Brainscape's Knowledge GenomeTM

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


See full index

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

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

what is the most common cause of incontinence in elderly?

A

OAB

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

Types of incontinence

A
  • urge
  • stress
  • overflow
  • mixed (urge + stress)
  • total
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what types of incontinence is pharmacologic tx mostly used for?

A

OAB, urge, & mixed incontinence

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

how well do these pharm options treat incontinence?

A

not very impressive c/t placebo

~1 void altered w meds

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

What are the names of the incontinence questionnnaires?

A

3IQ & QUID

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

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

A

similar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

all anti-spasmodic meds can cause…

A

confusion

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

what do CNS effects of antimuscarinic meds depend on?

A
  • CNS penetration

- M1 receptor binding

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

M3 receptors work on what parts of the body?

A
  • bladder smooth muscle
  • salivary gland
  • eye
  • gut
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

effects of M3 receptor antagonism:

A

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

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

Nonselective Muscarinic antagonists

A
  • tolterodine
  • fesoterodine
  • trospium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

“primarily” M3 selective antagonists

A
  • oxybutynin

- solifenacin

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

selective M3 antagonists

A

-darifenacin

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

what is the biggest ADR of the nonselective muscarinic antagonists?

A

xerostomia!!

trospium has the lowest amount but still ~20%

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

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

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

A

pts w urinary retention & closed angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tolterodine & Fesoterodine are substrates of what CYPs?

A

3A4 & 2D6

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

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

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

A

Extended Release transdermal patch & ER transdermal gel

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

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

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

A
  • cost
  • ADRs
  • polypharmacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

ALL OF THEM

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

Mirabegron MOA

A

B3 agonist

helps relax bladder & increase storage capacity

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

Mirabegron indications

A

OAB; only modestly effective

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

antimuscarinic agents + B3 agonists MAY…

A

improve outcomes!

according to some ~recent data~

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

Mirabegron ADRs

A

HTN in ~10% of pts

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

what alpha 1 adrenoreceptors are present in the prostate and bladder neck?

A

alpha 1A

stimulation –> bladder neck & prostate relaxation

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

1st gen BPH med type

A

alpha 1 & 2 antagonists

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

1st gen BPH drugs

A

phenoxybenzamine

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

2nd gen BPH med type

A

alpha 1 A & B antagonists (selectively antagonize alpha 1)

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

2nd gen BPH drugs

A

prazosin, terazosin, doxazosin, alfuzosin (ER is “functionally uroselective)

34
Q

3rd gen BPH med type

A

uroselective meds that are competitive antagonists for prostatic alpha 1 A>D>B receptors
(this will lead decreased vascular ADRs)

35
Q

3rd gen BPH drugs

A

tamsulosin, silodosin

*what we predominantly use

36
Q

Non-selective post-synaptic alpha 1 antagonists

alpha 1 A & B

A

Terazosin & Doxazosin

37
Q

alpha 1 blockers MOA

A
  • 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
Q

alpha blockers indication

A

BPH, HTN, medical “expulsive” therapy for nephrolithiasis

39
Q

alpha blocker interactions

A

VASODILATORS = CONTRAINDICATED (overlapping vasodilation)

40
Q

alpha blockers ADRs

A 
postural hypotension/dizziness
fatigue
nasal congestion/rhinitis
retrograde ejaculation 
floppy iris syndrome
41
Q

uroselective post synaptic alpha antagonists (alpha 1A>D>B)

A

alfuzosin - “functionally uroselective”

Tamsulosin & Silodosin - “pharmacologically uroselective”

42
Q

uroseletive alpha blockers MOA

A

alpha 1 receptor antagonist SPECIFIC to prostate & bladder neck –> smooth muscle relaxation

43
Q

which alpha blocker is a nonsulfonylarylamine?

A

tasmulosin

*challenge pt w a mild sulfa allergy

44
Q

uroselective alpha blockers indications

A

men & women: off label use to help pass kidney stones

men: BPH
women: improve sx d/t bladder outlet obstruction (not FDA-approved)

45
Q

uroselective alpha blockers ADRs

A

-less postural hypotension/dizziness d/t receptor selectivity
-more retrograde ejaculation *Must tell pt to expect this!
(silodosin&raquo_space; tamsulosin >alfuzosin)
-floppy iris syndrome (tamsulosin»)
-QT issues w alfuzosin

46
Q

Finasteride & Dutasteride MOA

A

tissue & hepatic 5 alpha reductase inhibitors –> inhibits conversion of testosterone to dehydrotestosterone

47
Q

Finasteride & dutasteride pearls:

A
  • “shrinks” the prostate

- will decrease [PSA] ~50% –> decreases OVERALL risk of prostate CA

48
Q

Finasteride & dutasteride indications

A

both are approved for BPH

finasteride also approved for male-pattern baldness

49
Q

Finasteride & dutasteride in pregnancy?

