Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 3 Test 1 > GU > Flashcards

GU Flashcards

1
Q

When the penis is flaccid:

A

arterial blood flow (in)=venous blood flow (out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

With an erection:

A

arterial blood flow (in)>venous blood flow (out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 main causes of ED (broad categories)

A
  1. Organic
  2. Psychogenic
  3. Medication/drug-induced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MC cause of organic ED

A

decreased blood flow (d/t dz ie DM, HTN, heart dz–> vascular problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Organic causes of ED

A
  • Decreased blood flow (MC)

- Hormone imbalance (low testosterone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

T or F- all people with low testosterone levels have ED?

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Psychogenic causes of ED

A

stress, anxiety, depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What meds can cause ED?

A
  • BP meds
  • Antipsychotic meds (esp 1st gens)
  • Antidepressants
  • BPH
  • Opioids
  • Nicotine
  • Excessive alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What specific BP meds can cause ED? (3)

A

BBs, clonidine, methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What specific antipsychotic meds can cause ED? (4)

A

1st gen antipsychotics (not 2nd gens): haloperidol, chlorpromazine, thioridazine, fluphenazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What specific antidepressants can cause ED?

A

SSRIs, SNRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the #1 reason why pts stop taking their antidepressants?

A

ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What specific BPH drugs can cause ED?

A

finasteride, dutasteride, silodosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What specific opioids can cause ED?

A

ALL, especially methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Are 1st or 2nd gen antipsychotics more likely to cause ED?

A

1st gen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a useful tool for patient hx for pts w/ ED?

A

International index of erectile function (IIEF-5) questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pt hx for ED (2 essential things to help obtain it)

A
  • IIEF-5 questionnaire

- Past medical hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ED physical exam findings (4)

A
  • hypogonadism (dec testosterone)
  • penile dz
  • enlarged prostate
  • HTN, DM (vascular dz)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the goal of therapy for ED?

A

increase QUANTITY and QUALITY of sexual intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Should ED txs be used for pts w/o ED?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

1st step before initiating tx of ED

A

Identify cause- physical vs psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tx algorithm for PHYSICAL ED

A
  • 1st= Lifestyle modifications

- if no effect–> devices and medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx algorithm for PSYCHOLOGICAL ED

A
  • 1st= Lifestyle modifications

- if no effect–> medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

For an erection to happen, muscle must be ____ (contracted/relaxed)

A

relaxed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Physiology of an erection: starts with _____

A

acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Physiology of an erection: 2 pathways after acetylcholine is released: ____ or _____

A

increased NO (nitric oxide) release or increased Prostaglandin E release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Physiology of an erection: When NO is released, this causes an increase of _____

A

cGMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Physiology of an erection: When prostaglandin E is released, this causes an increase of _____

A

cAMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Physiology of an erection: Increases in both cGMP and cAMP result in decreased _____

A

calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Physiology of an erection: When calcium is blocked, muscle_____, allowing erection

A

relaxes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which side of the “erection pathway” does Alporostadil affect?

A

increases prostaglandin E (Alporostadil is prostaglandin E), leading to increased cAMP and dec Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which side of the “erection pathway” do phosphodiesterase inhibitors affect?

A

Slows breakdown of cGMP, leading to increased cGMP and dec Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

ED tx algorithm: drug-induced ED

A
  • d/c offending agent
    OR
    -reduce dose of offending agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

ED tx algorithm: Organic ED–> What are the 1st line options? (2)

A

-Oral PDE inhibitor
or
-Vacuum erection device

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Organic ED: is it a physical or psychologic cause of ED?

A

physical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

ED tx algorithm: Organic ED–> What are the 2nd line options?

A

Intracavernosal therapy (injection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ED tx algorithm: Organic ED–> What are the 3rd line options?

A

Intraurethral alprostadil (suppository)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

ED tx algorithm: Organic ED–> What is the last line option?

