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Urology > Pharmacology > Flashcards

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
Q

SE of Phosphodiesterase Inhibitors

A 
Severe hypotension
Flushing
Headaches
Dyspepsia
Transient blue vision with sildenafil (Viagra)
Increase risk for non-arteritis ischemic optic neuropathy
Hearing loss
Priapism
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26
Q

Administration of Phosphodiesterase Inhibitors

A

Take 60 minutes prior to intercourse

Food/alcohol delay onset of action in sildenafil (Viagra) & vardenafil (Levitra)

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27
Q

Duration of Action of Phosphodiesterase Inhibitors

A

Tadalafil (Cialis): up to 36 hours

All others: 8-12 hours

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28
Q

Define Primary Hypogonadism

A

Testes fail to produce testosterone

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29
Q

Define Secondary Hypogonadism

A

Pituitary or hypothalamus malfunctino

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30
Q

MOA of Testosterone Replacement

A

Bind to the androgen receptor
Act in tissues that express the enzyme 5-alpha reductase
Can act as estrogen after converting to estradiol

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31
Q

Indications for Testosterone Replacement

A 
Decreased libido
Decreased AM erections
Loss of body hair
Low bone density
Gynecomastia
Small testes
Decreased muscle mass
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32
Q

Goal of Testosterone Replacement

A

Return testosterone level back to normal range

33
Q

Things to do Prior to Starting Testosterone Replacement

A

Screen for prostate cancer
Screen for erythrocytosis
Make sure sleep apnea is present

34
Q

SE of Testosterone Replacement

A 
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
Q

Contraindications of Testosterone Replacement Therapy

A 
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
Q

Routes of Testosterone Replacement

A 
Oral (hepatic SE)
Buccal  tablet (BID)
Subcutaneous pellet (replace 3-6 months)
Nasal gel (TID)
Parenteral: long acting
Transdermal/topical: patch, gel
37
Q

Which Formulation to Use

A 
Transdermal gel (1st): well tolerated
Some prefer injections
38
Q

Monitoring During Testosterone Replacement

A

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
Q

Examples of Gels

A

AndroGel: metered pump or packets
Testim
Fortesta
Axiron

40
Q

Adroderm

A

Worn on arm or torso

Significant skin irritation

41
Q

IM Testosterone

A 
Testosterone enanthate (Delatestry)
Testosterone cypionate (Depo-Testosterone)
Gluteal injections
42
Q

Urinary Tract Analgesic

A

Phenazopyridine (Pyridium)

Pentosan (Elmiron)

43
Q

Benefit of Phenazopyridine (Pyridium)

A

Symptomatic relief of urinary burning, itching, frequency, & urgency associated with UTI or post urologic procedures

44
Q

Contraindication of Urinary Tract Analgesics

A

GFR

45
Q

Prescribing Considerations for Urinary Tract Analgesics

A

Use

46
Q

SE of Urinary Tract Analgesics

A

Orange urine
HeadacheDizziness
Stomach cramps

47
Q

Indications of Pentosan (Elmiron)

A

Interstitial cystitis

48
Q

Define Interstitial Cystitis

A

Inflammation of the wall of the blader

49
Q

MOA of Pentosan (Elmiron)

A

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
Q

SE of Pentosan (Elmiron)

A 
Headache
Dizziness
Alopecia
Rash
Rectal hemorrhage
Diarrhea
Nausea
Abdominal pain
Dyspepsia
LFT abnormalities
51
Q

Medications for Incontinence (Anti-muscarinic Agents)

A 
Oxybutynin (Ditropan) (Ditropan XL)
Tolterodine (Detrol) (Detrol LA)
Trospium (Sanctura) (Trospium XR)
Solifenacin (Vesicare)
Darifenacin hydrobromide (Enablex)
Fesoterodine (Toviaz)
52
Q

Treatment of urgency, urgency-predominant mixed or OAB symptoms

A

Do not use pharmacologic therapy in demented patients

53
Q

Contraindications for Anti-muscarinic Agents

A

Gastric retention
Angle closure glaucoma
Neurogenic bladder

54
Q

MOA of Anti-muscarinic Agents

A

Increase bladder capacity

Block basal release of acetylcholine during bladder filling resulting in decreased urgency

55
Q

Prescribing Anti-muscarinic Agents

A

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
Q

SE of Anti-muscarinic Agents

A 
Dry mouth
Constipation
Blurred vision to near objects
Tachycardia
Drowsiness
Decreased cognitive function
Dizziness
57
Q

Considerations for Prescribing Anti-muscarinic Agents

A 
Hepatic metabolism at CYP450
Renal failure
Liver failiure
Cognitive impairment
Combinations to avoid
AE to avoid 
Generally prescribe ER or transdermal formulations
58
Q

Drug Combinations to Avoid with Anti-muscarinic Agents

A 
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
Q

Set Realistic Expectations Prior to Prescribing Anti-muscarinic Agents

A

Reduce number of incontinence episodes
30% of patients achieve complete bladder control
Failure of one medication, try another

60
Q

Common Antibiotics for UTI Treatment

A 
Ciprofloxacin
Trimethoprim/sulfamethoxazole (Bactrim/Septra)
Nitrofurantoin (Macrodantin)
Amoxicillin
Ampicillin
61
Q

Class of Ciprofloxacin

A

Fluoroquinolones

62
Q

MOA of Ciprofloxacin

A

inhibit DNA gyrase & topoisomerase IV necessary for replication of bacteria

63
Q

Pregnancy Category of Ciprofloxacin

A

Category C

64
Q

Black Box Warnings for Ciprofloxacin

A

Increased risk of tendinitis & tendon rupture

65
Q

Urologic Indications for Ciprofloxacin

A

Cystitis
UTI
Prostatitis

66
Q

Class of Trimethoprim/sulfamethoxazole (Bactrim/Septra)

A

Sulfa drugs

67
Q

MOA of Trimethoprim/sulfamethoxazole (Bactrim/Septra)

A

Folic acid synthesis inhibitors
Inhibits dihydropteroate synthetase
Inhibits dihydrofolate reductase

68
Q

Pregnancy Category of Trimethoprim/sulfamethoxazole (Bactrim/Septra)

A

Category C

69
Q

Nitrofurantoin (Macrodantin) in the Setting of CKD & Decreased CrCl

A

Can cause peripheral neuropathy

Don’t use with CrCl

70
Q

MOA of Nitrofurantoin (Macrodantin)

A

Disrupt bacterial cell wall synthesis through inhibition of bacterial enzymes

71
Q

Pregnancy Category of Nitrofurantoin (Macrodantin)

A

Category B

Contraindicated at term

72
Q

Urologic Indications of Nitrofurantoin (Macrodantin)

A

UTIs

73
Q

Class of Amoxicillin

A

Secondary generation penicillin

74
Q

MOA of Amoxicillin

A

Bactericidal to growing bacteria

Interferes with transpeptidation of cell wall synthesis

75
Q

Pregnancy Category of Amoxicillin

A

Category B

76
Q

Class of Ampicillin

A

Secondary generation penicillin

77
Q

MOA of Ampicillin

A

Bactericidal to growing bacteria

Interferes with transpeptidation of cell wall synthesis

78
Q

Pregnancy Category of Ampicillin

A

Category B

Urology (12 decks)

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