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Thera X > 16 Urologic Disorders Williams > Flashcards

16 Urologic Disorders Williams Flashcards

1
Q

What are the Sympathetic (Hypogastric Nerve) Receptors focused on for Urinary Incontinence?

A

α1-receptors and β3-receptors

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2
Q

What does stimulation of the α1-receptors cause?

A

Constricts bladder neck and internal urethral sphincter, inhibits urination

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3
Q

What does stimulation of the β3-receptors cause?

A

Relax Detrusor smooth muscle, inhibits bladder contractions

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4
Q

What is the Parasympathetic (Pelvic Nerve) involved in?

A

Major driver. Responsible for bladder contractions. Acetylcholine activates the M3 receptors

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5
Q

What are some causes of Transient Incontinence?

A

DRIP: Delirium (acute confusional states), Retention, Restricted mobility. Infection (UTI), Inflammation, Impaction, Polyuria, Pharmaceuticals

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6
Q

What are some drug classes that can cause urinary incontinence?

A

Psychotropics. Anticholinergics. Alcohol. Diuretics. Alpha-Adrenergics. Beta-Blockers. CCBs

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7
Q

What are some non-pharmacologic treatment options for Stress Incontinence?

A

Pelvic floor exercises. Behavioral treatment. Bladder neck suspension

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8
Q

What are some non-pharmacologic treatment options for Urge Incontinence?

A

Behavioral treatment. Surgery

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9
Q

What are some non-pharmacologic treatment options for Overflow Incontinence?

A

Obstruction removal. Catheterization

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10
Q

What are some non-pharmacologic treatment options for Functional Incontinence?

A

Behavioral treatment. Environmental adaptation. Incontinence garments/pads. External collection devices

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11
Q

What is the mechanism for Cholinergic Agents?

A

Stimulate bladder contraction

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12
Q

What are the uses for Cholinergic Agents?

A

Atonic bladder with overflow

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13
Q

What is the mechanism of Anticholinergic/Antispasmodic agents?

A

Diminish involuntary bladder contractions, increase bladder capacity. Blocks muscarinic receptors on Detrusor Muscle

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14
Q

What are the uses for Anticholinergic/Antispasmodic agents?

A

Urge or Stress with detrusor instability

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15
Q

What are the main Antispasmodic agents used?

A

Tolterodine (Detrol), Fesoterodine (Toviaz) and Trospium. These are the best since they target both M2 and M3 receptors

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16
Q

What are some of the other Antispasmodic agents used?

A

Oxybutynin (avoid IR). Solifenacin. Darifenacin

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17
Q

Which Antispasmodics require renal adjustment?

A

Trospium. Solifenacin

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18
Q

Which Antispasmodics are CYP3A4 substrates?

A

Festerodine (prodrug). Darifenacin

19
Q

What is the mechanism of an Alpha-Adrenergic Agonist?

A

Increases urethral smooth muscle contraction

20
Q

What are the uses for Alpha-Adrenergic Agonists?

A

Stress incontinence with sphincter weakness

21
Q

What is the main Alpha-Adrenergic Agonist used?

A

Pseudoephedrine 15-30mg TID

22
Q

What is the mechanism of B3-Adrenergic Agonists?

A

Direct relaxation of bladder smooth muscle

23
Q

What are the uses for B3-Adrenergic Agonists?

A

Urge incontinence, Urgency, Urinary frequency

24
Q

What is the main B3-Adrenergic Agonists used?

A

Mirabegron (Myrbetriq) 25-50mg QD

25
Q

When should Anti-Muscarinics be avoided?

A

In patients with NA-Glaucoma. Use extreme caution in patients with impaired gastric emptying

26
Q

What are some medication classes that can induce symptom exacerbation in BPH?

A

Alpha-adrenergic agonists (pseudoephedrine). Anticholinergics. Testosterone?

27
Q

What is the BPH treatment strategy for Mild symptoms?

A

Watchful waiting

28
Q

What is the BPH treatment strategy for Moderate symptoms?

A

Alpha-Adrenergic Antagonist OR 5-alpha-reductase inhibitor. You could also try them combined together

29
Q

What is the BPH treatment strategy for Severe symptoms?

A

Surgery

30
Q

What are some non-pharmacologic treatment options for BPH?

A

Avoid drinking excessive fluids in evening. Avoid drinking caffeine or alcohol. Frequently empty bladder during waking hours. Avoid meds that exacerbate symptoms

31
Q

What are the first line pharmacologic therapy options for BPH?

A

Alpha-1-adrenergic antagonists

32
Q

What is the mechanism of Alpha-1-adrenergic antagonists?

A

Relax smooth muscle in prostate and bladder neck –> enhance urinary flow. Does NOT reduce prostate size

33
Q

What are the Alpha-1-adrenergic antagonist drug options?

A

Alfuzosin (Uroxatal) and Tamsulosin (Flomax) are the best choices

34
Q

What are the Non-Selective Alpha-1-adrenergic antagonists?

A

Terazosin and Doxazosin. These have More CV ADRs, can cause Orthostatic hypotension, and NEED dose titration

35
Q

What are the Selective Alpha-1-adrenergic antagonists?

A

Alfuzosin. Tamsulosin. Silodosin. NO titration needed

36
Q

Which Alpha-1-adrenergic antagonists needs to be avoided with sulfa allergies?

A

Tamsulosin. Also take on empty stomach

37
Q

When is Alfuzosin contraindicated?

A

With potent 3A4 inhibitors

38
Q

What is a common ADR with Alpha-1-adrenergic antagonists?

A

Ejaculatory dysfunction. Sildosin and Tamsulosin have the greatest occurrence. Alfuzosin the least

39
Q

What DDI needs to be avoided with Alpha-1-adrenergic antagonists?

A

PDE-Inhibitors. Avoid taking Alpha-1-adrenergic antagonists 4 hours after taking a PDE-I (Except Tadalafil with Tamsulosin)

40
Q

What is the main use for Alpha-1-adrenergic antagonists?

A

Relieves IRRITATIVE symptoms

41
Q

What are 5-alpha-reductase inhibitors used for?

A

Reduce OBATRUCTIVE symptoms

42
Q

What are the 5-alpha-reductase inhibitor drug options?

A

Finasteride (Proscar) and Dutasteride (Avodart)

43
Q

What are the ADRs with 5-alpha-reductase inhibitors?

A

Sexual dysfunction (decreased libido, impotence, ejaculatory dysfunction). Pregnancy category X

Thera X (25 decks)

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