GU Pharm Flashcards by Danae Austrom

What is oxybutynin

Non selective anticholinergic. increses bladder capacity and diminishes detrussor muscle contraction

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What are the selective anticholinergics for OAB

Darifenacin (enablex), Solifenacin (vesicare), Trosposium (Trosec).
Selective for M3. have less CNS side effects

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If people cant tolerate side effects of Oxybutonin or Tolterodine

Switch them to Darifenacin (enalebrax), solifenacin (vesicare), or Troposium (trosec). LESS CNS side effects

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Overactive bladder

detrusser muscle over activity

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4 types of incontinence

OAB, SUI, Mixed OAB+ SUI, Overflow incontinence (BOO)

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Yohabamine For psychogenic ED

Blocks alpha 2 adrenergic receptors, decreasing adrenergic tone and alters mood.

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Side effects of Yohabamine

dizzyness, flushing, nausea. DO NOT USE in CAD

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Tedalofil (cialis) : first line therapy

onset is 30 min. Duration of effect is 36 hoiurs.

Can be given with or without food or alchohol

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Side effects of Tedanofil

HA, flushing, dyspepsia, transient visual disturbances.

Drug interaction: Nitrates and alpha blockers, CYP 3a4 inhibitors.

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Siledenafil and Varendenafil

60 min before sex
1/2 life 4 hours.
fatty foods decrease absorption

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side effects of sidenafil and varendofil

HA, flushing, dyspepisia, photophobia, light sensitivity and inability to distinguish green and blue.
DI: nitrates, CYP3A4 inhibitors

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Do not give phoshodiasterase 5 inhibitors to

unstable angina
hypotension
HTN >170
Hypotension < 90
Mi within 6 months

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What is symptoms of overactive bladder

urgency (with wet OAB) no urgency with dry. Frequency and nocturia.

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anticholinergic side effects/

blind as a bat, mad as a hatter, red as a beet, dry as a bone, bowel and baldder loose their tone, and the heart races alone.

dry mouth, constipation, blurred vision, tachycardia, erythema, puritis, dizzyness, confusion

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What drug does not cross the cross the BBBarrier

Trospium (tosec): LESS CNS side effects.

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How can we reduce anticholinergic side effects

change doasage forms. XR, transdermal oxytrol patch

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In elderly how should you dose oxybutonin

in elderly use long acting, transdermal patch or lower dosage. Or change med

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How long does it take to see improveement with PH5 inhibitors oxybutonin

in 1-4 weeks.
Start low and go slow
Can use PRN dosages for outings.

if you have a dry mouth what form of oxybutonin should you use

use oxytrol patch 2x week

What is MErabegron (merbetriq)

B3 recepto angonist (B3 recepto in bladder causes bladder to relax)
Causes increased bladder capacity and relaxation

advers effects of Merabegron

HA, increased HR/BP/QT, UTI

caustion in CKD, UTI

Who would you prescribe Merabron to

titrate up at 2 weeks

Open angle galucoma
taking a cholinesterase inhibitor
in combo with a low dose anticholinergic (when you dont want to increase dose)

Has LESS dry mouth and constiptaion
Monitor for urinary retention ( post void residual check)) or if patient having more symptoms of frequency, hesitancy, incomplete bladder emptying, frequency or increased urinary incontinence.

what is stress incontinence

loss of urine due to increase in intraabdominal pressure. (cough, exercise)

more common in women

how is stress incontinence caused

urethral hypermobility and/or sphincter deficiency. Caused by weakening of the pelvic floor from childbirth, obesity or postmenapausal.

What is the mechanism of action for stress urinary incontinence

Increases urethral coaptiation vascularity (cells come together to become more elastic) 2. Enhances alpha andrenergic responsiveness of urethral muscle in postmenapausal women with vaginal atrophy

When giving estrogen for SUI what what else do we want to prescribe

Progestrin (if using estrogen longer than 2 weeks) Estrogen builds endometrial lining. Progesterin sloughs it off. Increased RF endometrial cancer if you dont add progestrin ROUTINE ENDOMERIAL SURVEILANCE IS REOMENDED

how long do you want to RX estrogen therapies for

short duration. Lowest dose for the shortest period of time SE: breast tenderness, nausea, HA, bloating, increased RF endometrial, breast CA, MI, CVA, VTE

How do tricyclic antideprassents work for UI (Imipramine and Duloxetine) amytriptyline can be used for UI

if you depression, anxiety, and UI 1. alpha agonist and anticholinergic activity 2. Increases urethral resistance through adrenergic stimulation of smooth muscle of the neck of the bladder and proximal urethra. 3. assists in urine storage by decreasing bladder contractitily

AE of tricyclic antidepressants

orthostatic hypotension, dizzyness, arrythmias . CYP 3A4 interact

Overflow incontinence. causes

BPH DM neuropathy MS

Treatment of overflow incontinence.

alpha blockers 5A reductase inhibitors BOO: proscar or dusasteride

nocturnal enuresis or DM insipidus treatment if you have a sleep over or birthday party

Desmopressin (antidiuretic) 2. Give 1 hour pre hs

What are the side effects of desmopressin

water intoxification 1. fluid restriction 2 hours before, and 8 hours after 2. RF hyponatremia

where does dysplasia start in prostate

transitional zone and progresses to the peripheral zone. No median sulcus

What happens in BPH

1. hypertrophic bladder. Becomes overstretched and floppy. 2. Bladder diverticuli. 3. Get left over urine: RF UTI and prostatitis 4. RF baldder stones 5. Prolonged obstruction can dilate ureters: Increasing RF kidney failure

RF BPH

castrated men dont get BPH hormones may permit or cause BPH Age is a RF DRug: antidepressants, anticholinergics (hycosine, atropine) first gen antihistamines, decongestants. sudafed, salbutamol

irritative symptoms

``` frequency urgency nocturia urge incontinence small volume void ```

obstructive symptoms.

``` hesitancy weak stream straining sensation of incomplete emptying terminal dribbling ```

Patient comes in with suspected BPH; exam and diagnositics consist of

1. urinalysis 2. renal function 3. PSA

mild BPH management

watchful waiting. 40% improve. 45% stay the same. 15% worsen | Review at 6 months

phytotherapy

has antiinfalmmatory, antiadrenergic, estrogenic and 5 reductasein hibition Requires 2 months of tx. Review at 3-6 months RF bleeding and can breast tenderness

phytotherapy does not

reduce PSA, prostate size, or reduce levels of DHT

if PSA doesnt come down when taking a MOA

RED flag; suspect cancer should decrease by 50% in 6 months