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26 Cards in this Set
- Front
- Back
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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
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person lacks bladder control due to a brain or nerve condition
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Neurogenic bladder
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non pharmacological treatments for OAB
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• Kegel exercises
• Bladder training-‐scheduled voiding • Diary • Identifying factors that aggravate OAB – Excess fluid, caffeine, alcohol • Transcutaneous electrical nerve stimulation (TENS) |
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Pharmacological intervention for OAB
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• Cholinergic-‐Blocking Agents
– AKA-‐Anticholinergics |
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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 |
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General drug effects of cholinergic-‐blocking agents:
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– 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 |
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Oxybutynin (Ditropan, Oxytrol)
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Used for OAB and Also used as antispasmodic for neurogenic bladder
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Tolterodine (Detrol)
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• Often preferred
because less incidence of dry mouth |
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other drugs than can be prescribed for OAB
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• Solifenacin succinate (VESIcare)
• esoterodine fumarate (Toviaz) • derifenacin (Enablex) |
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Adverse effects of anti-cholinergics
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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 |
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• 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
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• Caused by excessive growth of epithelial (glandular) cells and smooth muscle cells
– Growth of prostate epithelial cells controlled by androgen (testosterone) |
BPH
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Surgical tx for BPH
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TURP-‐transurethral resection of the prostate
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Pharmacological interventions for BPH
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1. 5-‐Alpha-‐Reductase Inhibitors 2. Alpha-‐1 Adrenergic Blockers
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Blocks the enzyme responsible for converting testosterone to the potent 5-‐alpha dihydrotestosterone (DHT)
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5-‐alpha dihydrotestosterone (DHT)
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stimulates prostate growth/ enlargement
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5-‐alpha dihydrotestosterone (DHT)
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5-‐Alpha-‐Reductase Inhibitors drug names
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finasteride (Proscar) 5mg/day podutasteride (Avodart) ) 0.5mg/daily po
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• tamsulosin (Flomax)
• Silodosin (Rapaflo) • alfuzosin (Uroxatral) |
Alpha-‐1 adrenergic blockers
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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)
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Saw Palmetto
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herbal supplement for BPH
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A persistent inability to achieve or sustain an
erection suitable for satisfactory sexual performance |
ED – also known as impotence
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Drugs to Treat Erectile Dysfunction
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• Sildenafil (Viagra)
– First oral drug for the treatment of ED • Vardenafil (Levitra) • Tadalafil (Cialis) |
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how do ED drugs work?
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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 |
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Adverse Effects ED drugs
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• 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 |
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ED drugs CANNOT be used in men taking _____
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nitroglycerin
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when do you take an ED drug?
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30-60 minutes before intercourse and not more than once a day
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