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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

25
desmopressin dose
- 50-65: 1.66mg in either nostril - 65+: 0.83 in either nostril (can increase after 1 week if Na levels wNL)
26
botox and OAB
- IM injectio to detrusor during cystoscopy - better efficac than meds but can go overboard and just shut down the bladder lol ## Footnote can be used in adults with inadequate response or intolerance tto anticholinergic med
27
alpha blocker MOA in BPH
reduce tone in bladder → urine can flow through urethra
28
alpha blockers | list the agents
- nonspecific: terazosi, doxazosin, prazosin - alpha 1a specific: sildosin, alfuzosin, tamsulosin
29
alfuzosin admin
take with food, 50% decrease in absorption if taken on empty stomach
30
alpha (nonselective) blockers ADR
- hypotension - dizziness - blurred vision - drowsiness - astenia
31
alpha 1a selective blockers ADR
- RARELY hypotnsion, vertigo, drowsiness (dt alpha 1 specificity) - floppy iris syndrome - ejaculatory dysfunction
32
alpha 1a selective blockers DDI
they are metabolized by CYP (alfuzosin is CYP3A4)
33
5-alpha reductase inhibition (5aRI) MOA in BPH
reduces an enlarged prostate (3-6 month for symptom improvement (atrophies cells)
34
5alpha reductace inhibitors
- finasteride: inhibit type II 5-alpha-1 reductase, decrease DHT - dutasteriode: selective inhibitor of type I and II 5-alpha reductase; more potent
35
PDE5 inhibitor MOA in BPH
unclear, but ptentially smooth muscle relaxation of prostate, bladder, urethra ## Footnote study shows that alfuzosin + sildenafil may be better tahn monotherapy
36
drrugs to avoid in bph
- Saw palmetto: not effective - anticholinergics: reduce effect of detrusor contracton and bph pts need biggg push - TCAs - diphenhydramine - disopyramide - pseudoephedrine - ephedrine
37
Jalyn is a combo medication of:
dutasteride and tamsulosin ## Footnote can be good in pts with reallllly enlarged prostate
38
ENTADFI is a combo medicatio of
finasteride and tadalafil
39
BPH treatment guideliens
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
drugs associated with ed
- 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
PDE5 inhibitor MOA in ED
smooth musle relaxatio -> inflow of blood ## Footnote doesn't cause an erectio, prevents if from going away
42
PDE5 and nitrates
contraindicated; nitrate wait times - sildenafil: 24 hrs - vardenafil: 24 hrs - tadalafil: 48 hrs - av anafil: 24 hrs
43
PDE5 and high fat meals
high fat meals - decrease tmax and cmax of sildenafil - cmax of vardenafil
44
PDE5 with longest onset
vardenafil at 60 min
45
sildenafil onset and duration
- onset: 30-60 min - duration 2-4 hrs
46
PDE5 iwtth longest duration
tadalafil: 24-36 hrs
47
PDE5 iwht fastest osnet
avanafil: 15 min
48
PDE5 ADR
- GERD dt lower esophageal sphincter relaxation - hypotension - blurred vision (mostly sildenafl)
49
how long should a pt waint until a PDE5 is considered ineffective at trating ED
pt should have 7-8 doses before med is cosidered ineffective
50
vardenafil onset and duration
- onset 60 min - duration 4-6 hrs
51
tadalafil onset and duration
- onset: 30-45 min - duratoni: 24-36 hrs
52
avanafil onset and duration
- onset: 15 min - duration: 4-6 hrs

PHM 704: gremlins and wizards (16 decks)

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