NURS 5462 Urinary Incontinence Exam Questions And
Correct Answers (A+)
Detrusor Overactivity Treatement - ANSWER Patient voids at a time interval less than
incontinent interval, Once incontinence improves, interval between scheduled voiding is
increased by ½ hour increments until 3-4 hour interval is reached
Anticholinergics or smooth muscle relaxants can be used to decrease involuntary
contractions
Detrusor Overactivity RX - ANSWER Propantheline 15-30 mg TID or QID Dicyclomine
10-30 mg TID or QID Has anticholinergic and smooth muscle relaxant properties TCAs
Tofranil or Doxepin 25-50 mg TID or at HS Evaluate for orthostatic hypotension and
confusion Ditropan 2.5-5 mg QD or QID
Detrusor Overactivity [anticholinergics] - ANSWER Detrol- 2 mg BID Detrol LA- 4 mg
daily Ditropan XL-5-10 mg daily Levbid- 1 tab BID Symax Oxytrol Patch- change twice
weekly Gelnique- 1 gram gel q 24 hrs Vesicare Sanctura Sanctura XR Enablex Toviaz
Antimuscarinic Medications—Oxybutynin ANSWER Adverse effects (less common with
ER and topical): Dry mouth Blurred vision Constipation Possibly cognitive Interactions
with CYP34A and 2D6 • Monitor PVR if UI worsens
Antimuscarinic Medications—Tolterodine [Detrol] ANSWER Initial dose: 1-2 mg BID
immediate release, 2-4 mg QD for ER (Detrol LA) Adverse effects similar to
oxybutynin-ER; possible decreased xerostomia Interactions with CYP34A and 2D6
Antimuscarinic Medications—Trospium [Sanctura] - ANSWER Must be taken on an
empty stomach Associated with 56%-60% reduction in weekly urge incontinence
episodes No data in long-term-care populations Adverse events: dry mouth,
constipation, headache, abdominal pain, more muscarinic than anticholinergic
Antimuscarinic Medications—Darifenacin [Enablex]-ANSWER Dose is 7.5 or 15 mg/day
, Median reduction in weekly UI episodes 55%-58% in patients on 7.5 mg and 60%70% in
patients on 15 mg No data in long-term-care populations Adverse events: dry mouth,
***constipation; may have limited cognitive effects Interactions with CYP34A and 2D6
Detrusor Hyperactivity & Impaired Contractility 1 - ANSWER contractility is impaired
prior to therapy, so anticholinergics or bladder relaxants cause urinary retention
Antimuscarinic Medications— Solifenacin [VESIcare] - ANSWER Dose is 5 mg/day; may
be titrated to 10 mg/day Reduction in daily UI episodes 57%-69%, depending on dose No
data in long-term-care populations Adverse events: dry mouth, constipation, nausea,
and blurred vision; possible QTc Interactions with CYP34A and 2D6
Detrusor Hyperactivity & Impaired Contractility - ANSWER If PVR >150 cc and stress
incontinence is absent, use bladder retraining If stress incontinence is present, start
with bladder retraining, then add bladder relaxant Add Credé' maneuver to decrease
PVR
Outlet incompetence is manifested by - ANSWER Nonsurgical therapy Weight loss Kegel
exercises Use of vaginal cones Biofeedback Adjusting fluid intake Voiding frequently
Estrogen Especially in females with atrophic urethritis or vaginosis 0.3-0.625 mg qd
and/or 2 grams vaginal cream qod Alpha agonists Pseudoephedrine 15-30 mg BID or
TID
Stress Incontinence - ANSWER Surgical therapy Can be successful in 70-90% of patient
Periurethral bulking agents Injected into urethra to increase ability of sphincter to coapt
Stress Incontinence Management—Overview - ANSWER Pelvic Muscle Exercises
Biofeedback, Pessaries, Other Adjuncts
Pelvic Muscle Exercises - ANSWER Moderate repetitions of strongest possible
contractions: 3 sets of 8-10 contractions held for 6-8 seconds; start 3-4 times per week
Adjuncts to Pelvic Muscle Exercises - ANSWER Biofeedback: may be helpful for
