203 UG - Disease & Pharmacology Flashcards
Diuretics
Thiazide/thiazide-like diuretics - Hydrochlorothiazide
Loop diuretics - Frusemide
Potassium sparing diuretics - Spironolactone
Amiloride
Thiazide/thiazide-like diuretics
Hydrochlorothiazide
First line in HT
- Block the Na+ and Cl- cotransporter (NCC) in the distal convoluted tubule
AE: Hypokalaemia and metabolic alkalosis
Loop diuretics
Frusemide
- Inhibit NaCl reabsorption by the Na+/K+/2Cl–
Cotransporter (NKCC2) in the thick ascending limb (TAL) of loop of Henle
Potassium-sparing diuretics
Spironolactone
- Aldosterone/mineralocorticoid receptor antagonists in the late distal and cortical collecting tubules
MOA of Amiloride
Diuretics
Inhibition of Na+ influx through the epithelial Na+ channels (ENaC) channels in the luminal membrane
Treatments for Lower Urinary Tract Symptoms
Alpha1-blockers - Prazosin
5α-reductase inhibitor - Finasteride
Anticholinergic agents - Oxybutynin
Beta-3 adrenergic agonist - Mirabegron
Treatments for Prostate cancer
Androgen deprivation therapy
- Luteinizing hormone-releasing hormone (LHRH) analogs - Goserelin
- LHRH agonist monotherapy; LHRH agonist with 1st-generation anti-androgen - Flutamide
- LHRH antagonist - Degarelix
- Second-generation anti-androgens - Abirateroneacetate
Treatments for Testicular Cancer
Cisplatin
Treatments for Bladder/urothelial Cancer
Intravesical chemotherapy or BCG, immunotherapy
Treatments for Renal Cancer
Sunitinib – multikinase inhibitor
Platinum Analogs and its AE
Cisplatin - Nausea, vomiting, nephrotoxicity
Carboplatin - Myelosuppression
Oxaliplatin - Laryngopharyngeal dysesthesias
What is checkpoint inhibitor therapy?
For cancer
Targets immune checkpoints which are key regulators of the immune system.
Drugs used in checkpoint inhibitor therapy
Pembrolizumab - Humanized immunoglobulin G4 mAb to programmed death-1 (PD-1) receptor.
Nivolumab - PD-1 mAb
Atezolizumab - PD-L1 mAb
Cystitis
Lower UTI
infection confined to the bladder
膀胱炎
Pyelonephritis
Upper UTI
infection involving the ureters +/ kidneys
腎盂腎炎
Infection vs colonisation
UTI
Infection – the presence of bacteria and immune cells, i.e. evidence of active infection.
Colonization – the presence of bacteria, evidence that bacteria have established a symbiotic relationship with the host.
Complicated UTI
UTI complicated by
- systemic symptoms
- urinary structural abnormality/stones
Bacteriuria
Bacteria present in urine
- doesn’t always mean infection
細菌尿
Why do women have a higher risk of having UTI than men?
- short wide urethra
- proximity of urethra to anus
- increased risk with sexual activity, pregnancy
Routes of infection of UTI
Ascending infection (common) Bloodstream (uncommon)
If a person has no infection, where do we normally find pathogens in the urinary tract?
Lower end of urethra
Most common cause of uncomplicated UTI
E. coli
Important virulence factor for uropathogenic bacteria
Gram-negative coliform
Express flagella for motility & pilli for attachment
______ is a key mediator of gram-negative bacteria virulence
Lipopolysaccharide
Virulence factor of Proteus sp. infection-causing urolithiasis
Urease production
- breaks down urea to form ammonia, which increases urinary pH - precipitation of salts.
Urolithiasis
The presence of calculi (precipitated salts) anywhere along the course of the urinary tracts
尿石症
Presence of which 3 UTI symptoms suggest an involvement of upper urinary tract infection
Fever
Loin pain
Rigors
UTI symptoms
Dysuria (pain passing urine)
Frequency of urination
Nocturia
Haematuria
Fever
Loin pain
Rigors
When should we give catheterized patients antibiotics?
Only if there’s supporting evidence of UTI
Asymptomatic bacteriuria in pregnancy is usually?
Treated with antibiotics
If left untreated:
- 20-30% progress to pyelonephritis
- may lead to intra-uterine growth retardation (IUGR) of premature labor
Ideal antibiotic for uncomplicated lower UTI should be:
Excreted in urine in high concentration
Oral
Inexpensive
Few side effects
How long should gentamicin be prescribed?
complicated UTI or pyelonephritis
Maximum 3 days
- bc narrow TI - may cause toxicity
Vertically transmitted pathogens
“TORCHES pathogens”
Toxoplasmosis Other (Hep B, VZV, HIV, parvovirus B19, enterovirus, LCV) Rubella Cytomegalovirus HErpes simplex virus Syphilis.
Congenital/ in utero/ transplacental infections
Passage of microbiological pathogens from mother to foetus during development.
- Via transversing the placenta.
Perinatal infections
Infection of the neonate via maternal blood/ infected birth canal during birth.
Postnatal infections
Infection of the neonate via the normal routes (airborne, droplet, bodily fluids, fecal-oral)
What characterizes cytomegalovirus?
Blueberry muffin rash
Gonorrhoea presentation
Mucopurulent urethral discharge
- white, creamy, thick
*Neisseria gonorrhoeae
Chlamydia presentation
Urethral discharge (milky) - watery, milky
*Chlamydia trachomatis
Reiter’s syndrome
Can’t see
Can’t pee (urethritis)
Can’t climb a tree
- relates conjunctivitis, urethritis & arthritis
What characterizes primary syphilis?
Chancre lesion
Is bacterial vaginosis an STI?
No
- but will increase chances of getting STI (chlamydia, trichomoniasis, HIV)
Normal vagina pH
4 - 4.5
What is the most common viral STI?
Human papilloma virus
HPV presentation
Anogenital warts
What is the feature of bacterial vaginosis which Trichomnas vaginalis infection?
Presence of endosymbionts
Candida albicans
30% of females colonised w small numbers
Candida albicans infection presentation
Intensely itchy white vaginal discharge
白色念珠菌
Normal vaginal flora contains high levels of?
Lactobacillus spp.
Definition of infertility
Failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of a known reason) in a couple who have never had a child
Follicular phase
When follicle matures
Luteal phase
When corpus luteum degenerates
黃體期
Anovulatory infertility
When ovaries do not release an oocyte during a menstrual cycle
How does hypogonadotropic hypogonadism cause anovulatory infertility?
Lack of GnRH → decreased FSH & LH → follicles do not develop → no ovulation
How does hypergonadotropic hypogonadism cause anovulatory infertility?
Over-active hypothalamic-pituitary axis → too much GnRH, FSH or LH → follicles do not develop properly → no ovulation
How does hyperprolactinemia cause anovulatory infertility?
Increased release of prolactin → negative feedback - inhibits GnRH, FSH, LH → decrease FSH & LH → no ovulation
Polycystic ovarian syndrome
Multiple cysts covering the surface of ovaries → hyperandrogenism → decreases ovulation
Premature ovarian failure
Depletion of follicles
Luteal phase defects
Abnormality in corpus luteum → insufficient progesterone production
Endometriosis
Presence of endometrial glands outside uterine cavity
Most cases of recurrent genital herpes are caused by?
HSV-2
SERM for breast cancer
Tamoxifen
Tamoxifen act as an ______ on oestrogen receptors in mammary tissue;
Tamoxifen act as an ______ on oestrogen receptors in bone.
antagonist; agonist