A

do not use when pregnant or trying to conceive

can be absorbed through the skin so be careful!

50
Q

Finasteride & dutasteride ADRs?

A
  • ED & ejaculation disturbances

- rare reports of high-grade prostate CA & male breast CA (finasteride only)

51
Q

erectile dysfunction questionnaire:

A

IIEF-5

*make sure to always ask older pts, even if its awko taco

52
Q

common conditions associated with ED

A
  • DM
  • HTN
  • hyperlipidemia
  • obesity
  • testosterone deficiency
  • prostate CA
53
Q

ED occurs ___ years before CAD?

A

2-5

54
Q

common psychological causes of ED?

A
  • performance anxiety

- relationship issues

55
Q

treatment options for ED?

A
  • lifestyle changes
  • PDE5 inhibitors
  • intraurethral/intracavernosal alprostadil
  • implant or vacuum device (urology only)
56
Q

PDE5 inhibitor drugs

A
  • avanafil
  • sildenafil
  • vardenafil
  • tadalafil
57
Q

onset & duration of avanafil, sildenafil, & vardenafil

A

onset: ~30 min
duration: ~4 hrs

58
Q

onset & duration of tadalafil

A

onset: 45 min
duration: 36 hrs

59
Q

physiology of an erection

A

NO from corpus cavernosum –> activates granulate cyclase –> increase [cGMP] –> sm. muscle relaxation & inflow of blood to corpus cavernosum
*PDE5 degrades cGMP!! (stops erection)

60
Q

PDE5 inhibitors MOA

A

potentiates smooth muscle relaxation –> engorgement

61
Q

PDE5 inhibitor pearls

A
  • does not DIRECTLY cause erections but keeps it going

- efficacy varies w ED etiology but efficacy rate ~60-70%

62
Q

PDE5 inhibitor indications

A
  • ED (all for prn use)
  • BPH (especially if BPH and ED)
  • pulmonary arterial HTN (PAH)
63
Q

which PDE5 inhibitor is approved for daily use

A

tadalafil

can increase spontaneity

64
Q

do NOT use PED5 inhibitors with…

A

anti-HTN meds & vasodilators

*nitrates can cause catastrophic hypotension

65
Q

PDE5 inhibitor ADRs

A

HA, facial flushing, nasal congestion, dyspepsia, priapism (get help if >4hrs), nonarteric ischemia optic neuropathy

66
Q

sildenafil-specific ADR

A

cyanopsia

67
Q

tadalafil-specific ADR

A

backache/myalgias

68
Q

FSIAD

A

female sexual interest/ arousal disorder

69
Q

FSIAD drugs

A
  • flibanserin “the pink viagra”

- Bremelanotide

70
Q

flibanserin MOA

A

agonist at 5HT1 receptors & antagonist at 5HT2 receptors

71
Q

flibanserin indications

A

tx of PREmenopausal women w acquired, generalized FSIAD that is NOT caused by another medical/psych condition or d/t another drug

72
Q

flibanserin pearls

A

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
Q

flibanserin interactions

A

avoid moderate/strong 2C19 & 3A4 inhibitors 2wks before starting & for 2 days after stopping
*a single dose of fluconazole for vaginitis is BAD

74
Q

flibanserin ADRs

A

CNS depressant

severe hypotension & syncope (increased risk w ETOH use)

75
Q

Bremelanotide route

A

SQ in abd or thigh (prn; 45 min before anticipated sex)

76
Q

Bremelanotide Indications

A

PREmenopausal women w FSIAD

may increase libido, not blood flow

77
Q

Efficacy of Bremelanotide?

A

unknown..

BUT very expensive and should stop after 8 wks if no sx improvement

78
Q

Bremelanotide interactions?

A

-slow gastric emptying & alter PO drug absorption rate

careful w GLP-1s, opioids, & lubiprostone

79
Q

Bremelanotide precautions?

A

transient increased BP & decreased HR

*DO NOT USE in pts w CVD & uncontrolled HTN

80
Q

Bremelanotide ADRs:

A
  • Nausea *v common w 1st dose
  • flushing
  • injection site rxn
  • HA
  • hyperpigmentation (face, breast, gums)

Pharm Dedo Exam3 (3 decks)

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