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REPRO > PHARM_urinary incontinence > Flashcards

PHARM_urinary incontinence Flashcards

1
Q

the sympathetic nervous system activates which receptors to relax the bladder muscle?

A

Beta-3

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2
Q

the SNS activates which receptors to constrict the urethral smooth muscle?

A

alpha-1

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3
Q

the parasympathetic nervous system activates which receptor which causes bladder contraction?

A

M3

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4
Q

the somatic function of the pudendal nerve activates which receptor to constrict the external urethral sphincter?

A

cholinergic nicotinic

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5
Q

blocking what receptors in the salivary glands causes dry mouth?

A

M1
M3
M4

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6
Q

blocking what receptors in cardiac tissue causes tachycardia and palpitations?

A

M2

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7
Q

Blocking what receptors in the eyes causes dry eyes and blurry vision?

A

M3

M5

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8
Q

blocking what receptors in the GI tract causes slowing of transit time (constipation) and has effects on sphincter tone & gastric acid secretion

A

M1
M2
M3

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9
Q

blocking M1, M2, M3, M4, M5 receptors in the brain and CNS has what effects?

A

effects on memory, cognition and psychomotor speed, confusion, delirium, hallucinations, sleep disruption

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10
Q

blocking what receptors in the detrusor muscle of the bladder causes decreased contraction and urinary retention?

A

M2 (opposes Beta-receptor)

M3 (direct effect)

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11
Q

what are some of the peripheral effects of anticholinergic drugs?

A 
dry mouth
mydriasis
constipation
urinary retention
tachycardia
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12
Q

what are some of the central effects of anticholinergic drugs?

A 
sedation
confusion/delirium
hallucinations
slowed cognitive function
sleep disruption
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13
Q

which antimuscarinic drug used in urinary retention is a quaternary amine and doesn’t cross the BBB?

A

trospium

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14
Q

which antimuscarinic drug has significant M3 selectivity?

A

darifenacin (but not clinically relevant)

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15
Q

all the antimuscarinic drugs used in urinary incontinence are oral except which drug?

A

trospium

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16
Q

all the antimuscarinic drugs have significant CYP metabolism in the liver except which drug?

A

trospium

17
Q

which antimuscarinic drug has a really short half lives and thus can be given as an ER formulation?

A

oxybutynin

18
Q

what are some of the adverse effects of antimuscarinics when treating urinary incontinence?

A

urinary retention, especially in BPH
CV: palpitations, tachycardia and prolonged QTc
GI: mild constipation to severe obstructions (alters absorptions of concurrent oral drugs)

19
Q

what are some of the contraindications to antimuscarinic therapy?

A

angle closure or narrow-angle glaucoma

  • urinary & gastric obstruction
  • need for mental alertness
  • Alzheimer’s type dementia (can worsen already existing cholinergic deficit)
20
Q

which type of antimuscarinic drug preparation reduces the risk of dry mouth without any apparent loss of efficacy?

A

ER delivery

21
Q

the urothelium acts on ___________ receptors to sensitize mechanoreceptive affarent nerve endings.

A

NK2

22
Q

which sympathomimetic drug has significant CYP3A4 metabolism and works on beta-3 receptors to increase bladder capacity by relaxing detrusor s.m.?

A

mirabegron

23
Q

what happens when you take mirabegron with food?

A

you decrease the bioavailability

24
Q

which sympathomimetic has a very long half-life?

A

mirabegron

25
Q

what happens to the urinary excretion of pseudoephedrine & ephedrine when the urine becomes more acidic?

A

increases the urinary excretion of pseudoephedrine and ephedrine

26
Q

what are some of the adverse effects of mirabegron?

A

increased BP

tachycardia

27
Q

what are some of the adverse effects of pseudoephedrine and ephedrine?

A

HTN, tachyarrhythmia, A-fib
-insomnia
symptoms of CNS stim
*MAOI interaction

28
Q

name a drug that is used to strengthen the cholinergic-mediated detrussor muscle contraction.

A

neostigmine

29
Q

how frequently is neostigmine administered?

A

several times a day

30
Q

neostigmine MOA

A

inhibits Acetylcholinesterase, augments action of ACh at both muscarinic and nicotinic receptors

31
Q

what are some of the adverse effects of neostigmine?

A 
AV block
bradyarrhythmia
cardiac arrest
cardiac dysrhythmia
hypotension
syncope
tachycardia (responsive to hypotension)
32
Q

describe the adverse effects of opiates?

A

urinary retention

-mediated by mu & delta receptors in sacral cord inhibiting parasympathetic outlfow and hence detrussor activation

33
Q

how do you reverse the detrusor relaxation?

A

opiate antagonists, although reversal of analgesia

34
Q

which CYP enzyme metabolizes mirabegron?

A

CYP3A4

35
Q

about how long is the half-life of mirabegron?

A

about 50 hours

REPRO (13 decks)

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