Brainscape's Knowledge GenomeTM

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


See full index

PHARM 343 > Lower Urinary Tract Pharmacological > Flashcards

Lower Urinary Tract Pharmacological Flashcards

1
Q

Overactive Bladder
- Anticholinergic Mechanism

A

Blocks parasympathetic signals from activating detrusor muscles
- Reduces urination (Does not cure)

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

Alpha vs Beta Bladder Receptors

A

Alpha:
- Activation causes contraction of bladder neck resulting in increased resistance (Good for stress incontinence)

Beta
- Activation causes relaxation of bladder smooth muscle
(Good for urgency incontinence)

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

Overactive Bladder
- Antimuscarinic Summary

A

Decrease number of urinations and incontinence episodes
- Have side effects that may cause patient to stop taking
–> Cognition
–> Heart
–> Glaucoma

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

Overactive Bladder
- Antimuscarinic Adverse Effects

A

Dry Mouth
Dry Eyes
Confusion
Rapid Heart Rate
Urine Retention
Skin Flushing
Constipation

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

Overactive Bladder
- Antimuscarinic Heart

A

Solifenacin, Tolterodine, and Mirabegron can cause QT Prolongation
- Bradycardia
- Electrolyte Imbalance
- Heart Disease
- Kidney/Liver Impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Overactive Bladder
- Antimuscarinic Cognition

A

Older antimuscarinic medications are more likely to cross into the brain and cause confusion

Oxybutynin > Solifenacin > Tolterodine > Darifenacin > Fesoterodine > Trospium

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

Overactive Bladder
- Antimuscarinic Contraindications

A
  • Glaucoma
  • Myasthenia Gravis
  • GI: Obstruction, Inflammatory bowel, atony
  • Urogenital: Obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Overactive Bladder
- Beta-3 Adrenergic Agonist

A

Mirabegron
- Relaxes bladder smooth muscle preventing contractions

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

Overactive Bladder
- Beta-3 Adrenergic Agonist Adverse Effects

A

Adverse Effects:
- Nausea, Diarrhea, Constipation, Dizziness, Headache

CV Safety:
- Tachycardia, Increased BP, Prolonged QT

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

Antimuscarinic Drugs

A

Oxybutynin

Tolterodine
Fesoterodine
Propiverine

Darifenacin
Solifenacin

Trospium

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

Overactive Bladder
- Anticholinergic Interactions

A

Interacts with antihistamines and TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Overactive Bladder
- Cholinergic Interactions

A

Interacts with Cholinesterase Inhibitors for dementia

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

FORTA Classification
- What is it

A

Highlights Medications and their safety in older adults
- Class A (Absolutely)
- Class B (Beneficial)
- Class C (Careful)
- Class D (Don’t)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

FORTA Classification
- Overactive Bladder

A

A: No drugs
B: Fesoterodine
C: Most bladder drugs fall here
D: Propiverine, Immediate release Oxybutynin

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

Overactive Bladder
- Off Label Drugs

A

TCA
Dicyclomine
Flavoxate

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

Overactive Bladder
- Botulinum Toxin

A

Helps bladder muscles relax
- Used in Refractory Overactive Bladder
- Used in Chronic Urinary Infections
- Used in Neurologic Condition

Can make bladder too flaccid after treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Summary: How to Treat Overactive Bladder

A

Antimuscarinic
Beta-3-Agonist (Mirabegron)
Botulinum Toxin

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

Stress Incontinence
- Alpha Agonist

A

Ex. Pseudoephedrine

Squeezes off bladder neck to tighten the sphincter
- Some benefits, very stimulating drug that penetrates deep into CNS

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

Stress Incontinence
- Alpha Agonist Considerations

A

Not much evidence

Only use with non-pregnant women or men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stress Incontinence
- Alpha Agonist Adverse Effects

A
  • Increased BP
  • Cardiac Arrhythmias
  • Anxiety
  • Insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stress Incontinence
- Hormone Therapy Mechanism

A

Sensitizes alpha receptors
- Increasing bladder resistance

Minimize atrophy
- Ensures bladder muscles maintain their strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Stress Incontinence
- Hormone Therapy Considerations

A

Not much evidence

Testosterone therapy in men is avoided

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

Stress Incontinence
- Duloxetine Mechanism

A

Off Label use for Urinary Incontence
- Selective 5-HT and NE reuptake inhibitor (For depression)

Increases sphincter contractility

24
Q

Stress Incontinence
- Duloxetine Adverse Effects

A

Nausea

25
Q

Stress Incontinence
- Other Options

A

Surgical
- Bladder Suspension

Bulking Agents
- Autologous Fat
- Silicone

26
Q

Summary: How to Treat Stress Incontinence

A

Alpha Agonists (Little Evidence)
Hormone Therapy (Little Evidence)
Duloxetine

27
Q

Overflow Urinary Incontinence (BPH Treatment)
- BPH Treatment

A

Surgery
Catheterization (Allows patient to relieve urine)
Pharmacotherapy

28
Q

Overflow Urinary Incontinence (BPH Treatment)
- Surgery

A

TURP (Transurethral Resection of the Prostate)

Prostatectomy

29
Q

Overflow Urinary Incontinence (BPH Treatment)
- 5-Alpha Reductase Inhibitors Drugs

A

Finasteride, Dutasteride

Dutasteride works faster (3 months compared to 6)
Dutasteride reduces prostate size more

