Genitourinary Flashcards
DISCUSS ANTI-MUSCARINICS CLINICAL PHARM
Drug names:
- oxybutynin, tolterodine, solifenacin
MOA:
- Bind to muscarinic receptors, where they act as a competitive inhibitor of acetylcholine.
- Blocking muscarinic receptors therefore promotes bladder relaxation
- In patients with overactive bladder, this may reduce urinary frequency, urgency and urge incontinence.
- Antimuscarinics help in overactive bladder through antagonism of the M3 receptor,
Indications:
- Over reactive bladder
- Reduce urinary frequency, urgency and urge incontinence
Adverse effects:
- dry mouth
- tachycardia
- constipation
- blurred vision
Warning/caution:
- ▴dementia
- ▴elderly
- ▴angle-closure glaucoma
- ▴arrhythmias
- ▴urinary retention
Contraindications:
- ✗urinary tract infection
Interactions:
- ▴tricyclic antidepressants
Monitoring:
- This will hopefully reduce how often they need to pass water, the urgency with which they need to get to the toilet, and the chance of accidents. Explain that dry mouth is a very common side effect. If side effects are too much advice them to come in and stop the medication
- You should arrange to review your patient within a month of starting therapy to review response and side effects.
A patient is describing the following:
Storage/voiding symptoms, Urinary frequency, Urinary urgency, Nocturia – Needing to get up frequently at night to urinate, Hesitancy -Difficulty initiating the urinary stream, Incomplete bladder emptying, Straining – The need to strain or push to initiate and maintain urination, Weak stream, Post void dribbling. WHAT AM I? What is the first line of management
Benign prostatic hyperplasia
First line: Alpha blocker, Tamsulosin 400 micrograms once daily
Second line: 5- alpha – reductase inhibitor: finasteride
Third line: Phosphodiesterase 5 inhibitor, Sildenafil
DISCUSS 5 ALPHA REDUCTASE INHIBITORS (FINASTERIDE) CLINICAL PHARM
Indications:
- benign prostatic enlargement
- 5α-reductase inhibitors are second-line medical option
- They improve lower urinary tract symptoms, such as difficulty passing urine, urinary retention and poor urinary flow
Adverse effects:
- impotence
- reduced libido
- gynaecomastia
- hair growth
- Breast cancer
Warning/caution:
- male fetus to 5α-reductase inhibitors may cause abnormal development of the external genitalia
Contraindication:
- ✗pregnant women
Interactions:
- no clinical interactions
Monitoring:
- Tell him that the aim of finasteride treatment is to reduce the bulk of the prostate gland, which will relieve compression on the tube and make it easier to pass urine.
- Schedule a follow-up appointment in 3–6 months to review changes in lower urinary tract symptoms and the development of adverse effects.
A young man has been experiencing the following:
Trouble getting an erection
Trouble keeping an erection
Reduced sexual desire
What does he have and the first line treatment.
Erectile dysfunction
first line: Sildenafil phosphodiesterase (PDE) inhibitor.
DISCUSS SILDENIFIL CLINICAL PHARM
MOA:
- PDE-5 is responsible for the breakdown of cGMP, inhibition of this enzyme by sildenafil increases cGMP concentrations, improving penile blood flow and erection quality.
- PDE type 5 (PDE-5) that is found predominantly in the smooth muscle of the corpus cavernosum of the penis
- sexual stimulation releases nitric oxide
- it’s used to treat primary pulmonary hypertension.
Indications:
- Erectile dysfunction
- primary pulmonary hypertension
Adverse effects:
- flushing, headache, dizziness
- nasal congestion
- hypotension, tachycardia
- palpitations
- absence of stimulation (priapism)
- Visual disorders
Warnings/caution:
- ▴hepatic
- ▴renal impairment
Contraindications:
- ✗stroke
- ✗acute coronary syndrome
- ✗cardiovascular disease
Interactions:
- ✗nitrates or ✗nicorandil, as their combined effects on cGMP
- ▴vasodilators
- α-blockers and ccb (should not be taken within 4 hours of sildenafil
- ▴cytochrome P450 inhibitors, e.g. amiodarone
Monitoring:
- drug will not produce an erection without sexual stimulation
- taken an hour before sex
- seek medical advice if the erection does not subside within 2 hours after sexual activity has finished
- You should review the patient to enquire about therapeutic efficacy and side effects
