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PHM 704: gremlins and wizards > Witches and Wizards: Urology > Flashcards

Witches and Wizards: Urology Flashcards

1
Q

common causes of incontience

A
  • urethral obstructio (bph, strictures, stensosis)
  • impaired bladder contraction (dm, ms, spinal injuries)
  • incompetent sphincter (stress incontinene: sneezing, laughing)
  • bladderr inflammation (uti)
  • bladder stones (obstruciton, metabolic disease, uti)
  • malignancy
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2
Q

meds affecting continence

A
  • alpha agonst/antag
  • etoh - more urine production
  • ccbs - smooth muscle relaxers
  • duretics - increase urine productiion
  • sedative/hypotic - less aware of need to urinate
  • anticholinergics
    - narcs
    - antipsch
    - antidepresssant
    - pseudoephedrine causes retention dt agonism at beta 3 receptor
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3
Q

what volume charactierizes post void residual

A

50ml left in bladder after urination

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4
Q

By what mechanism do anticholinergic/antimuscarinic drugs cause confusion/delirium/dementia?

A

decreased levels of acetylcholine synthesis or the number of acetylcholine receptors -> decrease in cholinergic activity

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5
Q

stress incontience treatment

A
  • pseudoephdrine
  • midodrine
  • estrogen replacement (vagina applciation in older pts)
  • duloxetine (not fda pproved)
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6
Q

overflow incontence treatment

A

bethanechol

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7
Q

bethanechol MOA

A

stimulates muscarinic recedptors

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8
Q

bethanechol ADR

A
  • gi cramping
  • orthostasis with reflex tachy
  • urgency
  • bronchial constriction
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9
Q

OAB treatment guidelines

A
  1. behavioral therapy
  2. meds (ER over IR)
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10
Q

another name for urge incotenice

A

OAB

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11
Q

anticholinergic meds for treatment of OAB

A

hyoscymaine

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12
Q

antimuscharinic meds for treatment of OAB

A
  • oxybutinin
  • tolterodine
  • trospium
  • festoerdine
  • dicyclomine
  • prapantheline
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13
Q

which antimuscarnics don’t cross bbb

A
  • tolterodine
  • trospium
  • festerodine
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14
Q

festerodine

A
  • increased efficacy but increased risk of xerostomia and risk of withdrawal
  • has renal considerations
  • DDI CYP3A4

anti muscarnic used to treat OAB

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15
Q

antispasmodics meds for treatment of OAB

A
  • oxybutinin
  • flavoxate
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16
Q

M3 speicifc meds for treatment of OAB

A
  • darifenacin
  • solifenacin

both have CYP3A4 DDI; M3 specific in theory means less ADR

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17
Q

antimuscarinic ADR

A
  • hot hare
  • red beet
  • dry boe
  • blind bat
  • mad haatter
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18
Q

TCAs and OAB

A

imipramine (and ohter TCAs) have antimuscarnic properties, however do NOT use these in geriatrics to treat OAB

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19
Q

B3 adrenergic receptor agonistts meds for treatment of OAB

A
  • mirabegron
  • vibegron

MOA: detrusor msucle relaxation

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20
Q

mirabegron ADR

A
  • nausea
  • HA
  • dizziness
  • HTN - cautio in uncontrolled HTN
  • diarrhea OR consitpatin

dose redue for hepatic or renal dysfunction

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21
Q

vibegron ADR

A
  • nausea
  • HA
  • URI
  • UTI
  • diarrhea OR consptation
  • bronchtis
  • naspharyngitis

NO BP

dose reduce for severe hepatic or renal dysfunction

22
Q

treatment for nocturia

A

desmopressin intranasal (vasopressin/antidiuretic hromone)

butlike don’t actually use this in geriatric population lol

23
Q

desmopressin populations to avoid in

A
  • avoid:
    - fludi retention
    - hyponatremia
    - nasal conditions
  • contraindicated:
    - hyponatremia
    - polydipsia
    - conmittant use of loop diuretics, systemic or inhaled glucocorticoids
    - eGFR < 50
    - SIADH
    - diseases causing electrolyte abnormality
    - HF II-IV
    - uncontrlled HTN
24
Q

desmopressin monnitoring

A

Na levels

25
Q

desmopressin dose

A
  • 50-65: 1.66mg in either nostril
  • 65+: 0.83 in either nostril (can increase after 1 week if Na levels wNL)
26
Q

botox and OAB

A
  • IM injectio to detrusor during cystoscopy
  • better efficac than meds but can go overboard and just shut down the bladder lol

can be used in adults with inadequate response or intolerance tto anticholinergic med