30
Q

Overflow Urinary Incontinence (BPH Treatment)
- 5-Alpha Reductase Inhibitors Mechanism

A

Prevent formation of DHT (Testosterone Analogue)

Takes a long time to show any effects (3 months)

31
Q

Overflow Urinary Incontinence (BPH Treatment)
- 5-Alpha Reductase Inhibitors Adverse Effects

A

Impotence
Decreased Libido
Infertility
Decreased Volume of Ejaculate

32
Q

Overflow Urinary Incontinence (BPH Treatment)
- 5-Alpha Reductase Inhibitors Considerations

A

Contraindicated in Hypersensitivity

Increased risk for breast cancer and suicide
- Monitor for mental health

33
Q

Overflow Urinary Incontinence (BPH Treatment)
- Alpha Antagonists Drugs

A

Tamsulosin
Doxazosin
Terazosin
Alfuzosin
Silodosin

34
Q

Overflow Urinary Incontinence (BPH Treatment)
- Alpha Antagonists Mechanism

A

Acts on alpha 1 receptors on prostate
- Induces relaxation of muscles

35
Q

Overflow Urinary Incontinence (BPH Treatment)
- Alpha Antagonists Considerations

A

AM vs PM Dosing
- AM: May experience dizziness and other adverse effects throughout the day
- PM: Patient will sleep through adverse effects, however, may experience dizziness when they get up to urinate (risk of falls)

36
Q

Overflow Urinary Incontinence (BPH Treatment)
- Alpha Antagonists Adverse Effects

A

Dizziness
Retrograde Ejaculation
- Bladder neck may be too relaxed, causes ejaculate to backflow
Floppy iris

37
Q

Overflow Urinary Incontinence (BPH Treatment)
- PDE5-I Drugs

A

Tadalafil
Sildenafil
Vardenafil

38
Q

Overflow Urinary Incontinence (BPH Treatment)
- PDE5-I Mechanism

A

Relaxes smooth muscle of prostate and bladder
- Relaxation also allows blood to flow, good for treating Erectile Dysfunction

39
Q

Overflow Urinary Incontinence (BPH Treatment)
- PDE5-I Adverse Effects

A

Headache
Dyspepsia
NAION (Blood loss to optic nerve)
Priapism (Long lasting erection)

40
Q

Overflow Urinary Incontinence (BPH Treatment)
- PDE5-I Considerations

A

Contraindicated in
- Cardiovascular Diseases
- Nitrates
- Non-Selective Alpha Blockers
–> May go into shock because BP gets too low

Interactions with:
- Nitrates
- Alpha-Blockers
- Antihypertensive agents

41
Q

Overflow Urinary Incontinence (BPH Treatment)
- Alpha Antagonists vs PDE5-I

A

Quite similar
- Choice depends on patient’s comorbidities and how quick patient wants to see improvement

Tadalafil is quicker takes effect in first few weeks
Finasteride takes months

42
Q

Overflow Urinary Incontinence (BPH Treatment)
- NHP Drug

A

Saw Palmetto

43
Q

Overflow Urinary Incontinence (BPH Treatment)
- NHP Mechanism

A

5-Alpha Reductase Inhibition
Decreased DHT
Triggers Prostatic Cell Apoptosis
Anti-inflammatory effect

44
Q

Overflow Urinary Incontinence (BPH Treatment)
- NHP Considerations

A

Contraindicated in Hypersensitivity

Not recommended for treatment of BPH or LUTS

45
Q

Underactive Bladder
- Cholinergic Drugs

A

Bethanechol

46
Q

Underactive Bladder
- Cholinergic Mechanism

A

Stimulates bladder contraction (Parasympathetic)
–> Allows for urination

47
Q

Underactive Bladder
- Cholinergic Considerations

A

Contraindicated in:
- Bradycardia
- Uncontrolled asthma
- Active Peptic Ulcer Disease
- Seizure Disorders

Interactions with:
- Cholinesterase Inhibitors
- Anticholinergics
- Procainamide
- Quinidine

48
Q

Underactive Bladder
- Cholinergic Adverse Effects

A

GI Motility
Salivation
Flushing

49
Q

Underactive Bladder
- Other Options

A

PGE2 Intravesically
Cholinesterase Inhibitors
Stem Cell Therapy
Sacral Neuromodulation

50
Q

Summary: How to Treat Overflow UI

A

BPH Treatments
- Alpha Antagonist
- 5-Alpha Reductase Inhibitors
- Phosphodiesterase 5 Inhibitors

Neurogenic Treatments
- Cholinergic Agonist

51
Q

Nocturia
- Desmopressin Mechanism

A

Increases reabsorption of water
- Less urine produced

52
Q

Nocturia
- Desmopressin Adverse Effects

A

Nausea
Headache
Dizziness
Hyponatremia

53
Q

Nocturia
- Diuretics Mechanism

A

Furosemide dosed in the afternoon to urinate fluid before going to bed

54
Q

Summary: How to treat Nocturia

A

Desmopressin
Diuretics

55
Q

LUTS Monitoring

A

Efficacy
- How many urgent continence episodes
- How many leakage episodes

Validates Questionnaires
- ICIQ-UI
- International Prostate Symptom Score

Timeline
- Usually monthly
- Some medicines have earlier responses (Alpha Antagonists)

PHARM 343 (20 decks)

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