Read the case below and respond to

Read the case below and respond to the answers Chief Complaint “I can’t seem to control my urine. I feel like I have to urinate all the time. However, when I do go to the bathroom, I often pass only a small amount of urine. Sometimes I wet myself. I was started on a medication for my leaking a few weeks ago, but it doesn’t seem to be working. I also can’t seem to remember anything. It is a wonder that I remembered to come to the clinic today.” HPI Susan Jones is a 65-year-old woman with urinary urgency, frequency, and incontinence. She reports soiling her underwear at least two to three times during the day and night and has resorted to wearing panty liners or changing her underwear several times a day. The patient has curtailed much of her volunteer work and social activities because of this problem. Urinary leakage is not worsened by laughing, coughing, sneezing, carrying heavy objects, or walking up and down stairs. She does not report wetting herself without warning. She has been taking Detrol LA 2 mg PO daily for the past month with no improvement in her voiding symptoms, and she complains of new-onset confusion and difficulty remembering routine tasks. PMH HTN for many years, treated with medications for 10 years. Dyslipidemia for 5 years, controlled with a low-cholesterol diet, weight control, regular exercise, and medication. Menopausal; stopped ovulating at age 52; no longer has hot flashes. Has difficulty falling asleep and often has sleepless nights. She has no history of spinal or pelvic surgery. FH Noncontributory SH Nonsmoker; social drinker; married Meds Hydrochlorothiazide 25 mg PO once daily with supper Irbesartan 150 mg PO daily Pravastatin 40 mg PO at bedtime Detrol LA 2 mg PO daily Sominex (diphenhydramine) 15 mg PO at bedtime as needed, usually about five times a week Amitriptyline 50 mg PO at bedtime as needed All NKDA ROS Complains of urinary incontinence that has not responded to Detrol LA. Feels confused and has difficulty remembering routine tasks. Patient states that her ability to remember what she has to do became impaired in the past 3 weeks after Detrol was started. Physical ExaminationGen WDWN woman VS BP 135/84 mm Hg, P 90 bpm, RR 16, T 37°C; Wt 65 kg, Ht 5′2″ Skin No rashes, wounds, or open sores HEENT PERRLA; EOMI; no AV nicking or hemorrhages Neck/Lymph Nodes No palpable thyroid masses; no lymphadenopathy Pulm Clear to A&P Breasts Normal; no lumps CV Regular S1, S2; (+) S4; (-) S3, murmurs, or rubs Abd Soft, NTND, (+) bowel sounds Genit/Rect Genital examination shows atrophic vaginitis consistent with menopausal status. Perineal sensation and anal sphincter tone are normal. Pelvic examination shows no uterine prolapse and a mild degree of cystocele. Cervix is normal. No pelvic, adnexal, or uterine masses found. External hemorrhoids; heme (-) stool. Ext Normal; equal motor strength in both arms and legs Neuro Although alert, the patient is not oriented to correct month, day, or year. CNs II-XII grossly intact; DTRs 3/5 bilaterally; negative Babinski. When asked to recall a series of five objects after 5 minutes, the patient had difficulty and could only recall one object. Labs | Download (.pdf) | Print Na 140 mEq/L Hgb 12 g/dL K 4.2 mEq/L Hct 37% Cl 105 mEq/L Plt 400 × 103/mm3 CO2 28 mEq/L WBC 5.0 × 103/mm3 BUN 17 mg/dL SCr 1.2 mg/dL Glu 100 mg/dL UA No bacteria; no WBC Other Using an ultrasonic bladder scan, a residual urine volume was measured after the patient voided. No residual urine was found. The bladder was then filled with 300 mL saline. The patient felt the first desire to void at 100 mL. The catheter was removed. The patient was asked to cough in different positions. No stress urinary incontinence was demonstrated. The patient voided the entire volume of saline that was instilled. Assessment Overactive bladder with symptoms of urinary urgency, frequency, and incontinence, which has not responded to Detrol LA 2 mg PO daily for 1 month. Patient is also having new-onset confusion and forgetfulness, which are probably related to Detrol LA and to the total anticholinergic burden. Will evaluate carefully and consider alternative medication options. 3.a. What are the goals of pharmacotherapy in this case? The goal of pharmacotherapy is to reduce the incontinence occurrences, as well as changing the medication that the patient is already on for these issues (Detrol LA) due to adverse effects causing the patient to be forgetful and confused. Also, decrease adverse effects of current medication the patient on. 3.b. What nondrug therapies might be useful for this patient? A nondrug therapy that might be useful for this patient includes toilet-scheduling regimens and pelvic-floor muscle rehabilitation (Chughtai et al., 2019). While the patient is awake, toileting might be scheduled at set intervals or at increasing intervals. This patient has no disabilities and would benefit more from bladder training that involves progressive interval (Chughtai et al., 2019). Kegel exercises and vaginal weight training are examples of pelvic-floor muscle rehabilitation techniques. External neuromodulation, which involves stimulating nerves with a electrical or magnetic device, may be taken into consideration if pelvic-floor muscle retraining fails (Chughtai et al., 2019). 3.c. What pharmaco-therapeutic alternatives are available for treating overactive bladder? Compare and contrast antimuscarinic agents for treatment of overactive bladder syndrome. The patient is already on Detrol LA which is classified as an anticholinergic. This is causing her to have serious adverse effects which includes confusion, and impaired memory. Oral estrogen is an option. The body produces less estrogen after menopause (Lai et al., 2020). The supporting tissues around the bladder and the tube that allows urine to exit the body may become weaker as a result of this decline in estrogen (Lai et al., 2020). Oxybutynin is an anti-muscarinic agent that is used to treat overactive bladder. Anti-muscarinic medications are a specific group of anticholinergic drugs that block muscarinic receptors. For almost three decades, immediate-release oxybutynin was the go-to medication for treating OAB (Lai et al., 2020). It is nonselective anti-muscarinic efficacy for the urine bladder, it has considerable systemic adverse effects, especially dry mouth, which restrict its therapeutic relevance (Lai et al., 2020). What your opinion about these responses?

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."