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Repro Flash Cards > Pharm: GU and Prostate Drugs > Flashcards

Pharm: GU and Prostate Drugs Flashcards

1
Q

Finasteride is in what drug class?

A

5 alpha reductase inhibitor

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2
Q

What is Finasteride used for?

A

2nd line drug to treat mod to severe BPH

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3
Q

How does finasteride work?

A
  • Reduces static factor
  • induces apoptosis of glandular cells which then reduce prostate size
  • inhibits Type II alpha reductase, interfering with conversion of testosterone to 5 alpha dihydrotestosterone
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4
Q

What are the common s/e of using finasteride

A 
Impotence
decreased libido
orthostatic hypotension
abnormal ejaculation
sexual dysfunciton
gynecomastia
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5
Q

Does finasteride have adverse CV effects?

A

Nope

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6
Q

Contraindications of using finasteride for BPH

A

don’t handle the drug if pregnant because the drug has the potential to cause feminization of the male fetus

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7
Q

Does finasteride have a slower or faster onset than Tamulosin?

A 
Slower onset (up to 6 months) 
can use concurrently to produce rapid systematic improvement
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8
Q

Why do you need to obtain a baseline PSA level when starting finasteride?

A

Because it produces a 50% reduction of [PSA]

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9
Q

What is the drug class for Tamulosin?

A

alpha1 adrenergic antagonist

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10
Q

What is the DOC for BPH?

A

Tamulosin

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11
Q

How does Tamulosin work?

A
  • It acts to reduce the dynamic factor in urinary tract outflow by neurologic inhibition
  • It selectively antagonizes prostate alpa 1 a adrenergic receptors, relaxing smooth muscle and improving urine flow
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12
Q

What is tamulosin indicated for?

A

Mod to Severe BPH

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13
Q

The common side effects of using Tamulosin are what?

A

Retrograde ejaculation with 0.8mg dosing

Dizziness, syncope, infection, somnolence, decreased libido

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14
Q

Where is Tamulosin metabolized?

A

In the liver - metabolized by CYP3A4 and CYP2D6 enzyme systems

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15
Q

Does Tamulosin act slowly or quickly?

A

quickly! within 1 - 2 weeks

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16
Q

What do you need to remember about Tamulosin and the eye?

A

If using prior to cataract sx, can cause floppy iris syndrome

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17
Q

When taking Tamulosin with a PDE5 inhibitor, how long do you need to wait after administering one before the other?

A

4 hours

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18
Q

What is an herbal supplement that can be used for treatment of BPH?

A

Saw Palmetto

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19
Q

MoA of saw palmetto

A

shrinks inner lining of prostate gland that puts pressure on the urethra

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20
Q

Is saw palmetto currently recommended?

A

Nope

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21
Q

What two medications are used for the treatment of prostate cancer?

A

Leuprolide

Flutamide

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22
Q

What is the MoA of Leuprolide?

A

Agonist of both gonadotropin releasing hormone (GnRH) and leutenizing hormone receptor hormone (LHRH)

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23
Q

What is Leuprolide used for?

A

Palliative treatment of prostate cancer

Endometriosis

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24
Q

A common drug drug interaction with leuprolide is what?

A

Anti-diabetic medications

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25
Q

What is something that you need to know when taking leuprolide?

A

May cause a tumor flare after 2 weeks which includes bone pain, neuropathy, bladder outlet obstruction due to 2ndary increase in serum testosterone

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26
Q

Overall, does leuprolide increase or decrease testosterone?

A

Reduces testosterone levels to below castration levels

27
Q

Flutamide has an MoA of what?

A

Non-steroidal anti-androgen that inhibits androgen binding in target tissues

28
Q

Indications for Flutamide are what?

A

Metastatic prostate cancer with LHRH agonist

29
Q

What are some common S/E of using flutamide?

A 
Gynecomastia
Hot flashes
galactorrhea
impotence
possible liver failure
30
Q

When do you not want to use flutamide?

A

severe hepatic impairment

G6PD deficiency

31
Q

How much does the use of flutamide and leuprolide increase cancer survival rate?

A

7 months

32
Q

Testosterone is used what what?

