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26 Cards in this Set

  • Front
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– Characterized by urinary urgency with or without incontinence
• sudden compelling desire to urinate, a sensation that is difficult to defer
– Associated with urinary frequency and nocturia
Over Active Bladder OAB
person lacks bladder control due to a brain or nerve condition
Neurogenic bladder
non pharmacological treatments for OAB
• Kegel exercises
• Bladder training-­‐scheduled voiding
• Diary
• Identifying factors that aggravate OAB
– Excess fluid, caffeine, alcohol
• Transcutaneous electrical nerve stimulation
(TENS)
Pharmacological intervention for OAB
• Cholinergic-­‐Blocking Agents
– AKA-­‐Anticholinergics
Action: Blocks the action of acetylcholine (ACh) in the
parasympathe0c nervous system (PSNS)
Parasympathetic response is diminished
Allows symptoms of sympathetic nervous system activation to predominate
• Cholinergic-­‐Blocking Agents
– AKA-­‐Anticholinergics
General drug effects of cholinergic-­‐blocking agents:
– Increase in HR-­‐when someone has bradycardia – Dilated pupils (mydriasis)-­‐eye exam
– Decrease muscle rigidity and tremors-­‐Parkinson’s – Decrease GI motility, gastric secretions-­‐Irritable
bowel disease
– Decreased bronchial secretions, bronchodilation-­‐
COPD
– Decreased salivation, sweating
Oxybutynin (Ditropan, Oxytrol)
Used for OAB and Also used as antispasmodic for neurogenic bladder
Tolterodine (Detrol)
• Often preferred
because less incidence of dry mouth
other drugs than can be prescribed for OAB
• Solifenacin succinate (VESIcare)
• esoterodine fumarate (Toviaz)
• derifenacin (Enablex)
Adverse effects of anti-cholinergics
CV: Tachycardia, dysrhythmias – Cautiously in patients with cardiac instability
• CNS stimulation: confusion, restlessness, hallucinations
– Cautious in elderly
• Eyes: dilated pupils, blurred vision, dry eyes, photophobia, increased intraocular pressure
– Avoid use in patients with narrow-­‐angle glaucoma
• Nonmalignant prostate enlargement
• Commonly occuring-­‐70% of all men by age 60,
90% by 90!
• Not found to be a precursor to prostate cancer
BPH
• Caused by excessive growth of epithelial (glandular) cells and smooth muscle cells
– Growth of prostate epithelial cells controlled by androgen (testosterone)
BPH
Surgical tx for BPH
TURP-­‐transurethral resection of the prostate
Pharmacological interventions for BPH
1. 5-­‐Alpha-­‐Reductase Inhibitors 2. Alpha-­‐1 Adrenergic Blockers
Blocks the enzyme responsible for converting testosterone to the potent 5-­‐alpha dihydrotestosterone (DHT)
5-­‐alpha dihydrotestosterone (DHT)
stimulates prostate growth/ enlargement
5-­‐alpha dihydrotestosterone (DHT)
5-­‐Alpha-­‐Reductase Inhibitors drug names
finasteride (Proscar) 5mg/day podutasteride (Avodart) ) 0.5mg/daily po
• tamsulosin (Flomax)
• Silodosin (Rapaflo)
• alfuzosin (Uroxatral)
Alpha-­‐1 adrenergic blockers
Also marketed as Propecia for
male-­‐pattern baldness in low dose (1 mg/ day)
• Adverse effects: sexual dysfunction (common)
– Impotence, decreased libido, reduced semen volume
• Decrease levels of PSA
– Need baseline and periodic values during
treatment
finasteride (Proscar)
Saw Palmetto
herbal supplement for BPH
A persistent inability to achieve or sustain an
erection suitable for satisfactory sexual performance
ED – also known as impotence
Drugs to Treat Erectile Dysfunction
• Sildenafil (Viagra)
– First oral drug for the
treatment of ED
• Vardenafil (Levitra)
• Tadalafil (Cialis)
how do ED drugs work?
Inhibit action of the enzyme (PDE-­‐5) phosphodiesterase
– Relaxing penile smooth muscle
– This allows for increase blood flow into the penis
• Harder and longer lasting erection
– Sexual stimulation and arousal still required for an erection
Adverse Effects ED drugs
• Headache, heartburn, hypotension
• Angina
• Rash, flushing
• Concurrent use of nitrates-­‐life threatening hypotension, MI
• Prolonged erection lasting more that 4 hours – Priapism-­‐sustained erection
– Contact HCP
• Vision impairment
ED drugs CANNOT be used in men taking _____
nitroglycerin
when do you take an ED drug?
30-60 minutes before intercourse and not more than once a day