A 72 year old woman presents with complaints of persistent urinary urgency, and incontinence. Her past medical history is significant for type 2 diabetes, for which she is currently taking glyburide, 5 mg twice daily. Which of the following is the most appropriate treatment for this patient?
The patient is presenting with signs and symptoms of bladder instability. Oxybutynin both exes a direct antispasmodic effect and inhibits the muscarinic action of acetylcholine on smooth muscle. Although this agent exes approximately one fifth the anticholinergic activity of atropine, it has 4-10 times the antispasmodic activity of this agent. In addition, oxybutynin will not interact with her current medication regimen. Bumetanide is a "loop" diuretic used in the treatment of edematous states secondary to a wide variety of pathologic conditions. Since this agent promotes diuresis, it would most likely worsen the signs and symptoms of persistent urinary urgency, and urge incontinence. Metoprolol is a beta-1 selective receptor blocking agent indicated for the treatment of hypeension and tachyarrhythmias. The use of this agent would not have an effect on this patient's persistent urinary problems. Fuhermore, this agent is generally not used in diabetic patients, since it can block the normal premonitory signs of hypoglycemia. Neostigmine inhibits acetylcholine hydrolysis in the synaptic cleft acetylcholinesterase inhibition. The net effect is an increase in cholinergic activity, leading to detrusor muscle contraction. This agent is indicated for the treatment of urinary retention, and it would most likely worsen this patient's incontinence.
Bumetanide
Metoprolol
Neostigmine
Oxybutynin