Urology Flashcards
(31 cards)
receptors for storage and voiding phase
- b2 adrenergic receptos for storage reg
- m3 receptor for voiding
Common meds affect continence
- a agonist/antagonist
- alcohol
- anticholingerics
- cholinesterase inhs
- ccbs
- diuretics
- nacrotics
- antidepressants
- antipsychs
- sedative/hypnotics
- pseudoephedrine
treatment, monitoring, dosing, ci for nocturnal polyuria
desmopressin nasal spray
- monitor sodium
- for 50-64 yo= 1 spray (1.66 mcg) 30 mins b/f bed
- for +65 yo= 1 spray (0.83 mcg) 30 mins b/f bed
- CI: concomitant loop diuretics, CHF (low EF), uncontrolled htn, use of glucocosteriods
what is noctural polyuria
wakening 2 or more times in the night to urinate
urge incontinence/ overactive bladder
- involuntary leakage of urine
- most often neurologic
urge incontinence/ overactive bladder: antispasmodics treatment, ae, efficacy
Antispasmodics
-Darifenacin and Solifenacin both m3 specific, dec side effect
- ae : anticholgeric effects including dementia
- Darifenacin> ER tolerodine> Solifenacin are the best
urge incontinence/ overactive bladder: anti-muscarinics and botox treatment, ae, indication, efficacy
- Anti-muscarinic: Imipramine / other TCA; 25mg qd-tid, AE: cardiac effects and anticholingeric
- Botox; for people who failed other treatments - less dry mouth and complete resolution of urgency but higher rates of transient urinary retention and UTIs
urge incontinence/ overactive bladder: b3 adrenergic agonist treatment,moa, se, dose adj, efficacy
Mirabegron (Myrbetriq ER) 25-50mg/day
- detrusor muscle relaxation
- dose reduction for hepatic or renal dysfunction
- se: hypertension
- caution with uncontrolled htn
Vibegron 75mfg
- dose adj for SEVERE hepatic and renal dysfunction
- se: mild and rare
guideline on overactive bladder 1st line
behavioral therapies; bladder training, control strategies, pelvic floor muscle training and fluid management
guideline on overactive bladder 2nd line
- oral anti-muscarinics or b3 agonist
- er >ir for less SEs
- avoid oxybutynin patch
- combo of oral options for refractory
what population should we avoid vs use caution with anti-muscarinics
- narrow-angle glaucoma
- dec gastric emptying or urinary retention
- caution: frail patients
what is stress incontinence and who is at risk
- stress: sneezing, laughing, coughing
- dec pelvic wall musculature *women at risk due to child bearing
Stress incontinence treatment ae, dose
a receptor agonist
- pseudoephedrine 15-30 up to TID, ae: insomnia, HTN, HA, tremor, palpitations
- midodrine 2.5-5 mg po bid-tid
estrogen
- ae: pap, bleeding, DVT
- ERT as vaginal application
- not typically recommended in post-menopausal women
duloxetine 40 BID
- not FDA approved
Overflow incontinence and treatment
leak urine throughout the day
- bethanechol (urecholine) 10 mg tid
- ae: GI issues, orthostasis, urgency, bronchial constriction
- inc bladder tone
symptoms of BPH
- incomplete emptying
- frequency
- intermittency
- urgency
- weak stream
- straining nocturia
non pharm BPH
- pads
- TURP (cuts away at prostate)
- urethral dilation
- foley catheters
BPH treatment a1 blockers
terazosin> doxazosin> prazosin
-Doxazosin has major cv events in hypertensive pts
- ae: postural hypotension, dizziness/vertigo, blurred vision, drowsiness, asthenia
BPH treatment a1a blockes
Silodosin» Alfuzosin~ Tamsulosin
- relax tone
- rare hypotension, vertigo, drowsiness
- floppy iris syndrome
- ED *not seen with alfuzosin
BPH treatment 5a reductase inh
Dutasteride > Finasteride
- combo better for significant prostate enlargement
drugs to avoid in BPH
- TCA
- diphenhydramine
- disopyramide
- pseudoephedrine & ephedrine - increases tone of prostate
- anticholinergic
BPH treatment -combo a1a blocker and pde5 inh
alfuzosin and sildenafil superior to monotherapy in treating lower urinary tract symptoms and erectile dysfuction
BPH treatment algorithm
- start a blocker or PED5 if pt has ED
- then try combos
- if prostate >30cc add 5ARI (dutasteride, finasteride)
Drugs associated with ED
- diuretics
- antihypertensive
- cardiac and cholestrol drugs
- antidepressants
- tranquilizers
- h2 antagonist
- hormones
- cytotoxic agents
- immunomodulators
anticholingeric - recreational drugs
risk factors for ED
Metabolic syndrome
Lower UT symptoms
CVD
Tobacco smoking
Central neurologic conditions
Spinal Cord Injury
Depression or social or marital stress
Endocrinologic conditions
DM
