disease interactions ie advance diabetes, and parkison's disease
- 33.Older persons tend to have smaller bladder capacity, lower urine flow rate, and which of the following?
- A.
Decreased post-voiding residual volume
- B.
Increased post-voiding residual volume
- C.
Decreased nocturia
- D.
Increased detrusor contractile strength
- 34.What cellular mechanisms are likely responsible for age-related changes in the bladder?
- A.
“dense bands” in smooth muscle
- B.
Decreased axon sensitivity
- C.
Narrowing of spaces between muscle cells
- D.
Acetylcholine accumulation
- 35.Stress UI is a leakage that is associated with all of the following features EXCEPT:
- A.
Increased intra-abdominal pressure
- B.
Sphincter damage impairing closure
- C.
Detrusor overactivity
- D.
Impaired uretheral support
- 36.Urge UI is thought to be caused by:
- A.
Detrusor overactivity
- B.
Impaired compensatory mechanisms
- C.
Bladder outlet obstruction
- D.
A and B only
- 37.Stress UI is leakage that occurs with ________ in intra-abdominal pressure and is associated with ________ urethral sphincter support.
- A.
An increase; impaired
- B.
A decrease; impaired
- C.
An increase; improved
- D.
A decrease; improved
- 38.The major age-related changes in the bladder included increased involuntary contractions of what?
- A.
Detrusor overactivity (DO)
- B.
Detrusor underactivity (DU)
- C.
Pyloric sphincter overactivity (PO)
- D.
None of the above
- 39.The possible causes in urethral closure (resting) pressure decreases with age in women are:
- A.
Alterations in the mucosal and sub-mucosal layers
- B.
Decreased vascular density and blood flow
- C.
Both A and B
- D.
None of the above
- 40.All of the following are factors to consider when selecting an antimuscarinic agent for an older patient with UI EXCEPT:
- A.
ADEs
- B.
Patient-based factors
- C.
Efficacy
- D.
Issues that may complicate use of a drug
- 41.Urethral closure (resting) pressure decreases with age possible cause(s) in women include:
- A.
Alterations in the mucosal and sub-mucosal layers
- B.
Increased vascular density
- C.
Decreased blood flow
- D.
A and C only
- 42.The major age-related change(s) in the bladder for men and women include:
- A.
Detrusor overactivity (DO)
- B.
Diminished detrusor contractile strength
- C.
Obstruction due to the prostate
- D.
A and B
- 43.The major age-related changes in the bladder include all of the following EXCEPT:
- A.
Increased involuntary contractions
- B.
Diminished destructor contractile strength
- C.
Destructor overactivity
- D.
Bladder changes only identified in women
- 44.Which one of the following antimuscarinic agents failed to show a difference from placebo in reduction in urge UI episodes, but was superior for patient-based outcomes (e.g., quality of life)?
- A.
Oxybutynin
- B.
Tolterodine
- C.
Solifenacin
- D.
Darifenacin
- 45.Which one of the following has been proven to be the most effective in older persons?
- A.
Oxybutynin
- B.
Tolterodine
- C.
Darifenacin
- D.
None of the above
- 46.If a patient is using antimuscarinic medications to reduce urge UI, what must a patient experience for therapy to be considered as resulting in "cure"?
- A.
50% reduction in leakage over a period of 3 months
- B.
No leakage recorded in a 3-5 day bladder diary
- C.
No leakage recorded in a 3 month bladder diary
- D.
50% reduction in leakage over a period of 1 month
- 47.In persons age >50, tolterodine IR 2mg BID has been shown to produce similar effects to ___________ with respect to reduction in urge UI and frequency, but was tolerated significantly better with respect to ADE's (dry mouth and need for dose reduction).
- A.
Solifenacin
- B.
Darifenacin
- C.
Oxybutinin
- D.
None of the above
- 48.Based on efficacy, which of the following is an appropriate antimuscarinic drug for the treatment of UI in an elderly patient?
