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GU Pharm Flashcards

1
Q

What is oxybutynin

A

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

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2
Q

What are the selective anticholinergics for OAB

A

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

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3
Q

If people cant tolerate side effects of Oxybutonin or Tolterodine

A

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

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4
Q

Overactive bladder

A

detrusser muscle over activity

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5
Q

4 types of incontinence

A

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

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6
Q

Yohabamine For psychogenic ED

A

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

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7
Q

Side effects of Yohabamine

A

dizzyness, flushing, nausea. DO NOT USE in CAD

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8
Q

Tedalofil (cialis) : first line therapy

A

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

Can be given with or without food or alchohol

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9
Q

Side effects of Tedanofil

A

HA, flushing, dyspepsia, transient visual disturbances.

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

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10
Q

Siledenafil and Varendenafil

A

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

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11
Q

side effects of sidenafil and varendofil

A

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

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12
Q

Do not give phoshodiasterase 5 inhibitors to

A 
unstable angina
hypotension
HTN >170
Hypotension < 90
Mi within 6 months
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13
Q

What is symptoms of overactive bladder

A

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

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14
Q

anticholinergic side effects/

A

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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15
Q

What drug does not cross the cross the BBBarrier

A

Trospium (tosec): LESS CNS side effects.

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16
Q

How can we reduce anticholinergic side effects

A

change doasage forms. XR, transdermal oxytrol patch

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17
Q

In elderly how should you dose oxybutonin

A

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

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18
Q

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

A

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

19
Q

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

A

use oxytrol patch 2x week

20
Q

What is MErabegron (merbetriq)

A

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

21
Q

advers effects of Merabegron

A

HA, increased HR/BP/QT, UTI

caustion in CKD, UTI

22
Q

Who would you prescribe Merabron to

titrate up at 2 weeks

A
  1. Open angle galucoma
  2. taking a cholinesterase inhibitor
  3. 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.

23
Q

what is stress incontinence

A

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

  1. more common in women
24
Q

how is stress incontinence caused

A

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

25
Q

What is the mechanism of action for stress urinary incontinence

A

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

26
Q

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

A

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

27
Q

how long do you want to RX estrogen therapies for

A

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

28
Q

How do tricyclic antideprassents work for UI

(Imipramine and Duloxetine)

amytriptyline can be used for UI

A

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
29
Q

AE of tricyclic antidepressants

A

orthostatic hypotension, dizzyness, arrythmias . CYP 3A4 interact

30
Q

Overflow incontinence. causes

A

BPH
DM neuropathy
MS

31
Q

Treatment of overflow incontinence.

A

alpha blockers
5A reductase inhibitors
BOO: proscar or dusasteride

32
Q

nocturnal enuresis or DM insipidus treatment

if you have a sleep over or birthday party

A

Desmopressin (antidiuretic)

  1. Give 1 hour pre hs
33
Q

What are the side effects of desmopressin

A

water intoxification

  1. fluid restriction 2 hours before, and 8 hours after
  2. RF hyponatremia
34
Q

where does dysplasia start in prostate

A

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

35
Q

What happens in BPH

A
  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
36
Q

RF BPH

A

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

37
Q

irritative symptoms

A 
frequency
urgency
nocturia
urge incontinence
small volume void
38
Q

obstructive symptoms.

A 
hesitancy
weak stream
straining
sensation of incomplete emptying
terminal dribbling
39
Q

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

A
  1. urinalysis
  2. renal function
  3. PSA
40
Q

mild BPH management

A

watchful waiting. 40% improve. 45% stay the same. 15% worsen

Review at 6 months

41
Q

phytotherapy

A

has antiinfalmmatory, antiadrenergic, estrogenic and 5 reductasein hibition

Requires 2 months of tx. Review at 3-6 months
RF bleeding and can breast tenderness

42
Q

phytotherapy does not

A

reduce PSA, prostate size, or reduce levels of DHT

43
Q

if PSA doesnt come down when taking a MOA

A

RED flag; suspect cancer

should decrease by 50% in 6 months

GU (1 decks)

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