Urinary Incontinence Questions

1. Which of the following may improve urinary incontinence?

Correcting comorbid disease states

Correcting functional impairments

Optimizing medication therapy

All of the above

2. Stress UI is leakage that occurs with ________ in intra-abdominal pressure and is associated with ________ urethral sphincter support.

An increase; impaired

A decrease; impaired

An increase; improved

A decrease; improved

3. The possible causes in urethral closure (resting) pressure decreases with age in women are:

Alterations in the mucosal and sub-mucosal layers

Decreased vascular density and blood flow

Both A and B

None of the above

4. Which agent is currently available as a generic medication?

Oxybutynin

Solifenacin

Darifenacin

Fesoterodine

5. Urethral closure (resting) pressure decreases with age possible cause(s) in women include:

Alterations in the mucosal and sub-mucosal layers

Increased vascular density

Decreased blood flow

A and C only

6. Which pharmalogical intervention below do you think would be the BEST treatment of urinary incontinence?

Estrogen

Duloxetine

Amitriptyline

Oxybutynin

7. Urethral closure pressure decreases with ____________.

Gender

Age

Physical activity

Caffeine

8. What type of leakage is characterized by an increase in intra-abdominal pressure and is associated with impaired urethral sphincter support?

Urge UI

Stress UI

Explosive UI

Bladder UI

9. Which formulation of oxybutynin has the lowest published rate of dry mouth and constipation?

Oral syrup

Gelnique 400mg/gm

Oral tablet

Transdermal jelly 100mg/gm

10. ________ is better with ________ formulations especially in patients who are already taking multiple daily medications.

Compliance; once daily

Tolerance; twice daily

Efficacy; once daily

Efficacy; three times daily

11. The major age-related change(s) in the bladder for men and women include:

Detrusor overactivity (DO)

Diminished detrusor contractile strength

Obstruction due to the prostate

A and B

12. Which medication is available in a topical patch formulation?

Vesicare

Enablex

Oxybutynin

Sanctura

13. The major age-related changes in the bladder included increased involuntary contractions of what?

Detrusor overactivity (DO)

Detrusor underactivity (DU)

Pyloric sphincter overactivity (PO)

None of the above

14. 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"?

Tolerodine

Oxybutynin

Darlfenacin

Solifenacin

15. Which of the following adverse effects of anti-muscarinics is incorrect:

Dry mouth

Constipation

Alopecia

Altered cognition

16. The possible causes in urethral closure (resting) pressure decreases with age in women are:

Alterations in the mucosal and sub-mucosal layers

Decreased vascular density and blood flow

Both A and B

None of the above

17. Older persons tend to have smaller bladder capacity, lower urine flow rate, and which of the following?

Decreased post-voiding residual volume

Increased post-voiding residual volume

Decreased nocturia

Increased detrusor contractile strength

18. In women, mechanical urethral obstruction is usually due to:

Pelvic organ prolapse

Prior surgery

Prostate disease

A and B only

19. The major age-related changes in the bladder included increased involuntary contractions of what?

Detrusor overactivity (DO)

Detrusor underactivity (DU)

Pyloric sphincter overactivity (PO)

None of the above

20. Which of the following UI therapies had the lowest tolerance for dry mouth?

Tolterodine

Oxybutynin

Darifenacin

Solifenacin

21. 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).

Solifenacin

Darifenacin

Oxybutinin

None of the above

22. Based on efficacy, which of the following is an appropriate antimuscarinic drug for the treatment of UI in an elderly patient?

Ditropan

Detrol

Diprivan

A and B

23. Which of the following antimuscarinic drugs has shown higher efficacy rates in reducing urge UI and resulting in cure

Oxybutynin

Tolterodine

Darifenacin

All of the above have similar efficacies in reducing urge UI and resulting in cure

24. Which of the following is the most concerning antimuscarinic drug-related ADE for older adults in the treatment of urinary incontinence?

Constipation

Cognitive impairment

Diarrhea

UTI

25. Which of the following statements is false?

Major age-related changes in the bladder include increased involuntary contractions

Urinary incontinence can be attributed to detrusor overactivity alone

Diminished detrusor contractile strength is a major age-related change

Urethral closure pressure decreases with age

26. Older populations tend to have all of the following characteristics that lead to urinary incontinence EXCEPT:

Smaller voided volumes

Higher urine flow rate

Smaller bladder capacity

Increased post-voiding residual volume

27. Which of the following antimuscarinic agents is NOT metabolized by CYP450?

Trospium

Darifenacin

Oxybutinin

Solifenacin

28. Stress UI is a leakage that is associated with all of the following features EXCEPT:

Increased intra-abdominal pressure

Sphincter damage impairing closure

Detrusor overactivity

Impaired uretheral support

29. Which one of the following statements are FALSE about antimuscarinic:

All antimuscarinics are metabolized by CYP-450 enzymes

During antimuscarinic therapy with older adults a major drug related ADE of concern is cognitive impairment

Currently there is insufficient evidence that one agent with in this class is "safer" for all older patients

Agents within this class prescribed for UI may be associated with drug-disease interactions ie advance diabetes, and parkison's disease

30. Desmopressin acetate should not be used for nocturia in older persons because of the risk of:

Hypokalemia

Hypocalcemia

Hyponatremia

Hypoalbuminemia

31. Which is not a predominate factor in drug selection?

Differences in the incidence of ADEs

Formulation and manufacturer of the drug

Avoidance of ADEs to which the patient may be susceptible

Additional patient-based issues that may complicate the use of the drug

32. The major age related changes in the bladder include the following EXCEPT?

Detrusor overactivity

Diminished detrusor contractile strength

Increased number and density of striated and smooth muscle

Small bladder capacity

33. Urge UI is thought to be caused by:

Detrusor overactivity

Impaired compensatory mechanisms

Bladder outlet obstruction

A and B only

34. Current pharmacological agents for urinary incontinence target:

Alpha adrenergic receptors

Beta adrenergic agonists

Serotonergic receptors

Muscarinic receptors

35. Which of the following showed decrease urgency with UI when administered in addition to behavioral treatment?

Solefenacin

Darifenacin

Detrol LA

Oxybutynin IR

36. ________ oxybutin is associated with __________ published rates of dry mouth and constipation but the incidence of skin reaction to patch is ~15%.

