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Pharm 2 > Urology > Flashcards

Urology Flashcards

1
Q

1st line for ED

A

lifestyle changes

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2
Q

1st line pharm therapy for ED

A

PDE-5 Inhibitors

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3
Q

MOA: PDE-5 Inhibitors

A

inhibit PDE-5 and thus breakdown of cGMP = more blood flow = erection

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4
Q

class: Sildenafil, tadalafil, vardenafil, avanafil

A

PDE-5 Inhibitors

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5
Q

PDE-5 Inhibitors interactions

A

nitrates

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6
Q

which PDE-5 Inhibitor can be taken QD at low dose?

A

tadalafil (Cialis)

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7
Q

AEs: Common: HA, flushing, rhinorrhea
o Less common: abdominal/back pain, indigestion, hypotension, dizziness
§ Ask about low BP, look at other BP meds
§ If combined w/ alpha-blockers increases risk of hypotension
* Selective alpha-blockers are okay (tamsulosin, silodosin, alfuzosin)
o Priapism: painful, prolonged erection lasting 2-4 hours or more in absence of sexual arousal (go to ER)
o Rare: blurry vision, photophobia

A

PDE-5 Inhibitors

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8
Q

AE: blue vision

A

viagara

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9
Q

contras: PDE-5 Inhibitors

A

DO NOT GIVE to any man who takes or has access to and might take nitroglycerine medications
§ Can lead to fatal hypotension (vasodilation, decreasing perfusion, coronary perfusion, death)
§ Specifically ask about hx of MI, CAD, angina
§ Specifically ask about nitrate medications
* Nitroglycerin, nitrostat, isosorbide mononitrate

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10
Q

pt counseling for PDE-5 Inhibitors

A

Impact of high-fat meals – don’t eat a fatty meal before
o Need for sexual stimulation – won’t work w/o stimulation
o Single trial no adequate: 6-8 attempts w/ a medication and specific dose, may increase after
onset 15 min - 60 min. most last 4 hrs

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11
Q

Alprostadil MOA

A

prostaglandin analog that stimulates production of cAMP leading to muscle relaxation and increased
blood flow
* Can be injected into corpora cavernosa
* Can be inserted as a pellet into urethra

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12
Q

how to dx low testosterone

A

<300
§ Two separate lab draws before 10 AM on separate days

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13
Q

AEs: Gynecomastia, dyslipidemia, polycythemia, acne
§ Weight gain, HTN, edema, and CHF exacerbations also occur d/t sodium retention

A

testosterone

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14
Q

testosterone contras

A

Prostate cancer (fueled by testosterone), erythrocytosis, uncontrolled heart failure, sleep apnea,
liver failure

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15
Q

is BPH related to prostate cancer?

A

no

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16
Q

prostate is mostly ___ tissue

A

muscular/stromal

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17
Q

which class: relax smooth muscle, making it easier to void
§ Relaxation of bladder neck, prostatic urethra, and prostate smooth muscle

A

Alpha1-adrenergic antagonists

18
Q

1st line for BPH

A

Alpha1-adrenergic antagonists

19
Q

peak effect of Alpha1-adrenergic antagonists

A

after several weeks

20
Q

most uroselective Alpha1-adrenergic antagonists

A

Tamsulosin (Flomax) and silodosin (Rapaflo)

21
Q

counseling for Tamsulosin (Flomax)

A

Take 30 min after a meal to decrease risk of hypotension, after dinner preferred.
don’t take decongestants

22
Q

AEs: hypotension, retrograde ejaculation, nasal congestion, floppy iris syndrome

A

Alpha1-adrenergic antagonists

23
Q

5 Alpha-Reductase Inhibitors (5ARI) MOA

A

inhibits conversion of testosterone to dihydrotestosterone therefore preventing/reversing growth of
glandular (epithelial) tissue

24
Q

how long does it take 5 Alpha-Reductase Inhibitors (5ARI) to work

A

6 months

25
Q

class: Finasteride (Proscar) and dutasteride (Avodart)

A

5 Alpha-Reductase Inhibitors (5ARI)

26
Q

AEs: Decreased libido, ED, gynecomastia (rare), osteoporosis (rare and dose-related)

A

5 Alpha-Reductase Inhibitors (5ARI)

27
Q

counseling for 5 Alpha-Reductase Inhibitors (5ARI)

A

pregnant women should not touch the pills

28
Q

always order ____ for workup of nocturnal enuresis

A

urinalysis

29
Q

age consideration for pharm treatment of noctural enuresis

A

> 6 y/o

30
Q

Desmopressin, imipramine, anticholinergics (oxybutynin) treat ___

A

nocturnal enuresis

31
Q

MOA: Synthetic analog of vasopressin (ADH)
o Increases water reabsorption at the collecting duct reducing production of urine
o Administer 1 hr before bed to decrease urine production while asleep

A

desmopressin

32
Q

class: Oxybutynin, Tolterodine

A

anticholinergics

33
Q

1st line for urinary urge incontinence

A

antimuscarinics

34
Q

MOA: Antimuscarinics

A

competitively inhibit effects of muscarinic receptors on detrusor muscle cells
§ Decrease tone and motility of smooth muscle in bladder

35
Q

class: Oxybutynin, tolterotine, tropium chloride, solifenacin, danifenacin, fesoterodine

A

antimuscarinics

36
Q

contras: antimuscarinics

A

Acute angle glaucoma
§ Urinary retention
§ Gastric retention/gastroparesis
§ Myasthenia gravis

37
Q

antimuscarinics interactions

A

Potassium supplements – may increase risk of gastric irritation and ulcer

38
Q

AEs: HTN, nasopharyngitis, UTI, HA
* No anticholinergic SEs, no risk for retention

A

Mirabegron (Myrbetriq)

39
Q

AEs: hyponatremia

A

Desmopressin (DDAVP)

40
Q

treatment for adult nocturia

A

anticholinergics, Desmopressin (DDAVP)

Pharm 2 (29 decks)

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