84 - urinary frequency. 85 - retention, 86 - incontinence Flashcards
Loop diuretics eg? good when?
Loop of Henle (NKCC cotransport).
Better for impaired renal function.
Furosemide.
Eg of K sparing diuretic?
sprionolactone
Eg of an osmotic diuretic
mannitol
If medication is needed for BPH what do you use? Other Mx?
doxazosin or tamsulosin: alpha blockade.
2nd line is finasteride.
There may be a need for intermittent catherisation to prevent retention.
TURP surgery if BPH causes severe obstruction
Most common Mx of BPH / Ca
Active surveillance
Choice of Mx in prostate Ca that it organ confined is pretty much up to Pt. What are the options?
Surgery: excision
Wide beam radiotherapy
Brachytherapy: type of radiotherapy via insertion of radioactive iodine isotope seeds.
Active surveillance (with the understanding that future treatment is deferred androgen deprivation therapy)
What is meant by active surveillance for prostate
PSA and DRE every 3 months
MRI and biopsy at a year to check for undergrading.
If there is no change, keep monitoring.
What is a key benefit of active surveillance
Not over treating
not over diagnosing
Mx of locally spread prostate Ca
radiotherapy
Prostate mets go where?
bone - mostly spine
normally seen in blood of prostate mets
cause raised Alk. Phos. with increased bone turnover.
Also hypercalcemia rarely.
mx of metastatic prostate disease
Androgen deprivation through orchidectomy,
alpha-5 reductase inhibitors such as finasteride (which can halve PSA)
LHRH treatment.
T2DM medication
1: Metformin initially unless there is pre-existing renal disease, If so then go to 2nd stage.
2: add one of Gliptin, pioglitazone or sulfonylurea.
3: add another one of the above.
What causes SIADH
Excessive release of SIADH from post pituitary or tumour.
Mx of SIADH
Lifestyle changes and fluid restriction.
Treat underlying cause where possible.
Drug therapy is tolvaptan.
