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Genitourinary > Pharm 40 Objectives > Flashcards

Pharm 40 Objectives Flashcards

1
Q

What are the 4 different types of urinary incontinence?

A
  • Stress incontinence
  • Urge incontinence/OAB
  • Overflow incontinence
  • Mixed incontinence: combination of stress and urge (MC)
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2
Q

What are the classes of mediations used to treat OAB?

A
  • Antimuscarinics
  • Beta-3 Agonist
  • Local Estrogen
  • Paralytic Agent
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3
Q

What is the MOA of antimuscarinics?

A

Relax/block excess detrusor activity

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4
Q

What is the efficacy/benefit of antimuscarinics?

A

Modest benefit, no improvement on the sphincter

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5
Q

What are the ASEs of antimuscarinics?

A
  • Dry mouth
  • Dry eyes
  • Confusion
  • Constipation
  • Dizziness
  • Blurred vision
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6
Q

What are the drug interactions that you need to note before giving an antimuscarinic?

A
  • Alzheimer agents: Donepezil and Galantamine

- Antihistamines, Anti-Depression, B/P meds: cause addictive SEs

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7
Q

What are the drugs in the antimuscarinic class?

A
  • Oxybutynin (Patch or PO)
  • Tolterodine
  • Fesoterodine
  • Darifenacine
  • Solifenacine
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8
Q

What is an advantage of the Oxybutynin patch?

A
  • Avoids 1st pass effect
  • Low steady drug levels
  • Less antimuscarinic SEs
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9
Q

Are the new antimuscarinics more receptor sensitive or specific?

A

More receptor specific

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10
Q

What is the MOA of Beta-3 Agonist?

A

Relaxes the detrusor smooth muscle during urine storage phase thus increasing bladder capacity

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11
Q

What is the efficacy/benefit of Beta-3 Agonist?

A
  • Modest benefit

- Full Effect takes up to 8 wks

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12
Q

What is the ASE of Beta-3 Agonist?

A

HTN

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13
Q

What are the drug interactions that you need to note before giving a Beta-3 Agonist?

A

Warfarin

- need to monitor INR

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14
Q

What drug is apart of the Beta-3 Agonist class?

A

Mirabegron

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15
Q

What is the MOA of local estrogen?

A
  • Plumps up the tissue around the bladder sphincter

- Applied to vaginal/external urethra

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16
Q

What is the efficacy/benefit of local estrogen?

A

Benefit post menopausal women w/vaginal atrophy

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17
Q

What is the MOA of Paralytic agents?

A
  • Prevents muscular contraction by inhibiting Ach release at the NM junction
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18
Q

What drug is apart of the Paralytic agents?

A

Botulinum Toxin A intravesical injection

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19
Q

What medication can contribute to or interfere with treatment of OAB?

A
  • Diuretics: thiazides and loop diuretics
  • Anticholinergic medications: use for nocturnal enuresis
  • Cholinergic Medications: Bethanechol [use to wake the bladder], Aricept, Exelon, Pilocarpine
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20
Q

What drug is apart of the Cholinergic agonists?

A

Bethanechol

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21
Q

What is the MOA of Bethanechol?

A

Stimulates parasympathetic nervous system, increases bladder muscle tone causing contractions with initiate urinate.

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22
Q

What is the Bethanechol place in therapy?

A
  • Neurogenic bladder
  • Acute postoperative and postpartum NON-obstructive urinary retention
  • Neurogenic atony of the bladder w/ urinary retention
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23
Q

What is the ASEs of Bethanechol?

A

Increase HR contractility

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24
Q

What are the 4 non-pharmacological treatments for OAB?

A
  • Timed/prompted voiding
  • Pelvic flood muscle strengthening exercises (Kegels)
  • Biofeedback
  • Eliminate suspected bladder irritants
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25
Q

What does Timed/prompted voiding help with? and describe the “best patient” for this treatment.

A
  • Helps avoid full bladder

- Good for pt w/stress, overflow, and functional incontinence

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26
Q

What does Pelvic flood muscle strengthening exercises (Kegels) help with? and describe the “best patient” for this treatment.

A
  • Connect brain with bladder to gain conscious control of pelvic flood muscle and sphincters
  • Need motived pts willing to learn
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27
Q

Pelvic floor muscle strengthening exercises (Kegels) may not help pts with what?

