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Renal/GU pharm overview Flashcards

1
Q

what is the ending for alpha 1 adrenergic receptor antagonists

A

-zosin

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2
Q

what is the main MOA of A1 adrenergic antagonists?

A

blocks alpha receptors located on the prostate smooth muscle

Causes: reversal of smooth muscle contraction

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3
Q

what is the main effect in the body from A1 adrenergic receptors?

A

Relaxation of smooth muscle of the bladder neck and prostatic urethra

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4
Q

End result of A1 adrenergic antagonists

A

improve urine output

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5
Q

overall side effects of A1 adrenergic antagonists

A
  • dizziness
  • rhinitis
  • hypotension
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6
Q

1st generation selective alpha1 antagonists

list 2

A
  • Prazosin
  • Alfuzosin
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7
Q

2nd generation selective A1 antagonist

list 4

A
  • tamulosin
  • doxazosin
  • terazosin
  • sildosin
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8
Q

what A1 antagonist is extended release?

A

Sildosin

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9
Q

Benefit of 2nd gen a1 antagonists?

A

enabled QD

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10
Q

what 4 A1 antagonists can also impact BP?

A
  • prazosin
  • doxazosin
  • terazosin
  • tamsulosin
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11
Q

tamsulosin trade name

A

flomax

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12
Q

what A1 antagonis that also lowers BP has the least effect?

A

Tamsulosin

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13
Q

what is tamsulosin indicated for?

A

BPH
Kidney stones

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14
Q

What type of patient should tamsulosin be used with caution in?

A

Pt with orthostatic hypotension

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15
Q

when should tamsulosin never be used?

A

pts undergoing eye surgery

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16
Q

what are the 3 high yield side effects of tamsulosin

A
  1. orthostatic hypotension
  2. headache (due to blood vessel dilation)
  3. Ejaculation failure
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17
Q

starting dose of tamsulosin?

A

0.4 PO QD taken 30min after a meal

food increases onset time

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18
Q

onset of tamsulosin

A

4-8 hours

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19
Q

what is the MOA of Doxasozin

A

completely inhibits the postsynaptic A1 adrenergic receptors causing vasodilation and decreased sympathetic tone (in the prostate)

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20
Q

what is the effect of Doxazosin for treatment of HTN

A

vasodilation of the veins and arterioles that decreases total peripheral resistance

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21
Q

what is the brand name of doxazosin

A

Cardura

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22
Q

what is the effect within the body of doxazosin for treatment of BPH

A

decreases sympathetic tone
of the urethra stricture

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23
Q

what is the high yield side effect of Doxaszosin?

A

Edema (due to venous dilation)