Topical; lowest

IV; lowest

Topical; highest

IV; highest

37. The major age-related changes in urethral pathophysiology

Increased urethral closing pressure

The number but NOT density of striated fibers decreases

Prostate-induced mechanical urethral obstruction is common in females

None of the above

38. What cellular mechanisms are likely responsible for age-related changes in the bladder?

“dense bands” in smooth muscle

Decreased axon sensitivity

Narrowing of spaces between muscle cells

Acetylcholine accumulation

39. The correct brand name match for the following generics (tolterodine, solifenacin, darifenacin and fesoterodine) in order are:

Detrol, Vesicare, Enablex, Toviaz

Sanctura, Vesicare, Toviaz, Enablex

Detrol, Enablex, Toviaz, Vesicare

Sanctura, Oxytrol, Enablex, Evista

40. Which dose of salifenacin was assoicated with urinary retention and discontinuation ?

5 mg

10 mg

4 mg

15 mg

41. Tricyclic antidepressants for urinary incontinence are limited by which adverse effect?

Diarrhea

Anticholinergic effects

Nausea and vomiting

Constipation

42. Urethral age-related changes in men/women can be attributed to?

Decrease in density of striated and smooth muscle

Prior surgery

Increased involuntary contractions due to detrusor overactivity

Pelvic organ prolapse

43. Which of the following is not associated with UI in elderly patients?

Elderly patients are at risk for developing adverse effects of UI medications

Etiology is usually a specific condition of the lower urinary tract

Concurrent medications should be considered for the cause of UI

UI is associated with an increase in fall risk

44. Which of these is NOT a major age related related change in the bladder?

Increased involuntary contractions

Detrusor overactivity

Decreased involuntary contractions

Diminished detrusor contractile strength

45. Which agent is associated with the lowest rates of dry mouth and constipation?

Tolterodine

Darifenacin

Oxybutynin

Fesoterodine

46. Which of the following agents with an indication for stress UI does NOT have robust evidence?

Duloxetine

Oxybutynin

Tolterodine

Darifenacin

47. What is a possible cause of decreased urethral closure pressure?

Increased vascular density and blood flow

Diminished detrusor contractile strength

Alterations in the mucosal and submucosal layers

"ultra-close abutments" in smooth muscle cells to facilitate

48. Which of the following medication class is not associated with causing or worsening incontinence?

NSAIDS

Estrogens

Statins

TCAs

49. Which if the following was associated with more urinary retention and an increase incidence of discontinuation due to ADE's?

Detrol LA 2mg

Solifenacin 10 mg

Oxybutynin 5mg

Solifenacin 5 mg

50. All of the following are factors to consider when selecting an antimuscarinic agent for an older patient with UI EXCEPT:

ADEs

Patient-based factors

Efficacy

Issues that may complicate use of a drug

51. Which of the antimuscarinic agents is not metabolized by CYP450 enzymes?

Solifenacin

Trospium

Oxybutynin

Fesoterodine

52. Drug selection for urinary incontinence is primarily based on which of the following:

Incidences of ADE’s

Oxybutynin is always the primary choice

There is no difference between drug choices

Patient age

53. Which of the following about bladder biopsies from older person with normal urodynamic tests is correct?

Elevated caveolae

“dense bands” in smooth muscle membranes

Tight spaces between muscle cells

None of the above

54. The major age-related changes in bladder pathophysiology include:

Decreased involuntary contractions

Increased voided volume

Decreased detrusor contractile strength

All of the above

55. 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?

Some agents are more effective than others

All agents are equally effective in older persons

It is unclear whether these agents are equally effective, or more or less so, in older persons

No agents are particularly effective, they work by placebo effect

56. 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"?

50% reduction in leakage over a period of 3 months

No leakage recorded in a 3-5 day bladder diary

No leakage recorded in a 3 month bladder diary

50% reduction in leakage over a period of 1 month

57. Which if the following statements are FALSE?

Anticholinergic drugs are neither less efficacious nor significantly more likely to cause urinary retention

Desmopressin acetate is inappropriate for nocturia in older persons because of the risk of hyponatremic

Amitriptyline has robust evidence of efficacy and is supported by its anticholinergic effects

58. Solitenacin and darifenacin act primarily by:

Increasing bladder capacity

Acting at the level of the sacral cord to facilitate sphincter contraction

Ablating detursor overactivity

Facilitate sphincter contraction through smooth muscle α-1A receptors

59. Which of the following UI therapies has been shown to be the most efficacious?

Oxybutynin

Tolterodine

Solifenacin

There is no difference in efficacy among UI therapies

60. Which antimuscarinc agent for urge incontinence does not come in an extended-release formulation?

Oxybutynin

Tolterodine

Solifenacin

Tropsium

61. Which one of the following has been proven to be the most effective in older persons?

Oxybutynin

Tolterodine

Darifenacin

None of the above

62. Possible causes in women that cause a decrease in urethral closure pressure includes all of the following except:

Alterations in the mucosal and submucosal layers

Alterations in smooth muscle membranes

Decreased vascular density

Decreased blood flow

63. 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)?

Oxybutynin

Tolterodine

Solifenacin

Darifenacin