Genitourinary Flashcards

1
Q

Alpha blockers e.g. _____, ______ are indicated as 1st line rx of ___ when lifestyle alone is insufficient.
Also indicated for the add-on treatment of resistant _____ when other meds are insufficient.

A
  • doxazosin, tamsulosin, alfuzosin
  • BPH
  • resistant hypertension
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2
Q

MOA, alpha-blockers are highly selective for the….

A
  • a-1 adrenergic receptor, on SM e.g. blood vessels and urinary tract (around bladder neck and prostate)
  • blockade induces relaxation so they cause vasodilation and fall in BP and reduced resistance to bladder outflow
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3
Q

2 adverse effects of alpha-blocker use e.g. doxazosin, tamsulosin, alfuzosin

A

-postural hypo (do not give to pts with existing postural hypoT)
-dizziness
-syncope
(esp after the 1st dose)

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4
Q

If starting an alpha blocker e.g.. doxazosin, tamsulosin, alfuzosin for rx-resistant hypertension, which antihypertensive may you withold while the first dose of alpha blocker is started to protect against pronounced hypotension?

A

-omit beta-blocker (as this inhibits tachycardia-forms part of the compensatory response to vasodilation)

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5
Q

5 alpha reductase inhibitors e.g. _____, are indicated for 2nd line rx of:

A
  • finasteride
  • BPH (improves LUTS symptoms and reduce need for surgery)
  • dose 5mg daily
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6
Q

5 alpha reductase inhibitors e.g. finasteride, MOA for BPH rx:

A
  • reduce size of gland
  • inhibition of the intracellular 5-AR enzyme means testosterone is not converted to more active DHT (which stimulates prostatic growth) so it thereby improves urinary flow
  • but can take several months
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7
Q

2 SEs of 5 alpha reductase inhibitors e.g. finasteride (relates to the anti-androgen action)..

A
  • impotence & reduced libido. but these are usually transitory
  • breast tenderness and gynaecomastia, increased risk of breast cancer in men on finasteride
  • hair growth (can improve male-pattern baldness)
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8
Q

What is a bizarre CI of 5 alpha reductase inhibitors e.g. finasteride..?

A

-CI: PREGANT WOMEN DON’T TAKE THEM/BE EXPOSED TO THEM (by handling broken tablets or through semen during unprotected sex with a man on these drugs..) as exposure to a male fetus -> abnormal external genitalia development

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9
Q

In hormonal contraception, oestrogen +/ progesterone are given to suppress what to prevent what?

A

-suppress FSH/LH so prevent ovulation

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10
Q

All forms of oestrogen and progesterone are contraindicated in patients with what?

A

CI: BREAST CANCER

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11
Q

Sildenafil is a PDE-5 inhibitor used to treat erectile dysfunction or what condition in the lungs?

A

-Primary pulmonary hypertension

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12
Q

How does sildenafil act?

A
  • inhibits PDE-5
  • found in SM of corpus cavernosa/lung arterioles
  • PDE-5 usually would break down cGMP, so sildenafil increases cGMP conc
  • this improves penile blood flow/erection quality / pulmonary blood flow
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13
Q

As sildenafil is a vasodilator, suggest 3 SEs associated with it’s use:
NB: visual colour distortion should prompt urgent medical review as should priapism due to failure of erection to subside=

A
  • flushing
  • headache
  • dizziness
  • nasal congestion
  • hypotension, tachycardia, palpitations
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14
Q

Sildenafil has a small associated risk of vascular events

suggest 2 CIs for its use and 1 caution:

A

CI: STROKE
CI: ACS, CI: CVS DISEASE
CI: NITRATES/NICORANDIL that increase NO conc
Caution: hepatic/renal impairment

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15
Q

Oxybutinin and tolteradine, solifenacin belong to what class of medication

A

Antimuscarinics (for genitourinary use)

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16
Q

what GU pathology are antimuscarinics like oxybutynin and tolteradine used for?

A

-reduce urinary frequency, urgency and urge incontinence in OVERACTIVE BLADDER (if bladder training is ineffective)

17
Q

Mechanism of antimuscarinics (e.g. oxybutynin, tolteradine) for OVERACTIVE BLADDER?

A
  • competitively inhibit Ach on muscarinic receptors (m3)
  • blocking this promotes bladder relaxation (increases bladder capacity)
  • reduces symptoms
18
Q

Give 3 SEs of the antimuscarincs used to treat Overactive Bladder:

A
  • dry mouth
  • tachycardia
  • constipation
  • blurred vision
19
Q

What is the one CI to antimuscarinic use in Overactive Bladder hence what is an important part of assessment before prescribing?

A

-CI: URINARY TRACT INFECTION

Therefore: must do urinalysis before prescribing

20
Q

What is the com

A