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Pharm Dedo Exam3 > GU drugs > Flashcards

GU drugs Flashcards

1
Q

Overactive Baldder (OAB)

A

chronic condition w urgency, frequency, nocturia w or w/o urge incontinence in the absence of UTI or other pathology

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2
Q

what is the most common cause of incontinence in elderly?

A

OAB

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3
Q

Types of incontinence

A
  • urge
  • stress
  • overflow
  • mixed (urge + stress)
  • total
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4
Q

what types of incontinence is pharmacologic tx mostly used for?

A

OAB, urge, & mixed incontinence

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5
Q

how well do these pharm options treat incontinence?

A

not very impressive c/t placebo

~1 void altered w meds

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6
Q

what are some behavioral measures that can be taken to help decrease incontinence?

A
  • weight loss
  • fluid management
  • urge suppression
  • timed voiding
  • elimination of bladder irritants
  • assess & discontinue problematic meds (diuretics)
  • pelvic floor muscle training
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7
Q

What are the names of the incontinence questionnnaires?

A

3IQ & QUID

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8
Q

the # of pts who benefit from incontinence meds compared to the # of pts who have ADRs from these meds are…

A

similar

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9
Q

all anti-spasmodic meds can cause…

A

confusion

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10
Q

what do CNS effects of antimuscarinic meds depend on?

A
  • CNS penetration

- M1 receptor binding

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11
Q

M3 receptors work on what parts of the body?

A
  • bladder smooth muscle
  • salivary gland
  • eye
  • gut
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12
Q

effects of M3 receptor antagonism:

A

-decrease bowel & bladder contractility
-dry eyes/mouth
-blurred vision
(M3 antagonists are “cleaner” than M2 antagonists)

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13
Q

Nonselective Muscarinic antagonists

A
  • tolterodine
  • fesoterodine
  • trospium
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14
Q

“primarily” M3 selective antagonists

A
  • oxybutynin

- solifenacin

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15
Q

selective M3 antagonists

A

-darifenacin

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16
Q

what is the biggest ADR of the nonselective muscarinic antagonists?

A

xerostomia!!

trospium has the lowest amount but still ~20%

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17
Q

MOA of nonselective muscarinic antagonists:

A

antagonize primarily M2 & M3 receptors on detrusor smooth muscle to mediate bladder contraction –> decreased voiding, urgency, & frequency

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18
Q

who should you use precaution with when prescribing nonselective muscarinic antagonists?

A

pts w urinary retention & closed angle glaucoma

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19
Q

Tolterodine & Fesoterodine are substrates of what CYPs?

A

3A4 & 2D6

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20
Q

which M3 selective product has the highest xerostomia?

A

Oxybutynin IR (~70% of pts complain of this…rarely used d/t this ADR)

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21
Q

what forms of oxybutynin have the lowest xerostomia associated with them?

A

Extended Release transdermal patch & ER transdermal gel

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22
Q

ADRs of Darifenacin

A

xerostomia (~20-35%)
constipation (~15-20%)

*not actually clear if it is tolerated better or more effective than “older” agents, and is more costly!!

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23
Q

<10% of pts use antimuscarinics for more than 1 yr because…

A
  • cost
  • ADRs
  • polypharmacy
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24
Q

what urinary antimuscarinics are on the Beers Criteria (high risk for elderly pts w congnitive impairment)?

