Gentio Urinary Flashcards
What medications or drugs increase urine production?
Diuretics, Alcohol and Caffeine
Urgency Urinary incontinence treatment? 1st line? 2nd line? 3rd line?
1st line: Bladder training for 6 weeks
2nd line: Antimuscarinics
(Oxybutynin or Tolterodine)
3rd line: Mirabegron
Stress urinary incontinence treatment?
Pelvic muscle training at least 3 months
Or
Surgery
or
Duloxetine
Mixed treatment of urinary incontinence?
Bladder training for 6 weeks atleast
+
Pelvic floor muscle training for more than 3 months
TREAT ACCORDING TO DOMINATING TYPE CAUSING IT
Antimuscarinics examples?
Fesoterodine
Solfenancin
Trospium
Oxybutynin
Tolteridone
Antimuscarinics side effects?
Dry mouth
Constipation
Flushing
Dizziness
Drowsiness - Can affect Driving!
Tachycardia
Antimuscarinics contraindicated in?
- Angle closure Glaucoma
- Gastrointestinal obstruction
Nocturnal Enuresis treatment process? 5-7yrs
Fluid restriction
Enuresis alarm (more than 1-2 wet beds)
Review alarm after 4wks
Continue until min 2wks of dry nights
If finally unsuccessful -> Desmopressin
Nocturnal Enuresis over 5 years?
Desmopressin
*used in holidays, alarm not worked
Assess after 4 weeks + continue 3 months if responding
3 month intervals!!!
Specialist treatment for Nocturnal Enuresis?
Desmopressin +/- Antimuscarinic (Oxybutynin or tolterodine)
If not responding:
Imipramine
Desmopressin what to know
More potents and longer duration than vasopressin
No vasoconstrictor effect
Hyponatraemia caused -> convulsions
Hyponatraemia especially if given rapidly
Urinary retention 2 types?
Acute - medical emergency
Chronic - unable to completely empty bladders
Main chronic type of urinary retention?
Benign prostatic hyperplasia
Acute urinary retention treatment?
Immediate catheterisation
Before removing catheter: Alpha blocker given for 2 days prior
Chronic urinary retention?
Long term catheter used
May cause recurrent UTI’s
Urethra Trauma, Pain and stone
Benign Prostatic Hyperplasia treatment?
Alpha blockers (relaxes smooth muscle)
(Alfuzosin, Doxazosin, Tamsulosin, Terazosin)
Patients with enlarged prostrate, raised prostrate antigens, or at high risk of progression?
Finasteride or Dutasteride
Alpha blockers affect on BP
Lowers Bp - Postural Hypotension
Avoid Alpha blockers in which pts?
Patients that have history of:
- Fainting - Micturition Syncope
- Postural Hypotension
What should be counselled in Alpha blockers?
First dose can cause collapse - hypotensive
Take before bed
Lie down if dizziness, fatigue, or sweating develops until they feeling better
5 Alpha Reductase inhibitors examples?
Finasteride, Dutasteride
5 Alpha Reductase inhibitors can cause what?
- Breast disorder
- Sexual Dysfunction
Male breast cancer in Finasteride use?
Report lump pains or nipple discharge
Finasteride condoms use?
Use condom if partner is pregnant or likely to become pregnant
Finasteride and depression?
If depression or suicidal thoughts
STOP FINASTERIDE IMMEDIATELY
Inform GP
Phosphodiesterase type 5 inhibitor example?
Avanafil, Sildenafil, and Vardenafil
Longer acting erectile dysfunction drug?
Tadalafil (Max 1 dose (20mg))
Erectile Dysfunction Second line?
Intracavernosal, Intraurethralor
Topical Aprostadil
Erectile Dysfunction lifestyle change?
Smoking Cessation
Reduce Alcohol intake
Side effects of Phosphodiesterase type
5 inhibitor?
Flushing
Dizziness
Nasal Congestion
Migraine
Big side effect in erectile Dysfunction drug?
PRIAPISM - Erection lasting longer than 4hrs
Contraindications in erectile dysfunction drugs?
Patients taking Nitrates/have hypotension
Patients with unstable angina/stroke
Patients angina during intercourse
Patients who shouldn’t have sexual activity
Erectile dysfunction drugs - other drugs that interact with?
Nitrates
Alpha-Blockers
—— Leading to hypotension ——
Alpostadil counselling?
Wear a condom if partner is of child bearing age, pregnant or lactating
