DT is a 58 year old female starting treatment for overactive bladder with the anticholinergic tolteridine (Detrol) ER 4 mg po daily. Which of the following adverse reactions would we be counseling her about? Select one:

Overactive bladder is characterized by urinary urgency, frequency, nocturia, and sometimes urge incontinence caused by involuntary detrusor muscle contractions. Tolterodine (Detrol) is an anticholinergic medication used to reduce bladder spasms by blocking muscarinic receptors in the bladder. While effective in improving urinary symptoms, it also produces systemic anticholinergic effects. Patient teaching should focus on recognizing common adverse reactions and preventing complications, especially in older adults. Rationale: A. Urinary incontinence and excessive sweating are not expected adverse effects of tolterodine. The medication is prescribed specifically to reduce urge incontinence by decreasing detrusor overactivity, not worsen it. Anticholinergic drugs also tend to reduce sweating rather than increase it because they inhibit muscarinic stimulation of sweat glands, which can sometimes lead to dry skin and heat intolerance. B. Constipation and impaired cognition are common adverse effects of anticholinergic medications such as Tolterodine (Detrol). Reduced parasympathetic activity slows gastrointestinal motility, leading to constipation, while central nervous system anticholinergic effects may cause confusion, memory problems, or impaired concentration. These effects are particularly important to monitor in middle-aged and older adults receiving long-term therapy. C. Diarrhea and anxiety are not typical effects of tolterodine because anticholinergics usually decrease gastrointestinal motility rather than increase it. Diarrhea is more associated with increased parasympathetic stimulation. Anxiety is also not a common primary adverse effect, although some patients may report general discomfort from dry mouth or urinary retention rather than direct mood disturbances. D. Insomnia and bradycardia are not the expected major adverse reactions with tolterodine therapy. Anticholinergics more commonly cause mild tachycardia rather than bradycardia because of vagal inhibition on the heart. Sedation or confusion may occur more often than insomnia, and cardiovascular monitoring is usually focused on urinary retention and anticholinergic burden rather than slowed heart rate.