Genitourinary system Flashcards
What drug is used to tx stress incontinent in women only
Duloxetine
First line tx for urinary frequency
DOT
D- Darifenacine
O- Oxybutynin
T- Tolterodine
S- Solifenacin
They are Antimuscarinic
State the 2nd line tx for urinary frequency and incontinent
Mirabegron
It’s a beta adrenoceptor agonist
Prolongs QT interval
Other drugs used to tx urinary frequency and incontinent
Propantheline
TCA’s eg imipramine
Non drug tx of urinary frequency and incontinent
Pelvic floor exercise and bladder training
State the indication of oxybutynin
Reduce symptoms of urgency and incontinent and increase bladder capacity
MR preps have less side effect
What is nocturnal enuresis
Involuntary discharge of urine during sleep
Non drug tx of nocturnal enuresis
Reassurance, advice on fluids , diet, toileting behaviour, enuresis alarm
Drug tx for nocturnal enuresis
Oral or SL desmopressin
( imipramine for children who do not respond to all tx)
Commo n side effect of Desmopressin
Hyponatremia( too much water dilution ) and nausea
Counselling for pt on desmopressin
Hypnonatremic convulsions. Warn pts to avoid fluid overload including during swimming) and to stop desmopressin during an episode of Vomiting or diarrhoea which can lead to loss of Na until fluid balance is normal
Caution with Desmopressin
Avoid intranasal route due to increased side effects
Limit fluid intake to minimum from I hrs before desmopressin dose until 8 hrs afterwards
What’s acute urinary retention
It’s an emergency
Inability to voluntarily urinate
Painful and require immediate Catheterization
What’s chronic urinary retention
Gradual development over months or years or the inability to empty bladder completely
Painless
Tx of Chronic urinary retention
Surgically or medically with alpha blockers
Most common cause of urinary retention in men
BENIGN PROSTATIC HYPERPLASIA (BPH)
What are the complications of BPH
Renal impairment, urinary retention or recurrent infection
Men with enlarged prostate suffer from urinary retention, urgency or nocturnal, frequency. T/ F
True
First line drug tx for urinary retention
Alpha blockers eg Alfuzosin, doxazosin, tamsulosin, prazosin, Indoramin and terazosin
Aphasia blockers can impair driving and performance of skilled task. True or false,?
True
2nd line tx for urinary retention
5 alpha reductase inhibitor
Finasteride and dutasteride
Used for pt with enlarged prostrate, raised prostrate specific antigen concentration considered to be high risk of progression
MHRA advice for 5 alpha reductase Inhibitor
Conception and contraception
Both excreted in semen. Use of condom is recommended if sexual partner is pregnant or likely to due to teratogenicity
Handling and storage for alpha reductase inhibitors
Women of child bearing potential should avoid handling crushed or broken tablets of Finasteride or leaking capsules of dutasteride
Patient and carer advice for Alpha reductase inhibitors
Both cause Breast cancer
Report any breast changes eg lumps, pain, nipple discharge
MHRA for Finasteride
Reports of depression and suicidal thoughts in men taking for male pattern hair loss. Stop immediately if depression develops
Facts about Alpha blockers in elderly
Caution in elderly and pts having cataract surgery due to floppy iris syndrome risk
Contraindications of alpha blockers eg Tamsulosin, Doxaso zin
Postural hypotension and micturition syncope ( faint on urinating)
Side effects of alpha blockers
Ist dose hypotension
Postural hypotension
Vomiting
Dry mouth
Diarrhoea
Dizziness
Headache
Dry mouth
Malaise
Common side effect of tamsulosin
Dizziness and sexual dysfunction
Exception to legal category with Tamsulosin
Tamsulosin hydrochloride 400 microgram capsules can be sold to the public for the treatment of functional symptoms of benign prostatic hyperplasia in men aged 45–75 years to be taken for up to 6 weeks before clinical assessment by a doctor.
