Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
BPH, UI, ED
Pharm-II
| Question | Answer |
|---|---|
| When does incidence of ED increase | in men over 50-50 yo and goes to 40% 60-69% |
| Med conditions associated with ED | HTN, Arterosclerosis, hyperlipedimia, DM, Psych d/o |
| Meds that cause erectile dysfunction | anticholinergic agents, Dopamine, agonists, estrogents, antianderogens, CNS depressants, agents decrease penile blood floow (anti HTN drugs) |
| In general, how do we approach ED tx | identify and reverse underlying cause |
| Nonparhm tx to ED | lifestyle modifications (lipids), psychotherapy, vacuume erection device, surgical tx (penile prosthesis) |
| What is the main drug of choice for ED | Phosphodiesterase inhibitors |
| MOA of PDE5 | inhibits the breakdown of cGMP which prolongs smooth muscle relaxation (vasodilation) |
| 3 examples of PDE5 | sildenafil, vardenafil, tadalafil (all substrate of CYP systems) |
| Which PDE5i works the fastest? | sildenafil (30-60m) |
| Which drug is a weak CYP inhibitor | sidenifil |
| Which is the longer acting PDEi and when do we use it | Tadalafil (Cialis) works up to 36 hours |
| Dosing for tadlafil | 10mg prior to sex or 2.5mg qday for pts who take the other >2/week |
| AE’s PDEi | HA, facial flushing, dyspepsia, nasal congestion dizzy, abnl vision |
| What is a prolonged erection and priapism | >4hrs, >6hrs |
| What are some serious but rare SE’s | priapism, and anterior ischemia of the optic neropathy |
| With sildenafil-assicaited deaths, what did most pts die from? | MI, or CA, CV |
| What is CI with using PDEs | nitrate use, and high CV risk |
| What drugs are CI with PDEs | nitrates, alpha blockers, CYP inhibitors |
| What is the OTHER drug that is used for ED | alprostadil: stimulates adenyl cyclase: ↑production of cAMP→vasodialation |
| Two types of dosing | caverjet: intracavernosa: 5-10mins before, Muse (intraurethral) |
| AE’s of alprostadil | local pain, syncope, dizzy, priapism, fibrotic rxn in injection site (caverjet) |
| Algorithym for ED | organic: PDEi→intracavernosal alprostadil→intraurethral alprostadil→penile prosthesis |
| Three mechanisms for BPH | excess testosterone, excessive a-adrenergic tone, bladder detrusor muscle instability |
| Drugs that ↑ bBPH | testosterone, anticholinergics, symptahomimetics |
| What are examples of antihistamines | 1st generation antihistamines, phenothiazines, TCAs: ↓ detrusor contractility |
| Examples of sympathomimetics and their action | pseudoephedrine, oxymetazoline, phenylephdrine: excess a-adrenergic tone of prostate and bladder neck |
| AUA sx score for mild, mod, sever | mild <7 Mod 8-19 severe: >20 |
| Mild typical s/s for BPH | peak urin flow rate <10ml/s, postvoid residual>25-50, ↑ BUN and SCr |
| Mod s/s for BPH | same as mild + obstructive voiding sxs and irritative voiding (signs of detrusor instability) |
| Severe sigsn of BPH | all above + more complications of BPH |
| Tx goals for BPH | ↓ sxs, ↓ dz progression, prevent complications |
| BPH compliications | post-renal/chronic renal failure, infx, hematuria, bladder stones |
| Tx for mild, mod, sev | mild: watchful waiting mod: pharm tx severe: surgery |
| Three catagories for BPH tx | a1 and a1a blockers: relax smooth muscle and may ↓ prostate size, 5-areductase inhibitor: ↓ conversion of testosterone to DHT, Herbals |
| How long does a1 and a1a onset usually take | 2-4wekks |
| What is 1st line for moderate dz | a1 a1A blockers |
| What is the MC a1 and a1A drug | a1: terazosin a1A: tamsulosin |
| Which drug is most likely to cause abnl ejaculation | silodosin: a1A blocker |
| What is finasteride, used when | 5a-reductase inhibitor , when prostate >50g |
| Name two herbals can be used for BPH, which one more effective | Beta-sitosterol pygeum, saw palmetto, 1st better |
| Onset of action for 5a-reductase inhibitors | 6m may cause ↓ libido |
| What may ↑ tx effective ness | combination drugs (dutasteride/tamsuloxin: jalyn) |
| Three mechanisms for urinariy incontinence | Detrusor muscle control, internal and external urethral sphincter |
| What controls the detrusor muscle | both parasympathetics and B-adrenergic |
| What contraols the internal urethral sphincter | alph-adrenergic |
| What controls the external urethral sphincter | somatic or voluntary control |
| Is incontinence a nl part of aging | no, age predisposes, but doesn’t cause |
| 4 types of incontinence | urge, stress, overflow, functional |
| What is not caused by bladder or urethra-specific factors for incontinence | functional |
| Causes/rf’s for UI (diappers) | delirium, infx, atrophic urethritis/vaginitis, pharm, psych, excessive uring output, restricted mobilitys, stool imbaction |
| What drugs can cause urinary retention | CCBs, narcotics, antipsychotics, anticholinergics, a-receptor antagonist(men) |
| What are diruetics to avoid for UI | alcohol and caffeine |
| What are s/s of urge (bladder overactivity) | loss of mod-lg vols of urine w/ intense need to void |
| Three drug classes for urge incontinence | anticholinergics, TCAs, topical estrogen (only w/ urethritis or vaginitis) |
| What is 1st line for urge incontinence | anticholinergics |
| What are anticholinergics used | oxybutynin, tolterodine |
| s/s of stress (uretheral underactivity) | loss of sm vols of urine, from ↑ abd pressure |
| classes for stress UI | 5-HT/NE reuptake inhibitar: smooth muscle control: a-adrenergic agonists, topical estrogen, imipramine |
| 1st line for strees UI | duloxetine, (alternative is a-adrenergics: pseudophedrine) imipramine 2nd line |
| What are s/s for overflow/urethral overactivity, bladder underactivity | weak stream, dribbline ↑ frequency and incomplete voiding |
| Tx for above | Cholinomimetics: bethanechol: short term use only |
| What are CI for bethanechol | heart dz or asthma |
| s/s for functional UI and tx | impaired mobility, cognitive impairment: scheduled bathroom breaks |
Created by:
becker15
Popular Pharmacology sets