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PHARM 343 > Lower Urinary Tract Pharmacological > Flashcards

Lower Urinary Tract Pharmacological Flashcards

(55 cards)

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1
Q

Overactive Bladder
- Anticholinergic Mechanism

A

Blocks parasympathetic signals from activating detrusor muscles
- Reduces urination (Does not cure)

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2
Q

Alpha vs Beta Bladder Receptors

A

Alpha:
- Activation causes contraction of bladder neck resulting in increased resistance (Good for stress incontinence)

Beta
- Activation causes relaxation of bladder smooth muscle
(Good for urgency incontinence)

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3
Q

Overactive Bladder
- Antimuscarinic Summary

A

Decrease number of urinations and incontinence episodes
- Have side effects that may cause patient to stop taking
–> Cognition
–> Heart
–> Glaucoma

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4
Q

Overactive Bladder
- Antimuscarinic Adverse Effects

A

Dry Mouth
Dry Eyes
Confusion
Rapid Heart Rate
Urine Retention
Skin Flushing
Constipation

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5
Q

Overactive Bladder
- Antimuscarinic Heart

A

Solifenacin, Tolterodine, and Mirabegron can cause QT Prolongation
- Bradycardia
- Electrolyte Imbalance
- Heart Disease
- Kidney/Liver Impairment

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6
Q

Overactive Bladder
- Antimuscarinic Cognition

A

Older antimuscarinic medications are more likely to cross into the brain and cause confusion

Oxybutynin > Solifenacin > Tolterodine > Darifenacin > Fesoterodine > Trospium

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7
Q

Overactive Bladder
- Antimuscarinic Contraindications

A
  • Glaucoma
  • Myasthenia Gravis
  • GI: Obstruction, Inflammatory bowel, atony
  • Urogenital: Obstruction
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8
Q

Overactive Bladder
- Beta-3 Adrenergic Agonist

A

Mirabegron
- Relaxes bladder smooth muscle preventing contractions

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9
Q

Overactive Bladder
- Beta-3 Adrenergic Agonist Adverse Effects

A

Adverse Effects:
- Nausea, Diarrhea, Constipation, Dizziness, Headache

CV Safety:
- Tachycardia, Increased BP, Prolonged QT

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10
Q

Antimuscarinic Drugs

A

Oxybutynin

Tolterodine
Fesoterodine
Propiverine

Darifenacin
Solifenacin

Trospium

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11
Q

Overactive Bladder
- Anticholinergic Interactions

A

Interacts with antihistamines and TCA

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12
Q

Overactive Bladder
- Cholinergic Interactions

A

Interacts with Cholinesterase Inhibitors for dementia

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13
Q

FORTA Classification
- What is it

A

Highlights Medications and their safety in older adults
- Class A (Absolutely)
- Class B (Beneficial)
- Class C (Careful)
- Class D (Don’t)

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14
Q

FORTA Classification
- Overactive Bladder

A

A: No drugs
B: Fesoterodine
C: Most bladder drugs fall here
D: Propiverine, Immediate release Oxybutynin

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15
Q

Overactive Bladder
- Off Label Drugs

A

TCA
Dicyclomine
Flavoxate

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16
Q

Overactive Bladder
- Botulinum Toxin

A

Helps bladder muscles relax
- Used in Refractory Overactive Bladder
- Used in Chronic Urinary Infections
- Used in Neurologic Condition

Can make bladder too flaccid after treatment

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17
Q

Summary: How to Treat Overactive Bladder

A

Antimuscarinic
Beta-3-Agonist (Mirabegron)
Botulinum Toxin

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18
Q

Stress Incontinence
- Alpha Agonist

A

Ex. Pseudoephedrine

Squeezes off bladder neck to tighten the sphincter
- Some benefits, very stimulating drug that penetrates deep into CNS

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19
Q

Stress Incontinence
- Alpha Agonist Considerations

A

Not much evidence

Only use with non-pregnant women or men

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20
Q

Stress Incontinence
- Alpha Agonist Adverse Effects

A
  • Increased BP
  • Cardiac Arrhythmias
  • Anxiety
  • Insomnia
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21
Q

Stress Incontinence
- Hormone Therapy Mechanism

A

Sensitizes alpha receptors
- Increasing bladder resistance

Minimize atrophy
- Ensures bladder muscles maintain their strength

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22
Q

Stress Incontinence
- Hormone Therapy Considerations

A

Not much evidence

Testosterone therapy in men is avoided

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23
Q

Stress Incontinence
- Duloxetine Mechanism

Study These Flashcards
A

Off Label use for Urinary Incontence
- Selective 5-HT and NE reuptake inhibitor (For depression)

