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43 Cards in this Set
- Front
- Back
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Urge Incontinence (overactive bladder) rx
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anticholinergics/antispasmotics like oxybutynin or tolterodine
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SE of Oxybutynin
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SOW: sedation, orthostasis, weight gain (dry mouth, constipation, careful in those with BPH and glaucoma)
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What do anti-cholinergics do for urge incontinence?
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They block the M3 receptors from ACH leading to relaxation of the detrusor muscle and decreased urge!
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What does vesicare do?
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antispasmotic/antimuscarinic blocks ACH and relaxes smooth muscle in hydrochloride
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What is enablex? What can it prolong?
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selective antagonists of the M3 muscarinic receptor - limits bladder contractions, reduces ssx of bladder irritability, uregency and frequency are decreased. MAY PROLONG QT if in high doses.
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What is trospium Cl? (sanctura)
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an antimuscarinic agent for tx of urge incontinence (overactive bladder). administered orally on empty stomach in the am. dose an hour before meal less hepatic metabolism t.f. few drug interactions, hydrophillic, AE: dry mouth, HA, constipation.
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What is toviaz (fesoterodine)? what is it similar to?
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it's similar detrol LA (tolterodine). they have the same active metabolite. expect toviax and detrol have same efficacy AND se @ 4 mg dose. Toviaz is available as 8 mg tab which can increase efficacy and SE
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What is gelnique?
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a new topical form of oxybutynin. alternative to the patch! it is applied topically to lower blood levels and avoids 1st pass metabolism t.f. fewer anticholinergic effects!
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what are the mainstays of stress incontinence therapy?
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topical estrogens! (preferred over systemic agents)
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what drug is being looked at for stress incontinence?
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duloxetine (cymbalta) (a dual norepinephrine and serotonin reuptake blocker
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why shouldn't we use systemic estrogens on someone with stress incontinence?
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-will worsen urinary incontinence
-should not be administered alone (w.o progestin) in women with uterus |
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What non-pharmacological treatments can you give a pt with stress incontinence?
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bladder training, pelvic floor strengthening (kegals, weights), biofeedback, extracorporeal magnetic innervation, intravaginal supports, disposable pads, catheters for overflow incontinence, surgery
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what causes BPH?
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it's age related. as men age there's decreased testosterone, and remember its converted to DHT =m/c of prostate enlargement. it binds and the alpha 1 receptors increase, causing more compression and muscle contraction. prostate tissue is stimulated by NE causing contraction of smooth muscle around the urethra. more contraction, more retention of urine!
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ssx of BPH
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none to severe
frequency, urgency, hesitancy, decr in stream, straining, nocturia, interrupted flow high PSA |
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What drugs relax prostatic smooth muscle?
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tamsulosin (flomax)
alpha 1 antagonists uroxatral |
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what drugs interfere w/testosterone effects on the prostate?
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finasteride (proscar)
dutasteride (avodart capsules) |
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What about the alpha 1 antagonists?
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great for BPH
examples: prazosin, terazocin, doxazocin)...except flomax and uroXatral- they must be titrated and given at bedtime to avoid 1st dose syncope! |
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who is flomax for? (tamsulosin)
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for pts who cant tolerate hypotension or titrating meds!
it works right away, the others take 2-4 weeks. can cause hypotension, dizziness, syncope, and orthostasis CAN CAUSE EJACULATORY DYSFUNCTION! |
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what's the MOA of finasteride (proscar) and dutasteride (avodart)? what's the problem with it?
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5-reductase inhibitors!
it shrinks the prostate and helps relieve ssx BUT ITS EXPENSIVE!!! AND CATEOGRY X! AND TAKES A LONG TIME TO WORK: 8+ WEEKS! (so you must prescribe an alpha blocker too) |
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what are the AE of finasteride and dutasteride?
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BERG. NC
blood donation issues ejaculate delay and decreased rash gynecomastic nausea/ab pain category x: women can't handle these meds - risk to fetus |
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do alpha 1's shrink the prostate?
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no they only relieve your symptoms! finasteride and dutasteride
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when do you use combo therapy? alpha 1 blocker and 5 alpha reductase inhibitor?
