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METABOLIC > PPT - UROLOGY + HAEMATOLOGY > Flashcards

PPT - UROLOGY + HAEMATOLOGY Flashcards

1
Q

What classes of drugs are used for urinary urgency (aka overactive bladder syndrome)?

A

Muscarinic receptor antagonists
Beta 2 adrenoreceptor agonist

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2
Q

What are examples of muscarinic receptor antagonists?

A

Oxybutinin
Tolterodine

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3
Q

What are examples of beta 3 adrenoreceptor agonists?

A

Mirabegron

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4
Q

What are the side effects of antimuscarinics?

A

Dry mouth
Tachycardia
Constipation
Blurred vision
Urinary retention is bladder outflow obstruction

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5
Q

What are contraindications for Anticholinergics?

A

Closed angle glaucoma
GI obstruction
Intestinal agony
Myasthenia gravis
Paralytic ileus
Plyoric stenosis
Severe UC
Significant bladder outflow obstruction
Urinary retention

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6
Q

What are contraindications for beta-3 adrenergic receptor agonists e.g. mirabegron?

A

Severe uncontrolled hypertension

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7
Q

What are the side effects of beta 3 receptor agonist side effects?

A

Hypertension
Constipation
Headache

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8
Q

What treatment options are there for stress incontinence?

A

Pelvic floor exercises
Surgery
Vaginal oestrogens
Duloxetine - SSRI

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9
Q

How do vaginal oestrogens work for managing stress inconsistency?

A

???
In women who have gone through the menopause low oestrogen levels may contribute to urinary incontinence.
Should only be used in post-menopausal women who have vaginal atrophy!!

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10
Q

Who is duloxetine recommended for when considering management of stress incontinence?

A

It may be used second-line where conservative treatment including pelvic floor training has failed, and only if surgery is not appropriate or the woman prefers pharmacological treatment, but should not be offered routinely.

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11
Q

What non-drug treatment should be offered for urgency incontinence?

A

Bladder training

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12
Q

What no drug treatment should be offered for mixed incontinence?

A

Pelvic floor and bladder training

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13
Q

How should you pharmacologically manage a woman with mixed incontinence?

A

Women with mixed urinary incontinence should be treated according to the predominant type, refer to Urgency incontinence or Stress incontinence for drug treatment options.

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14
Q

How do you assess the severity of BPH?

A

International Prostate Severity Score (IPSS)

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15
Q

What is the first line therapeutic intervention for BPH?

A

Alpha blockers

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16
Q

Why are alpha adrenoreceptor first line over 5 alpha reductase inhibitors?

A

They work faster. 5 alpha reductase inhibitors can take up to 6 months to work
Less severe side effects

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17
Q

Whats the moa of alpha blockers in BPH?

A

work by relaxing the smooth muscle in the prostate and the bladder neck, which can improve urine flow and reduce urinary symptoms.

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18
Q

What are the potential adverse effects of alpha blockers?

A

Orthostatic hypotension
Headaches
ED
Rhinitis
Dizziness
Asthenosphere
Oedema

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19
Q

What are the main drug interactions with alpha blockers?

A

Other hypotensive agents
PDE5 inhibitors such as sildenafil - causes significant hypotension

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20
Q

Describe the moa of 5-alpha-reductase inhibitors in BPH?

A

inhibiting the activity of the enzyme 5-alpha-reductase. This enzyme is responsible for converting testosterone to dihydrotestosterone (DHT), which is a hormone that promotes the growth of the prostate gland. By inhibiting 5-alpha-reductase, 5-ARIs reduce the levels of DHT in the prostate gland and peripheral tissues, which can lead to a decrease in the size of the prostate gland and an improvement in urinary symptoms.

21
Q

What are the adverse drug effects of 5-alpha-reductase inhibitors?

A

Breast enlargement and tenderness
Decreased libido
Impotence
Ejaculation disorders e.g. retrograde ejaculation

22
Q

What are drug interactions of 5-alpha-reductase inhibitors?

A

Non-dihydropyrimidine CCB as they increase the drug levels

23
Q

Why must pregnant women be careful around 5-alpha reductase inhibitors?

A

It can cause abnormal development of the male foetus external genitalia so women must not take them or be exposed to them. They must not even touch them as they are very readily absorbed thrigh the skin

24
Q

Why are 5 alpha reductase inhibitors more effective than alpha blockers over time?

