urinary system agents Flashcards
nephr/o, ren/o
kidneys
pyel/o
renal pelvis
ur/o, urin/o
urin
ureter/o
ureters
cyst/o
urinary bladder
urethr/o
urethra
prostat/o
prostate
Phosphodiesterase Inhibitors (PDE-I)
1st line ED Agents
Sildenafil, Vardenafil, Tadalafil MOA
Inhibit phosphodiesterase (PDE) 5 leading to increased levels of cyclic guanosine monophosphate (cGMP) and enhancing the effects of nitric oxide (NO) and smooth muscle relaxation in the corpus cavernosum of the penis Also cause relaxation of smooth muscle of the pulmonary vasculature
Sildenafil, Vardenafil, Tadalafil uses
Erectile dysfunction
Pulmonary arterial hypertension
Sildenafil, Vardenafil, Tadalafil adverse effects
Headache, flushing, dizziness
Visual abnormalities
Priapism
Sildenafil, Vardenafil, Tadalafil contrainindications
Concomitant use of nitrates
Sildenafil, Vardenafil, Tadalafil interactions
Nitrates
Antihypertensives
CYP-450 3A4 Inhibitors
Sildenafil, Vardenafil, Tadalafil counseling
Ineffective in the absence of sexual arousal
Do not engage in sexual activity if clinically inadvisable
No protection against STDs
Do not take if you are using a nitrate
Be aware of s/sx of low blood pressure
Seek medical attention if priapism occurs
Benign Prostatic Hyperplasia (BPH )
Enlargement of the prostate gland
Occurs in all males with advancing age
Age 60: 50% of all men will have BPH
Age 85: 90% of all men will have BPH
Terazosin, Doxazosin, Alfuzosin, Tamsulosin
α- Adrenergic blockers, alpha blockers
Terazosin, Doxazosin, Alfuzosin, Tamsulosin adverse effects
Dizziness, hypotension, orthostatic hypotension, weakness, somnolence, impotence, decreased libido
Terazosin, Doxazosin, Alfuzosin, Tamsulosin interactions
Antihypertensive agents
Terazosin, Doxazosin, Alfuzosin, Tamsulosin patient counseling
Be aware of s/sx of low blood pressure
Results of therapy may take several days to weeks
Terazosin, Doxazosin, Alfuzosin, Tamsulosin MOA
Antagonists of α₁-adrenergic receptors
Relaxes prostatic smooth muscle
± peripheral vasculature
Finasteride, Dutasteride MOA
Interfere with testosterone’s stimulatory effect on prostate gland size
Block conversion of T to DHT
Slow disease progression & decrease risk of complications
Finasteride, Dutasteride class
α-Reductase Inhibitors
Finasteride, Dutasteride uses
Moderate to severe BPH disease with enlarged prostate glands Both agents offer once daily dosing Delayed onset of clinical effect Takes about 6 months to see full effects Adequate clinical trial 6-12 months Male pattern Baldness
Finasteride, Dutasteride adverse effects
Breast tenderness and swelling, neoplasm of male breast, decreased libido, ejaculation disturbances, erectile dysfunction, testicular pain
Associated with more sexual dysfunction
2nd line agent in treating younger males
Finasteride, Dutasteride contraindications
Pregnancy, female gender, children
Finasteride, Dutasteride pregnancy
Exposure of male fetus to finasteride may result in offspring with ambiguous genitalia (pseudo-hermaphroditic)
Pregnant women should avoid contact
Pharmacists (women) should use rubber gloves
Finasteride, Dutasteride counseling
Women of childbearing age should not touch or handle broken tablets
Results of therapy may take several months
Urinary Incontinence (UI)
Urinary Incontinence (UI): The involuntary leakage of urine Chronic UI is one of the most common reasons for elderly institutionalization in the US
Tolterodine, Oxybutynin
Anticholinergic agents
Tolterodine, Oxybutynin MOA
Antagonize muscarinic cholinergic receptors
Relaxation of detrusor muscle
Reduction in frequency and intensity of bladder contractions
Tolterodine, Oxybutynin indications
UI/Overactive bladder
Tolterodine, Oxybutynin adverse effects
Anticholinergic – dry mouth, constipation, xerophthalmia, blurred vision, mydriasis, tachycardia, sedation, dizziness, hallucinations, delirium
Tolterodine, Oxybutynin contraindications
Uncontrolled narrow-angle glaucoma
Urinary retention
Gastric retention/conditions with severely decreased GI motility
Tolterodine, Oxybutynin interactions
Anticholinergic agents
Tolterodine – CYP3A4 and 2D6 inhibitors and inducers
Tolterodine, Oxybutynin counseling
Drink water and/or eat sugarless candy to lessen dry mouth effects
Exercise caution with driving due to possibility of sedation
Extended release – Do not crush or chew
Oxybutinin gel – Apply to clean, dry, intact skin on abdomen, thighs, or upper arms/shoulders. Rotate site; do not apply to the same site on consecutive days. Wash hands after use. Cover treated area with clothing after gel has dried to prevent transfer of medication to others. Do not bathe, shower, or swim until 1 hour after gel is applied.
Oxybutinin transdermal – Apply to clean, dry skin on abdomen, hip, or buttocks. Select a new site for each new system, avoiding reapplication to the same site within 7 days.
