Exam 2 lecture 8 Flashcards Preview

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Flashcards in Exam 2 lecture 8 Deck (57):
1

drug dosing is mostly based on

CrCl

2

PK changes

- bioavailability (absorption)
- drug distributio
- metabolism (Phase 1 & II slowed)
- renal elimination

3

volume of distribution

- reduction in tissue binding
- body composition altered
-protein binding (decreased binding of acidic drugs, altered binding of basic drugs)

4

normal phenytoin concentration

-10-20mcg/mL
-90% bound normally
- low albumin-> difference in ratio

5

renal elimination

- decreased glomerular filtration, renal tubular secretion & reabsorption
- accumulation of metabolites
- efficacy (codein, procainamide)
- toxicity (meperidine, propoxyphene)

6

pts on dialysis have CrCl of

7

intermittent dialysis

maintains a high concentration until dialysis then drops

8

continuous dialysis

more like normal kidney function

9

drug characteristics that affect removal in HD

- MW
- water solubility
-protein binding
- Vd

10

PD is

not as effective as HD at removing substances

11

Metformin is contraindicated with

SCr>1.4 in females 1.5 in males
- risk of lactic acidosis

12

drugs needing dose adjusted

- warfarin, LMWH
- phenytoin
- spironolactone, digoxin, procainamide
- NSAIDs, meperidine, morphine
-insulin, glyburide, metformin
-ABX: AGs, cephs, PCN, FQs, vanc
- gout: colchicine & allopurinol

13

Metformin is contraindicated with

SCr>1.4 in females 1.5 in males
- risk of lactic acidosis

14

is overactive bladder (OAB) more common in M/F ?

=

15

is OAB with incontinence more common in M/F?

females

16

urge urinary incontinence

- OAB
- detrusor contracts during filling phase

17

stress urinary incontinence

- urethra or urethral sphincters cannot sufficiently impede urine flow

18

overflow incontinence

- bladder underactivity
- bladder outlet obstruction (BOO)

19

functional

unrelated to urethral or bladder capability

20

symptoms of urge urinary incontinence

- frequency (>8Xday) & urgency
- nocturia (>1/night) &/or enuresis (nocturnal incontinence)
- usually large volume due to complete emptying

21

stress urinary incontinence

- urethral underactivity
- UI during activities
- small volume

22

overflow incontinence

- bladder is full but unable to empty
- bladder underactivity (loss of function of detruser muscle)
- BOO(BPH)
- difficulty initiating stream, dribbling, small amounts of urine leaking constantly

23

pelvic floor muscle rehab is used in

stress UI

24

bladder training is used in

urge UI

25

urge UI treatment

- anticholinergics/ antispasmodics 1st line (oxybutynin or tolterodine)
- oxybutynin IR (ditropan): gold standard

26

adverse effect of oxybutynin

orthostatic hypotension

27

oxybutynin IR

- ditropan
- 2.5-5mg PO 2-3x/day

28

oxybutinin ER

- ditropan XL
- 5-10mg PO QD
- decreased ADE

29

oxybutynin transdermal

- oxytrol
- OTC

30

tolterodine

- detrol, detrol LA
- IR: 2mg PO BID
- ER: 4mg PO QD
- alternative 1st line for urge UI
- no orthostatic hypotension

31

fesoterodine

- toviaz
- alt 1st line for urge UI

32

solifenacin

- vesicare
- urge UI

33

darifenacin

- enablex
- urge UI

34

trospium

- sanctura
- urge UI

35

mirabegron

- myrbetriq
- beta3 agonist
- consider in those intolerant of anticholinergic effects
- 25-50mgPO QD
- urge UI

36

tricyclic antidepressents

- urge UI
- reserved in those with a concurrent indication (peripheral neuropathy, depression)
- orthostatic hypotension
- overdoses are potentially life-threatening
- desipramine & nortiptyline preferred due to

37

tricyclic antidepressents

- urge UI
- reserved in those with a concurrent indication (peripheral neuropathy, depression)
- orthostatic hypotension
- overdoses are potentially life-threatening
- desipramine & nortiptyline preferred due to decreased side effects

38

duloxetine

- cymbalta
- 1st line is stress UI
-40mg PO BID

39

alpha-adrenergic agonist

- stress UI
-pseudoephedrin 15-60mg TID
- phenylephrine 10mg QID

40

topical estrogens

- Stress UI in combo with urethritis or vaginitis due to estrogen deficiency

41

overflow incontinence treatment

- intermittent self catherization 3-4X/day
- bethanechol: rarely used

42

epithelial tissue of prostate

produces prostatic secretions

43

stromal tissue of postate

smooth muscle c ontraction if alpha-adrenergic receptor stimulated

44

capsule tissue of prostate

- fibrous, connective tissue that also contracts when alpha-adrenergic receptor stimulated

45

pathophys of BPH

- static factors: growing prostate
- dynamic factors: alpha stimulation
- detrusor factors: 2* to BOO

46

symptoms of BPH

- obstructive: diminished stream, urinary hesitancy, incomplete bladder voiding
- irritative: urinary frequency & urgency, nocturia

47

mild BPH

- aymptomatic
- peak urinary flow rate 25-50mL

48

moderate BPH

- all of mild plus obstructive or irritative voiding symtoms

49

severe BPH

- all of moderate plus one or more complication of BPH

50

mild BPH treatment

- watchful waiting
- behavior modification

51

severe BPH symptoms & complications treattment

surgery

52

alpha- adrenergic antagonists

- do not reduce prostate side
- relax intrinsic urethral sphincter & prostatic smooth muscle

53

3rd generation alpha blockers

- tamsulosin (flomax) & silodosin

54

2nd generation alpha blockers

prazosin, terazosin (Hytrin), doxazosine (Cadura), alfuzosin
- terazosin & doxazosin 1 mg PO at bedtime
- orthostatic hypotension

55

3rd generation alpha blockers

- tamsulosin (flomax) & silodosin
- tamsulosin 0.4mg PO QD
- avoid in sulfa allergy
- good in pts at risk for hypotension

56

5- alpha reductive inhibitors

- reduce size of prostate
- decrease intraprostatic DHT & SDHT
- takes 6-12 months to take effect
- second line in sexually active men
- pregnancy X
- dutasteride (Avodart) 0.5mg PO QD
- finasteride (proscar) 5mg PO QD

57

BPH treatment not commonly used

- GNrh antagonists
- antiandrogens