GU Classes Flashcards
Urinary tract anti-infectives MEDS and Prototype
- fosfomycin (Monurol)
- methenamine (Urex)
- nitrofurantoin (Macrobid)
- trimethoprim (Prinsol)
- trimethoprim-sulfamethoxazole (Bactrim)
Prototype: Fosfomycin
MOA and Indications to UTAI
MOA: acidify urine producing an environment that is not conducive to bacterial survival and leading to bacterial cell death
Indications:
- UTI
- Pyelonephritis
- Prophylaxis (length/placement of urethra, sexually active woman with more than 4 UTIs
in a year)
CI to UTAI
- Fosfomycin CI < 12 y/o, has very bad GI effects
- Nitrofurantoin won’t tx pyelonephritis
- Renal dysfunction since they go thru renal circulation
- Pregnancy/lactation: Nitrofurantoin and trimethoprim- sulfamethoxazole are to be avoided in the 1st trimester d/t p congenital anomalies, but they can usually be given
safely in the 2nd and 3rd trimesters.
Nitrofurantoin may also have the risk of causing hemolytic anemia in some neonates if given at term.
Trimethoprim-sulfamethoxazole may increase the risk of jaundice in newborns if given close to term.
AE and DDI to UTAI
AE:
- GI : n/v/d, bladder irritation, dysuria, vaginitis
- Neuro : h/a, dizziness
- Labs : blood dyscrasia (marrow suppresion) ; depends on how long you’re on med
- Derm : will cause pruritis, urticaria
*GI irritation alleviated w/ food
DDI: multiple drugs so it depends
NI to UTAI
VS, electrolytes, I&Os (urinary retention and for intra-renal failure), prevention of UTI ( female: urinate after sex, bubble baths, wiping front to back; Males: retract foreskin), take full course of abx
Urinary tract anti-spasmodics MEDS and prototype
MEDS: darifenacin (Enablex), fesoterodine (Toviaz), oxybutynin (Ditropan), solifenacin (VESIcare), tolterodine (Detrol), mirabegron (Mytbetreq)
Prototype: Oxybutynin
MOA of UTAS
- Block parasympathetic activity (spasms of UT muscles)
- Suppressing overactivity
- Relaxes detrusor and UT muscles
- Beta-Agonists
- Stimulate sympathetic nerves in bladder
- Relaxes detrusor muscles
Indications of UTAS
- Overactive bladder
- Bladder spasms (Inammation in the urinary tract, such as cystitis, prostatitis, urethritis,
and urethrocystitis/urethrotrigonitis) - Trospium specifically blocks muscarinic receptors and reduces the muscle tone of the
bladder - Mirabegron (Myrbetriq) and vibegron (Gemtesa) are drugs for treating overactivebladder and incontinence (beta3-agonists). Stimulate the sympathetic nerves in the bladder, which leads to detrusor muscle relaxation
CI to UTAS
- Pyloric / duodenal obstruction / surgery: anticholinergic effects can cause serious
complications - Obstructive urinary tract problems: worsened by blocking of muscle activity/relaxation
of the bladder - Glaucoma / MG / Hemorrhage: exacerbated by anticholinergic effects
- HTN * Beta-Agonist: worsen htsn (Mirabegron)
AE to UTAS
- GI : n/v/dry mouth
- Card : tachycardia
- CNS :nervousness, blurred vision, dizziness
- decreased sweating, urinary retention
DDI UTAS
- Haloperidol, phenothiazines: decreased effectiveness with oxybutynin
- Antifungals / antivirals: risk of toxicity
- QT prolonging agents (antihistamines, antipsychotics)
Additional AE of Oxybutynin
- Decreased sweating (risk of overheating)
NI UTAS
Monitor temp (VS), skin, CNS, vision (opthamology consult), dry mouth (off sugar free gum)
Urinary tract analgesics MEDS
MEDS: phenazopyradine (Pyridium): OTC/pxn
- Decreases pain assoc with UTI (analgesics)
MOA and Indications to UTA
MOA: Exerts a direct, topical analgesic effect on urinary tract mucosa
Indications: Relieve symptoms (burning, urgency, frequency, pain) r/t UTI, trauma, surgery
- Don’t use more than 3 days, it can cause renal toxicity
CI AE, DDI to UTA
CI: Severe liver / renal dysfunction
AE:
- GI – GI upset, liver toxicity
- GU – renal toxicity
- Derm – rash
- CNS – h/a
- *Staining (red-orange) of all body fluids
DDI: none
NI UTA
monitor for rash, fluid discoloration, 2-3 days max on med, GI/hepatic fx
Bladder protectants MED
pentosan (elmiron)
MOA and indication to Bladder protectants
MOA:
- Coats to bladder mucosal wall
- Protects from irritation r/t solutes in urine
Indications: Interstitial cystitis
CI to bladder protectants
- Risk of bleeding: any condition w/risk of bleeding (surgery, pregnancy, anticoagulation, hemophilia) d/t heparin like properties
- Heparin induced TCP
- HIT
- Hepatic / Renal dysfunction
AE and DDI bladder protectants
AE:
- Heme
- May progress to hemorrhage
- CNS – h/a
- Derm - alopecia
DDI: Anticoagulants, Salicylates (aspirin), NSAIDs increase risk of bleeding
NI bladder protectants
Monitor CMP, LFT, bleeding (petechiae, bruising on arms, bloody gums/nose, weak, fatigue, dyspnea)
BPH MEDS and prototype
- alfuzosin (Uroxatral)
- doxazosin (Cardura)
- tamsulosin (Flomax)
- Terazosin
finasteride (Proscar) - dutasteride (Avodart)
Prototype: Doxazosin
MOA of BPH meds and indications
MOA:
- Alpha blockers (have an effect on bp)
- Dilate arterioles and veins, relaxation of sympathetic effects on bladder and
urinary tract
- Testosterone blockers
- Inhibit enzyme that converts testosterone to dihydrotestosterone
Indications: BPH
CI to BPH meds
- Hepatic / renal dysfunction
- Adrenergic blockers – heart failure, CAD, aggravated by drop of BP or tachy
- Testosterone blockers – female gender*, androgen effects for females, family should be
cautioned not to touch b/c absorption through skin (wear gloves) - No blood donation/pregnancy for 6 mos after tx d/t exposure to testosterone blocking
effects
AE of BPH meds
- Adrenergic blockers : h/a, fatigue, dizziness, lethargy, tachycardia, hypotension, sexual dysfunction (antihypertensive effects)
- Testosterone blockers : decreased libido, potence, sexual dysfunction (look up meds)
- Cannot donate blood for 6 mos. after tx
- Contraceptives for 6 mos. after tx
DDI BPH
- Adrenergic blockers : Antihypertensives, nitrates, ED drugs (Increased antihypersensive
effects) - Testosterone blockers (Dutasteride and nasteride) : saw palmetto (toxicity)
