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Clinical Pharmacology 2 > BPH/GU > Flashcards

BPH/GU Flashcards

1
Q

release of urine from bladder

A

micturition

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2
Q

problem outside of urinary tract (reversible)

A

transient UI

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3
Q

abnormality of urinary tract

A

established UI

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4
Q

DIAPPERS - transient etiology

A

Delirium/dementia
Infection/inflammation
Atrophic urethritis/vaginitis
Pharmaceuticals
Psychological
Excessive urine output
Restricted mobility
Stool impaction

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5
Q

common meds causing urinary incontinence

A

anti-HTN
psychotherapeutics
alcohol
antihistamines/anticholinergics
narcotic analgesics
alpha blockers
CCBs
antidepressants/psychotics

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6
Q

loss of small amounts of urine with increased abdominal pressure –> compromised muscle of urethral sphincter or pelvic floor, exertional activity causing urine through weak sphincter

females > males
most common type of UI

A

stress UI

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7
Q

RF for SUI

A

pregnancy and childbirth
menopause
cognitive impairment
increased age
urinary tract surgery

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8
Q

urine leakage with physical activity (related to exertion level), NO nocturia, postvoid residual normal 0-100

A

SUI

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9
Q

always first line for SUI

A

non-pharm interventions

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10
Q

first line interventions for SUI

A

lifestyle modifications (weight reduction, smoking cessation)
scheduling regimens (timed voiding, bladder training)
pelvic floor muscle rehab (kegels, biofeedback, vaginal weight training)
external neuromodulation (nonimplantable electrical stimulation)

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11
Q

what are pharmacological interventions for SUI

A

duloxetine, a1 adrenergic receptor agonists, estrogens

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12
Q

inhibitor of serotonin and norepinephrine reuptake which increases internal/external urethral sphincter muscle tone

allows lower frequency of incontinence and micturitions/day
increased efficacy with pelvic floor exercises in women

A

duloxetine

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13
Q

duloxetine is/is not approved for treatment of SUI

A

not

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14
Q

duloxetine ADRs

A

nausea, HA, constipation, dry mouth, insomnia (resolve with time, increase dose slowly)

do not use within 14 days of MAO-I

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15
Q

What precautions should you consider with duloxetine?

A

hepatotoxicity, renal impairment, CYP1A2 concomitant (ciprofloxacin, fluvoxamine)

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16
Q

contraction of urethral smooth muscle via stimulation of a1 receptors

increased efficacy with estrogen (women)
NOT FDA approved

A

pseudophedrine and phenylephrine

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17
Q

ADRs of psuedophedrine/phenylephrine

A

HTN, HA, dry mouth, nausea, insomnia, restlessness

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18
Q

what are precautions for psuedophedrine/phenylephrine

A

uncontrolled HTN, tachyarrhythmias, CAD, MI, cor pulm, hyperthyroidism, renal failure, glaucoma

CI: use w/n 14 days of MAO-Is

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19
Q

urethral epithelial proliferation increase, local circulation
– NO Benefit seen orally
ONLY TOPICAL PRODUCTS WHEN URETHRITIS OR VAGINITIS
no combo with progestins

A

estrogen

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20
Q

ADRs of estrogen

A

abdominal pain, breast pain, weakness, vaginitis, DVT/PE, vasodilation

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21
Q

What are CIs of topical estrogen

A

abnormal vaginal bleeding
hx of or current thrombophlebitis/DVT/PE
active or hx of stroke, MI
carcinoma of breast/estrogen dependent tumor
hepatic dysfunction or disease
pregnancy

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22
Q

sudden, intense urge to urinate –> involuntary loss of urine, dextrusor muscle inappropriately contracting

A

urge UI (UUI)

