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
T/F- continuous COC dosing can only be done with monophasic
F- any with estrogen less than 50mcg which is all in Canada can be used
when is breakthrough bleeding common with contraception? when should it stop?
first 3-6 months- less or stopped after
lengths of time to best effect of emergency contraception
7 days copper, 3 days plan B,
difference between 1’ and 2’ dysmennorhea
both abdominal and pelvic pain associated with menses. 2’ has underlying cause of organic pathology (endometriosis, obstructed uterine flow, etc) vs 1’ has no identifiable cause
non pharm for dysmennorhea
heat, exercise, smoking cessation
pharm for dysmennorhea-how long to determine if working?
NSAIDs at onset of menses for 2-3 days scheduled with LD if needed, acet only ever if CI to NSAIDs, CHC. Need 3-6 month trial
sign might be endometriosis vs dysmen
pain persists after mentrual day 2, dyspareunia, infertility
how to manage endometriosis pain
NSAID or opioid first, then COC or progest only, then GnRH analogue or IUD
comment on Gonadotropin releasing hormone analogues (use, efficacy, dosage forms, se), what is used in conjunction
inhibit secretio of LH and FSH,not more effective than COC or progestin for pain, not good for endometriomas, nafarelin is intranasal, goserelin is SC, leuproide is IM, none more effective vs others. SE= hypoestrogenic state (hot flash, insomnia, mood changes, vaginal atrophy, decrease BMD). Hormone therapy is added back for this: estrogen and medroxyprogesterone acetate or norethindrone alone
what is danazol
androgen agonist for endometriosis, can be effective for dysmennorhea portion, limtied by SE (androgenic= hirsutism, acne, negative effect of lipids)
how is clomiphene dosed for endometriosis associated infertility
50mg daily f5d starting on day 5 if bleeding, but any day if none- helps induce ovulation. Limit to 3 cycles- if no result, quit.
drugs of choice for ED, CI
PDE5 inh- silden, tadal, varden. CI= nitrates, symptomatic hypotension,
what are the injections given for ED
prostaglandin E analogues- alprostadil (intracavernosal or urethral instillation)
counselling on PDE5inh
take 30-60 minutes before activity, efficacy depends on mental arousal, high fat meal delays absorption except in tadalafil, CI with nitrates (24 hours, 48 for tadal), common SE flushing, HA, dyspepsia (transiet), transient visual disturbance (blue/green color hard to distingush, blurry, increased light sensitive, etc- most common with silden) , may take a few times before works so don’t be discouraged first try
first line therapy for vasomotor sx (and what that is)- what if you’ve had a hysterectomy? What if 1st line is CI?
vaso sx=hot flashes and night sweats. Estrogen; if no hysterectomy, need combined HT or do non hormonal.If hysterectomy can do estrogen alone. If CI estrogen, non hormonal therapy only
non pharm for hot flashes
dress in layers, fan, cool drinks, smoking cessation, stretching, yoga possibly
how long does it take to see benefit with estrogen used for menopausal sx
4 weeks on standard dose, 8-12 if low
why is progesterone always added to estrogen in menopause? what dose?
to reduce risk of endometrial hyperplasia; use MPA 5mg daily if cyclical regimen (estrogen all the time, MPA for days 1-14, expect withdrawal bleed when estrogen is stopped), and 2.5 mg daily for continuous (minimum 1.5)
how long should estrogen therapy be used for for menopause
lowest dose shortest duration possible. Greater harm than benefit if over 5 years
non hormonal therapy for menopause
parox, escit, venlafax, clonidine, gabapentin. SSRI best tolerated
