Genitourinary

Question 1

Selective alpha1- blockers

Answer 1

I- blocks alpha1 receptor which relaxes bladder smooth muscle and decreases resistance to urinary flow
BPH (prazosin is also used fro HTN)

Tamsulosin- 400microg od
Allfuzosin 10mg od
Silodosin 8mg od
Prazosin 0.5-2mg bd

M-BP, volume depletion (risk of orthostatic hypotension), treatment with antihypertensives, first dose hypotension, improvement in BPH symptoms, cataracts surgery (risk of floppy iris syndrome)

C- dizziness (particularly on first dose and when standing- get up slowly), caution driving- dizziness and drowsiness, tell opthamologist youre taking this medication,
alfuzosin-swallow whole immediately after food
Silodosin- swallow whole, take with food to minimise AE
Tamsulosin- swallow whole

Question 2

Anticholinergics

Answer 2

Anticholinergic- reduce bladder contractility and increase bladder capacity

I-Urinary urge incontinence

D-
Darifenacin- 7.5-15mg once daily
Oxybutynin oral: 2.5-5mg bd-tds (max 20mg/d in divided doses). patch: 1 patch twice per week (every 3-4 days)
Propantheline- 15-30mg bd-tds (max 90mg/d) (rarely used of urinary incontinence)
Solifenacin- 5-10mg once daily
Tolterodine- 1-2mg bd

M- anticholinergic AE (dry mouth, dry eyes, constipation, blurred vision, dizziness), other anticholinergic drugs and CYP drug interactions (esp solifenacin and darifenacin), dementia/cognition (anticholinergics can reduce congition), urinary retention/bladder scan/post void residual volume, efficacy,  
solifenacin- QT prolongation
Renal function (dose reduction required)- solifenacin, tolterodine 

C- AE- dry mouth, dry eyes, constipation, blurred vision, dizziness- these tend to be worse when starting but do improve with time, dont drive until you know how the medication effects you, consider a bladder diary to measure efficacy
oxybutynin patch- apply to dry unbroken skin on abdo, hip, buttock, rotate patch site, safe patch disposal

CALs- all- 12
Oxybutynin- 12 (patch 21)
Solifenacin- 12, A
Tolterodine- 12, 16

Question 3

PDE- 5 Inhibitors

Answer 3

Phosphodiesterase-5 Inhibitor- inhibits breakdown of cGMP causing smooth muscle relaxation and increased blood flow

I- Erectile dysfunction, pulmonary arterial hypertension (sildenafil and tadalafil only), tadalafil- BPH related lower urinary tract symptoms

D
Sildenafil- 25-100mg 1 hour before intercourse. Takes longer to work when taken with food.
PAH- 20mg bd-tds

Tadalafil- 5-20mg 0.5-12h before intercourse. Can be taken 2.5-5mg daily (BAH or ED).
PAH- 20- 40mg once daily

Vardenafil- 5-20mg 30-60min before intercourse. Take longer to work when taken with food.

M- BP, bleeding disorder/active peptic ulcer (platelets contain PDE5- no safety data), migraine (reports of PDE5-I causing migraine), priapism, drug interactions (CI with nitrates of any form (inc topical), nicroandil, sodium nitroprusside, rociguat- due to risk of profound hypotension or MI- allow at least 24h (48h with tadalafil) before giving nitrate) (separate from prazosin by at least 4h, 6h for vardenafil), ocular issues- (non-arteritic anterior ischemic optic neuropathy), cardiovascular risk (recent acute MI/stroke, risk of physical exertion, uncontrolled hyper or hypotension), ECG (risk of QT prolongation with vardenafil), LFTs and renal function (dose reductions required)

AE- headache, dizziness, flushing, dyspepsia, nasal congestion/rhinitis

C- max of 1 dose per day for ED, do not take if you already take nitrates- can cause dangerous drop in BP, tell all drs/pharm esp in emergency that you take this medicine, can cause dizziness- get up slowly from sitting or lying, dont drive until you know how this medicine effects you, tell dr asap if you notice changes in vision or hearing, may worsen dizziness/fainting esp if taking other BP medications, can cause transient visual changes (sildenafil- blue green tinge, increase light sensitivity, blurred vision, tadalafil-visual changes), know how to treat priapism- if erection lasts >2h take 2 60mg pseudoephedrine if >4h go to hospital

CALs- 5, 16