- A.
Ditropan
- B.
Detrol
- C.
Diprivan
- D.
A and B
- 49.Which formulation of oxybutynin has the lowest published rate of dry mouth and constipation?
- A.
Oral syrup
- B.
Gelnique 400mg/gm
- C.
Oral tablet
- D.
Transdermal jelly 100mg/gm
- 50.Desmopressin acetate should not be used for nocturia in older persons because of the risk of:
- A.
Hypokalemia
- B.
Hypocalcemia
- C.
Hyponatremia
- D.
Hypoalbuminemia
- 51.Current pharmacological agents for urinary incontinence target:
- A.
Alpha adrenergic receptors
- B.
Beta adrenergic agonists
- C.
Serotonergic receptors
- D.
Muscarinic receptors
- 52.According to a number of secondary analysis and randomized controlled trials about the efficacy of pharmacological agents for UI, including Oxybutynin, Tolterodine, Solifenacin, Darifenacin; which of the following statements are true?
- A.
Some agents are more effective than others
- B.
All agents are equally effective in older persons
- C.
It is unclear whether these agents are equally effective, or more or less so, in older persons
- D.
No agents are particularly effective, they work by placebo effect
- 53.Which of the following antimuscarinic drugs has shown higher efficacy rates in reducing urge UI and resulting in cure
- A.
Oxybutynin
- B.
Tolterodine
- C.
Darifenacin
- D.
All of the above have similar efficacies in reducing urge UI and resulting in cure
- 54.Which antimuscarinc agent for urge incontinence does not come in an extended-release formulation?
- A.
Oxybutynin
- B.
Tolterodine
- C.
Solifenacin
- D.
Tropsium
- 55.Which medication is available in a topical patch formulation?
- A.
Vesicare
- B.
Enablex
- C.
Oxybutynin
- D.
Sanctura
- 56.Tricyclic antidepressants for urinary incontinence are limited by which adverse effect?
- A.
Diarrhea
- B.
Anticholinergic effects
- C.
Nausea and vomiting
- D.
Constipation
- 57.Which if the following was associated with more urinary retention and an increase incidence of discontinuation due to ADE’s?
- A.
Detrol LA 2mg
- B.
Solifenacin 10 mg
- C.
Oxybutynin 5mg
- D.
Solifenacin 5 mg
- 58.Which of the following showed decrease urgency with UI when administered in addition to behavioral treatment?
- A.
Solefenacin
- B.
Darifenacin
- C.
Detrol LA
- D.
Oxybutynin IR
- 59.The major age-related changes in the bladder included increased involuntary contractions of what?
- A.
Detrusor overactivity (DO)
- B.
Detrusor underactivity (DU)
- C.
Pyloric sphincter overactivity (PO)
- D.
None of the above
- 60.The possible causes in urethral closure (resting) pressure decreases with age in women are:
- A.
Alterations in the mucosal and sub-mucosal layers
- B.
Decreased vascular density and blood flow
- C.
Both A and B
- D.
None of the above
- 61.Urethral age-related changes in men/women can be attributed to?
- A.
Decrease in density of striated and smooth muscle
- B.
Prior surgery
- C.
Increased involuntary contractions due to detrusor overactivity
- D.
Pelvic organ prolapse
- 62.One study has shown that _______ decreases the frequency of UI when administered in addition to behavioral treatment in nursing-home residents, as measured by “wet checks”?
- A.
Tolerodine
- B.
Oxybutynin
- C.
Darlfenacin
- D.
Solifenacin
- 63.Which of the following is the most concerning antimuscarinic drug-related ADE for older adults in the treatment of urinary incontinence?
- A.
Constipation
- B.
Cognitive impairment
- C.
Diarrhea
- D.
UTI
- 64.Which dose of salifenacin was assoicated with urinary retention and discontinuation ?
- A.
5 mg
- B.
10 mg
- C.
4 mg
- D.
15 mg
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