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Pharmacology > Anticholinergics (urinary incontinence) > Flashcards

Anticholinergics (urinary incontinence) Flashcards

1
Q

BPH

A

benign prostatic hypertrophy = prostate enlargement

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2
Q

what are the bladder neck and urethra innervated by

what stimulates it

what can cause stimulation

A

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

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3
Q

how to improve symptoms of BPH

A

inhibit alpha 1 receptors in prostate/bladder

relaxes the smooth muscle in these areas= increased urine flow

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4
Q

what is something we should keep in mind (side effect) when we give alpha 1 blocker

A

first dose effect

marked hypotension and orthostatic hypotension with first few doses

due to unopposed Beta 2 vasodilation

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5
Q

what are BPH agents

A

alpha 1 blockers

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6
Q

when is it indicated to give an alpha 1 blocker (BPH agent)

A

HTN (only if pt has BPH too)
BPH
nightmares

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7
Q

What are the BPH agents

A

all are alpha 1 receptor blockers

prazosin (minipress)
terazosin (hytrin)
doxazosin (cardure)
tamsulosin (flomax)

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8
Q

what is the most commonly used drug for BPH

A

Tamsulosin (flomax)!!

DOES NOT work for BP

used for kidney stones too

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9
Q

What drug is an alpha 1 blocker but not used in HTN at all

and why!!!

A

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!

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10
Q

What is acetylcholine responsible for activating

what receptor/organs does it impact

A

responsible for activating the parasympathetic nervous system

works on the muscarinic receptors of

  • eyes
  • heart
  • lungs
  • gi tract
  • bladder!!
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11
Q

what does Ach do to the bladder

A

promotes relaxation of the sphincter and contraction of the detrusor muscle

promotes voiding

aka drugs mimicking AcH will do the same thign

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12
Q

Anticholinergics on bladder

A

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

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13
Q

what are the adverse effects of a NON SELECTIVE antichollinergics

A

decreased lacrimation (Tear)

mydriasis (dilation of pupil)

urinary retention

dry mouth

constipation

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14
Q

what are the anticholinergic agents

A

oxybutynin (ditropan and ditropan XL)
- comes as patch (oxytrol patch)

tolterodine (detrol and detrol LA)

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15
Q

oxybutinin

A

ditropan

Anticholinergic

well absorbed orally
patch is slow absorption

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16
Q

tolterodine

A

detrol
anticholinergic

high specificity for muscarinic receptor in bladder

high first pass effect

17
Q

gout

MOA

A

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!!!

18
Q

what is thought to be the main cause of gout

A

too little excretion of uric acid

19
Q

what drugs treat gout

A

NSAIDS (endomethycin common)

xanthine oxidase inhibitors

colchicine

probenecid

20
Q

colchicine history

A

historically used for gout was very cheap

now that FDA approved way more expensive

21
Q

How do colchicine drugs work

A

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

22
Q

what are the two xanthine oxidase inhibitors of anti gout

A

allopurinol (zyloprim)

febuxostat (uloric)

23
Q

Allopurinol

MOA

A

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 !!!

24
Q

what is xanthine oxidase responsible for

A

converting hypoxanthine to xanthine to uric acid

aka we inhibit this= decrease in uric acid formed from food

25
Q

ADME of allopurinol

A

well absorbed

half life 2 hours

used one a day

26
Q

febuxostat

A

uloric

more expensive
good for those not tolerant to allopurinol

27
Q

what drug is used to treat gout by inhibiting uric acid reabsorption via URAT-1 protein transporter

what else does the drug affect

A

Probenecid

more uric acid in urine and therefore decrease in plasma conc

also inhibits the active secretion of organic acids (pencillin) so stays in body longer

28
Q

which drugs are NOT used for acute gout

A

probenecid

allopurinol

will make it worse

29
Q

what drug inhibits active secretion of organic acids

how

A

organic acid= penicillin stays in blood longer

drug that does that= probenecid

how: blocks OAT-1
organic acid transporter protein

Pharmacology (13 decks)

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