Genitourinary Flashcards
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.
- doxazosin, tamsulosin, alfuzosin
- BPH
- resistant hypertension
MOA, alpha-blockers are highly selective for the….
- 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
2 adverse effects of alpha-blocker use e.g. doxazosin, tamsulosin, alfuzosin
-postural hypo (do not give to pts with existing postural hypoT)
-dizziness
-syncope
(esp after the 1st dose)
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?
-omit beta-blocker (as this inhibits tachycardia-forms part of the compensatory response to vasodilation)
5 alpha reductase inhibitors e.g. _____, are indicated for 2nd line rx of:
- finasteride
- BPH (improves LUTS symptoms and reduce need for surgery)
- dose 5mg daily
5 alpha reductase inhibitors e.g. finasteride, MOA for BPH rx:
- 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
2 SEs of 5 alpha reductase inhibitors e.g. finasteride (relates to the anti-androgen action)..
- 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)
What is a bizarre CI of 5 alpha reductase inhibitors e.g. finasteride..?
-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
In hormonal contraception, oestrogen +/ progesterone are given to suppress what to prevent what?
-suppress FSH/LH so prevent ovulation
All forms of oestrogen and progesterone are contraindicated in patients with what?
CI: BREAST CANCER
Sildenafil is a PDE-5 inhibitor used to treat erectile dysfunction or what condition in the lungs?
-Primary pulmonary hypertension
How does sildenafil act?
- 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
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=
- flushing
- headache
- dizziness
- nasal congestion
- hypotension, tachycardia, palpitations
Sildenafil has a small associated risk of vascular events
suggest 2 CIs for its use and 1 caution:
CI: STROKE
CI: ACS, CI: CVS DISEASE
CI: NITRATES/NICORANDIL that increase NO conc
Caution: hepatic/renal impairment
Oxybutinin and tolteradine, solifenacin belong to what class of medication
Antimuscarinics (for genitourinary use)