GU Flashcards
What are meds that are anticholinergics/antimuscarinics? What’s their MOA?
oxybutynin (Ditropan) tolterodine (Detrol) darifenacin (Enablex) solifenacin (Vesicare) fesosterodine (Toviaz) Antagonize PSNS stimulation of muscarinic receptors in bladder (increases bladder capacity & initial urge to void)
How is oxybutynin different?
Oxybutynin has both antimuscarinic, local anesthetic to bladder & antispasmodic
What are side effects of anticholinergics/antimuscarinics?
SE: ANTICHOLINERGIC EFFECTS dry mouth, vision changes (blurred vision), cognitive impairment, urinary retention
Tachycardia
Edema
Dizziness
Abd pain
diarrhea
What caution must you take with Detrol?
those with glaucoma & prolong QT
What is the MOA for mirabegron?
Decrease frequency of B3 receptors, produce smooth muscle relaxation & increase size of bladder
What drug/drug interactions are with Mirabegron?
Interactions w codeine, tamoxifen (reduce levels) ketoconazole
What are the guidelines for OAB management?
1st line: ER anticholinergic, mirabegrom 2nd line: different anticholinergic, botulinum A toxin. Duloxetine 3rd: surgical intervention Same for peds, women & geriatrics
What is the difference between upper and lower UTI?
lower UTI- bladder, urethra upper- renal (complicated)
What is the MOA for alpha-adrenergic antagonists? What med is under this class?
reduces urethral stricture, more beneficial in BPH - tamsulosin
What are some side effects for tamsulosin?
postural hypotension precipitate stress incontinence
What are some urinary tract analgesics?
methenamine (Urised) phenazopyridine (Pyridium, Uristat) flavoxate (Urispas)
What is the order of treatment for uncomplicated cystitis?
What is the order of treatment for uncomplicated pyelonephritis?
What antibitics would you give to a pregnant women w UTI?
Amoxicillin is effective in approximately two thirds of UTIs in pregnant women and is safe for the fetus. Also safe are cephalexin and nitrofurantoin (only during the first and second trimesters). Sulfonamides are safe except in the last trimester. In pregnancy, the urine is cultured 1 week after treatment and every 4 to 6 weeks during the pregnancy. (Arcangelo, 20161108, p. 525)
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What antibiotics would you use for children w UTI?
First-line antimicrobial agents include the β-lactams amoxicillin–clavulanate (25–45 mg/kg/d divided every 12 hours), cephalexin (25–50 mg/kg/d, divided every 6–12 hours), and cefpodoxime (10 mg/kg/d divided every 12 hours) as well as TMP–SMX (8–10 mg/kg/d divided every 12 hours). Two-day to 4-day courses have been shown to be as effective as 7 to 14 days. (Arcangelo, 20161108, p. 525)
What are uncomplicated and complicated UTI’s?
Uncomplicated
Premenopausal, sexually active, nonpregnant woman who has not had a recent UTI
Complicated
Most common cause:
Psuedomonas
Enterococcus
Staphylococcus
Serratia
Providencia
Fungi
Men
Also rule out urethritis
Postmenopausal or pregnant woman
Patient w urinary structural defects, neurologic lesions, or a catheter
Persisted > 7 day
What is the order of therapy for treatment of BPH?
1st: tx underlying cause, limit fluids, void frequently, lifestyle mod
2nd: 5 alpha reductase inhibitors or alpha adrenergic blockers
3rd: combo therapy
Name 5 alpha reductase inhibitor meds. What is the MOA?
finasteride (Proscar)
dutasteride (Avodart)
Inhibit androgen, block testosterone from converting to DHT
When would you initiate pharmacological management of BPH
exhausted lifetyle modifications
AND
Decrease urination
urg/freq
Decrease urine stream
Pelvic pain bladder distention
UTIs
What are side effects of 5 alpha reductase inhibitors?
Decrease libido, impotence, gynecomastia
What labs would you monitor for in 5 alpha reductase inhibitors?
Lowers PSA by 50%, takes 6 months
Name alpha adrenergic blockers. What the MOA?
tamsulosin/Flomax
doxazosin/Cardura
terazosin/Hytrin
Relax SM of prostate & bladder
What are some side effects for alpha adrenergic blockers?
Postural low BP take HS
Flomax: in high doses can cause erectile dysfunction
Cardura: benefit for cardiac dx as well, caution w CHF, hepatic or renal impairment
What is the time frame response for Alpha adrenergic blockers
6mo for improvement
Name Phosphodiesterase-5 inhibitors meds. What is the MOA?
inhibit breakdown of one of the messengers involved in erectile response, main cGMP catalyzing enzyme in smooth muscle. Block cyclic nucelotide hydrolysis.
What are side effects of Phosphodiesterase-5 inhibitors? What is contraindicated?
Priapism
HA
Flushing dyspepsia
Comorbid conditions: DM, HTN, HLD, use of nitrates
Which antimuscarinic/anticholinergic meds have the least effect on cognitive function?
darifenacin (Enablex)
What are contraindications of anticholinergics/antimuscarinincs?
GI obstruction
GU retention
BPH
BEERS list
Myasthenia gravis
Parkinson
renal/hepatic impairmen