A

ALL OF THEM

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25
Mirabegron MOA
B3 agonist | helps relax bladder & increase storage capacity
26
Mirabegron indications
OAB; only modestly effective
27
antimuscarinic agents + B3 agonists MAY...
improve outcomes! | according to some ~recent data~
28
Mirabegron ADRs
HTN in ~10% of pts
29
what alpha 1 adrenoreceptors are present in the prostate and bladder neck?
alpha 1A | stimulation --> bladder neck & prostate relaxation
30
1st gen BPH med type
alpha 1 & 2 antagonists
31
1st gen BPH drugs
phenoxybenzamine
32
2nd gen BPH med type
alpha 1 A & B antagonists (selectively antagonize alpha 1)
33
2nd gen BPH drugs
prazosin, terazosin, doxazosin, alfuzosin (ER is "functionally uroselective)
34
3rd gen BPH med type
uroselective meds that are competitive antagonists for prostatic alpha 1 A>D>B receptors (this will lead decreased vascular ADRs)
35
3rd gen BPH drugs
tamsulosin, silodosin | *what we predominantly use
36
Non-selective post-synaptic alpha 1 antagonists | alpha 1 A & B
Terazosin & Doxazosin
37
alpha 1 blockers MOA
- antagonize alpha 1A receptors in bladder neck, prostate, & urethra (relieving OVS) - antagonize alpha 1B receptors in vascular smooth m --> postural hypotension & syncope * *LIMITED BY DOSE TITRATION
38
alpha blockers indication
BPH, HTN, medical "expulsive" therapy for nephrolithiasis
39
alpha blocker interactions
VASODILATORS = CONTRAINDICATED (overlapping vasodilation)
40
alpha blockers ADRs
``` postural hypotension/dizziness fatigue nasal congestion/rhinitis retrograde ejaculation floppy iris syndrome ```
41
uroselective post synaptic alpha antagonists (alpha 1A>D>B)
alfuzosin - "functionally uroselective" | Tamsulosin & Silodosin - "pharmacologically uroselective"
42
uroseletive alpha blockers MOA
alpha 1 receptor antagonist SPECIFIC to prostate & bladder neck --> smooth muscle relaxation
43
which alpha blocker is a nonsulfonylarylamine?
tasmulosin | *challenge pt w a mild sulfa allergy
44
uroselective alpha blockers indications
men & women: off label use to help pass kidney stones men: BPH women: improve sx d/t bladder outlet obstruction (not FDA-approved)
45
uroselective alpha blockers ADRs
-less postural hypotension/dizziness d/t receptor selectivity -more retrograde ejaculation *Must tell pt to expect this! (silodosin >> tamsulosin >alfuzosin) -floppy iris syndrome (tamsulosin>>) -QT issues w alfuzosin
46
Finasteride & Dutasteride MOA
tissue & hepatic 5 alpha reductase inhibitors --> inhibits conversion of testosterone to dehydrotestosterone
47
Finasteride & dutasteride pearls:
- "shrinks" the prostate | - will decrease [PSA] ~50% --> decreases OVERALL risk of prostate CA
48
Finasteride & dutasteride indications
both are approved for BPH | finasteride also approved for male-pattern baldness
49
Finasteride & dutasteride in pregnancy?
do not use when pregnant or trying to conceive | can be absorbed through the skin so be careful!
50
Finasteride & dutasteride ADRs?
- ED & ejaculation disturbances | - rare reports of high-grade prostate CA & male breast CA (finasteride only)
51
erectile dysfunction questionnaire:
IIEF-5 | *make sure to always ask older pts, even if its awko taco
52
common conditions associated with ED
- DM - HTN - hyperlipidemia - obesity - testosterone deficiency - prostate CA
53
ED occurs ___ years before CAD?
2-5
54
common psychological causes of ED?
- performance anxiety | - relationship issues
55
treatment options for ED?
- lifestyle changes - PDE5 inhibitors - intraurethral/intracavernosal alprostadil - implant or vacuum device (urology only)
56
PDE5 inhibitor drugs
- avanafil - sildenafil - vardenafil - tadalafil
57
onset & duration of avanafil, sildenafil, & vardenafil
onset: ~30 min duration: ~4 hrs
58
onset & duration of tadalafil
onset: 45 min duration: 36 hrs
59
physiology of an erection
NO from corpus cavernosum --> activates granulate cyclase --> increase [cGMP] --> sm. muscle relaxation & inflow of blood to corpus cavernosum *PDE5 degrades cGMP!! (stops erection)
60
PDE5 inhibitors MOA
potentiates smooth muscle relaxation --> engorgement
61
PDE5 inhibitor pearls
- does not DIRECTLY cause erections but keeps it going | - efficacy varies w ED etiology but efficacy rate ~60-70%
62
PDE5 inhibitor indications
- ED (all for prn use) - BPH (especially if BPH and ED) - pulmonary arterial HTN (PAH)
63
which PDE5 inhibitor is approved for daily use
tadalafil | can increase spontaneity
64
do NOT use PED5 inhibitors with...
anti-HTN meds & vasodilators | *nitrates can cause catastrophic hypotension
65
PDE5 inhibitor ADRs
HA, facial flushing, nasal congestion, dyspepsia, priapism (get help if >4hrs), nonarteric ischemia optic neuropathy
66
sildenafil-specific ADR
cyanopsia
67
tadalafil-specific ADR
backache/myalgias
68
FSIAD
female sexual interest/ arousal disorder
69
FSIAD drugs
- flibanserin "the pink viagra" | - Bremelanotide
70
flibanserin MOA
agonist at 5HT1 receptors & antagonist at 5HT2 receptors
71
flibanserin indications
tx of PREmenopausal women w acquired, generalized FSIAD that is NOT caused by another medical/psych condition or d/t another drug
72
flibanserin pearls
1st drug approved for FSIAD NOT approved for use in POSTmenopausal women may take 8-10wks for max effect dosed QS to minimize risk of injury r/t hypotension, syncope, & CNS depression
73
flibanserin interactions
avoid moderate/strong 2C19 & 3A4 inhibitors 2wks before starting & for 2 days after stopping *a single dose of fluconazole for vaginitis is BAD
74
flibanserin ADRs
CNS depressant | severe hypotension & syncope (increased risk w ETOH use)
75
Bremelanotide route
SQ in abd or thigh (prn; 45 min before anticipated sex)
76
Bremelanotide Indications
PREmenopausal women w FSIAD | may increase libido, not blood flow
77
Efficacy of Bremelanotide?
unknown.. | BUT very expensive and should stop after 8 wks if no sx improvement
78
Bremelanotide interactions?
-slow gastric emptying & alter PO drug absorption rate | careful w GLP-1s, opioids, & lubiprostone
79
Bremelanotide precautions?
transient increased BP & decreased HR | *DO NOT USE in pts w CVD & uncontrolled HTN
80
Bremelanotide ADRs:
- Nausea *v common w 1st dose - flushing - injection site rxn - HA - hyperpigmentation (face, breast, gums)

Pharm Dedo Exam3 (3 decks)

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