Nonpharmacologic measures have been ineffective in a 7-year-old diagnosed with enuresis. When planning treatment, the nurse practitioner would consider which medication as third-line treatment?

Rationale: A. Oxybutynin (Ditropan XL) is used primarily for bladder overactivity and may be considered earlier than third-line therapy depending on the patient’s symptoms. B. Desmopressin acetate (DDAVP) is usually first-line pharmacologic therapy for primary nocturnal enuresis, particularly when fluid restriction and behavioral strategies have failed. C. Tolterodine (Detrol) is another anticholinergic used for overactive bladder but is generally not considered third-line for uncomplicated enuresis. D. Imipramine (Tofranil), a tricyclic antidepressant, is considered third-line therapy for enuresis due to its potential for significant side effects, including cardiac toxicity in overdose. It is reserved for patients who do not respond to behavioral strategies and first-line medications.