Pharmacology

Question 1

Nocturnal enuresis.

Answer 1

Antidepressants imipramine and amitriptyline: anti diuretic and anti cholinergic.
Desmopressin: severe nocturnal frequency. Anti diuretic and anti cholinergic

Question 2

Overactive bladder

Answer 2

Anti cholinergic agents: block contractions of detrusor muscle, by blocking muscarinic R. Therefore increasing functional bladder capacity.
S/E dry mouth, constipation, palpitations, confusion.
Oxybutynin and tolterodine

Question 3

Erectile dysfunction

Answer 3

Underlying abnormality is inability of corpora cavernosa to maintain engorgement.
PDE5 inhibitors sildenafil, tadalafil, varenafil. PDE5 breaks down cGMP . Therefore preventing this thus maintaining erection.
S/E dizziness, dyspepsia, flushing and headache.
Do Not use with nitrates or NO donors.

Question 4

Priapism

Answer 4

Intra cavernosal irrigation plus 🅰1 adrenergic agonist causing vasoconstriction.
Phenylephrine 1ml of 10mg/ml in 500ml of saline and inject 10ml every 5 mins.

Question 5

Prostate ca hormonal management:

Answer 5

LHRH agonists: 3 monthly injections, stimulate HPAxis to down regulate R in pituitary therefore leading to decreased production of testosterone and LH.

• side effects hot flushes, muscle weakness, decreased libido,erectile dysfunction, and tumor flare
• buserelin, goserelin, leuprorelin

Anti androgens: used for four weeks to counter testosterone flare. S/E painful gynacomastia
Flutamide, bicalutamide

Other forms of hormonal mx oestrogen and bilateral orchidectomy

Question 6

Drugs in BPH

Answer 6

Alpha adrenergic blockers treat dynamic part of obstruction by working on alpha R in prostate, ureters and bladder. Alfuzosin & tamsulosin are more uro selective, also doxZosin and terazosin. S/E hypotension, dizziness and sedation.
(🅰🚫 are also used as medical management of acute urinary retention)

Testosterone 5 🅰reductase inhibitors, finesteride and dutasteride. Prevent testosterone conversion into DHT therefore prostate shrinkage