A

penile prosthesis (surgery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

ED tx algorithm: Psychogenic ED (2)

A
  • psychotherapy

- behavior modification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

List the non pharm tx for ED (devices)

A
  • Vacuum erection device (1st line)

- Penile prosthetic implant (last line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

2 first line therapies for ED tx

A

Vacuum erection devices and Oral PDE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Vacuum erection device time of onset

A

30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How long should vacuum erection devices be used for?

A

only for 30-60 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Vacuum erection devices: what maintains erection?

A

tension bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a downside of vacuum erection devices that you need to inform your pt of?

A

ejaculation won’t always occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

CIs for the 2 devices

A
  • sickle cell anemia

- pt already on anticoagulants ie coumadin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

ABSOLUTE CI for devices

A

sickle cell anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the 3 categories of pharmacologic tx of ED?

A
  • phosphodiesterase inhibitors
  • Prostaglandin E1
  • Unapproved (rx and herbal) agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

1st line pharm therapy for ED?

A

phosphodiesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

List the phosphodiesterase inhibitors

A

Sildenafil, vardenafil, tadalafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Sildenafil brand name

A

Viagra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

vardenafil brand name

A

Levitra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

tadalafil brand name

A

Cialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

which PDE inhibitors inhibit PDE-5, slowing the breakdown of cGMP?

A

Sildenafil, vardenafil, tadalafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which PDE inhibitors inhibit PDE-6?

A

Sildenafil, vardenafil (minimal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Where is the enzyme PDE-6 found in the body?

A

the eyes around the photoreceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

PDE-6 affects what part of your vision?

A

color vision, especially the color blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What ADR can occur in drugs that inhibit PDE-6? What do you do if this occurs?

A

color changes can occur. Stop drug immediately before photoreceptor damage is permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Onset of action for vardenafil?

A

1 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Onset of action for Sildenafil?

A

30 min- 1 hr (shortest onset of the 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Onset of action for tadalafil?

A

2 hrs (longest onset of the 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Duration of action for Sildenafil?

A

4 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Duration of action for tadalafil?

A

24-36 hrs (longest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Duration of action for vardenafil?

A

4 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the fatty meal effect?

A

absorption of the drug is affected by fatty meals, so you must take the drug on an empty stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which PDE inhibitors have the fatty meal effect?

A

sildenafil, vardenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Photoreceptor damage (color changes) are most common with which PDE inhibitor?

A

sildenafil (viagra); vardenafil only small risk; tadalafil rare, but there’s still a warning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the least potent PDE inhibitor?

A

sildenafil (dose= 25-100 mg); others dose= 5-20 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which PDE inhibitors should you take on an empty stomach?

A

sildenafil, vardenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which PDE inhibitors can you take with or without food?

A

tadalafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is a good thing to keep in mind when deciding which ED med is best to prescribe your pt?

A

insurance coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

MOA- PDE inhibitors

A

inhibits phosphodiesterase enzymes, slows breakdown of cGMP, allowing for depression of Ca, leading to smooth muscle relaxation and erection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What side of the erection pathway do PDE inhibitors affect?

A

left side (NO, cGMP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Drug-drug interactions- PDE inhibitors

A

-Alcohol and nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Are PDE inhibitors absolutely CI’d if pt is on nitrates?

A

No.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

If pt is on nitrates, how long must they wait to take their nitrates after taking viagra?

A

24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

If pt is on nitrates, how long must they wait to take their nitrates after taking cialis?

A

48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Are PDE inhibitors absolutely CI’d if pt drinks alcohol?

A

No. moderate ETOH consumption is ok (ETOH in excess=absolute CI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

ADRs- PDE inhibitors

A

Rare and serious:

  • nonarteritic anterior optic neuropathy (NAION)
  • priaprism

Other:
-change in color vision (mainly viagra)(d/t PDE-6 inhibition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Definition: vision changes in the eye (not the same as the color changes)

A

nonarteritic anterior optic neuropathy (NAION)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Define priaprism

A

erection lasting >4 hrs

82
Q

List the prostaglandin E1 drugs for tx of ED

A

Aprostadil

83
Q

MOA- Alprostadil

A

Increases cAMP, decreasing Ca

84
Q

What side of the erection pathway does Alprostadil affect?

