Drugs for BPH, incontinence, impotence

jmanderson's version from 2015-11-13 02:42

BPH and incontinence drugs

Question Answer
Give three drugs or drug categories that can precipitate (not just aggravate it through causing coughing) urinary incontinence.diuretics, ACh inhibitors, alpha-receptor antagonists
Give one over the counter (OTC) drug for incontinence and how it is administered.Oxybutynin Transdermal patch (Oxytrol)
Give the drug whose extended release form has the fewest adverse effects of all the oral incontinence drugs.Trospium
the drug that is an alternative for patients who cannot tolerate anticholinergics and what it acts on Mirabegron (Myrbetriq®) - β3-adrenergic receptor agonist
special population for whom estrogen is appropriate for incontinencepost-menopausal women
reproductive adverse effect of 3rd generation alpha-antagonistsinclude ejaculatory dysfunction (which is NOT equal to erectile dysfunction) for both tamsulosin and silodosin
3rd generation alpha-antagoniststamsulosin and silodosin
That the prostate has a sex hormone binding globulin receptor and that it is this receptor that mediates the steroid effects on prostate cells. Importantly, in their model, while estradiol stimulates these receptors, DHT acts as an antagonist at them.the alternate theory of estradiol versus DHT action proposed by the Rosner laboratory.
two drugs in the combination agent for BPHdutasteride and tamsulosin
Describe the clinical effectiveness of saw palmetto for BPHAUA does not recommend ; the standard dose is INEFFECTIVE
Describe the limits of pharmacological intervention for urinary incontinencePharmacological management: at best, medications can decrease the number of incontinence episodes by 1/day v. placebo. Placebo may decrease the number of episodes by 1 or 2 a day.
drug of choice for stress urinary incontinence Oxybutynin
Oxybutynin MOAnon-selective M receptor antagonist -> increase sphincter tone and relax detrusor muscle
advantage of tolterodine over oxybutynin.Tolterodine = little activity at non-muscarinic receptors -> fewer AEs
Oxybutynin AEsanticholinergic; orthostatic hypotension (alpha antagonist), sedation and wt gain (antihistamine), due to active metabolite DEO
Explain what a patient receiving onabotulinumtoxin A should be able to do and why.Due to the risk of urinary retention Botox should only be used in patients willing to perform SELF-CATHETERIZATION
route of administration onabotulinumtoxin AIntradetrusor injection
duration of onabotulinumtoxin A actionLast ~ 4-8 months
four cardiovascularly related contraindications of alpha-agonistsHTN, tachyarrhythmias, CAD, MI
Give four advantages of alpha-antagonists used for BPH over 5α-reductase inhibitors.faster acting, more effective at relieving sx, do not reduce PSA levels, less sexual dysfunction, relieve sx independent of prostate size
Describe an effect of terazosin and doxazosin that is not typically mediated by adrenergic receptors.Induces stromal and epithelial cell apoptosis (Contributes to the improvement of symptoms and long-term therapeutic response)
very serious cardiovascular effect of alfuzosin (alpha-blocker)QT prolongation
important advantage of 3rd generation alpha1-adrenergic antagonists over 1st and 2nd generation onesFewer peripheral antihypertensive effects (selective for alpha-1a), dosed w/o titration
preferred 3rd generation adrenergic agent.Tamsulosin
one advantage of 5α-reductase inhibitors over adrenergic agents for BPHDecrease gland size by 25%
what parameter should be checked before prescribing a 5α-reductase inhibitor and why?Check for prostate CA because it reduces PSA levels by 50% (PSA indicates prostate malignancy)
why a physician might not choose to prescribe solifenacin over oxybutynin1-solifenacin has shown to be UROSELECTIVE so wouldnt help in stress incontinence b/c that has to do with the urethra, 2-solifenacin must be capped at a smaller dose in renal/hepatic impairment

Impotence Drugs

Question Answer
Give three effects of androgens in womenIncreased facial and body hair, deepening of the voice, enlargement of the clitoris, baldness, increased musculature, natural androgens increase RBC production
one effect of anabolic steroids that could affect fertilityWill suppress spermatogenesis.
one effect of anabolic steroids that could precipitate coronary artery diseaseIncrease acne, erythrocytosis, increase LDL –decrease HDL.
one indication for aromatase inhibitorsBlocking aromatase stops testosterone conversion to estradiol and therefore is used in breast cancer (can cause osteoporosis).
Explain the role of nitric oxide in the normal attainment of penile erection and where it comes from.Sexual stimulation -> NO released from NANC nerves and endothelial cells -> stimulates guanylate cyclase (increases cGMP) -> vessel relaxation -> penile erection (PDE5 catabolizes cGMP to inhibit prolonged erections)
Describe what in its kinetics distinguishes tadalafil from other PDE5 inhibitors.Tadalafil = duration of action ~24-36 hrs
appropriate counseling of a patient with normal sexual functioning who wants a prescription for a PDE5 inhibitor in order to enhance their sexual abilitiesPatients who have normal sexual function should not seek, or be encouraged to seek, treatment in an effort to enhance sexual function.
Apply the populations of patients for whom PDE5 inhibitors are contraindicated to a clinically-relevant case scenario.PDE5 inhibitors are contraindicated in pts taking nitrates → would cause additional hypotension (stimulates guanylyl cyclase), dietary sources don’t interact w/ PDEi’s
Explain why testosterone is called a “pro-hormone”.because most of its actions are actually mediated via DHT or estradiol
Explain what limits oral use of testosterone.Testosterone (T-undecanoate) can be given PO, but may cause LIVER TUMORS
Explain the effects of exogenous androgen treatment on aspects of the HPG axis.exogenous testosterone → inhibits GnRH, LH, and FSH → shuts down endogenous testosterone secretion
the population that should receive testosterone.Only give to hypogonadal men with T levels < 3 ng/mL
the population that should not receive testosteroneT should not be given to men w/ prostate CA (it stimulates tumor growth) OR men w/ CVD (increases risk for adverse CV events like MI)
Give two indications for danazol.Endometriosis (by atrophying ectopic endometrial tissue), Fibrocystic breast dz (inhibits growth of breast CA tissue)
Erectile dysfunctionpenis does not become firm enough to enter vagina
Ejaculatory dysfunctionpenetration occurs, but no ejaculation of semen
Give three non-pharmacological treatments for ED.Vacuum erection device, surgery, marital counseling
site of sildenafil’s action.a PDE5 inhibitor (increases cGMP levels in vascular smooth muscle)
Explain why PDE5 inhibitors give a “more natural erection”.Because the natural process of NO → cGMP must already be working, PDE5i’s just potenttiates the natural process to make it work better (thus only works on pts with neurogenic and vascular causes of ED)
Describe alprostadil’s MOA to affect penile erection.MOA = a PGE1 analog (increases cAMP causing direct arterial smooth muscle relaxation and increased blood flow to corpora)
Give (gulp) the two mechanisms of alprostadil’s administration.intracavernosal injection (more effective), intraurethral insert (poor bioavailability)
Give the mechanism of flibanserin action.MOA = a serotonin agonist/antagonist that slightly increases female libido
Explain the danger of taking flibanserin with alcohol.causes hypotension (i.e., 55/46 mmHg)

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