Urology Flashcards
receptors for storage and voiding phase
- b2 adrenergic receptos for storage reg
- m3 receptor for voiding
Common meds affect continence
- a agonist/antagonist
- alcohol
- anticholingerics
- cholinesterase inhs
- ccbs
- diuretics
- nacrotics
- antidepressants
- antipsychs
- sedative/hypnotics
- pseudoephedrine
treatment, monitoring, dosing, ci for nocturnal polyuria
desmopressin nasal spray
- monitor sodium
- for 50-64 yo= 1 spray (1.66 mcg) 30 mins b/f bed
- for +65 yo= 1 spray (0.83 mcg) 30 mins b/f bed
- CI: concomitant loop diuretics, CHF (low EF), uncontrolled htn, use of glucocosteriods
what is noctural polyuria
wakening 2 or more times in the night to urinate
urge incontinence/ overactive bladder
- involuntary leakage of urine
- most often neurologic
urge incontinence/ overactive bladder: antispasmodics treatment, ae, efficacy
Antispasmodics
-Darifenacin and Solifenacin both m3 specific, dec side effect
- ae : anticholgeric effects including dementia
- Darifenacin> ER tolerodine> Solifenacin are the best
urge incontinence/ overactive bladder: anti-muscarinics and botox treatment, ae, indication, efficacy
- Anti-muscarinic: Imipramine / other TCA; 25mg qd-tid, AE: cardiac effects and anticholingeric
- Botox; for people who failed other treatments - less dry mouth and complete resolution of urgency but higher rates of transient urinary retention and UTIs
urge incontinence/ overactive bladder: b3 adrenergic agonist treatment,moa, se, dose adj, efficacy
Mirabegron (Myrbetriq ER) 25-50mg/day
- detrusor muscle relaxation
- dose reduction for hepatic or renal dysfunction
- se: hypertension
- caution with uncontrolled htn
Vibegron 75mfg
- dose adj for SEVERE hepatic and renal dysfunction
- se: mild and rare
guideline on overactive bladder 1st line
behavioral therapies; bladder training, control strategies, pelvic floor muscle training and fluid management
guideline on overactive bladder 2nd line
- oral anti-muscarinics or b3 agonist
- er >ir for less SEs
- avoid oxybutynin patch
- combo of oral options for refractory
what population should we avoid vs use caution with anti-muscarinics
- narrow-angle glaucoma
- dec gastric emptying or urinary retention
- caution: frail patients
what is stress incontinence and who is at risk
- stress: sneezing, laughing, coughing
- dec pelvic wall musculature *women at risk due to child bearing
Stress incontinence treatment ae, dose
a receptor agonist
- pseudoephedrine 15-30 up to TID, ae: insomnia, HTN, HA, tremor, palpitations
- midodrine 2.5-5 mg po bid-tid
estrogen
- ae: pap, bleeding, DVT
- ERT as vaginal application
- not typically recommended in post-menopausal women
duloxetine 40 BID
- not FDA approved
Overflow incontinence and treatment
leak urine throughout the day
- bethanechol (urecholine) 10 mg tid
- ae: GI issues, orthostasis, urgency, bronchial constriction
- inc bladder tone
symptoms of BPH
- incomplete emptying
- frequency
- intermittency
- urgency
- weak stream
- straining nocturia
non pharm BPH
- pads
- TURP (cuts away at prostate)
- urethral dilation
- foley catheters
BPH treatment a1 blockers
terazosin> doxazosin> prazosin
-Doxazosin has major cv events in hypertensive pts
- ae: postural hypotension, dizziness/vertigo, blurred vision, drowsiness, asthenia
BPH treatment a1a blockes
Silodosin» Alfuzosin~ Tamsulosin
- relax tone
- rare hypotension, vertigo, drowsiness
- floppy iris syndrome
- ED *not seen with alfuzosin
BPH treatment 5a reductase inh
Dutasteride > Finasteride
- combo better for significant prostate enlargement
drugs to avoid in BPH
- TCA
- diphenhydramine
- disopyramide
- pseudoephedrine & ephedrine - increases tone of prostate
- anticholinergic
BPH treatment -combo a1a blocker and pde5 inh
alfuzosin and sildenafil superior to monotherapy in treating lower urinary tract symptoms and erectile dysfuction
BPH treatment algorithm
- start a blocker or PED5 if pt has ED
- then try combos
- if prostate >30cc add 5ARI (dutasteride, finasteride)
Drugs associated with ED
- diuretics
- antihypertensive
- cardiac and cholestrol drugs
- antidepressants
- tranquilizers
- h2 antagonist
- hormones
- cytotoxic agents
- immunomodulators
anticholingeric - recreational drugs
risk factors for ED
Metabolic syndrome
Lower UT symptoms
CVD
Tobacco smoking
Central neurologic conditions
Spinal Cord Injury
Depression or social or marital stress
Endocrinologic conditions
DM
Major risk of death with this combo regarding for ED treatment
Death in patients with CAD taking nitrates and PDE5
High risk pts for PDE5 therapy
- unstable or refractory angina
- uncontrolled hypertension
- severe CHF (4)
- recent MI or stroke w/in 2 weeks
- high risk cardiac arrhythmias
- obstructive hypertrophic cardiomyopathy
onset and duration and nitrates timing sildenafil, clinical pearl
“little blue pill/ vitamin V”
30-60 mins
last 2-4 hrs
space out 24 hr with nitrates
food effect- high fat meal
onset and duration of action and nitrates timing vardenafil
60 mins
last 4-6 hrs
space out 24 hr with nitrates
onset and duration and nitrates timing of action tadalafil
“the weekender”
60 mins
last 24-36 hrs
space out 48 hr with nitrates
onset and duration and nitrates timing of action avanafil
“the quickie”
15 min
last 4-6hrs
space out 12-24 hrs with nitrates
Counseling points for PDE5 inh
- wont work w/o sexual stimulation
- try up to 8 times
- sufficient time to work 30-60 mins for most