A

right side (prostaglandin E, cAMP)

85
Q

List the 2 routes of administration of Alprostadil

A
  1. Intracavernous injection

2. Intraurethral (MUSE)- suppository

86
Q

Alprostadil intracavernous injection brand names (2)

A

Caverject, Edex

87
Q

Which form of alprostadil is a suppository inserted into the urethra?

A

MUSE

88
Q

Which form of alprostadil is preferred?

A

Intracavernous injection

89
Q

Why is the intracavernous injection the preferred method of administration of Alprostadil?

A

faster absorption

90
Q

Intracavernous injection of Alprostadil: ADRs? (3)

A
  • Injection site rxn
  • Fibrous deposits
  • Curvature of the penis
91
Q

What part of the penis is the intracavernous injection of Alprostadil injected into?

A

right into the penis cavernosa

92
Q

What should be done to reduce fibrous deposits and injection site rxns with the intracavernous injection of Alprostadil?

A

rotate injection sites (switch sides of the cavernosa)

93
Q

How big is the needle for the intracavernous injection?

A

1/2”, 27-30 gauge (prefilled syringe)

94
Q

Alprostadil onset of action?

A

5-15 min (5 min-injection, 15 min- MUSE-slower absorption)

95
Q

Alprostadil duration of action?

A

14-44 min for either; DOSE RELATED

96
Q

What is the non-response rate w/ Alprostadil injections? (%)

A

30%

97
Q

What are the unapproved rx agents for ED? (3)

A
  • Pentolamine
  • Papaverine
  • Trazodone
98
Q

Which UNAPPROVED rx agents for ED are available as injections?

A

Pentolamine and Papaverine

99
Q

What are the unapproved herbal OTC agents for ED? (3)

A
  • Yohimbine
  • Wild yam
  • DHEA (dehydroepiandosterone)
100
Q

What is the problem with herbal OTC agents for tx of ED?

A
  • Not found to be super efficacious in txing ED

- not FDA regulated

101
Q

What should you always tell pts to look for on the bottles of herbal supplements, since herbals are not FDA regulated?

A

USP gold seal (indicates good manufacturing practices)

102
Q

BPH- sex and age

A

males >60 yo

103
Q

What is the MC benign neoplasm in men?

A

BPH

104
Q

What % of men have enlarged prostate and BPH symptoms?

A

40%

105
Q

What % of men require tx for BPH symptoms?

A

20%

106
Q

Functions of the prostate (2)

A
  1. produce ejaculation fluids (40%)

2. antibacterial secretions

107
Q

Layers of the prostate (3)

A
  1. Epithelial (glandular)
  2. Stromal (smooth muscle)
  3. Capsule (fibrous)
108
Q

What receptors are located in the epithelial layer of the prostate?

A

androgen receptors

109
Q

What receptors are located in the stromal layer of the prostate?

A

a1 receptors

110
Q

What receptors are located in the capsule layer of the prostate?

A

a1 receptors

111
Q

How many growth phases of the prostate are there?

A

2

112
Q

Describe the growth phases of the prostate

A
  1. puberty-25yo (1st growth of the prostate)

2. 40 yo- rest of life

113
Q

Size range of prostate from 1st to 2nd growth phases

A

1g to 25-50g

114
Q

Are there more a1 adrenergic receptors in the bladder or the prostate?

A

Many more in the prostate

115
Q

Normal prostate- ratio of stromal layer:epithelial layer

A

2:1

116
Q

What layer of the prostate expands in BPH?

