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NBME 23 Answers

nbme23/Block 2/Question#12 (38.3 difficulty score)
A 75-year-old woman has stress urinary ...
Stimulation of α-adrenoreceptors🔍,📺
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 +6 
submitted by sugaplum(412),
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papilampnhernonelyo si an ahpla ntigoas htat imesasultt treraulh mostoh umelcs r.nccaiotnot - from daeottp,u vowe,reh it alos syas ti si ton crnmddeeemo eatttenmr morayen

ugalaxy  α1 stimulation (via α1 agonist) constricts the bladder sphincter thereby, preventing sudden bouts of micturition during coughing/sneezing (abdominal stress). +7  
sammyj98  I thought that B3 stimulation stopped urination +5  
adong  @sammyj98 B3 would facilitate bladder relaxation +  
hvancampen  @sammyj98- were you thinking of oxybutynin? (thats what I thought of!) According to FA, its used for urge incontinence not stress. +1  
drzed  Nah he/she's talking about Beta-3 receptors which are Gs coupled. Gs increases cAMP thus it would cause smooth muscle relaxation -> bladder relaxation! +1  
donttrustmyanswers  From Mayo: "There are no approved medications to specifically treat stress incontinence in the United States. The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence in Europe, however." +1  
nreid4  @hvancampen oxybutynin is an M3 muscarinic antagonist, not B3. +  
alienfever  I thought about B3 agonist as well and got this wrong. I think maybe B3 agonist can be used for bladder (URGENCY incontinence) where the main issue is detrusor over reactivity. In STRESS incontinence however the problem has nothing to do with detrusor, so we use α1 agonist to constrict the sphincter. +2  
fatboyslim  (FA 2020 242) Mirabegron is a B3 agonist. B3 stimulation causes detrusor muscle relaxation, hence it is used for URGE incontinence, not STRESS incontinence. I think the drug they are referring to is Ephedrine? Also, remember "O"xybutynin (muscarinic antagonist) is for "O"veractive bladder (urge incontinence) +  



 +5 
submitted by ugalaxy(12),
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α1 toumiilnsta vi(a 1α nst)oiga crtosisntc hte laredbd tpishecrn ,eyrbeht eeginptrnv nesddu bsout fo tritcnomiiu rudngi ehgg/ecunsognizni (lmdibnaoa st.es)sr




I used reverso logic.

Terazosin is an alpha blocker, helps with urinary retention by relaxing sphincter smooth muscle. What would help constrict the same muscle? Stimulating the same receptor. Ez pz.