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PPT Phase II > Urology > Flashcards

Urology Flashcards

1
Q

Give two examples of muscarinic receptor antagoinists

A

oxybutinin

tolterodine

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2
Q

what nerve innervates the external urethral sphincter?

A

pudendal nerve

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3
Q

Does relaxation or contraction of the bladder detrusor muscle cause micturition?

A

contraction

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4
Q

Urgency urinary incontinence is caused by what?

A

overactive bladder

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5
Q

stress urinary incontinence is due to what?

A

urethral sphincter incompetence

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6
Q

Overflow incontinence is caused by what?

A

hypotonic bladder or bladder outlet obstruction, which produces urinary retension

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7
Q

What are the symptoms of overactive bladder syndrome?

A

urinary urgency
nocturia
frequency often accompanied by urgency incontinence ( a sudden desire to urinate)

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8
Q

What are the causes of overactive bladder syndrome?

A

in women it is usually idiopathic but it can have a neurogenic component.
In men, outflow obstruction is most common initiating factor. UMN lesions can also produce overactive bladder.

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9
Q

What first line, non pharmacological approaches are there for management of overactive bladder?

A

Reduction of excessive fluid intake.
Weight loss.
Smoking cessation.
Pelvic floor muscle rehabilitation and suppression of urge

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10
Q

What pharmacological options are there for urinary urgency? Name 2 classes and an example of each

A

Muscarinic receptor antagonists e.g. oxybutinin, tolterodine.

Beta3-adrenoceptor agonist - mirabegron

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11
Q

what is the mechanism of action of muscarinic receptor antagonists for urinary urgency?

A

they bind to muscarinic receptors where they inhibit ACh. Contraction of the smooth muscle fo the bladder is under parasympathetic control so blocking muscarinic receptors promotes bladder relaxation and increases bladder capacity. They antagonise M3 receptors whch are the main muscarinic receptor subtype in the bladder

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12
Q

what is the mecanism of action of mirabegron?

A

stimulation of beta3-adrenoceptors in the bladder trigone flattens and lengthens the bladder base which facilitates urine storage.

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13
Q

what condition is mirabegron use contraindicated in?

A

people with severe HTN becaue it can increase BP and HR

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14
Q

What are teh side effects of muscarinic antagonists

A 
Anticholinergics have a BCD for U:
Blurred vision
Constipation
Dry mouth
Urinary retention

+ tachycardia

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15
Q

List some examples of third line treatments for urge incontinence.

A

Oral desmopressin can help reduce nocturia.
botulinum toxin type A could be considered.
intermittent bladder catheterisation may be needed.
options of intractable symptoms include percutaneious sacral nerve stimulation or surgery.

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16
Q

What is the first line recommended therapy for stress incontinence?

A

pelvic floor muscle training for at least 8-12wks

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17
Q

What surgical treatments are there for stress incontinence?

A

surgical slings, or colposuspension to provide urethral suppor

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18
Q

What can be used as a pharmacological treatment for stress incontinence that works in about half of those treated?

A

duloxetine - an SNRI

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19
Q

What is the main cause of stress incontinence in women and men?

A

urethral sphincter weakness or incompetence.

The most common cause in women is loss of collagenous support in the pelvic floor due to trauma or hormonal changes.

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20
Q

What treatment can be tried in postmenopausal women with stress incontinence?

A

topical oestrogen.

it may stimulate urethral mucosal proliferation and enhance internal urethral sphincter response to neural stimulation.

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21
Q

How does duloxetine, an SNRI, work to treat stress incontinence?

A

It augments SNS activity. it relaxes detrusor and enhances external urethral sphincter activity by increasing efferent impulses in the pudendal nerve.

22
Q

How do you assess the severity of a pt’s BPH?

A

Using an international prostate severity score.

asks questions like how often they have the sensation of not completely emtying bladder after urination etc.

23
Q

What are the symptoms of BPH?

A 
incomplete emptying,
frequency,
intermittency,
urgency,
weak stream,
straining,
nocturia
24
Q

What is the first line treatment for BPH? Give examples

A 
alpha blocker
e.g.:
tansulosin
alfuzosin
doxazosin
terazosin
25
Q

Describe the mechanism of action of alpha blockers in BPH.

A

Most drugs in this group are highly selective for the alpha1-adrenoceptor. These receptors are found mainly in smooth muscle, including in blood vessels and the urinary tract. Blocking them induces relaxation, therefore, causing reduced resistance to bladder outflow.
alpha blockers also cause vasodilation due to their effects on alpha1 receptors on blood vessels.

26
Q

What are the adverse drug effects of alpha blockers?

