Urology Pharm Flashcards
What are the major differences between the alpha-1 blockers and 5 alpha reducatase inhibitors
Alpha 1s are best at reducing symptoms. 5-alpha are best at reducing size and don’t cause orthostatic hypotension
Where are alpha-1 receptors located?
base of bladder and prostate
Which alpha-1 blockers cause more BP lowering effects than the others?
Terazosin (Hytrin) and Doxazosin (Cardura)
What are the initial prescription instructions for alpha-1s?
start at a small dose at bedtime and titrate up slowly over several weeks
How long might it take to notice reduction symptoms from 5 alpha reductase inhibitors?
up to a yr
What should you use when interpreting PSA results in patients on 5 alpha reductase inhibitors?
use a factor of 2 in first 24 months of therapy and then 2.5 there after
Name the phosphodiasterase inhibitors
Tadalafil (Cialis), Vardenafil (Levitra), Sildenafil (Viagra), Avanafil (Stendra)
What can happen if phosphodiasterase inhibitors are combined with nitrates or alpha-1 blockers?
severe hypotension
Which phosphodiasterase inhibitor can cause transient blue vision and may increase risk for nonarteritic ischemic optic neuropathy?
sildenafil (Viagra)
In general how long before intercourse should phosphodiasterase inhibitors be taken?
60 min
Which phosphodiasterase inhibitor has a 36 hr duration compared to 8-12 hrs for the others?
Tadalafil (Cialis)
How long should you hold nitrates even if the patient is having an MI and they’ve used a PDE-5 recently?
24 hours after use of a PDE-5 or for 48 hours if used taldafil (Cialis)
Can work in 3 different ways: binding to the androgen receptor, Act in tissues that express the enzyme 5-alpha reductase, and act as estrogen after converting to estradiol
testosterone
What is testosterone not used to treat?
impaired spermatogenesis
What do you need to screen for before prescribing testosterone?
prostate cancer in men over 50, erythrocytosis, and sleep apnea
good first choice of therapy for testosterone replacement. Well tolerated. Achieves normal testosterone levels in most. educate regarding transfer onto others
transdermal gel
How long after starting testosterone therapy do you need to check serum levels?
2-3 months
How long after starting testosterone therapy do you need to check PSA and DRE?
3-6 months then yearly
Name the urinary tract analgesic used for symptomatic relief of urinary burning, itching, frequency and urgency associated with UTI or post urologic procedures
Phenazopyridine (Pyridium)
Side effects of Phenazopyridine (Pyridium)
skin/sclera yellow and urine bright orange
Max amount of time you can use Phenazopyridine (Pyridium)
more than 2 days
Most commonly used muscarinic antagonists that increase bladder capacity and block release of Ach resulting in decreased urgency
Oxybutynin (Ditropan) (Ditropan XL) or Tolterodine (Detrol) (Detrol LA)
CI for muscarinic antagonists
dementia, gastric retention, angle closure glaucoma
How long does it take for muscarinic antagonists to take effect?
4-6 weeks
