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CONTINUING PROFESSIONAL DEVELOPMENT
1. Which of the following statements
about urge incontinence is TRUE?
a) Urge incontinence is caused by detrusor
b) Urge incontinence is also known as
c) Urge incontinence is the most common
form of incontinence in the elderly.
d) All of the above.
2. Anticholinergic agents currently
recommended for urge incontinence
include all of the following medicines
3. Adverse effects due to
anticholinergic medicines requiring
referral to a doctor include all of the
a) Cognitive effects such as delirium and
b) Mild dry mouth alone.
d) Blurred vision.
4. Medicines with significant
anticholinergic effects include all of
the following EXCEPT:
c) Hyoscine hydrobromide.
It is highly likely that June is suffering
from the effects of anticholinergic
toxicity due to the oxybutynin dose of
5 mg twice daily. Her inhaled
anticholinergics may also be contributing
to her anticholinergic burden, despite low
systemic absorption. If a further medicine
with anticholinergic effects was added to
her regime at any stage, this could
potentially worsen the adverse effects she
is already experiencing.
Four weeks later June comes to the
pharmacy to give you an update.
She stopped taking the oxybutynin
and the ipratropium inhaler on your
advice and has followed up with her
doctor. Her symptoms of dry mouth
and eyes, constipation and confusion
gradually improved over the following
three weeks. Following this episode,
June is motivated to try non-drug
methods to control her incontinence
and has noted an improvement after
reducing her caffeine intake and
attending physiotherapy sessions,
which have taught her physical and
behavioural strategies. She will consider
trialling a low dose of oxybutynin
2.5 mg daily with close monitoring by
her doctor, if physical methods do not
continue to be satisfactory.
You provide June with:
1. The website address for the
Continence Foundation of Australia:
www.continence.org.au which will
provide her with information on
2. Information on how to talk to a
continence nurse advisor through
the National Continence Helpline.
Ph: 1800 33 00 66.
3. The Bladder and urine control
PSA Self Care Fact Card.
KEY LEARNING POINTS
• Treatment of incontinence with
anticholinergics is limited by side
effects, particularly in the elderly
who are more susceptible to these
• Anticholinergic burden can cause
confusion, delirium, reductions
in short-term memory and
impediments to daily living and
quality of life.
• When considering causes of cognitive
decline in the elderly, consider all
medicines that may be contributing
to the total anticholinergic burden.
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