Block 5: GU and ED Pharm Flashcards

Question

Flibanserin | Brand, Indication, MOA, ADR

Answer 1

Addyi **Indication:** pre-menopausal women with hypoactive sexual desire disorder (HSDD) **MOA:** Serotonin 1A agonist and a serotonin 2A antagonist reducing sexual interest and desire **ADR** Hypotension and syncope

Answer 2

Prostate specific antigen (PSA)

Answer 3

Fland that forms part of the male reproductive system between the bladder and urethra

Answer 4

Secrete an alkaline fluid of 70% seminal volume: 1. Lubrication and nutrition for the sperm. 2. Liquefaction of the seminal plug. 3. Neutralize the acidic vaginal environment

Answer 5

Benign prostatic hyperplasia: enlarged prostate 1. Static compression of the urethra (Increased glandular volume) 2. Dynamic compression of the urethra (Smooth muscle component of the prostate) 3. Difficulty in urination 4. Autonomic tone in the prostate and bladder neck controlled by alpha-1 adrenergic receptors 5. Dihydrotestosterone (DHT) is metaboized by type II 5-alpha-reductase promoting growth

Answer 6

1. Storage sx 2. Voiding sx

Answer 7

1. Alpha 1 blockers: relaxes the prostate smooth muscle and reduces urethral resistance to flow 2. 5-alpha reductase inhibitors – Inhibits formation of DHT to help “shrink” the prostate gland

Answer 8

**Sympathetic tone:** Constricts the sphincter muscle via action at the a1 receptors. Prostate is rich in a1 receptors **To improve urination of BPH:** Reduce effects of noradrenergic tone in the prostate and sphincters by blocking a1 receptors

Answer 9

1. Prazosin (minipress) 2. TERAZOSIN (Hytrin) 3. DOXAZOSIN (Cardura)

Answer 10

Minipress **MOA:** Selective α1 receptor blocker **Indication:** Not approved for BPH (only for hypertension) **ADR:** orthostatic hypotension from first dose phenomenon

Answer 11

Cardura **Indication:** BPH, HTN

Answer 12

Hytrin **Indication:** BPH, HTN

Answer 13

1. Silodosin (Rapaflo) 2. Tamsulosin (Flomax) 3. Alfuzosin (Xatral): Lacks a1-A receptor selectivity, but has “uroselectivity” to the prostate **Selective inhibition of the a1-A receptors in prostate reducing effect on BP on vasculature from less a1-B antagonism**

Answer 14

Flomax **MOA:** Selective inhibition of the a1-A receptors in prostate **Indication:** BPH

Answer 15

Rapaflo **MOA:** Highly selective inhibition of the a1-A receptors (uroselective) in prostate over a1-B **Indication:** BPH

Answer 16

Uroxatral **MOA:** Does not have receptor selectivity at a1-A but has ‘uroselctivity’ and a lower incidence of ejaculatory dysfunction **Indication:** BPH

Answer 17

1. Orthostatic hypotension 2. Dizziness 3. Stuffy nose 4. Impaired ejaculation and sexual dysfunction

Answer 18

1. Finasteride (Proscar) 2. Dutasteride (Avodart) **MOA:** Shrink the prostate * Enzyme inhibitors reduce the amount of testosterone turned into DHT, a hormone required for prostate gland growth * Onset is longer than alpha blockers and may take 3 months to see imporvement **ADR:** Impotence, ED, decreased libido

Answer 19

**5a-Reductase Inhibitors:** Arrest Disease Progression **a1-blockers:** relieve sx rapidly

Answer 20

**Filling:** Efficient and low pressure **Storage:** Low pressure, with perfect continence **Emptying:** Periodic complete urine expulsion, at low pressure, when convenient

Answer 21

Coordination of the ANS and somatic NS controlled by the pontine micturition center in the brainstem

Answer 22

**Parasympathetic receptors – Muscarinic - Pelvic Nerve:** Bladder or detrusor (contraction) **Sympathetic receptors - Adrenergic - Hypogastric nerve:** * a1 – adrenergic (Contacts) * b2 – adrenergic (relaxes)

Answer 23

1. **Withdrawal of Parasympathetic (ACh) tone** allows Sympathetic (NE) tone to dominate. 1. **Sympathetic tone relaxes **the bladder (detrusor) smooth muscle via b2/b3 receptors. 1. **Sympathetic tone constricts** the sphincter muscle via the a1 receptors

Answer 24

1. **Withdrawal of Sympathetic (NE) tone** and activation of Parasympathetic (ACh) tone 1. **Parasympathetic (ACh) tone causes constriction** of the bladder (detrusor) smooth muscle via muscarinic receptor activation 1. **Sphincter muscle relaxes** due to withdraw of sympathetic tone and increased parasympathetic tone 1. **Voluntary lower body muscle contraction** assists with contracting the bladder

Answer 25

**Urge:** Leakage accompanied by or immediately preceded by urinary urgency **Stress:** Loss of urine with exertion, sneezing, or coughing **Mixed:** Loss of urine associated with urgency and also with exertion, effort, sneezing, or coughing **OAB:** A symptom complex of urgency, with or without urge incontinence,but usually with frequency and nocturia

Answer 26

**OAB:** Bladder muscle experiences frequent involuntary contractions **SUI:** Bladder muscle experiences a stress related contraction and support muscles are unable to remain shut

Answer 27

1. Behavioral therapy 2. Medication (Anti-cholinergics, β3 Agonists) 3. Combined therapy 4. Minimally invasive therapy 5. Surgery **Kegel exercises**

Answer 28

1. Inhibition of involuntary bladder contractions and spasticity (Muscarinic antagonists) 2. Increased bladder capacity (Muscarinic antagonists and β3 receptor agonists)

Answer 29

**Efficacy:** * Less frequnecy * Less urge UI * Increased voided volume **ADR:** * Dry mouth * Dyspepsia * Constipation * CNS effects

Answer 30

**Flavoxate HCl (Urispas):** Relaxes spasms, increases capacity of bladder **Oxybutynin HCl (Ditropan, Oxytrol, Gelnique):** Decreases hyperreflexively of bladder and urge to void **Tolterodine (Detrol IR & LA):** Used for urinary incontinence, frequency and urinary urgency, & bed wetting and causes detrusor muscle relaxation **Darifenacin (Enablex):** M3 selectivity **Solifenacin (Vesicare):** M3 selectivity **Trospium (Sanctura IR, XL):** Quaternary amine

Answer 31

Toviaz **MOA:** Rapidly hydrolyzed by esterases to the active metabolite (5-hydroxymethyl tolterodine) **Indication:** Over-active bladder

Answer 32

1. Block parasympathetic cholinergic tone with antimuscarinic antagonists 2. Allows noradrenergic sympathetic tone to dominate * Detrusor muscle relaxation * Sphincter contraction

Answer 33

1. Dry mouth 2. Constipation 3. Blurred vision 4. DX 5. Cognitive impairment (Flavoxate, Oxybutynin, Solifenacin) **ER may cause fewer ADRs**

Answer 34

Mirabegron (Myrbetriq), Vibegron (Gemtesa) **Indication:** OAB **ADR:** Hypertension, tachycardia

Answer 35

1. Sympathetic tone relaxes the bladder (detrusor) smooth muscle via b2/b3 receptors **MOA:** Selective b3 receptor agonist that increases Sympathetic tone to the detrusor muscle, allowing relaxation of the detrusor muscle and increased bladder capacity **CI:** Severe uncontrolled hypertension, Moderate inhibitor of CYP2D6