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pharmacology > Renal/GU pharm overview > Flashcards

Renal/GU pharm overview Flashcards

1
Q

what is the ending for alpha 1 adrenergic receptor antagonists

A

-zosin

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2
Q

what is the main MOA of A1 adrenergic antagonists?

A

blocks alpha receptors located on the prostate smooth muscle

Causes: reversal of smooth muscle contraction

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3
Q

what is the main effect in the body from A1 adrenergic receptors?

A

Relaxation of smooth muscle of the bladder neck and prostatic urethra

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4
Q

End result of A1 adrenergic antagonists

A

improve urine output

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5
Q

overall side effects of A1 adrenergic antagonists

A
  • dizziness
  • rhinitis
  • hypotension
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6
Q

1st generation selective alpha1 antagonists

list 2

A
  • Prazosin
  • Alfuzosin
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7
Q

2nd generation selective A1 antagonist

list 4

A
  • tamulosin
  • doxazosin
  • terazosin
  • sildosin
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8
Q

what A1 antagonist is extended release?

A

Sildosin

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9
Q

Benefit of 2nd gen a1 antagonists?

A

enabled QD

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10
Q

what 4 A1 antagonists can also impact BP?

A
  • prazosin
  • doxazosin
  • terazosin
  • tamsulosin
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11
Q

tamsulosin trade name

A

flomax

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12
Q

what A1 antagonis that also lowers BP has the least effect?

A

Tamsulosin

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13
Q

what is tamsulosin indicated for?

A

BPH
Kidney stones

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14
Q

What type of patient should tamsulosin be used with caution in?

A

Pt with orthostatic hypotension

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15
Q

when should tamsulosin never be used?

A

pts undergoing eye surgery

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16
Q

what are the 3 high yield side effects of tamsulosin

A
  1. orthostatic hypotension
  2. headache (due to blood vessel dilation)
  3. Ejaculation failure
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17
Q

starting dose of tamsulosin?

A

0.4 PO QD taken 30min after a meal

food increases onset time

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18
Q

onset of tamsulosin

A

4-8 hours

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19
Q

what is the MOA of Doxasozin

A

completely inhibits the postsynaptic A1 adrenergic receptors causing vasodilation and decreased sympathetic tone (in the prostate)

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20
Q

what is the effect of Doxazosin for treatment of HTN

A

vasodilation of the veins and arterioles that decreases total peripheral resistance

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21
Q

what is the brand name of doxazosin

A

Cardura

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22
Q

what is the effect within the body of doxazosin for treatment of BPH

A

decreases sympathetic tone
of the urethra stricture

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23
Q

what is the high yield side effect of Doxaszosin?

A

Edema (due to venous dilation)

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24
Q

what is the MOA of terazosin

A

reversible a1 antagonist with MINIMAL effect on A2

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25
Q

what a1 antagonist preserves the negative feedback?

A

Terazosin

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26
Q

what A1 antagonist leads to decreased arterial tone?

A

Terazosin

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27
Q

what A1 antagonist causes myasthenia

A

Terazosin

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28
Q

when should terazosin be taken?

A

at bed time to avoid syncope

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29
Q

what are the three types of anti-androgens

A
  1. 5 a-reductase inhibitors
  2. Receptor inhibitors
  3. steroid synthesis inhibitors
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30
Q

what class is finasteride?

A

5 a-reductase inhibitor

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31
Q

what is the brand name of finasteride?

A

Proscar

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32
Q

what is the MOA of finasteride

A

competitively inhibits type 2, 5 alpha reductase which inhibits the conversion of testosterone to dihydrotestosterone

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33
Q

what three things happens within the body when taking finasteride

A
  1. suppresion of serum dihydrotestosterone
  2. reduction of prostate size
  3. improves urinary flow
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34
Q

what drug should be used with finasteride for symptomatic BPH

A

finasteride + alpha blocker (doxazosin) to reduce symptom progression

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35
Q

what size prostate indicates use of finasteride?

A

40g or more

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36
Q

what are the 2 main side effect of finasteride

A
  1. decreased libido
  2. gynecomastia
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37
Q

what drug is also indicated for alopecia (male pattern hair loss)

A

finasteride

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38
Q

how quickly do dihydrotestosterone levels and prostate size return to normal after stopping finasteride?

A

dihydrotestosterone: 14 days
prostate size: 3 months

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39
Q

what is the main MOA of PDE inhibitors

A

inhibit the PDE enzymes to increases cAMP and cGMP

40
Q

what is the MOA of PDE4 inhibitors

A

bronchial dilation for severe COPD

41
Q

waht is the MOA of PDE3 inhibitors

A

positive inotropic vasodilators with antiplatelet effects

42
Q

what is PDE4 inhibitors indicated for?

A

severe COPD

43
Q

what is PDE5 indicated for?

A

ED and pulmonary HTN

44
Q

what is PDE3 inhibitors indicated for?

A

acute heart failure, peripheral vascular disease

45
Q

what PDE inhibitor is not meant for long term use?

A

PDE3 inhibitor

46
Q

what do PDE enzymes normally do?

A

decease cAMP and cGMP

47
Q

what are the 3 types of PDE5 inhibitors?