A

May NOT help pts w/ nerve damage or dementia

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28
Q

What does Biofeedback help with? and describe the “best patient” for this treatment.

A
  • Helps to learn how to contract pelvic floor muscles, need special equipment
  • Pt needs to be motivated and willing to learn
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29
Q

What are possible bladder irritants that should be eliminated?

A
  • Sugar substitutes, diet sodas
  • Caffeine
  • Alcohol
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30
Q

What is the MC organism and preferred treatment for Acute uncomplicated cystitis?

A
  • MC Organism: E.coli

- Preferred: Nitrofurantoin

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31
Q

What is the MC organism and preferred treatment for Recurrent cystitis including prophylaxis?

A
  • MC Organism: E.coli

- Preferred: Nitrofurantoin

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32
Q

What is the MC organism and preferred treatment for Pyelonephritis?

A
  • MC Organism: E.coli

- Preferred: Ciprofloxacin

33
Q

What is the MC organism and preferred treatment for Vaginal yeast infection?

A
  • MC Organism: Candida albicans

- Preferred: Azole topicals or Fluconazole oral

34
Q

What is the MC organism and preferred treatment for Bacterial prostatitis; acute and chronic?

A
  • MC Organism: E.Coli

- Preferred: Cipro or TMP/SMS, Cipro or Levo

35
Q

What is the MC organism and preferred treatment for Chlamydia?

A
  • MC Organism: Chlamydia trachomatis

- Preferred: Azithro 1g PO or Doxy x7 days

36
Q

What is the MC organism and preferred treatment for Genital Herpes?

A
  • MC Organism: Herpes simplex

- Preferred: Acyclovir or Valacyclovir

37
Q

What is the MC organism and preferred treatment for Gonorrhea?

A
  • MC Organism: Neisseria gonorrhea

- Preferred: Ceftriaxone IM x1 + Azithro 1g PO x1

38
Q

What is the MC organism and preferred treatment for Syphilis?

A
  • MC Organism: Treponema pallidum

- Preferred: Penicillin G benzathine IM x1

39
Q

What is the MC organism and preferred treatment for Trichomoniasis?

A
  • MC Organism: Trichomonas vaginalis

- Preferred: Metronidazole 2mg PO x1

40
Q

What is the clinical effectiveness and typical treatment strategies for the use of acyclovir or valacyclovir for genital herpes?

A
  • Acyclovir is dosed 4x a day for 7-10 days
  • Valacylovir is dosed BID x7 days
  • Pts are more likely to be compliment with Valacyclovir d/t only being dose BID rather than 4x a day
41
Q

What is the treatment option for women with “hypoactive sexual disorder”?

A

Filbanserin 100mg PO qPM

42
Q

What is the MOA of Filbanserin?

A

Increases dopamine and norepi by decreasing serotonin

43
Q

What is the expectied time course of Filbanserin?

A
  • Not an as needed must be taken regularly to be effective
44
Q

Filbanserin is not effective for treating what?

A

Not effective for sexual dysfunction related to SE of medications (SSRIs)

45
Q

What are the ASEs of Filbanserin?

A
  • Sedation (MC)
  • Dizziness
  • Dleepiness
  • Nausea
  • Fatigue
  • Hypotension
    (take at bedtime)
46
Q

What are the CIs of Filbanserin?

A

Avoid alcohol and CYP3A4 inhibitors

47
Q

What is the tx options for “Men with hypoactive sexual desire or hypogonadism”?

A

Testosterone

  • Patch
  • Topical gel
  • IM injection (Depo-testosterone)
48
Q

What is the MOA of testosterone?

A

Reverse age-related decline of testosterone by supplementation

49
Q

Testosterone may not be effective in who?

A

No clear benefit show for elderly men

50
Q

What are the ASEs of testosterone?

A
  • Increase risk for MI and CVA
  • Increased RBC in bone marrow
  • Prostate hypertrophy and prostate CA
  • Lipid disturbances, lowers HDL
  • Fluid retention (avoid in CHF)
  • Acne
  • Gynecomastia
51
Q

What are the CI of testosterone?

A
  • Prostate CA
  • Elevated Hematocrit >55% -polycythemia
  • CHF
52
Q

What labs should be monitored and how often after starting testosterone?

A
  • Monitor testosterone levels 3-6 mos after starting tx.

- Monitor LFT, HgB, and HCT, lipid panels periodically

53
Q

What drug class is the 1st the first line tx for men with physiologic sexual dysfunction or erectile disorder (ED)?

