Genito-urinary system Flashcards
Why are alpha blockers and ACE inhibitors risks of urinary incontinence?
ACE: induce cough,
alpha blockers: relax the bladder outlet and urethra
Give examples of some conditions which increase detrusor muscle overactivity and therefore worsen urinary incontinence?
UTI, urinary obstruction, oestrogen deficiency, nervous system diseases
What are the four classes of incontinence?
Stress, urgency, mixed, overflow incontinence
What is the treatment for stress incontinence?
FEMALE) Pelvic floor muscle training for at least 3 months, incl 8 contractions TDS.
Second line= duloxetine – SNRI
What is overflow incontinence?
Where a person cannot empty their bladder completely and it becomes over distended
What is used to treat nocturnal enuresis?
Nothing under 5,
a) desmopressin
b) add antimuscarinic
What is the main treatment for urge incontinence?
First bladder training for 6 weeks then drug treatment Antimuscarinics i.e. oxybutynin, tolterodine, solifenacin, next mirabegron
MOA for antimuscarinics?
Antimuscarinics bind to the acetylcholinesterase inhibitor – competitive inhibition. Contraction of the smooth muscle of the bladder is under parasympathetic control so blocking the muscarinic receptors therefore promotes bladder relaxation and increases bladder capacity
Side effects of antimuscarinics
Dry mouth, bradycardia then tachycardia, constipation, urinary retention, drowsiness, caution cardiac- QT prolongation
What class of drug is mirabegron?
Beta 3 agonist
What is the treatment for acute urinary retention?
Catheterisation, before this is removed: alpha blockers (alfuzosin, doxazosin, tamsulosin etc) should be given by at least two days
First line treatment for BPH? (benign prostatic hyperplasia)
Alpha blockers
MOA of this first line treatment for BPH
Alpha blockers work by relaxing the smooth muscle producing an increase in urinary flow rate and an improvement with obstructive symptoms
What class of drug is finasteride and dutasteride?
5a reductase inhibitor
What counselling/MHRA alerts would you alert patients with for finasteride and dutasteride?
To report breast symptoms i.e. lumps, pain or nipple discharge. To also report any signs of depression and suicidal thoughts (MHRA).
Use condoms if partner is pregnant or likely to be pregnant. Women of child bearing potential, avoid handling crushed finasteride tablets and leaking dutasteride capsules
First line for erectile dysfunction?
PDE inhibitor (phosphodiesterase inhibitor) i.e. sildenafil.
NB: don’t use with nitrates
Which PDE5 inhibitor has a short action?
Sildenafil and vardenafil and avanfil so can be used PRN
Which PDE5 inhibitor has a longer duration of action?
Tadalafil – therefore used as required AND can be used as a regular lower daily dose to allow for spontaneity
What is alprostadil? (second line for Erectile Dysfunction)
Alprostadil is a prostaglandin E1 NB: patients should seek help if erection lasts longer than 4 hours, apply ice pack to upper inner thigh (alternate between right and left every two mins for up to 10 mins): may result in opening of venous valves….
If longer than 6 hours, penile aspiration
What is a failed responder in Erectile Dysfunction ?
Tried more than 6 doses at max dose with sexual stimulation and failed to respond
What drug is used for premature ejaculation?
Dapoxetine (short acting SSRI)
When can you start a COC?
At any time during menstruation, but… if take on/after day 6 of menstrual use protection for a week
List benefits of COCs
Reduced ovarian, endometrial and colorectal cancer, predictable bleeding, management of symptoms and PCOS, endometriosis and premenstrual syndrome, maintain bone density in peri-menopausal females under 50
How long should COCs be discontinued prior to surgery?
4 weeks
