The patient felt the first desire to void at 100 mL. The catheter was removed. The patient was asked to cough in different positions. No stress urinary incontinence was demonstrated. The patient voided the entire volume of saline that was instilled. Assessment Overactive bladder with symptoms of urinary urgency, frequency, and incontinence, which has not responded to Detrol LA 2 mg PO daily for 1 month. Patient is also having new-onset confusion and forgetfulness, which are probably related to Detrol LA and to the total anticholinergic burden. Will evaluate carefully and consider alternative medication options. QUESTIONS 2.a. Assess the severity of incontinence based on the subjective and objective information available. 2.c. Differentiate urge incontinence from stress incontinence, overflow incontinence, and functional incontinence. 2.f. What are the possible consequences of persistent CNS adverse effects of anticholinergic agents in this patient? 3.c. What pharmacotherapeutic alternatives are available for treating overactive bladder? Compare and contrast antimuscarinic agents for treatment of overactive bladder syndrome. 4- Provide patient educational material to assist with adherence and /or nor –pharmacologic management of overactive bladder.
