urology Flashcards
alpha blockers:
- examples? 3
- suffix?
- main indications? 2
- mechanism of action?
- doxaZOSIN
- tamulOSIN
- alfuZOSIN
- zosin
1) 1st line for benign prostatic hyperplasia (where lifestyle changes are insufficient)
2) add-on treatment on resistant hypertension
- where Ca2+ blockers, ACEi and thiazide diuretics are insufficient
alpha blockers mainly block a1-adrenoreceptor, which are mainly found in smooth muscle (blood vessels + urinary tract)
- blockage of these causes relaxation
- > vasodilation + drop in BP and reduced resistance to bladder outflow
alpha blockers:
- examples? 3
- main side effect? when does this occur?
- how to reduce this?
- main contraindication?
- interactions?
- doxaZOSIN
- tamsulOSIN
- alfuZOSIN
postural hypotension, dizziness + syncope
- particularly after first dose (like with ACEi + ARBs)
- if combining with other anti-hypertensives, temporarily reduce dose of others when start alpha blocker to avoid first dose hypotension
- postural hypotension is main contraindication
additive hypotensive effect with other anti-hypertensives, but this may be therapeutic aim
alpha blockers:
- examples?
- when to take?
- what side effect to warn patients about?
- doxaZOSIN
- tamulOSIN
- alfuZOSIN
- take at night (esp initially) to lessen effect of hypotension
- dizziness/syncope
5 alpha reductase inhibitors:
- main example?
- indication?
- mechanism of action?
finestaride
1) 2nd line (after alpha blockers) in benign prostatic hyperplasia
reduce the size of the prostate gland
- by inhibiting the intracellular enzyme 5a-reductase, which normally converts testosterone to its more active metabolite: dihydrotestosterone.
- dihydrotestosterone normally stimulates prostatic growth
nb this drug takes weeks/months to improve symptoms, hence why it’s normally given second line after alpha blockers
5 alpha reductase inhibitors:
- main example?
- common side effects? 4
- may increase risk of which cancer?
finestaride
relate to their anti-androgen action:
- impotence (normally only temporary)
- reduced libido (normally only temporary)
- breast tenderness + enlargement (gynacomastia)
- hair growth (so can be used to treat male pattern baldness)
slightly increases risk of breast cancer in men
5 alpha reductase inhibitors:
- main example?
- absolute contraindication?
- interactions?
finestaride
exposure of drug to male foetus may cause abnormal development of genetalia
- pregnant women must not be exposed to this drug (let alone take them)
eg by
- handling broken/damaged tablets
- through semen during unprotected sex with a man taking them
no clinically significant interactions
5 alpha reductase inhibitors:
- main example?
- how long to take before symptoms of BPH improve?
- normally temporary side effects to warn patients of? 2
- which side effect to report to doctor?
- what to warn about having sex with partner?
finestaride
- up to 6 months for symptoms to improve
- low libido
- erectile dysfunction
- go to doctor if get tenderness or growth of tissue under nipples (as can have surgery for prostate instead) - say can rarely get breast cancer on this drug
- if partner is pregnant, they mustn’t come into contact with it (don’t let handle pills and use condoms)