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for symptomatic prostatic enlargement - most benefit from the combo!
proscar and avodart reduce prostate size and prevent disease progression |
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what happens in a normal erection?
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corpora cavernosa fills with blood and decreases venous outflow due to the compression!
parasymapathetic stimulation from ach. ACH STIMULATES SMOOTH MUSCLE relaxation by NO and other second messengers (cGMP). when cGMP accumulates it will cause the beginning phases of the erection - causing eeven further relaation, increasing blood flow, causing an erection.. cGMP is broken down by phosphodiestereas type 5 which is the enzyme inhibited by viagara, cialis, and levitra. |
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what causes ED?
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1) vascular- HTN, atherosclerosis, drugs
2) neurologic - DM, spinal cord injuries, drugs 3) hormonal - normal aging or ochiectomy, or pituitary/hypothalamic dz 4) psychogenic |
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how do you tx ed?
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1) control underlying causes
2) change drugs that may be causing ED 3) drugs: viagra testosterone replacement alprostadil trazadone yohimbine |
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what's the MOA of sildenafil (viagara)?
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phosphodiesterase type 5 inhibitor increases cGMP --> smooth muscle relaxation and increased blood flow to the penis
(ONLY WORKS when male is stimulated!) 56-82% efficacy! |
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when do you take sildenafil?
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on an empty stomach 30-60 mins before sex
-hepatic metabolism |
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what are the AE and drug interactions of sildenafil?
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AE: most commonly related to vasodilation -> flushing, HA, nasal congestion, dizziness, heartburn
Drug interactions: nitrates and viagara can cause SEVERE hypotension -food may prolong time to onset of erection + overall rigidity -metabolism may be inhibted by drugs that inhibit CYP3A4 -caution in heart pts |
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what the recommended dose of cialis (tadalafil)?
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10 mg prior to anticipated sexual activity (dose may be increased 20 mg or decreased to 5 mg)
-approved for the tx of ED for up to 36 hours. can be given daily too 2.5-5 for spontaneity. don't give it to those with nitrates, cialis will last a long time then! |
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MOA of levitra (vardenafil)
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similar to viagara
PD5 ihibitor 10 mg 60 minutes prior to sex - give once a day, not more than 1. metabolism: hepatic via CYP3A4 |
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with pts with bilateral NS and given sildenafil, erections are sufficient for vaginal penetration for what percent of men?
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72%
for unilateral nerve sparing it was 50% |
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OUT of the ED meds, which has the longest duration of activity?
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cialis = 24-36 hours. viagra and levitra: 30-60 minutes
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AE of PD type 5 inhbitors
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flushing, and headache!
some resports of dizziness, unilateral loss of vision /hearing, flu like syndrome, CPK increased, rhinitis, abnormal vision, and colors - priapism |
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who is testosterone indicated for?
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those with hypogonadism, low libido, low serum testosterone
-may improve libido, muscle strength, and well being |
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administration of testosterone?
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IM
patches are applied to arms, buttocks, or back q24 hours in AM |
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what category is testosterone?
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X - women of child bearing age should be careful
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AE of testosterone:
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-cancer (rule out BPH or prostate b4 prescribing)
-lipids (negative effect) -weight gain (sodium retention) -contact dermatitis -ONLY for pts with hypogonadism, sx of low testosterone, measure serum testosterone -category x -SCHEDULE 3 (so it has abuse potential) |
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MOA of alprostadil?
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prostagladin E1 (causes vasodilation. used after viagra fails or the vacuum erection devices. 70-90% effective but NOT continued by pts for long term)
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how do you dose alprostadil?
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onset within 5-10 minutes so inject into penis 5-10 minutes prior to intercourse
-may give 2nd dose after 1 hour if no response |
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what are the AE of alprostadil?
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-local fibrosis
-priapism -pain |
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tell me about intraurethral implants
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less effected than injectable
insert applicator into penis, and plunge the pellet to release the drug |
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ae of intraurethral implants
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urethral pain
vaginal ssx painful and prolonged erections |
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other drugs
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rapaflo, silodosin == alpha 1a blockers
and yohimbine = an alpha 2 blockers (not really effective!) |
