American Board of Internal Medicine (ABIM) Certification Practice Exam

For urinary urgency/frequency in multiple sclerosis, which pharmacologic agent is recommended?

1. Pregabalin

2. Olanzapine

3. Oxybutynin

4. Armodafinil

The correct answer is: Oxybutynin

In the context of managing urinary urgency and frequency associated with multiple sclerosis (MS), oxybutynin is the recommended pharmacologic agent. Oxybutynin is an anticholinergic drug that acts to relax the bladder smooth muscle, thereby reducing the frequency and urgency of bladder contractions. This mechanism is particularly beneficial for individuals with MS, who often experience overactive bladder symptoms due to neurological dysfunction affecting bladder control. Oxybutynin has been well-studied and is known for its efficacy in alleviating symptoms of urinary incontinence and urgency in various populations, including those with neurological conditions such as MS. The other options do not primarily target urinary symptoms associated with MS. Pregabalin is typically used for neuropathic pain and seizures; olanzapine is an antipsychotic medication primarily used to treat schizophrenia and bipolar disorder; armodafinil is a wakefulness-promoting agent often utilized in the treatment of narcolepsy or sleep apnea. Consequently, these agents are not appropriate choices for addressing urinary urgency and frequency in the context of multiple sclerosis.