A

stromal layer

117
Q

BPH- ratio of stromal layer:epithelial layer

A

5:1

118
Q

BPH pathophys: epithelial tissue

A

Androgen receptors (5a reductase): testosterone converted into DHT–> causes prostate enlargement

119
Q

BPH pathophys: stromal & capsule

A

a1 receptors: bind norepinephrine, cause muscle contraction

120
Q

Static vs Dynamic causes of BPH

A
  • Static= physical block-permanent enlargement of tissue

- Dynamic= muscle contraction- affect urethral lumen

121
Q

BPH symptoms (7)

A
  • urinary frequency
  • urinary urgency
  • urinary intermittency
  • Nocturia (getting up in middle of night to pee)
  • Hesitancy
  • Straining
  • Decreased force of stream
122
Q

BPH signs (6)

A
  • DRE- enlarged prostate
  • Elevated PSA
  • Elevated BUN, Scr (with obstruction)
  • Increased post-void residual volume
  • Decreased urine flow rate
  • Weakened stream
123
Q

PSA value in BPH

A

elevated, >1.4 ng/mL

124
Q

BPH- post-void residual volume

A

Increased, >25-50 mL (more urine left in bladder)

125
Q

BPH-urine flow rate

A

decreased (less than 10 ml/sec)- dec flow rate, weakened stream

126
Q

Med induced BPH: meds that affect the prostate directly (2)

A
  • Testosterone

- a-agonists- more short term/reversible, pts usu not on these meds chronically.

127
Q

Med induced BPH: meds whos ADRs mimic BPH symptoms, but don’t actually change the prostate (5)

A
  • Anticholinergics
  • antihistamines (diphernhydramine-benadryl) (?like an anticholinergic?)
  • phenothiazine
  • TCAs
  • Large doses of diuretics
128
Q

How does testosterone affect the prostate?

A

inc testosterone= inc prostate size

129
Q

List a-agonists that directly affect the prostate

A

pseudoephedrine, ephedrine, phenylephrine

130
Q

List the complications of untreated BPH (7)

A
  • AKI
  • Gross hematuria
  • Overflow urinary incontinence or unstable bladder
  • Recurrent UTIs (bc of residual urine in the bladder)
  • Bladder diverticula
  • Bladder stones
  • Long standing obstruction leading to chronic renal failure
131
Q

Non-pharm tx of BPH (mild symptoms) (2)

A
  1. Watchful waiting

2. Behavior modification

132
Q

What is included as part of behavior modification as a non-pharm tx of BPH? (4)

A
  1. Medication review
  2. Restrict fluids close to bedtime
  3. minimize caffeine and alcohol
  4. bladder training (frequent emptying)
133
Q

Tx for pt w/ severe symptoms from BPH

A

surgery (complex, many risks)

134
Q

What is the name or the survery for pts w/ BPH to determine need for tx?

A

AUA BPH symptom score index

135
Q

How many questions are in the AUA BPH symptom score index? What is the rating scale?

A
  • 8 questions, rate each 0-5; 0=best, 5=worst
136
Q

Severity of BPH based on the AUA BPH symptom score index (actual numbers)

A

Mild: less than 7
Mod: 8-19
Severe: >20

137
Q

BPH tx flow chart: mild sympts

A

Watchful waiting

138
Q

BPH tx flow chart: mod sympts

A
  1. a1 antagonist OR 5a reductase inhibitor; if response- continue, if no reponse-surgery
  2. a1 antagonist AND 5a reductase inhibitor; if response- continue, if no reponse-surgery
139
Q

BPH tx flow chart: severe sympts/complications

A

surgery

140
Q

Pharmacologic tx for BPH: classes (3)

A
  • a1 antagonists
  • 5-a reductase inhibitors
  • herbal products
141
Q

a1 antagonists MOA

A

block a1 receptors in prostate, relaxing stromal layer

142
Q

5-a reductase inhibitors MOA

A

block 5a reductase (epithelial layer), reducing production of androgens/testosterone

143
Q

Which BPH drug class relaxes smooth muscle in the prostate?

A

a1 antagonists

144
Q

Which BPH drug class decreases prostate size?