Correct Answers (A+)
Detrusor Overactivity Treatement - ANSWER Patient voids at a time interval less than
incontinent interval, Once incontinence improves, interval between scheduled voiding is
increased by ½ hour increments until 3-4 hour interval is reached
Anticholinergics or smooth muscle relaxants can be used to decrease involuntary
contractions
Detrusor Overactivity RX - ANSWER Propantheline 15-30 mg TID or QID Dicyclomine
10-30 mg TID or QID Has anticholinergic and smooth muscle relaxant properties TCAs
Tofranil or Doxepin 25-50 mg TID or at HS Evaluate for orthostatic hypotension and
confusion Ditropan 2.5-5 mg QD or QID
Detrusor Overactivity [anticholinergics] - ANSWER Detrol- 2 mg BID Detrol LA- 4 mg
daily Ditropan XL-5-10 mg daily Levbid- 1 tab BID Symax Oxytrol Patch- change twice
weekly Gelnique- 1 gram gel q 24 hrs Vesicare Sanctura Sanctura XR Enablex Toviaz
Antimuscarinic Medications—Oxybutynin ANSWER Adverse effects (less common with
ER and topical): Dry mouth Blurred vision Constipation Possibly cognitive Interactions
with CYP34A and 2D6 • Monitor PVR if UI worsens
Antimuscarinic Medications—Tolterodine [Detrol] ANSWER Initial dose: 1-2 mg BID
immediate release, 2-4 mg QD for ER (Detrol LA) Adverse effects similar to
oxybutynin-ER; possible decreased xerostomia Interactions with CYP34A and 2D6
Antimuscarinic Medications—Trospium [Sanctura] - ANSWER Must be taken on an
empty stomach Associated with 56%-60% reduction in weekly urge incontinence
episodes No data in long-term-care populations Adverse events: dry mouth,
constipation, headache, abdominal pain, more muscarinic than anticholinergic
Antimuscarinic Medications—Darifenacin [Enablex]-ANSWER Dose is 7.5 or 15 mg/day
, Median reduction in weekly UI episodes 55%-58% in patients on 7.5 mg and 60%70% in
patients on 15 mg No data in long-term-care populations Adverse events: dry mouth,
***constipation; may have limited cognitive effects Interactions with CYP34A and 2D6
Detrusor Hyperactivity & Impaired Contractility 1 - ANSWER contractility is impaired
prior to therapy, so anticholinergics or bladder relaxants cause urinary retention
Antimuscarinic Medications— Solifenacin [VESIcare] - ANSWER Dose is 5 mg/day; may
be titrated to 10 mg/day Reduction in daily UI episodes 57%-69%, depending on dose No
data in long-term-care populations Adverse events: dry mouth, constipation, nausea,
and blurred vision; possible QTc Interactions with CYP34A and 2D6
Detrusor Hyperactivity & Impaired Contractility - ANSWER If PVR >150 cc and stress
incontinence is absent, use bladder retraining If stress incontinence is present, start
with bladder retraining, then add bladder relaxant Add Credé' maneuver to decrease
PVR
Outlet incompetence is manifested by - ANSWER Nonsurgical therapy Weight loss Kegel
exercises Use of vaginal cones Biofeedback Adjusting fluid intake Voiding frequently
Estrogen Especially in females with atrophic urethritis or vaginosis 0.3-0.625 mg qd
and/or 2 grams vaginal cream qod Alpha agonists Pseudoephedrine 15-30 mg BID or
TID
Stress Incontinence - ANSWER Surgical therapy Can be successful in 70-90% of patient
Periurethral bulking agents Injected into urethra to increase ability of sphincter to coapt
Stress Incontinence Management—Overview - ANSWER Pelvic Muscle Exercises
Biofeedback, Pessaries, Other Adjuncts
Pelvic Muscle Exercises - ANSWER Moderate repetitions of strongest possible
contractions: 3 sets of 8-10 contractions held for 6-8 seconds; start 3-4 times per week
Adjuncts to Pelvic Muscle Exercises - ANSWER Biofeedback: may be helpful for