A
  1. Tadalafil
  2. Sildenafil
  3. Vardenafil
48
Q

what are the main effects of PDE5 inhibitors on the body

A
  • pulmonary vasodilation
  • penile smooth muscle relaxation
49
Q

what is the brand name of tadalafil?

A

cilias

50
Q

what is the MOA of Tadalafil for BPH

A

PDE5 reduction in smooth muscle and endothelial cell proliferation

51
Q

what is the MOA of tadalafil for ED?

A

causes a release of NO into the corpus cavernosum during sexual stimulationg which activates cGMP

52
Q

what drug can decrease nerve activity and improve smooth muscle relaxation of the prostate

A

tadalafil

53
Q

what drug class should be used with caution with patients experiencing chest pain

A

PDE5 inhibitors (use with caution with nitrates)

54
Q

what are the main side effects of tadalafil

A
  1. flushing
  2. headache
    (similar to NTG)
55
Q

what is the brand name for sildenafil

A

Viagra

56
Q

caution should be taken when prescribing Sildenafil to what type of patients

A

pts taking:
* alpha blocking antihypertensive agents
* nitrates

57
Q

what side effect can tadalafil produce?

A

hypotension

58
Q

how long should nitrates be delayed for PDE5 inhibitors?

A

24 hours

59
Q

what is the brand name of vardenafil

A

levitra

60
Q

what is the MOA of spironolactone

A

competetive inhibitor of aldosterone that competes with dihydrotestosterone for androgen receptors

61
Q

what does spironolactone do to 17 a-hydroxylase?

A

Inhibits 17 a-hydroxylase activity causing a lowering of plama testosterone and andostnedione

62
Q

what class is Ketoconazole

A

steroid synthesis inhibitors

63
Q

what is the MOA of Ketoconazole

A

inhibits the adrenal and gonadal steroid synthesis

64
Q

what are the indications for ketoconazole

A
  • fungal disease
  • prostatic carcinoma
65
Q

what is a main SE of taking ketoconazole

A

gynecomastia during therapy

66
Q

what are the types of diuretics

A
  1. thiazides
  2. loop diuretics
  3. potassium sparing diuretics
  4. osmotic diuretics
  5. carbonic anhydrase inhibitors
67
Q

what is the main MOA of diuretics

A

increases the production of urine

68
Q

what is the MOA of Thiazides

A
  1. diuresis (volume loss increasing Na/H exchanger in the PCT)
  2. K+ excretion (paradoxical aciduria)
  3. K+ (metabolic alkalosis)
69
Q

what part of the nephron does loop diuretics act on

A

the NKCC2 of the thick ascending limb

70
Q

what are the two names of loop diuretics

A
  • furosemide
  • ethacrynic acid
71
Q

what are the 2 subtypes of potassium sparing diuretics

A

aldosterone receptor antagonist and epithelial Na+ blocks

72
Q

spironolactone and eplerone are what class of diuretics?

A

Aldosterone receptor antagonists

73
Q

triamtrene and amaloride are what type of diuretic?

A

epithelial Na+ block

74
Q

Does potassium sparing diuretics cause alkalosis or acidosis

A

acidosis

75
Q

how do potassium sparing aldosterone blockers work?

A

inhibit the renal K+ and H+ secretion

76
Q

how do potassium sparing epithelial Na+ diuretics work?

A

they create an influx of K+ to the cells in exchange for H+eate an influx o

77
Q

what is the MOA of osmotic diuretics?

A

opposes the water extraction in the descending loop of henle

78
Q

what are the two names of osmotic diuretics?

A
  1. mannitol
  2. urea
79
Q

what is the MOA of carbonic anhydrase inhibitors?

A

decreases HCO3- reabsorption causing acidosis

80
Q

what is the main diuretic that acts on PCT?

A

Acetazolamide (carbonic anhydrase inhibitors)

81
Q

where does adenosine act in the nephron?

A

in the glomerulus

82
Q

what is the MOA of adenosine as a diuretic

A

causes the contraction of the afferent arteriole

83
Q

Alpha cells help (1) the urine through the (2) pump on the apical surface

A
  1. acidify
  2. H+/ATPase pump
84
Q

Beta cells help (1) the urine through the (2) pump on the apical surface

A
  1. alkanize
  2. HCO3-/Cl- pump
85
Q

what part of the nephron has the most reabsorption?

A

PCT
* all glucose, amino acids, organic solutes

86
Q

aldosterone is the (blank) whisperer.

what does this mean?

A

sodium whisperer
keeps sodium in the system and is a volume expander

87
Q

ADH

A

antidiuretic hormone

88
Q

how does ADH control the permeability of cells?

A

by regulating the insertion of aquaporin into the apical membrane

brings the water back in and concentrates the urine

89
Q

ADH is aka

A

AVP
arginine vasopressin

90
Q

what part of the tubule is where ADH acts?

A

the collecting tubule

91
Q

what regulates ADH secretion?

A

serum osmolality and volume status

92
Q

where do ADH antagonists act

A

at the vasopressin receptor

93
Q

what transporter does ADH stimulate?

A

the insertion of the urea transporter in the collecting duct cells in th emedulla

94
Q

what changes the osmolality

A

adding fluid in and taking fluid out

95
Q

what is the main purpose of ADH

A

to maintain homeostasis so the water doesn’t get lost

96
Q
A

pharmacology (19 decks)

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