Increases sphincter contractility

24
Q

Stress Incontinence
- Duloxetine Adverse Effects

25
Stress Incontinence - Other Options
Surgical - Bladder Suspension Bulking Agents - Autologous Fat - Silicone
26
Summary: How to Treat Stress Incontinence
Alpha Agonists (Little Evidence) Hormone Therapy (Little Evidence) Duloxetine
27
Overflow Urinary Incontinence (BPH Treatment) - BPH Treatment
Surgery Catheterization (Allows patient to relieve urine) Pharmacotherapy
28
Overflow Urinary Incontinence (BPH Treatment) - Surgery
TURP (Transurethral Resection of the Prostate) Prostatectomy
29
Overflow Urinary Incontinence (BPH Treatment) - 5-Alpha Reductase Inhibitors Drugs
Finasteride, Dutasteride Dutasteride works faster (3 months compared to 6) Dutasteride reduces prostate size more
30
Overflow Urinary Incontinence (BPH Treatment) - 5-Alpha Reductase Inhibitors Mechanism
Prevent formation of DHT (Testosterone Analogue) Takes a long time to show any effects (3 months)
31
Overflow Urinary Incontinence (BPH Treatment) - 5-Alpha Reductase Inhibitors Adverse Effects
Impotence Decreased Libido Infertility Decreased Volume of Ejaculate
32
Overflow Urinary Incontinence (BPH Treatment) - 5-Alpha Reductase Inhibitors Considerations
Contraindicated in Hypersensitivity Increased risk for breast cancer and suicide - Monitor for mental health
33
Overflow Urinary Incontinence (BPH Treatment) - Alpha Antagonists Drugs
Tamsulosin Doxazosin Terazosin Alfuzosin Silodosin
34
Overflow Urinary Incontinence (BPH Treatment) - Alpha Antagonists Mechanism
Acts on alpha 1 receptors on prostate - Induces relaxation of muscles
35
Overflow Urinary Incontinence (BPH Treatment) - Alpha Antagonists Considerations
AM vs PM Dosing - AM: May experience dizziness and other adverse effects throughout the day - PM: Patient will sleep through adverse effects, however, may experience dizziness when they get up to urinate (risk of falls)
36
Overflow Urinary Incontinence (BPH Treatment) - Alpha Antagonists Adverse Effects
Dizziness Retrograde Ejaculation - Bladder neck may be too relaxed, causes ejaculate to backflow Floppy iris
37
Overflow Urinary Incontinence (BPH Treatment) - PDE5-I Drugs
Tadalafil Sildenafil Vardenafil
38
Overflow Urinary Incontinence (BPH Treatment) - PDE5-I Mechanism
Relaxes smooth muscle of prostate and bladder - Relaxation also allows blood to flow, good for treating Erectile Dysfunction
39
Overflow Urinary Incontinence (BPH Treatment) - PDE5-I Adverse Effects
Headache Dyspepsia NAION (Blood loss to optic nerve) Priapism (Long lasting erection)
40
Overflow Urinary Incontinence (BPH Treatment) - PDE5-I Considerations
Contraindicated in - Cardiovascular Diseases - Nitrates - Non-Selective Alpha Blockers --> May go into shock because BP gets too low Interactions with: - Nitrates - Alpha-Blockers - Antihypertensive agents
41
Overflow Urinary Incontinence (BPH Treatment) - Alpha Antagonists vs PDE5-I
Quite similar - Choice depends on patient's comorbidities and how quick patient wants to see improvement Tadalafil is quicker takes effect in first few weeks Finasteride takes months
42
Overflow Urinary Incontinence (BPH Treatment) - NHP Drug
Saw Palmetto
43
Overflow Urinary Incontinence (BPH Treatment) - NHP Mechanism
5-Alpha Reductase Inhibition Decreased DHT Triggers Prostatic Cell Apoptosis Anti-inflammatory effect
44
Overflow Urinary Incontinence (BPH Treatment) - NHP Considerations
Contraindicated in Hypersensitivity Not recommended for treatment of BPH or LUTS
45
Underactive Bladder - Cholinergic Drugs
Bethanechol
46
Underactive Bladder - Cholinergic Mechanism
Stimulates bladder contraction (Parasympathetic) --> Allows for urination
47
Underactive Bladder - Cholinergic Considerations
Contraindicated in: - Bradycardia - Uncontrolled asthma - Active Peptic Ulcer Disease - Seizure Disorders Interactions with: - Cholinesterase Inhibitors - Anticholinergics - Procainamide - Quinidine
48
Underactive Bladder - Cholinergic Adverse Effects
GI Motility Salivation Flushing
49
Underactive Bladder - Other Options
PGE2 Intravesically Cholinesterase Inhibitors Stem Cell Therapy Sacral Neuromodulation
50
Summary: How to Treat Overflow UI
BPH Treatments - Alpha Antagonist - 5-Alpha Reductase Inhibitors - Phosphodiesterase 5 Inhibitors Neurogenic Treatments - Cholinergic Agonist
51
Nocturia - Desmopressin Mechanism
Increases reabsorption of water - Less urine produced
52
Nocturia - Desmopressin Adverse Effects
Nausea Headache Dizziness Hyponatremia
53
Nocturia - Diuretics Mechanism
Furosemide dosed in the afternoon to urinate fluid before going to bed
54
Summary: How to treat Nocturia
Desmopressin Diuretics
55
LUTS Monitoring
Efficacy - How many urgent continence episodes - How many leakage episodes Validates Questionnaires - ICIQ-UI - International Prostate Symptom Score Timeline - Usually monthly - Some medicines have earlier responses (Alpha Antagonists)

PHARM 343 (35 decks)

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