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Pharmacology Flashcards

1
Q

Medications Used for BPH

A

Alpha-1 blockers
5-alpha-reductase inhibitors
Combo: Dutasterid-Tamulosin (Jalyn)
Tadalafil (Cialis)

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2
Q

Examples of Alpha-1 Blockers

A 
Terazosin (Hytrin)
Doxazosin (Cardura)
Alfuzosin (Uroxatrol)
Tamsulosin (Flomax)
Silodosin (Rapaflo)
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3
Q

MOA of Alpha-1 Blockers

A

Relax smooth muscle in the bladder neck & the prostatic capsule & prostatic urethra

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4
Q

Reason for Alpha-1 Blockers

A

Short & long term symptom management

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5
Q

Where are alpha-1 receptors located?

A

Base of the bladder

In the prostate

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6
Q

SE of Alpha-1 Blockers

A 
Dizziness
Orthostatic hypotension
Asthenia (muscle weakness)
Nasal congestion
Problems with ejaculation (especially with Tamsulosin (Flomax))
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7
Q

Alpha-1 Blockers with More BP Effects

A

Terozosin (Hytrin)

Doxazosin (Cardura)

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8
Q

Alpha-1 Blockers with Less BP Effects

A

Tamsulosin (Flomax)
Alfuzosin (Uroxatrol)
Silodosin (Rapaflo_

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9
Q

Examples of 5-alpha-reductase Inhibitors

A

Finasteride (Proscar)

Dutasteride (Avodart)

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10
Q

Benefits of 5-Alpha-Reductase Inhibitors

A

Long term decrease in prostate size & decreased need for prostatic surgery

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11
Q

MOA of 5-Alpha-Reductase Inhibitors

A

Competitive inhibitor of both tissue & hepatic 5-alpha reductase
Inhibition of the conversion of testosterone to DHT & suppress serum DHT levels
Decreases prostatic size

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12
Q

Efficacy of 5-alpha-reductase Inhibitors

A

May be up to a year to notice reduction in symptoms
Reduce symptoms scores
Increase maximum urinary flow rate
Reduction in mean prostatic volume
Decreased need for surgery
Decreased development of acute urinary retention

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13
Q

Major SE of 5-Alpha-Reductase Inhibitors

A

Decreased libido
Ejaculatory or erectile problems
Decreases serum PSA by 50%

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14
Q

Cialis for BPH

A

Blocks PDE5 in the prostate & bladder

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15
Q

Medications not to Use with Cialis

A

Nitrates

Alpha-1 Blockers

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16
Q

Medications for Erectile Dysfunction

A 
Alprostadil
Tadalafil (Cialis)
Vardenafil (Levitra)
Sildenafil (Viagra)
Avanafil (Stendra
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17
Q

Drug Category for Alprostadil (Caverject, Muse)

A

Prostaglandin

Vasodilator

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18
Q

MOA of Alprostadil (Caverject, Muse)

A

Vasodilation on vascular & smooth muscles

Relaxes trabecular smooth muscle by dilation of cavernosal arteries

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19
Q

Onset & Duration of Action of Alprostadil (Caverject, Muse)

A

Onset: 5-20 minutes
Duration:

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20
Q

Contraindications of Alprostadil (Caverject, Muse)

A

Conditions that predispose the patient to priapism
Anatomic or fibrotic conditions of the penis
For pellets: urethral stricture, perineal pain

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21
Q

SE of Alprostadil (Caverject, Muse)

A

Syncope
Priapism
May cause BP lowering

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22
Q

Phosphodiasterase Inhibitors

A

Tadalafil (Cialis)
Vardenafil (Levitra)
Sildenafil (Viagra)
Avanafil (Stendra)

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23
Q

MOA of Phosphodiasterase Inhibitors

A

Release of nitric oxide (NO) during sexual stimulation
NO produces smooth muscle relaxation & inflow of blood
Enhances the effect of NO by inhibiting phosphodiesterase type 6 (PDE-5)
Do not directly cause penile erections