A

5-a reductase inhibitors

145
Q

Which BPH drug class halts dz progress?

A

5-a reductase inhibitors (halts but doesn’t reverse)

146
Q

Which BPH drug class is best to tx a muscle related cause of BPH?

A

a1 antagonists

147
Q

Which BPH drug class is best to tx a pt w/ a very enlarged prostate?

A

5-a reductase inhibitors

148
Q

Peak onset of a1 antagonists?

A

1-6 wks

149
Q

Peak onset of 5-a reductase inhibitors?

A

3-6 mo (longer onset)

150
Q

Efficacy of BPH drug classes?

A

Both a1 antagonists and 5-a reductase inhibitors are equally efficacious (++); 5-a reductase inhibitors are better for enlarged prostates, however

151
Q

Which BPH drug class decreases PSA?

A

5-a reductase inhibitors

152
Q

Which BPH class causes the most sexual dysfunction?

A

5-a reductase inhibitors (++) (most problems d/t dec testosterone)

a1 antagonists still cause some (+)

153
Q

Which BPH drug class has cardiovascular ADRs?

A

a1 antagonists

154
Q

How many generations of a1 antagonists are there for tx of BPH?

A

2- 2nd gen and 3rd gen

155
Q

Which generation of a1 antagonists are the best for a pt with both HTN and BPH?

A

2nd gen

156
Q

Which generation of a1 antagonists are the most prostate specific and have less side effects as a result?

A

3rd gen

157
Q

List the 2nd gen a1 adrenergic antagonists for tx of BPH (5)

A

Prazosin, terazosin, doxazosin, doxazosin GTS (XL), alfuzosin

158
Q

List the 3rd gen a1 adrenergic antagonists for tx of BPH (2)

A

Tamsulosin, silodosin

159
Q

Indications for 2nd gen a1 adrenergic antagonists

A

pt w/ HTN and BPH–> less prostate specific

160
Q

Indications for 3rd gen a1 adrenergic antagonists

A

pt w/ BPH (no HTN), with muscular cause; 3rd gens are more urospecific (prostate specific)

161
Q

a1 adrenergic antagonists ADRs (6)

A
  • Dizziness (esp 2nd gen)
  • Hypotension (esp 2nd gen)
  • Syncope w/ 1st dose (make sure pt lying or sitting down after taking 1st dose)
  • Muscle weakness
  • H/A

*Rare/serious: floppy iris syndrome- refer to opthalmologist

162
Q

Describe how you should dose a1 adrenergic antagonists for tx of BPH

A

start low dose and titrate up based on sympts and tolerance of ADRs

163
Q

T or F? a1 adrenergic antagonists affect the prostate size?

A

F

164
Q

3 main differences btw 2nd and 3rd gen a1 adrenergic antagonists

A
  1. Time to sympt relief is decreased- 2nd gen= 2-6 wks, 3rd gen= several days (3rd gen quicker symptom relief)
  2. Receptor selectivity- increased uroselection in 3rd gen –> less side effects
  3. Frequency- 2nd gen=take multiple times/day (unless XL), 3rd gen= take once a day (better for pt compliance)
165
Q

List the 5a-reductase inhibitors for tx of BPH (2)

A

-Finasteride, dutasteride

166
Q

T or F? The 5a-reductase inhibitors will decrease prostate size?

A

T

167
Q

Which 5a-reductase inhibitor is better tolerated/has less systemic side effects? Why?

A

Dutasteride; blocks more conversion leading to lower levels of DHT

168
Q

Which 5a-reductase inhibitor is more selective for prostatic enzymes?

A

Finasteride

169
Q

How often do you need to take 5a-reductase inhibitors?

A

once daily

170
Q

5a-reductase inhibitors- ADRs

A

Sexual dysfunction (ED)

171
Q

Which 5a-reductase inhibitor requires special handling? Why?

