Fred Gage Flashcards
define BPH
Benign prostatic hyperplasia refers to an increase in number of cells.
RFs for BPH
older age, black ethnicity
Pathophysiology of BPH
Thought to be a result of failure of apoptosis.
Clinical features of BPH
BPH presents with lower urinary tract symptoms:
Hesitancy in starting urine, urgency but reduced force of urine stream, increased frequency of urination nocturia, but not true polyuria (large amounts of urine), this is when you have increased frequency and only produce small amount of urine each time.
Straining to void (begin)
Terminal dribbling.
ED
retrograde ejaculation
Ix for BPH
Urine dipstick to exclude infection
PSA for prostate cancer
Digital rectal exam
Abdo exam for palpable bladder: indicates urine retention.
Bloods: check for urea and electrolytes, any evidence of renal failure.
Urine flow analysis: maximum urine flow rate, if reduced urine flow rate, then it can be confirmation of BPH.
Mx of BPH
often none
5 alpha reductase inhibitors e.g. finasteride
Transurethral resection of the prostate
MICA atenolol
M:
Beta blocker
B1 adrenoceptors are located in the heart and B2 adrenoceptors are found in the smooth muscle of blood vessels and airways. Via the B1 receptor, B-blockers reduce the force of contraction and speed of conduction in the heart. This relieves myocardial ischaemia by reducing the cardiac work and oxygen demand and increasing myocardial perfusion. They improve prognosis in heart failure, by protecting the heart from chronic sympathetic stimulation.
They slow the ventricular rate in AF mainly by prolonging the refractory period of the AV node. Through the same effect, they may terminate SVT if this is due to a self-perpetuating (re-entry) circuit that takes in the AV node.
In hypertension, B -blockers lower BP through a variety of means, one of which is by reducing renin secretion from the kidney, since this is mediated by B1 receptors.
I:
Ischaemic heart disease - improve symptoms associated with angina and acute coronary syndrome
Chronic heart failure
Atrial fibrillation
Supraventricular tachycardia (SVT)
Hypertension
C:
In patients with asthma, B-blockers will cause life threatening bronchospasm and should be avoided
When used in heart failure, B-blockers should be started at very low dose and increased slowly as they may impair cardiac function.
Should be avoided in pts with haemodynamic instability and heart block.
A:
Cause fatigue, cold extremities, headache and GI disturbance (eg. nausea)
Can cause sleep disturbance and nightmares
May cause impotence in men.
MICA Pioglitazone
It is of Thiazolidinedione class. It is an anti-diabetic used to treat type 2 diabetes.
Mechanism of action:
Pioglitazone selectively stimulates the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-y) and to a lesser extent PPAR-a. It modulates the transcription of the genes involved in the control of glucose and lipid metabolism in the muscle, adipose tissue and the liver. As a result, pioglitazone reduced insulin resistance in the liver and peripheral tissues, decreases gluconeogenesis in the liver, and reduced quantity of glucose and glycated haemoglobin in the bloodstream.
Indications:
- Used to lower blood glucose levels in type2 diabetes either along or in combination with a sulfonylurea, metformin or insulin.
Contraindications
- Known hypersensitivity to pioglitazone, other TZDs or any of components of its pharmaceutical forms.
- Its safety in pregnancy, lactation and people under 18 is not established.
Adverse effects
- Hypoglycaemia, risk is low in the absence of other drugs that lower blood glucose
- Fluid retention and peripheral oedema
- Mild weight again dude to increase in subcutaneous adipose tissue.
- Chronic administration of the drug has led to occasional instances of cholestatic hepatitis
MICA gliclazide
M: Gliclazide is an oral antihyperglycemic agent used for the treatment of non-insulin-dependent diabetes mellitus (NIDDM).
Gliclazide binds to the β cell sulfonyl urea receptor (SUR1). This binding subsequently blocks the ATP sensitive potassium channels. The binding results in closure of the channels and leads to a resulting decrease in potassium efflux leads to depolarization of the β cells. This opens voltage-dependent calcium channels in the β cell resulting in calmodulin activation, which in turn leads to exocytosis of insulin containing secretorty granules.
I: T2DM
C: acute porphyrias
A: anaemia, angiodema, dyspepsia, GI disorder
What is a cataract?
clouding of lens in eye
symptoms of cataracts
Your vision is cloudy or blurry
Colors look faded
You can’t see well at night
Lamps, sunlight, or headlights seem too bright
You see a halo around lights
You see double (this sometimes goes away as the cataract gets bigger)
You have to change the prescription for your glasses often
RFs for developing cataracts
Have certain health problems, like diabetes
Smoke
Drink too much alcohol
Have a family history of cataracts
Have had an eye injury, eye surgery, or radiation treatment on your upper body
Have spent a lot of time in the sun
Take steroids (medicines used to treat a variety of health problems, like arthritis and rashes)
