GU and Renal Flashcards
What is an alpha-1-blocker (doxazosin, tamsulosin) used for? describe their mechanism.
(1.) 1st line for BPE when lifestyle interventions fail
(2. ) Doxazosin, tamsulosin are highly selective:
- Doxazasin = α1 -adrenergic receptor antagonist
- Tamsulosin = α1A + α1D-adrenoceptor antagonist.
(3.) These receptors are found on smooth muscles of bladder and prostate (+blood vessels), and blockade of receptors induces relaxation and thus reducing resistance to bladder outflow
An elderly gentleman needs cataract surgery and is taking tamsulosin for his lower urinary tract symptoms, why is it important that he lets his surgeon know that he is taking it?
Intraoperative Floppy Iris Syndrome (IFIS) has been observed during cataract surgery in some patients currently on or previously treated with alpha blockers. The patient’s surgeon should be prepared to modify their surgical technique in these patients. Patients do not need to stop their alpha-blockers, they just need to let their surgeon know they are taking them.
The patient taking alfuzosin complains of dizziness when standing up quickly after taking tamsulosin with his breakfast, how would you advise him?
(1. ) Postural hypotension is a side effect of alpha-blockers
(2. ) Pt’s BP should be checked to ensure that it is not very low.
(3. ) Advise pt to take medication at night to see if this improves the side effects, however if there are any concerns then the patient should be advised to stop the medication.
Why may a pt experience diminished ejaculation when on an alpha-blocker? What are other causes of this?
(1.) Retrograde ejaculation occurs when seminal fluid preferentially flows into the bladder, instead of the normal antegrade direction due to failure of the bladder neck to close.
(2. ) Other causes of retrograde ejaculation
- incompetence of bladder neck usually from prior surgery such as transurethral resection of prostate gland
- medications include antidepressants
- neurologic pathology such as diabetes and multiple sclerosis.
What drugs is used to treat UTI in early pregnancy?
Nitrofurantoin is suitable for use in pregnancy except at the end of pregnancy it is contraindicated because of possibility of haemolytic anaemia due to immature red cell enzyme systems.
Why is folic acid recommended in pregnancy?
Folic acid (also known as vitamin B9) is very important for the development of a healthy foetus, as it can significantly reduce the risk of neural tube defects (NTDs), such as spina bifida.
