16 Urologic Disorders Williams Flashcards by Chris Clark

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

α1-receptors and β3-receptors

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What does stimulation of the α1-receptors cause?

Constricts bladder neck and internal urethral sphincter, inhibits urination

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What does stimulation of the β3-receptors cause?

Relax Detrusor smooth muscle, inhibits bladder contractions

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What is the Parasympathetic (Pelvic Nerve) involved in?

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

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What are some causes of Transient Incontinence?

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

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What are some drug classes that can cause urinary incontinence?

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

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

Pelvic floor exercises. Behavioral treatment. Bladder neck suspension

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

Behavioral treatment. Surgery

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

Obstruction removal. Catheterization

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

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

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What is the mechanism for Cholinergic Agents?

Stimulate bladder contraction

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What are the uses for Cholinergic Agents?

Atonic bladder with overflow

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What is the mechanism of Anticholinergic/Antispasmodic agents?

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

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What are the uses for Anticholinergic/Antispasmodic agents?

Urge or Stress with detrusor instability

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What are the main Antispasmodic agents used?

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

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What are some of the other Antispasmodic agents used?

Oxybutynin (avoid IR). Solifenacin. Darifenacin

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Which Antispasmodics require renal adjustment?

Trospium. Solifenacin

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Which Antispasmodics are CYP3A4 substrates?

Festerodine (prodrug). Darifenacin

What is the mechanism of an Alpha-Adrenergic Agonist?

Increases urethral smooth muscle contraction

What are the uses for Alpha-Adrenergic Agonists?

Stress incontinence with sphincter weakness

What is the main Alpha-Adrenergic Agonist used?

Pseudoephedrine 15-30mg TID

What is the mechanism of B3-Adrenergic Agonists?

Direct relaxation of bladder smooth muscle

What are the uses for B3-Adrenergic Agonists?

Urge incontinence, Urgency, Urinary frequency

What is the main B3-Adrenergic Agonists used?

Mirabegron (Myrbetriq) 25-50mg QD

When should Anti-Muscarinics be avoided?

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

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

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

What is the BPH treatment strategy for Mild symptoms?

Watchful waiting

What is the BPH treatment strategy for Moderate symptoms?

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

What is the BPH treatment strategy for Severe symptoms?

Surgery

What are some non-pharmacologic treatment options for BPH?

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

What are the first line pharmacologic therapy options for BPH?

Alpha-1-adrenergic antagonists

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

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

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

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

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

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

What are the Selective Alpha-1-adrenergic antagonists?

Alfuzosin. Tamsulosin. Silodosin. NO titration needed

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

Tamsulosin. Also take on empty stomach

When is Alfuzosin contraindicated?

With potent 3A4 inhibitors

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

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

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

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

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

Relieves IRRITATIVE symptoms

What are 5-alpha-reductase inhibitors used for?

Reduce OBATRUCTIVE symptoms

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

Finasteride (Proscar) and Dutasteride (Avodart)

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

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