The video version of this podcast can be found here: · https://youtu.be/BnwK2Vts3gYThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in September 2024 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only. I also cover the guideline on Adrenal insufficiency published on 28th August 2024. I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement. There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast: · Redcircle: https://redcircle.com/shows/primary-care-guidelines· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for September 2024 can be found here:· https://www.nice.org.uk/guidance/published?from=2024-09-01&to=2024-09-31&ndt=Guidance&ndt=Quality+standardThe links to the guidance covered in this episode can be found here:Vibegron for treating symptoms of overactive bladder syndrome:· https://www.nice.org.uk/guidance/ta999Adrenal insufficiency: identification and management:· https://www.nice.org.uk/guidance/ng243The Imperial Centre for Endocrinology prednisolone withdrawal regimen can be found here:· https://www.impendo.co.uk/prednisolone/prednisolone-withdrawalIntro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in September 2024, focusing on what is relevant in Primary Care only. We are going to cover just two areas, the treatment of overactive bladder and the guideline on adrenal insufficiency, which was published late in August 2024 and did not make it into last month’s episode. Right, let’s get started. The first area is a technology appraisal on Vibegron for treating the symptoms of overactive bladder syndrome in adults. It is very similar to the technology appraisal on mirabegron. Before looking at the recommendation, let’s have a quick overview of Overactive bladder syndrome. It is a condition characterized by a frequent and urgent need to pass urine, sometimes with urinary incontinence. It is often caused by involuntary contractions of the bladder wall. Treatment for OAB involves lifestyle changes, behavioural therapies, and medications. NICE recommends that bladder training and lifestyle advice should be offered as first-line treatments. Then an antimuscarinic drug should be offered second-line and beta 3 agonists should be offered third line. So, let’s look at the two types of drug treatment:Antimuscarinic Agents (or Anticholinergics) are the most commonly prescribed drugs and they work by blocking muscarinic receptors in the bladder, reducing the involuntary contractions of the detrusor muscle.Examples are:OxybutyninTolterodineSolifenacinDarifenacin andFesoterodineSince muscarinic receptors are also found in other parts of the body (e.g., the salivary glands, eyes, and intestines), antimuscarinic agents can cause side effects such as dry mouth, constipation, blurred vision, and cognitive dysfunction, especially in elderly patients.Beta-3 Adrenergic Agonists are drugs like mirabegron and vibegron which offer an alternative to antimuscarinics. These drugs specifically stimulate beta-3 receptors on the detrusor muscle, causing the muscle to relax. This increases the bladder’s capacity and reduces the urgency and frequency of urination.Beta-3 agonists tend to have fewer side effects compared to antimuscarinic agents. Some common side effects are mild increases in blood pressure, arrythmias, headache, and urinary tract infections.So, in summary, the main difference between these Drug Classes are that Antimuscarinics work by reducing involuntary bladder ...