A

As they actually stop the conversion of testosterone to dihydrotestosterone so they actually reduce the growth of the prostate rather than just providing symptomatic relief

25
Q

Who should be offered a 5 alpha reductase inhibitor first line for BPH?

A

If raised PSA, enlarged prostate and at high risk of progression e.g. the elderly

26
Q

How is finasteride excreted?

A

In the semen

27
Q

What drug classes can be given for prostate cancers?

A

Antiandrogens
Gonadorelin analogues

28
Q

Whats an example of an anti androgen?

A

Flutamide

29
Q

Whats an example of a GnRH analogues?

A

Leuprolide
Goserelin
Buserelin
Gonadorelin

30
Q

How do GnRH analogues work for prostate cancer?

A

They cause an initial increase in LH and FSH - chronic use results in a sustained suppression of these and serum testosterone levels fall to levels comparable to surgical castration

31
Q

What drug class is best for urothelial bladder cancer treatment?

A

Cisplatin-based combination therapy

32
Q

What drug classes are used for renal cell carcinomas?

A

Tyrosine kinase inhibitors - sorafenib, sunitinib
MTOR inhibitor - everolimus
Tyrosine kinase receptor inhibitor - bevacizumab

33
Q

What mets are renal cell carcinoma most likely to cause and why?

A

Cannon ball mets in the lungs as they grow very quickly down the renal veins

34
Q

Which iron salts are used for managing IDA?

A

Ferrous sulphate
Ferrous fumarate
Ferrous glutamate
(Choice usually decided by cost and SE)

35
Q

When is parenteral iron used to treat IDA/

A

When oral therapy is unsuccessful e.g. cannot tolerate or if continuous blood loss or malabsorption

36
Q

What are parenteral iron options for IDA management?

A

Iron dextran
Iron sucrose
Ferric carboxymaltose
Iron isomaltoside

37
Q

What is heme iron? What is non-heme iron?

A

Iron from meat - FE2+ can be easily absorbed

Non-heme
Iron from plants - Fe3+ must be converted to Fe2+ first before absorption

38
Q

How does the body regulate iron levels?

A

Just through absorption - the body has no way to excrete iron other than through the skin which is why haemachromatosis causes bronze discolouration of the skin

39
Q

What are the adverse drug effects of iron?

A

Constipation
Diarrhoea
Epigastric pain
Faecal impaction
GI irritation
Nausea

40
Q

What drug interactions reduce iron absorption? How should we tell a pt to help this?

A

Calcium and zinc salts
Levothyroxine
Bisphosphonates
Ciproflox
Tetracyclines

They should take these meds 2 hours before oral iron

41
Q

Why do some oral iron preparations contain vitamin C?

A

As vitamin C helps cotransport iron - increases absorption of iron

42
Q

Why is ferrous gluconate typically used if ferrous fumarate or ferrous sulphate isnt tolerated?

A

as it has half the elemental iron content so causes less adverse efefcts (also takes longer to replenish iron levels)

43
Q

Whats the oral dose of elemental iron recommended for IDA/

A

100-200mg daily

44
Q

Whats the recommended duration of treatment in IDA? Why?

A

After Hb is back to normal continue for 3 months after as the bone marrow stores need replenishing too!

45
Q

When giving iron therapy, how much should the Hb concentration rise a day?

A

1-2g/L a day over 3-4 weeks

46
Q

Whats the risk of low folic acid in pregnancy?

A

Increased risk of neural tube defects (involved in DNA methylation)

47
Q

When should a pregnant women start taking folic acid and why?

A

From before she is pregnant to 12 weeks of pregnancy
This is the phase of organogenesis. It’s important to start before she is pregnant as typically half the organogenesis occurs before a woman knows she os pregnant

48
Q

Why should you always give vitamin B12 before starting folic acid in a pt?

A

If you treat folate deficiency and the pt also has a B12 deficiency there is a risk of a very severe B12 deficiency which can preciptate subacute combined degeneration of the cord (i.e. folic acid deficiency can mask the symptoms of a B12 deficiency)
So you should always give IM hydroxycobalamin before starting folic acid!

METABOLIC (43 decks)

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