Oxybutynin

INTRODUCTION

Indications

Urinary symptoms that may be associated with neurogenic bladder, including Frequent urination, Urgency, Nocturia, Urge incontinence. Overactive bladder with symptoms of urge incontinence, urgency, and frequency.

Action

Inhibits the action of acetylcholine at postganglionic receptors. Has direct spasmolytic action on smooth muscle, including smooth muscle lining the GU tract, without affecting vascular smooth muscle. Therapeutic Effects: Increased bladder capacity. Delayed desire to void. Decreased urge incontinence, urinary urgency, and frequency and decreased number of urinary accidents associated with overactive bladder.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, agitation, confusion, hallucinations, headache. EENT: blurred vision. CV: tachycardia. GI: constipation, dry mouth, nausea, abdominal pain, diarrhea. GU: urinary retention. Derm: decreased sweating, transdermal only: application site reactions. Metab: hyperthermia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of urine retention (difficult urination, painful or distended abdomen). Excessive urinary retention may require dose adjustment by physician.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Be alert for decreased sweating and increased body temperature (hyperthermia), especially during exercise. Notify physician of a prolonged or persistent elevation in body temperature.

• Monitor changes in mood and behavior, including confusion, agitation, and hallucinations. Notify physician if these changes become problematic.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor transdermal application site for pain, swelling, and irritation. Report prolonged or excessive reactions to the physician.

Interventions

• When appropriate, implement pelvic floor muscle strengthening activities and other therapeutic exercises to help maintain bladder control.

• Because of the risk of arrhythmias and impaired thermoregulation, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient to increase fluid intake and dietary fiber to avoid constipation. Laxatives may also be helpful in patients susceptible to fecal impaction.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, blurred vision, or GI problems (nausea, diarrhea, constipation, dry mouth, abdominal pain).

Pharmacokinetics

Absorption: Rapidly absorbed following oral administration, but undergoes extensive first-pass metabolism; XL tablets provide ...