Nicole 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 Nicole's history would help support a diagnosis of overactive bladder?

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

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

Instructions:

APA 7th edition format

Use at least 2 evidenced-based, peer-reviewed references no older than 5 years.

Two paragraph, minimum 250 words.