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24
Q

Contraindications of Phosphodiasterase Inhibitors

A

Men taking nitrates

Caution with alpha-1 blockers (severe hypotension)

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25
SE of Phosphodiesterase Inhibitors
``` Severe hypotension Flushing Headaches Dyspepsia Transient blue vision with sildenafil (Viagra) Increase risk for non-arteritis ischemic optic neuropathy Hearing loss Priapism ```
26
Administration of Phosphodiesterase Inhibitors
Take 60 minutes prior to intercourse | Food/alcohol delay onset of action in sildenafil (Viagra) & vardenafil (Levitra)
27
Duration of Action of Phosphodiesterase Inhibitors
Tadalafil (Cialis): up to 36 hours | All others: 8-12 hours
28
Define Primary Hypogonadism
Testes fail to produce testosterone
29
Define Secondary Hypogonadism
Pituitary or hypothalamus malfunctino
30
MOA of Testosterone Replacement
Bind to the androgen receptor Act in tissues that express the enzyme 5-alpha reductase Can act as estrogen after converting to estradiol
31
Indications for Testosterone Replacement
``` Decreased libido Decreased AM erections Loss of body hair Low bone density Gynecomastia Small testes Decreased muscle mass ```
32
Goal of Testosterone Replacement
Return testosterone level back to normal range
33
Things to do Prior to Starting Testosterone Replacement
Screen for prostate cancer Screen for erythrocytosis Make sure sleep apnea is present
34
SE of Testosterone Replacement
``` Polycythemia Worsening of BPH symptoms Acne Increase in PSA Oral & prolonged IM doses associated with liver issues Increased risk of prostate cancer Decreased spermatogenesis Fluid retention Worsening of sleep apnea Possible increased risk of CV events ```
35
Contraindications of Testosterone Replacement Therapy
``` CV events in the last 6 months Known prostate cancer Known breast cancer Severe lower urinary tract symptoms HCT >50% Untreated severe sleep apnea PSA >4 mcg/L PSA >3 mcg/L with risk factors for prostate cancer ```
36
Routes of Testosterone Replacement
``` Oral (hepatic SE) Buccal tablet (BID) Subcutaneous pellet (replace 3-6 months) Nasal gel (TID) Parenteral: long acting Transdermal/topical: patch, gel ```
37
Which Formulation to Use
``` Transdermal gel (1st): well tolerated Some prefer injections ```
38
Monitoring During Testosterone Replacement
Serum testosterone Serum LH: primary hypogonadism Bone density Hematocrit: 3-6 months after starting therapy, then yearly PSA prior to initiating therapy: 3-6 months after starting therapy, then yearly DRE: 3-6 months after starting therapy, then yearly
39
Examples of Gels
AndroGel: metered pump or packets Testim Fortesta Axiron
40
Adroderm
Worn on arm or torso | Significant skin irritation
41
IM Testosterone
``` Testosterone enanthate (Delatestry) Testosterone cypionate (Depo-Testosterone) Gluteal injections ```
42
Urinary Tract Analgesic
Phenazopyridine (Pyridium) | Pentosan (Elmiron)
43
Benefit of Phenazopyridine (Pyridium)
Symptomatic relief of urinary burning, itching, frequency, & urgency associated with UTI or post urologic procedures
44
Contraindication of Urinary Tract Analgesics
GFR
45
Prescribing Considerations for Urinary Tract Analgesics
Use
46
SE of Urinary Tract Analgesics
Orange urine HeadacheDizziness Stomach cramps
47
Indications of Pentosan (Elmiron)
Interstitial cystitis
48
Define Interstitial Cystitis
Inflammation of the wall of the blader
49
MOA of Pentosan (Elmiron)
Adhere to the bladder wall mucosa where it may act as a buffer to protect the tissues from irritating substances in the urine Low-molecular weight heparinoid
50