A

Finasteride- can be absorbed through skin- caution handling, must wear gloves

172
Q

List the herbal products available for tx of BPH (5)

A
  • Saw palmetto
  • stinging nettle
  • South african stargrass
  • pumpkin seed
  • African plum
173
Q

MC herbal BPH tx?

A

Saw palmetto (widely used herbal product for BPH)

174
Q

Urinary Incontinence: MC gender?

A

Females

175
Q

UI incidence increases with ___ (both men and women)

A

age

176
Q

Women with UI- ages and %

A

-less than 25 yo - 20%
-25-60 yo- 30%
60 yo- 40%

177
Q

Overall % of men with UI?

A

9%

178
Q

Normal Urinary cycle (4 steps)

A
  1. Empty Bladder
  2. 1/2 full (1st sensation to void)
  3. Full (high desire to void)
  4. Urination
179
Q

Which muscles are contracted and relaxed during urination?

A
  • detrusor: contracts

- pelvic floor muscles: relax

180
Q

UI can be to either under or over functioning of which muscle?

A

detrusor

181
Q

3 classifications of clinical presentations in UI

A
  1. Stress
  2. Urge
  3. Overflow
182
Q

UI d/t stress is caused by:

A

urethral underactivity

-occurs during exertion (exercise, coughing, sneezing)

183
Q

UI d/t urge is caused by:

A
  • overactive bladder and/or detrusor muscle

- associated w/ frequency, urgency, nocturia, and eneuresis

184
Q

Definition of eneuresis

A

involuntary urination

185
Q

UI d/t overflow is caused by:

A
  • overactive urethra and/or underactive bladder

- bladder fills but is unable to empty- strain, hesitancy, dec force of stream (similar sympts to BPH)

186
Q

Meds that induce or worsen UI (6)

A
  • Diuretics
  • Alpha receptor antagonists (BPH meds)
  • Sedation hypnotics
  • Antidepressants (esp TCAs)
  • Alcohol
  • ACEIs- d/t cough (exertional)
187
Q

Non-pharm txs of UI (5)

A
  • Decrease risk factors- healthy weight, prevent constipation (straining), fluid modification (ex- if nocturia, limit fluid intake before bed), caffeine and alcohol reduction
  • Bladder training- scheduled toileting (every 2 hrs)
  • Pelvic floor exercises- Kegels
  • Urine collection- urinals at bedside, pads, depends
  • Physical therapy- improves strength
188
Q

Pharm tx based on whether UI is related to ____ or _____

A

stress or overactive bladder

189
Q

List the 2 options for pharmacologic tx of stress-related UI

A
  • duloxetine (cymbalta)

- a-adrenergic agonists (pseudoephedrine-sudafed, phenylephrine-sudafed PE)

190
Q

1st line pharm tx for stress-related UI

A

Duloxetine (cymbalta)

191
Q

2nd line pharm tx for stress-related UI

A

-a-adrenergic agonists (pseudoephedrine-sudafed, phenylephrine-sudafed PE)

192
Q

Duloxetine ADRs

A

H/A, dry mouth, fatigue; *s/e’s improve over time

193
Q

a-adrenergic agonists ADRs

A

dizziness, confusion, urinary retention, photosensitivity

194
Q

List the 2 options for pharmacologic tx of UI caused by overactive bladder

A

ANTICHOLINERGICS:

  • Oxybutynin (ditropan)
  • Tolterodine (detrol)
195
Q

1st line pharm tx for OAB-related UI

A

Anticholinergics; oxybutinin=MC

196
Q

Dosage forms of oxybutynin

A
  1. Oral- IR and XL

2. Dermal- TDS and gel

197
Q

Oxybutinin ADRs (4)

A
  • dizziness
  • dry mouth* (MC, but better with XL form)
  • constipation
  • nausea
198
Q

Dosage forms of tolterodine

A

Oral- IR and LA (LA=long acting)

199
Q

tolterodine ADRs

A

dry mouth (better with LA form)

200
Q

1st line tx for overactive bladder

A

Anticholinergics

Pharm 3 Test 1 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions