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MP is a 55-year-old woman who presents with complaint of inability to hold urine. She describes incidents where laughing or coughing results in a

May 29, 2024

MP is a 55-year-old woman who presents with complaint of inability to hold urine. She describes incidents where laughing or coughing results in a small to moderate release of urine. She has started wearing Peri Pads to avoid embarrassment.

Past Medical History

• Six vaginal deliveries, all to full term

• Osteoarthritis

• Postmenopausal

Medications

• Boniva, 150 mg once a month

• Calcium, 500 mg daily

• Vitamin D3, one daily

Family History

• Mother, alive and well; hypertension, type 2 diabetes

• Father, deceased; cardiovascular disease, myocardial infarction at age 77

Social History

• No alcohol intake

• Previous smoker

• Walks 2 miles/day

Physical Examination

• Vital signs normal

• Palpation of uterus suggests enlargement

Labs

• Liver function: Normal

Discussion Questions

1. What factors in MP’s history would help support a diagnosis of overactive bladder?

2. The clinician prescribes oxybutynin 10 mg (extended-release). What does MP need to know about this drug?

3. If oxybutynin is ineffective, the clinician could use mirabegron, a beta-3 agonist. What does MP need to know about this new drug?

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