Anticholinergics (urinary incontinence) Flashcards
BPH
benign prostatic hypertrophy = prostate enlargement
what are the bladder neck and urethra innervated by
what stimulates it
what can cause stimulation
alpha 1 receptors
they cause constriction in the muscles upon stimulation = compression of urethra and decreased urinary bladder emptying
hard time urinating
drugs such as pseudoephedrine and anticholinergics cause
how to improve symptoms of BPH
inhibit alpha 1 receptors in prostate/bladder
relaxes the smooth muscle in these areas= increased urine flow
what is something we should keep in mind (side effect) when we give alpha 1 blocker
first dose effect
marked hypotension and orthostatic hypotension with first few doses
due to unopposed Beta 2 vasodilation
what are BPH agents
alpha 1 blockers
when is it indicated to give an alpha 1 blocker (BPH agent)
HTN (only if pt has BPH too)
BPH
nightmares
What are the BPH agents
all are alpha 1 receptor blockers
prazosin (minipress)
terazosin (hytrin)
doxazosin (cardure)
tamsulosin (flomax)
what is the most commonly used drug for BPH
Tamsulosin (flomax)!!
DOES NOT work for BP
used for kidney stones too
What drug is an alpha 1 blocker but not used in HTN at all
and why!!!
tamsulosin (flomax) - urine flow at its max
approximately 70% of alpha 1 receptors in prostate are subtype 1A and this drug is specific to that
less hypotension!
What is acetylcholine responsible for activating
what receptor/organs does it impact
responsible for activating the parasympathetic nervous system
works on the muscarinic receptors of
- eyes
- heart
- lungs
- gi tract
- bladder!!
what does Ach do to the bladder
promotes relaxation of the sphincter and contraction of the detrusor muscle
promotes voiding
aka drugs mimicking AcH will do the same thign
Anticholinergics on bladder
inhibit muscarinic action of AcH on smooth muscle
causes delayed desire to void by decreasing detrusor muscle contraction
overall= decreased urgency and frequency of incontinence
what are the adverse effects of a NON SELECTIVE antichollinergics
decreased lacrimation (Tear)
mydriasis (dilation of pupil)
urinary retention
dry mouth
constipation
what are the anticholinergic agents
oxybutynin (ditropan and ditropan XL)
- comes as patch (oxytrol patch)
tolterodine (detrol and detrol LA)
oxybutinin
ditropan
Anticholinergic
well absorbed orally
patch is slow absorption
tolterodine
detrol
anticholinergic
high specificity for muscarinic receptor in bladder
high first pass effect
gout
MOA
mtp joint
too much uric acid in body- crystalize out in acidic environment (distal joints)
causes inflammatory process
phagocytosis occurs and cause an inflammatory response = pain!!!
what is thought to be the main cause of gout
too little excretion of uric acid
what drugs treat gout
NSAIDS (endomethycin common)
xanthine oxidase inhibitors
colchicine
probenecid
colchicine history
historically used for gout was very cheap
now that FDA approved way more expensive
How do colchicine drugs work
interferes with mitotic spindles and microtubule formation
stops replication of quickly reproducing cells (GI irritation)
inhibits mobility of granulocytes
inhibits release of pro inflammatory factors from granulocytes (glycoprotein)
toxic at high doses
also used to freeze cells on slides
not used as much anymore
does not lower uric acid levels
what are the two xanthine oxidase inhibitors of anti gout
allopurinol (zyloprim)
febuxostat (uloric)
Allopurinol
MOA
zyloprim
used to prevent gout - most common one
inhibits xanthine oxidase= reducing production of uric acid from food we eat
drop in levels within 2-3 days (could be 2-3 weeks)
most used drug !!!
what is xanthine oxidase responsible for
converting hypoxanthine to xanthine to uric acid
aka we inhibit this= decrease in uric acid formed from food