A 
orthostatic hypotension (mostly first dose).
Headache (due to vasodilation effects).
Dizziness
Erectile Disorders
Rhinitis
Asthenia
Oedema
27
Q

Name some predictable drug interactions with alpha blockers

A

mostly with other agents that would cause hypotension:
- CCBs, beta-blockers, ACEi, ARBs.
Also interactions with PDE 5 inhibitors e.g. sildenafil

28
Q

What risk factors make progression of symptoms from benign prostatic enlargement more likely?

A 
older men,
weak stream,
higher symptoms scores,
evidence of bladder decompensation (such as chronic urinary retention),
larger prostates
higher PSA levels
29
Q

If a man came to you with LUTS and had a high symptom score, a normal PSA level but a significantly enlarged prostate rather than a moderately large prostate, what pharmacological treatment would you offer first line? Give some examples of this class of drugs.

A

5-alpha reductase inhibitor e.g. finasteride, dutasteride.

5-alpha reductase inhibitors are more effective in men with larger prostates. It is also the one to offer if the pt is considered to be at high risk of progression.

30
Q

describe the MOA of 5 alpha reductase inhibitors

A

they reduce the size of the prostate gland. they inhibit the enzyme 5alpha-reductase whcih converts testosterone to dihydrotestosterone which stimulates prostatic growth.

31
Q

what is the problem with just giving 5-alpha reductase to a man with severe LUTS?

A

it takes 6-12 months to work so it is recommended to give an alpha blocker alongside.

32
Q

Name 5 adverse drug effects of 5-alpha-reductase inhibitors

A

breast enlargement, breast tenderness, decreased libido, ejaculation disorders, impotence.

33
Q

what would be the surgical treatment for severe LUTS or complications of BPH?

A

TURP

34
Q

Name 3 long term effects of a TURP

A
  1. impotence (5-10%)
  2. retrograde ejaculation (80-90%)
  3. incontinence (<5%)
35
Q

Name an anti-androgen that is used second line in metastatic prostate cancer

A

cyproterone acetate - inhibits pituitary gonadotrophin secretion

36
Q

Give an example of gonadorelin analogues

A

goserelin (Zoldadex)
buserelin
leuprolide

37
Q

What is the mechanism of action of gonadorelin analogues?

A

synthetic GnRH that suppress prostate cancer cells. initially GnRH analogues cause an increase in LH and FSH but chronic administration results in sustained suppression of pituitary gonadotrophins. serum testosterone falls to levels comparable to surgical castration.

38
Q

What is the base of chemotherapy drugs that is best to use when treating urothelial bladder cancer?

A

cisplatin-based combination chemotherapy

39
Q

What chemotherapy agent is best for systemic therapy in pts with metastatic bladder cancer?

A

platinum-based chemotherapy

40
Q

what class of drugs are used first line in prostate cancer?

A

GnRH analogues e.g. goserelin

41
Q

What is first line pharmacology used for advanced renal cancer? give 2 examples

A

tyrosine kinase inhibitors e.g. sunitinib, sorafenib

42
Q

What is second-line pharmacology therapy for someone with advanced renal cancer? Give an example

A

mTOR inhibitor e.g. everolimus

43
Q

What can immunotherapy with interferon alpha be combined with to treat advanced renal cell cancer if it hasn’t responded to the first and second line therapies?

A

bevacizumab (a tyrosine kinase inhibitor)

44
Q

What is the recommended treatment for a seminoma (type of testicular cancer)?

A

orchidectomy

45
Q

after an orchidectomy to treat a seminoma, you might follow up with chemotherapy with what pharmacological agent, if the recurrence risk was high?

A

chemotherapy with carboplatin

46
Q

One of the chemotherapy combinations used for metastatic testicular cancer (seminoma) is the (BEP) combination. What does this consist of?

A

bleomycin
etoposide
cisplatin

47
Q

what pharmacological therapy is first-line for erectile dysfunction?

A

phosphodiesterase type 5 inhibitors e.g. sildenafil, tadalafil

48
Q

what is the MOA of sildenafil?

In what situation would it not treat erectile dysfunction?

A

inhibits PDE5 from degrading cGMP which is generated by NO release in penile tissue. This makes the erection last longer. sexual stimulation to initiate release of NO is essential for these drugs to produce an erection so they won’t work if a person is not sexually stimulated to begin with.

49
Q

What is second-line therapy for erectile dysfunciton? give an example

A

prostaglandin E1 analogue.

e.g. alprostadil

50
Q

what is the MOA of alprostadil?

how is it administered?

A

vasodilates by acting on smooth muscle cells surface to increase intracellular cAMP whcih reduces intracellular Ca concentration.
it is administered by intracavernosal injection

PPT Phase II (37 decks)

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