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23
Q

UUI RF

A

increased age
neuro disease
bladder outlet obstruction

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24
Q

urinary frequency and urgency >8 times/day, nocturia, PVR normal

A

UUI

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25
non-pharm UUI
weight reduction, smoking cessation, less alcohol/caffeine/bladder irritants scheduling pelvic floor muscle rehab: exercises, biofeedback nonimplantable electrical stimulation condom cath
26
UUI pharm
anticholinergics = oxybutynin, tolterodine, trospium chloride, solifenacin, darifenacin, fesoterodine B3 adrenergic aognists botulinum toxin a TCAs
27
antagonize muscarinic receptors increasing bladder storage
anticholingergics: oxybutynin, tolterodine, trospium chloride, solifenacin, darifenacin, fesoterodine
28
anticholinergic ADRs
CNS- drowsiness, dizziness, confusion GI - delayed gastric motility, constipation opthalmic - blurred vision, dry eyes dry mouth
29
precautions w/ anticholinergics
additive side effects w/ other meds similar (antihistamines, muscle relaxants, TCAs, antipsychotics)
30
anticholinergics are CI with
gastric retention, uncontrolled glaucoma
31
increases bladder capacity by relaxing detrusor muscle during storage phase
mirabegron, b3 adrenergic agonist
32
mirabegron, b3 adrenergic agonist ADRs
HTN, nasopharyngitis, UTI, headache
33
mirabegron, b3 adrenergic agonist precautions
ESRD, severe hepatic impairment, urinary retention, uncontrolled HTN moderate inhibitor of CYP2D6 --> start with lowest possible dose of digoxin
34
neurotoxin inhibiting release of acetylcholine at neuromuscular junction, injected directly into detrusor muscle to prevent muscle contraction FDA approved in those who cannot respond to anticholinergics ADRs: urinary retention, UTI, dysuria, hematuria
botulinum toxin a
35
decrease bladder contractility and increase outlet resistance but no more effective than oxybutynin IR with increased ADRs and used ONLY with concomitant depression, neuropathic pain, mixed UI, nocturnal incontentce with altered sleep patterns
TCAs
36
the two TCA drugs preferred are
desipramine and nortriptyline
37
bladder overactivity is --- while urethral underactivity is ---
UUI, SUI
38
overflow incontinence from
over-distended bladder, unable to empty from obstruction with lower abdominal fullness, hesitancy, straining to void, decreased urine stream, interrupted stream, sense of incomplete emptying, +/- frequency/urgency PVR increased
39
non-pharm overflow treatment
anti-incontinence devices, condom cath with leg bag, internal catheters manage underlying cause
40
mechanisms of UI
detrusor overactivity (urgency incontinence) sphincter dysfunction (stress incontinence) bladder outlet obstruction (overflow incontinence)
41
force and flow of urine stream decreased, hesitancy, straining, dribbling, incomplete emptying, intermittency ----> increased frequency, nocturia, urgency, dysuria, urge incontinence
BPH "LUTS" symptoms
42
what are treatments for BPH?
alpha adrenergic antagonists 5-alpha reductase inhibitors phosphodiesterase inhibitors anticholinergics (more irritative, >/= 250ml PVR, avoid) combo
43
2nd gen alpha selective to enhance urinary outflow with relaxation of musculature of prostatic stroma
alpha-adrenergic antagonists -- --zosin 1st gen = not used 2nd gen = terazosin, doxazosin, rpazosin, alfuzosin (1) 3rd gen = tamsulosin (1a)
44
ADRs of alpha adrenergic antagonists
HOTN, dizziness, syncope (3rd gen agent if concerned) weakness N/V intraop floppy iris syndrome ejaculatory dysfunction (3rd gen)
45
must monitor with alpha adrenergic antagonists --
BP and HR take dose at bedtime, slwoly uptitrate dose, stabilize BP if patient needs cataract surgery, must inform opthalmologist !
46
decrease conversion of testosterone to DHT in prostate, decreasing size of prostate gland
finasteride, dutasteride 5 alpha reductase inhibitors must do PSA and DRE at baseline and yearly, repeat PSA at 6 months if 50% decrease, evaluate for cancer delayed onset of improvement (6 months), more useful in larger prostate size >40g pregnancy category X
47
ADRs of 5 alpha reductase inhibitors
sexual dysfunction, nausea/abdominal pain, HA, dizziness, weakness
48
increase cGMP --> smooth muscle relaxation in prostate and bladder neck, directly relaxing detrusor muscle with similar efficacy vs alpha-adrenergic agents, but do not address flow rate or PVR only for those with BPH and ED CrCl <30 or hepatic impairment must avoid use!
phosphodiesterase inhibitor: tadalafil ADRS: HA, flushing, priapism
49
combo treatments for BPH
alpha adrenergic antagonists + 5a reductase inhibitors (tamsulosin + fnasteride) with: prostate size >40g and PSA >/=1.4 alpha adrenergic antagonists + anticholinergic agents -- do not use if PVR >/= 250ml, may cause urinary retention
50
severe BPH treatments
saw palmetto, surgery
51
organic ED
vascular, neurologic, hormonal
52
psychogenic ED
lack of response to psychogenic stimuli
53
causes of ED
- hormonal deficiencies - psychogenic disorders - poor nervous function - vascular damage -smoking - illicit drug use
54
drugs that could cause ED
antihypertension, CNS, digoxin, eesetrogen, amphetamines, antihistamines
55
increase cGMP concentrations for ED, 1st line
phosphodiesterase-5 inhibitors (sildenafil, etc)
56
CI of PDE-5 inhibitors
normal erection function nitrates -- hold 48 hours post tadalafil 24 hours for sildenafil and vardenafil treat angina with non nitrates
57
ADRs of PDE-5 inhibitors
blue-green vision, back pain, Qtc prolongation, HOTN hearing loss HA, flushing, dizziness, priapism
58
PDE-5 inhibitor education
30-60 min before activity, on empty stomach, 5-8 doses angina = d/c, relax monitor frequency/quality, BP and HR, ADRs
59
prostaglandin E1 analog --> direct dilation of cavernosal arteries with 1st dosing with supervision and at least 24 hours between dosing can combo with papaverine or phentolamine (not FDA approved)
intracavernosal alprostadil
60
CIs of intracavernosal alprostadil
deformation predisposition to priapism leukemia, myeloma, sickle cell disease ADRs: penile ache, scarring/plaques, priapism
61
alprostadil suppository
no more than 2 in 24 hours CIs: pregnant partners (condom must be used) deformation sickle cell anemia ADRs: soreness, priapism, increased UTI risk monitor administration, BP, frequency/quality

Clinical Pharmacology 2 (12 decks)

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