SE of Pentosan (Elmiron)
``` Headache Dizziness Alopecia Rash Rectal hemorrhage Diarrhea Nausea Abdominal pain Dyspepsia LFT abnormalities ```
51
Medications for Incontinence (Anti-muscarinic Agents)
``` Oxybutynin (Ditropan) (Ditropan XL) Tolterodine (Detrol) (Detrol LA) Trospium (Sanctura) (Trospium XR) Solifenacin (Vesicare) Darifenacin hydrobromide (Enablex) Fesoterodine (Toviaz) ```
52
Treatment of urgency, urgency-predominant mixed or OAB symptoms
Do not use pharmacologic therapy in demented patients
53
Contraindications for Anti-muscarinic Agents
Gastric retention Angle closure glaucoma Neurogenic bladder
54
MOA of Anti-muscarinic Agents
Increase bladder capacity | Block basal release of acetylcholine during bladder filling resulting in decreased urgency
55
Prescribing Anti-muscarinic Agents
Extended release agents have lower rates of SE Start with lowest available dose Evaluate for response in 4-6 weeks May respond to one agent & not another
56
SE of Anti-muscarinic Agents
``` Dry mouth Constipation Blurred vision to near objects Tachycardia Drowsiness Decreased cognitive function Dizziness ```
57
Considerations for Prescribing Anti-muscarinic Agents
``` Hepatic metabolism at CYP450 Renal failure Liver failiure Cognitive impairment Combinations to avoid AE to avoid Generally prescribe ER or transdermal formulations ```
58
Drug Combinations to Avoid with Anti-muscarinic Agents
``` 1st generation antihistamines Muscle relaxants Some anti-psychotics TCAs Ipratropium (Combivent) Tiotropium (Spiriva) Cholinesterase inhibitors (donepezil, rivastigmine, glantamine) Triospium & ETOH within 2 hours Mirabegron Metoprolol & darifenacin Grapefruit juice (darrifenacin, solifenacin, festerodine, tolerodine) ```
59
Set Realistic Expectations Prior to Prescribing Anti-muscarinic Agents
Reduce number of incontinence episodes 30% of patients achieve complete bladder control Failure of one medication, try another
60
Common Antibiotics for UTI Treatment
``` Ciprofloxacin Trimethoprim/sulfamethoxazole (Bactrim/Septra) Nitrofurantoin (Macrodantin) Amoxicillin Ampicillin ```
61
Class of Ciprofloxacin
Fluoroquinolones
62
MOA of Ciprofloxacin
inhibit DNA gyrase & topoisomerase IV necessary for replication of bacteria
63
Pregnancy Category of Ciprofloxacin
Category C
64
Black Box Warnings for Ciprofloxacin
Increased risk of tendinitis & tendon rupture
65
Urologic Indications for Ciprofloxacin
Cystitis UTI Prostatitis
66
Class of Trimethoprim/sulfamethoxazole (Bactrim/Septra)
Sulfa drugs
67
MOA of Trimethoprim/sulfamethoxazole (Bactrim/Septra)
Folic acid synthesis inhibitors Inhibits dihydropteroate synthetase Inhibits dihydrofolate reductase
68
Pregnancy Category of Trimethoprim/sulfamethoxazole (Bactrim/Septra)
Category C
69
Nitrofurantoin (Macrodantin) in the Setting of CKD & Decreased CrCl
Can cause peripheral neuropathy | Don't use with CrCl
70
MOA of Nitrofurantoin (Macrodantin)
Disrupt bacterial cell wall synthesis through inhibition of bacterial enzymes
71
Pregnancy Category of Nitrofurantoin (Macrodantin)
Category B | Contraindicated at term
72
Urologic Indications of Nitrofurantoin (Macrodantin)
UTIs
73
Class of Amoxicillin
Secondary generation penicillin
74
MOA of Amoxicillin
Bactericidal to growing bacteria | Interferes with transpeptidation of cell wall synthesis
75
Pregnancy Category of Amoxicillin
Category B
76
Class of Ampicillin
Secondary generation penicillin
77
MOA of Ampicillin
Bactericidal to growing bacteria | Interferes with transpeptidation of cell wall synthesis
78
Pregnancy Category of Ampicillin
Category B

Urology (12 decks)

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