Klinická farmakologie a farmacie – 1/2020

www.klinickafarmakologie.cz  / Klin Farmakol Farm 2020; 34(1): 34–37 / KLINICKÁ FARMAKOLOGIE A FARMACIE 37 KAZUISTIKA Anticholinergiká používané v liečbe hyperaktívneho močového mechúra a vplyv na kognitívne funkcie starších pacientov vhodným liečivom hyperaktívneho močového mechúra u pacientov s kognitívnymi poruchami je oxybutynín (48). Štúdie s tolterodínom zahŕňali málo probandov, preto sa k jeho vplyvu na kog‑ nitívne funkcie treba vyjadrovať opatrne (12, 49). Pacientke, u ktorej vyvstala klinická otázka z úvodu článku bolo nasadené trospium v poči‑ atočnej dávke 45mg denne s dobrým klinickým efektom a bez výskytu nežiaducich účinkov. Po štyroch týždňoch sa dávka znížila na 30mg denne dlhodobo. Kvartérna štruktúra a hydrofilita mo‑ lekuly limitujú prestup trospia hematoencefalickou bariérou a znižujú jeho vplyv na kognitívne funkcie u starších pacientov (50). Medzi trospiom a ostat‑ nou medikáciou pacientky neboli identifikované žiadne potenciálne interakcie. V prípade závažných kognitívnych porúch sa odporúčamedziodborová spolupráca praktického lekára s urológom, gynekológom, psychiatrom, ge‑ riatrom, klinickým farmakológomalebo klinickým farmaceutom. Farmakoterapia sa odporúča kom‑ binovať s rôznymi behaviorálnymi technikami (51). Je vhodné zvážiť aj použitie liečiv z iných skupín, napr. β3-agonistumirabegron, desmopresín, u žien estrogény, umužov s benígnou hyperpláziou pro‑ staty kombinované preparáty, vždy po posúdení klinického stavu a potrieb pacienta (52). LITERATÚRA 1. Bujdák P. Diagnostika a liečba dráždivého močového. Via Pract 2012; 9(2): 70–74. 2. Irwin DE, Milsom I, Hunskaar S, et al. Population‑based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50(6): 1306–1315. 3. Goncalves F. Hyperaktívny močový mechúr. In: Hegyi L, Krajčík Š. Geriatria. Bratislava: Herba, 2010: 358–359. 4. 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