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Applied Pharmacology > Genitourinary System > Flashcards

Genitourinary System Flashcards

1
Q

Give examples of alpha blockers and what that drug is given to treat?

A
  • Doxazosin (BPH and HTN)
  • Tamsulosin (BPH)
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2
Q

What are the main indications for alpha blockers?

A
  • Benign prostatic hyperplasia
  • add on treatment for resistant HTN
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3
Q

What is the MOA of alpha blockers?

A

Highly selective for the alpha1-adrenoreceptors.

Bind and inhibit alpha1-adrenoceptors in smooth muscle (including blood vessels & urinary tract – bladder neck and prostate in particular) causing muscle relaxation:
- Vasodilation
- Fall in BP
- Reduced resistance to bladder outflow

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4
Q

what are the main side effects of Alpha Bloackers?

A

Side effects are as a result of the effects on vascular tone:
- Postural Hypotension
- dizziness
- syncope

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5
Q

What are the contraindications of alpha blockers?

A
  • Postural Hypotension
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6
Q

What are the key drug interactions of alpha blockers?

A
  • Antihypertensive drugs
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7
Q

Give some examples of anti-muscarinics?

A
  • Oxybutynin
  • Solifenacin
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8
Q

What are anti-muscarinics indicated in?

A

1st line treatment in overactive bladder to reduce urinary:
- Frequency
- Urgency
- Urge incontinence

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9
Q

What is the MOA of Anti-muscarinics?

A
  • Bind muscarinic receptors (M3 in bladder) and acts as a competitive inhibitor of acetylcholine (which contracts the bladder) to then promote bladder relaxation which increases bladder capacity and reduces urinary frequency, urgency and urge incontinence in overactive bladder.
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10
Q

What are the main side effects of anti-muscarinics?

A
  • Dry mouth
  • constipation
  • tachycardia
  • Blurred vision
  • urinary retention if there is an outflow obstruction.
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11
Q

What are the key contraindications of anti-muscarinics?

A
  • UTI
  • elderly
  • dementia
  • Pts susceptible to acute-angle glaucoma due to risk of rising intraocular pressure.
  • Pts at risk of arrhythmias
  • Pts at risk of urinary retention
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12
Q

What are the key drug interactions of anti-muscarinics?

A
  • other anti-muscarinics e.g., tricyclic antidepressants
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13
Q

Give an example of Phosphodiesterase type 5 inhibitors?

A

Sildenafil

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14
Q

What are the main indications for prescribing Phosphodiesterase type 5 inhibitors?

A
  • erectile dysfunction
  • primary pulmonary hypertension
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15
Q

What is the MOA of Phosphodiesterase type 5 inhibitors?

A

Selective for PDE Type-5 (PDE-5) - found in smooth muscle of the:
- Corpus cavenosum of the penis
- Arteries of the lung

Sexual stimulation releases nitric oxide (NO) which stimulates cGMP production causing:
- arterial smooth muscle relaxation
- vasodilation
- penile engorgement

  • Inhibition of PDE-5 prevents the breakdown of cGMP which
    increases cGMP concentrations and improves penile blood flow and erection quality
  • Causes arterial vasodilation in pulmonary vasculature
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16
Q

What are the main side effects of Phosphodiesterase type 5 inhibitors?

A

Due to vasodilator action:
- Flushing
- Headaches
- Dizziness
- Nasal congestion
- Hypotension
- Tachycardia
- Palpitations

  • Small risk of associated vascular events e.g. MI/ Stroke
  • Visual disorders (including colour distortion due to inhibition of PDE-5 in the retina)  urgent medical review
17
Q

What are the key interactions of Phosphodiesterase type 5 inhibitors?

A

Drugs that increase NO concentration e.g.,
- Nitrates
- Nicorandil
^^ combined effects on cGMP can cause marked arterial vasodilatation and cardiovascular collapse

Use with caution with other vasodilators due to increased risk of hypotension e.g.
- Alpha blockers (should not be take within 4h)
- Calcium channel blockers

Cytochrome P450 inhibitors can increase plasma concentrations and adverse effects of sildenafil e.g.
- Amiodarone
- Diltiazem
- Fluconazole

18
Q

What are the key contraindications of Phosphodiesterase type 5 inhibitors?

A

Avoid where vasodilation can be dangerous, including:
- Recent stroke
- Recent ACS
- History of CVS disease.

Avoid/ lower dose in pts with:
- Hepatic impairment )
- Renal impairment

19
Q

Give and example of 5 alpha reductase inhibitor?

A

Finesteride

20
Q

What are the main indications of 5-alpha reductase inhibitor?

A
  • 2nd line for BPH
  • LUTs
21
Q

Side effects of 5-alpha reductase inhibitors:

A

Relate to their antiandrogen action:
- Impotence (transient)
- Reduced libido (transient)
- Breast tenderness
- Gynecomastia
- Hair growth

Rare:
- Breast cancer in men

22
Q

What is a key contraindication of Finesteride?

A
  • Pregnant women should not even be exposed to them e.g. by handling broken or damaged tablets, or through semen during unprotected sex with a man taking these drugs  can cause abnormal development of the external genitalia in a male foetus

Applied Pharmacology (7 decks)

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