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24
Q

what is the MOA of terazosin

A

reversible a1 antagonist with MINIMAL effect on A2

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25
what a1 antagonist preserves the negative feedback?
Terazosin
26
what A1 antagonist leads to decreased arterial tone?
Terazosin
27
what A1 antagonist causes myasthenia
Terazosin
28
when should terazosin be taken?
at bed time to avoid syncope
29
what are the three types of anti-androgens
1. 5 a-reductase inhibitors 2. Receptor inhibitors 3. steroid synthesis inhibitors
30
what class is finasteride?
5 a-reductase inhibitor
31
what is the brand name of finasteride?
Proscar
32
what is the MOA of finasteride
competitively inhibits type 2, 5 alpha reductase which inhibits the conversion of testosterone to dihydrotestosterone
33
what three things happens within the body when taking finasteride
1. suppresion of serum dihydrotestosterone 2. reduction of prostate size 3. improves urinary flow
34
what drug should be used with finasteride for symptomatic BPH
finasteride + alpha blocker (doxazosin) to reduce symptom progression
35
what size prostate indicates use of finasteride?
40g or more
36
what are the 2 main side effect of finasteride
1. decreased libido 2. gynecomastia
37
what drug is also indicated for alopecia (male pattern hair loss)
finasteride
38
how quickly do dihydrotestosterone levels and prostate size return to normal after stopping finasteride?
dihydrotestosterone: 14 days prostate size: 3 months
39
what is the main MOA of PDE inhibitors
inhibit the PDE enzymes to increases cAMP and cGMP
40
what is the MOA of PDE4 inhibitors
bronchial dilation for severe COPD
41
waht is the MOA of PDE3 inhibitors
positive inotropic vasodilators with antiplatelet effects
42
what is PDE4 inhibitors indicated for?
severe COPD
43
what is PDE5 indicated for?
ED and pulmonary HTN
44
what is PDE3 inhibitors indicated for?
acute heart failure, peripheral vascular disease
45
what PDE inhibitor is not meant for long term use?
PDE3 inhibitor
46
what do PDE enzymes normally do?
decease cAMP and cGMP
47
what are the 3 types of PDE5 inhibitors?
1. Tadalafil 2. Sildenafil 3. Vardenafil
48
what are the main effects of PDE5 inhibitors on the body
* pulmonary vasodilation * penile smooth muscle relaxation
49
what is the brand name of tadalafil?
cilias
50
what is the MOA of Tadalafil for BPH
PDE5 reduction in smooth muscle and endothelial cell proliferation
51
what is the MOA of tadalafil for ED?
causes a release of NO into the corpus cavernosum during sexual stimulationg which activates cGMP
52
what drug can decrease nerve activity and improve smooth muscle relaxation of the prostate
tadalafil
53
what drug class should be used with caution with patients experiencing chest pain
PDE5 inhibitors (use with caution with nitrates)
54
what are the main side effects of tadalafil
1. flushing 2. headache (similar to NTG)
55
what is the brand name for sildenafil
Viagra
56
caution should be taken when prescribing Sildenafil to what type of patients
pts taking: * alpha blocking antihypertensive agents * nitrates
57
what side effect can tadalafil produce?
hypotension
58
how long should nitrates be delayed for PDE5 inhibitors?
24 hours
59
what is the brand name of vardenafil
levitra
60
what is the MOA of spironolactone
competetive inhibitor of aldosterone that competes with dihydrotestosterone for androgen receptors
61
what does spironolactone do to 17 a-hydroxylase?
Inhibits 17 a-hydroxylase activity causing a lowering of plama testosterone and andostnedione
62
what class is Ketoconazole
steroid synthesis inhibitors
63
what is the MOA of Ketoconazole
inhibits the adrenal and gonadal steroid synthesis
64
what are the indications for ketoconazole
* fungal disease * prostatic carcinoma
65
what is a main SE of taking ketoconazole
gynecomastia during therapy
66
what are the types of diuretics
1. thiazides 2. loop diuretics 3. potassium sparing diuretics 4. osmotic diuretics 5. carbonic anhydrase inhibitors
67
what is the main MOA of diuretics
increases the production of urine
68
what is the MOA of Thiazides
1. diuresis (volume loss increasing Na/H exchanger in the PCT) 2. K+ excretion (paradoxical aciduria) 3. K+ (metabolic alkalosis)
69
what part of the nephron does loop diuretics act on
the NKCC2 of the thick ascending limb
70
what are the two names of loop diuretics
* furosemide * ethacrynic acid
71
what are the 2 subtypes of potassium sparing diuretics
aldosterone receptor antagonist and epithelial Na+ blocks
72
spironolactone and eplerone are what class of diuretics?
Aldosterone receptor antagonists
73
triamtrene and amaloride are what type of diuretic?
epithelial Na+ block
74
Does potassium sparing diuretics cause alkalosis or acidosis
acidosis
75
how do potassium sparing aldosterone blockers work?
inhibit the renal K+ and H+ secretion
76
how do potassium sparing epithelial Na+ diuretics work?
they create an influx of K+ to the cells in exchange for H+eate an influx o
77
what is the MOA of osmotic diuretics?
opposes the water extraction in the descending loop of henle
78
what are the two names of osmotic diuretics?
1. mannitol 2. urea
79
what is the MOA of carbonic anhydrase inhibitors?
decreases HCO3- reabsorption causing acidosis
80
what is the main diuretic that acts on PCT?
Acetazolamide (carbonic anhydrase inhibitors)
81
where does adenosine act in the nephron?
in the glomerulus
82
what is the MOA of adenosine as a diuretic
causes the contraction of the afferent arteriole
83
Alpha cells help (1) the urine through the (2) pump on the apical surface
1. acidify 2. H+/ATPase pump
84
Beta cells help (1) the urine through the (2) pump on the apical surface
1. alkanize 2. HCO3-/Cl- pump
85
what part of the nephron has the most reabsorption?
PCT * all glucose, amino acids, organic solutes
86
aldosterone is the (blank) whisperer. | what does this mean?
sodium whisperer *keeps sodium in the system and is a volume expander*
87
ADH
antidiuretic hormone
88
how does ADH control the permeability of cells?
by regulating the insertion of aquaporin into the apical membrane | brings the water back in and concentrates the urine
89
ADH is aka
AVP arginine vasopressin
90
what part of the tubule is where ADH acts?
the collecting tubule
91
what regulates ADH secretion?
serum osmolality and volume status
92
where do ADH antagonists act
at the vasopressin receptor
93
what transporter does ADH stimulate?
the insertion of the urea transporter in the collecting duct cells in th emedulla
94
what changes the osmolality
adding fluid in and taking fluid out
95
what is the main purpose of ADH
to maintain homeostasis so the water doesn't get lost
96

pharmacology (32 decks)

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