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Urology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Name 3 types pde5 inhibitors

A
  • Sildenafil 50mg
  • vardenafil (both 5h DOA - take on demand)
  • Tadalafil 20 mg (24-36h DOA- take daily )
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2
Q

Name 5 side effects pde5 inhibitors

A
  • Headache
  • facial flushing
  • dyspepsia
  • nasal congestion
  • altered vision
  • severe hypotension very rare
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3
Q

What is the original indication of sildenafil?

A

Treat pulmonary ht

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4
Q

Name 3 specific drug adverse effects of sildenafil

A
  • Contraindicated in retinitis pigmentosa due to risk retinal haemorrhage, visual impairment
  • interact with food and alcohol
  • NAION: non - arteritic anterior ischemic anterior neuropathy
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5
Q

Name 2 drug specific adverse effects for taldalafil

A
  • Myalgia

* backache

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6
Q

Name 3 absolute contraindications to pde5 inhibitors

A
  • Nitrates: severe hypotension
  • unstable angina
  • retinitis pigmentosa
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7
Q

Name 5 relative contraindications to pde5 inhibitors

A
  • Alpha blockers for LUTS: priapism
  • agents that inhibit cyp p450 (ketoconazole ant-fungal, erythromycin, protease inhibitors ):reduce dose pde5
  • mi past 6 months
  • CvA
  • history of priapism or conditions predisposing to priapism (leukemia, myelofibrosis, polycythemia, sickle cell disease )
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8
Q

Moa PDE 5 inhibitors?

A

Selective inhibition pde5, enzyme which degrades cGMP

Leads to sinusoidal smooth muscle relaxation, increased blood flow and erection

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9
Q

Name 4 GnRH agonists for prostate cancer

A 
Aka lhrh analogues
• leuprorelin
• goserelen
• buserelin
• triptorelin
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10
Q

Moa lhrh analogues for prostate cancer?

A

Aka GnRH agonist
• initially stimulate lh, increase testosterone causing “flare”
• later down - regulation receptors in pituitary causing low lh and testosterone

Anti-androgen usually given initially for 4 weeks to prevent testosterone flare

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11
Q

Name 4 adverse effects GnRH agonists for prostate cancer

A
  • Bone pain and even paraplegia initially in patients with bone metastasis due to testosterone flare
  • hot flushes
  • headache
  • ED and decreased libido
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12
Q

Name an example of a GnRH antagonist for prostate cancer

A

Degarelix

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13
Q

Moa degarelix for prostate cancer?

A

GnRH antagonist - competitively bind to pituitary GnRH receptors, thus reduce release of lh and FSH and consequently testosterone by testes

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14
Q

Name 6 adverse effects GnRH antagonists

A
  • Back pain
  • Breast enlarge
  • decrease libido
  • hot flashes
  • headache
  • slow or fast heart rate
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15
Q

Name 4 anti- androgens used for prostate cancer

A
  • Flutamide and bicalutamide used most commonly (non-steroidal)
  • cyproterone acetate rarely used (steroidal)
  • abiraterone
  • enzalutamide
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16
Q

Moa flutamide and bicalutamide?

A

Non-steroidal Anti-androgen.
Compete with DHT for intracellular receptors in prostate to prevent prostate stimulation
• prevent flare caused by GnRH agonist
• use for complete androgen blockade
• may preserve potency and erectile function

17
Q

Name 2 adverse effects bicalutamide

A

Non-steroidal anti-androgen
• painful Gynaecomastia common(prevent by giving small dose irradiation to breasts pre-treat)
• hepatotoxic

18
Q

Moa alpha blockers for BPH?

A

Reduce stromal smooth muscle tone by block alpha 1 adrenoreceptors
Reduce dynamic component of bladder outlet obstruction
Alpha 1a receptor = dominant prostatic subtype

19
Q

Adverse effects alpha blockers for BPH? (5)

A
  • Vasodilation: hypotension, dizzy, syncope, headache (caution if severe ischaemic heart disease or cerebrovascular disease)
  • leg oedema
  • retrograde ejaculation, especially selective alpha 1a blockers eg tamsulosin
  • asthenia
  • nasal congestion

Contraindicated if planned cataract surgery- intraoperative floppy iris syndrome

20
Q

Name 5 alpha blockers for BPH

A

• Prazosin ( cheap but more side effects) (minipress!)
Long acting;
• doxazosin (cardura)
• tamsulosin (selective for alpha 1 A) ( flomax! )
• Terazosin
• alfuzosin

21
Q

Moa 5 alpha reductase inhibitors for BPH?

A

• Block conversion testosterone to dihydrotestosterone
. Reduce static component of bladder outlet obstruction
• reduce prostatic volume of about 25% over 3-6 months

22
Q

Name 2 5 alpha reductase inhibitors

A

Finasteride

Dutasteride

23
Q

Name 3 adverse effects dutasteride

A

Example of 5 alpha reductase inhibitor
• sexual dysfunction: decreased libido, ED
• decreased ejaculate
• hypospadias in fetus

Urology (18 decks)

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