27
Q

alpha blocker MOA in BPH

A

reduce tone in bladder → urine can flow through urethra

28
Q

alpha blockers

list the agents

A
  • nonspecific: terazosi, doxazosin, prazosin
  • alpha 1a specific: sildosin, alfuzosin, tamsulosin
29
Q

alfuzosin admin

A

take with food, 50% decrease in absorption if taken on empty stomach

30
Q

alpha (nonselective) blockers ADR

A
  • hypotension
  • dizziness
  • blurred vision
  • drowsiness
  • astenia
31
Q

alpha 1a selective blockers ADR

A
  • RARELY hypotnsion, vertigo, drowsiness (dt alpha 1 specificity)
  • floppy iris syndrome
  • ejaculatory dysfunction
32
Q

alpha 1a selective blockers DDI

A

they are metabolized by CYP (alfuzosin is CYP3A4)

33
Q

5-alpha reductase inhibition (5aRI) MOA in BPH

A

reduces an enlarged prostate (3-6 month for symptom improvement (atrophies cells)

34
Q

5alpha reductace inhibitors

A
  • finasteride: inhibit type II 5-alpha-1 reductase, decrease DHT
  • dutasteriode: selective inhibitor of type I and II 5-alpha reductase; more potent
35
Q

PDE5 inhibitor MOA in BPH

A

unclear, but ptentially smooth muscle relaxation of prostate, bladder, urethra

study shows that alfuzosin + sildenafil may be better tahn monotherapy

36
Q

drrugs to avoid in bph

A
  • Saw palmetto: not effective
  • anticholinergics: reduce effect of detrusor contracton and bph pts need biggg push
    • TCAs
    • diphenhydramine
    • disopyramide
    • pseudoephedrine
    • ephedrine
37
Q

Jalyn is a combo medication of:

A

dutasteride and tamsulosin

can be good in pts with reallllly enlarged prostate

38
Q

ENTADFI is a combo medicatio of

A

finasteride and tadalafil

39
Q

BPH treatment guideliens

A
  1. alpha blocker (if conmittant ED, can start with PDE5)
  2. if lack of response to alpha blocker or cannot tolerate:
    - consider PDE5 trial
    - if prstate > 30 cc, consider addition of 5aRI
    - surgical options
  3. if indadequate reponse to PDE5 trial or additio of 5aRI, consider surgery
40
Q

drugs associated with ed

A
  • diuretics: TZDs and spironolactone
  • anti-HTN: BB (except nebivolol), methyldopa, clonidine
    • if possible, switch to ace, arb, ccb
  • cardiac or cholesterol drugs: digoxin, gemfibrozil
  • antidepressants: SSRI, TCA, Li, MAOI
  • tranquilizers: haldol, phenothiazines (chlorpromazine)
  • H2RA: cimetidine
  • hormones: progesterone, estrogen, CS, 5-alpha reductase inhibitors
  • cytotoxic agents: MTX
  • immunomodualtors: intereron alpha
  • anticholinergic: dispyramide, anticonvulsants
  • recreational drugs: etoh, cocaine
  • opioids
  • nsaids
41
Q

PDE5 inhibitor MOA in ED

A

smooth musle relaxatio -> inflow of blood

doesn’t cause an erectio, prevents if from going away

42
Q

PDE5 and nitrates

A

contraindicated; nitrate wait times
- sildenafil: 24 hrs
- vardenafil: 24 hrs
- tadalafil: 48 hrs
- av anafil: 24 hrs

43
Q

PDE5 and high fat meals

A

high fat meals
- decrease tmax and cmax of sildenafil
- cmax of vardenafil

44
Q

PDE5 with longest onset

A

vardenafil at 60 min

45
Q

sildenafil onset and duration

A
  • onset: 30-60 min
  • duration 2-4 hrs
46
Q

PDE5 iwtth longest duration

A

tadalafil: 24-36 hrs

47
Q

PDE5 iwht fastest osnet

A

avanafil: 15 min

48
Q

PDE5 ADR

A
  • GERD dt lower esophageal sphincter relaxation
  • hypotension
  • blurred vision (mostly sildenafl)
49
Q

how long should a pt waint until a PDE5 is considered ineffective at trating ED

A

pt should have 7-8 doses before med is cosidered ineffective

50
Q

vardenafil onset and duration

A
  • onset 60 min
  • duration 4-6 hrs
51
Q

tadalafil onset and duration

A
  • onset: 30-45 min
  • duratoni: 24-36 hrs
52
Q

avanafil onset and duration

A
  • onset: 15 min
  • duration: 4-6 hrs

PHM 704: gremlins and wizards (16 decks)

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