GI bleed, BPH, genitourinary Flashcards
what can happen in untreated hepatitis
cirrhosis, liver failure, hepatoma (liver cancer)
which hepatitis’ have vaccines
a and b only
name alpha antagonists- what are they used for
sx of BPH (improve urinary flow)- alfuzosin, doxazocin, silodosin, tamsulosin, terazosin
name 5 alpha reductase inhibitors- what are they used for
dutasteride, finasteride
how long does it take to see improvement with alpha antagonists
days to weeks (max response within weeks)- not influenced by prostate size
which alpha antagonists are associated with first dose syncope and what should be done about it
doxazocin and terazosin- start at low dose and titrate up- also take HS. This is not required with the others as they have greater selectivity for alpha 1a receptor which predominates in prostate, bladder neck, and urethra- these other 3 also have more constant drug concentrations when taken with meal
SE of alpha antagonists
dizzy, HA, nasal congestion
who do 5 alpha reductase inhibitors work best in
men with large prostate
is it appropriate to use both alpha antagonists and 5 alpha reductase inhibitors in BPH
yes- consider both if sx and prostate enlargement. Do for 6-12 months and try to remove alpha antag. If sx recur, restart it
which PDE5 inhibitor can be used both for erectile dysfx and BPH
tadalafil
what drugs should be avoided in BPH
decongestants or other with alpha adrenergic acitivty- they can stimulate smooth muscle in bladder neck and prostate and increase obstruction
side effects of 5 alpha reductase inhibitors and how they work
prevent metabolism of testosterone. SE sexual dysfx (decreased libido, erectile dysfx)
questions to ask regardingurinary incontinence
do you ever- leak urine (how often? when laugh/sneeze/cough?), have difficulty getting to toilet? feel unable to completely empty bladder?
modifiable causes of incontinence
caffeine, smoking, BPH, constipation,urinary tract infection, urogenital aging, obesity, meds (alcohol, alpha agonists or antag, antichol, chol, diuretics, psychotropics, sedative hypnotics, sympatholytics)
what is first line for incontinence
non pharm- kegels (pelvic floor training), bladder training (timed voiding)
2nd line in incontinence
start pharm therapy- antichol, mirabegron, vasinal estrogen if postmenopause urogenital atrophy
estrogen in incontinence
only for stress, evidence weak, worth a try, only topical not systemic
name anticholinergics for UI-how do they work
darifenacin, fesoterodine, oxybut, solfenacin, tolteridine, trospium. Work- improve bladder capcity, improve urge sx, enhance QOL and reduce incontinence
what is mirabegron- what is it for/ SE?
beta 3 agonist for urge incontinence. AE= HTN, tachy, nasopharyngitis, UTI. Uncommon QT
absolute CI to COC
breast cancer, cerobrovascular disease or hx, valvular heart idsease, current or past clot, diabetes with micovascular complications, less than 6 weeks post partum if breastfeeding, migraines with aura at any age, HTN, smoker over 35
what generation of progestins are less andorgenic and why is this important
third gen (desorgestrel, norgestimate)- better for acne
which progestin is not approved for contraception, but only for acne
cyproterone acetate
what might drospirenone be useful for
a progestin- related to aldosterone antagonist spironolactone- both progestin and antiandrogenic activity therefore may be good for PMDD. However, might have higher risk VTE
what is the window for taking progestin only pills
3 hours- or use backup