A

Hypogonadism

33
Q

What are common S/E of Testosterone

A 
prostate hypertrophy
emotional liability
altered libido
Increased risk of hepatitis
DVT
HTN
Agression
acne
34
Q

Contraindications of Testosterone

A

Serious hepatic, renal, cardiac disease

35
Q

What are common dx dx interactions with using testosterone

A

increased effectiveness of Vitamin K antagonists (warfarin)

36
Q

What is the tricyclic antidepressant used for treatment of urinary incontinence?

A

Imipramine

37
Q

The MoA of imipramine is what?

A

Increases synaptic concentrations of serotonin and NE which down regulated beta adrenergic receptors and an anti-cholinergic effect on detrusor muscle of bladder

38
Q

What are common s/e of imipramine

A

Sedation
Anticholinergic effects (can’t see, can’t pee, can’t spit, can’t shit)
Orthostatis
Impotence

39
Q

Is imipramine a first line drug for UI?

A

No. It has a lot of S/E and drug interactions

40
Q

Should you use imipramine in the elderly?

A

Not really

41
Q

Tolterodine is what drug class?

A

Anti-cholinergic agent

42
Q

What is the MoA of tolterodine?

A

selective antagonist of bladder muscarinic receptors which then decrease detrusor muscle pressure in bladder to increase residual urine volume

43
Q

What are the indications for tolterodine?

A

Overactive bladder and urge incontinence

44
Q

Common s/e of tolterodine?

A

Anti-cholinergic effects

HA, diarrhea, arthralgia, QT prolongation

45
Q

When do you not want to use tolterodine?

A

Pre-existing urinary retention
Gastric retention
Narrow angle glaucoma

46
Q

Oxybutinin is in what drug class?

A

Anticholinergic agent

47
Q

The MoA of oxybutinin is what?

A

Same as tolterodine (selective antagonist of bladder muscarinic receptors which then decrease detrusor muscle pressure in bladder to increase residual urine volume)

48
Q

What are some added contraindications for using oxybutinin for UI compared to tolterodine?

A

Hyperthyroidism
GERD
Ulcerative cholitis

49
Q

What drug may increase the concentration of Oxybutinin?

A

Pramlintide (anti diabetic drug)

50
Q

Oxybutinin may decrease the effectiveness of what drug?

A

Doneprezil (alzheimer medication)

51
Q

What are the 2 drugs used to treat erectile dysfunction?

A

Sildenafil (Viagra)

Tadalafil (cialis)

52
Q

The MoA of Sildenafil and Tadalafil is what?

A

Inhibits PDE5 to increaesd concentration of nitric oxide leading to corpus cavernosum relaxation and inflow of blood to cause erection

53
Q

Indications for Sildenafil and Tadalafil are what?

A

ED

Pulmonary artery hypertension

54
Q

What are common s/e of PDE5 inhibitors?

A 
dyspepsia
flushing
diarrhea
color vision changes
hypotension
angina
arrythmias
55
Q

Drugs that should not be taken with PDE5 inhibitors are what?

A

Nitrates!!
Also, anti-HTN
Grapefruit juice

56
Q

Considerations of taking PDE5 inhibitors when it comes to length of erection

A

If >4 hours, go to hospital so epinphrine can be injected into penis and counteract parasympathetic effect –> flaccidity

57
Q

What is an added consideration when it comes to using this substance and Tadalafil?

A

Avoid high doses of EtOH with Tadalafil use

58
Q

Is the half life of Tadalafil or Sildenafil longer?

A

Tadalafil is longer (15-17.5 hours) so it can be taken daily at a lower dose

59
Q

Mirabegron is used for what?

A

Overactive bladder withs/s of urinary frequency, urgency, Urge UI

60
Q

What is the MoA of Mirabegron?

A

Activate beta 3 adrenergic receptors in bladder resulting in relaxation of detrusor muscle during urge storage phase thus increasing bladder capacity

61
Q

Common S/E of Mirabegron include what?

A

HTN

Angioedema of face, tongue, lips, larynx

62
Q

Contraindications of Mirabegron

A
  • Use with caution in patients with BOO due to increased risk of Urinary retention
  • Chronic uncontrolled HTN
63
Q

What are dx dx interactions that should be considered with use of Mirabegron?

A

Anticholinergic agents may enhance ADRs of the drug
Rifampin may increase concentration of drug

Anticholinergic meds in this module:
Tolterodine and oxybutinin

64
Q

Are dose adjustments necessary with Mirabegron in the elderly?

A

Yes

Repro Flash Cards (2 decks)

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