A

Type 5 phosphodiesterase (5-PDE) inhibitors

54
Q

What drugs are apart of the Type 5 phosphodiesterase (5-PDE) inhibitors?

A
  • Sildenafil (Viagra)

- Tadalafil (Cialis)

55
Q

What is the MOA of Type 5 phosphodiesterase (5-PDE) inhibitors?

A
  • Inhibits break down of cyclic GMP by 5-PDE which potentiates SM relaxation and vasodilation.
  • Nitric oxide increases relaxing SM in blood vessels in corpus cavernosum increases penile flow and erection during sexual stimulation
56
Q

What is the expected time course of Type 5 phosphodiesterase (5-PDE) inhibitors?

A

30min to 4 hrs depending on dose and if taken with food

57
Q

What are the ASEs of Type 5 phosphodiesterase (5-PDE) inhibitors?

A
  • HypoTN
  • HA
  • Potential visual disturbances
  • Priapism (rare)
58
Q

What are the CI of Type 5 phosphodiesterase (5-PDE) inhibitors?

A

Cannot take if pt has had any form of nitrate within 48 hrs [potential fatal hypotension]

59
Q

What drug class is the 1st line tx for benign prostatic hyperplasia (BPH)?

A

Alpha-1 blockers

60
Q

What drugs are apart of the Alpha-1 blockers?

A
  • Doxazosin
  • Prazosin or Terazosin at HS
  • Tamsulosin
  • Silidosin
61
Q

What is the MOA of Alpha-1 blockers?

A

Synthetic testosterone derivative, decreases synthesis of DHT

62
Q

What is the ASEs of Alpha-1 blockers?

A

HypoTN

- caution w/safety [can limit dose titration to effect]

63
Q

What drug class is the 2nd line tx for benign prostatic hyperplasia (BPH)?

A

5-Alpha Reductase Inhibitor

64
Q

What drugs are apart of the 5-Alpha Reductase Inhibitor?

A
  • Finasteride

- Dutasteride

65
Q

What is the MOA of 5-Alpha Reductase Inhibitor?

A

Reduce prostate volume

66
Q

5-Alpha Reductase Inhibitor are most effective in pts with what?

A
  • Enlarged prostate
    OR
  • PSA is >30
67
Q

What are the ASEs of 5-Alpha Reductase Inhibitor?

A
  • Impotence (poss. Permanent)

- Angioedema

68
Q

What are safety precautions with 5-Alpha Reductase Inhibitor?

A

Do not let family members touch - potential for breast CA

69
Q

What drug class is used for BPH as well as ED? and what is the MOA for treating BPH?

A
  • 5-PDE inhibitors

- Improves sxs of BPH by SM relaxation of prostate tissue

70
Q

What are the CI/safety concerns with Nitrofurantoin?

A
  • Resistance rates are growing

- Not appropriate for most older adults/people with reduced kidney function or complicated UTI’s

71
Q

What are the CI/safety concerns with Metronidazole?

A

Avoid alcohol consumption

72
Q

What are the CIs with Fluoroquinolones?

A
  • Epilepsy
  • QT prolongation
  • CNS lesions/inflammation
  • H/o stroke
73
Q

What are the safety concerns/ASEs of Fluoroquinolones?

A
  • Phototoxicity
  • Myasthenia gravis
  • Tendon rupture
74
Q

What are the CI/safety concerns with Sulfonamide antibiotics?

A
  • Sulfa allergy

- Pregnancy

75
Q

What are the CI/safety concerns with Penicillins?

A
  • Allergy
76
Q

What is a short-term treatment (up to 2 days) that can be purchased OTC (95 mg) or prescribed (100 or 200 mg) to manage urinary pain associated with a UTI?

A

Phenazopyridine

- numbs the bladder

77
Q

When should you advise a pt to take Phenazopyridine?

A
  • Use BID

- In the 1 and 2nd day of UTI

78
Q

What should you tell the pt to expect when taking Phenazopyridine?

A
  • Turns urine bright orange and can stain underwear

- Can stain contact lenses

79
Q

What are the main CI/populations which should avoid using Phenazopyridine?

A
  • Renal impairment
  • Elderly: can accumulate in pts with renal insufficiency
  • G6PD deficiency: hemolytic anemia

Genitourinary (2 decks)

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