Genitourinary

Question 1

Alpha blockers e.g. _____, ______ are indicated as 1st line rx of ___ when lifestyle alone is insufficient.
Also indicated for the add-on treatment of resistant _____ when other meds are insufficient.

Answer 1

• doxazosin, tamsulosin, alfuzosin
• BPH
• resistant hypertension

Question 2

MOA, alpha-blockers are highly selective for the….

Answer 2

• a-1 adrenergic receptor, on SM e.g. blood vessels and urinary tract (around bladder neck and prostate)
• blockade induces relaxation so they cause vasodilation and fall in BP and reduced resistance to bladder outflow

Question 3

2 adverse effects of alpha-blocker use e.g. doxazosin, tamsulosin, alfuzosin

Answer 3

-postural hypo (do not give to pts with existing postural hypoT)
-dizziness
-syncope
(esp after the 1st dose)

Question 4

If starting an alpha blocker e.g.. doxazosin, tamsulosin, alfuzosin for rx-resistant hypertension, which antihypertensive may you withold while the first dose of alpha blocker is started to protect against pronounced hypotension?

Answer 4

-omit beta-blocker (as this inhibits tachycardia-forms part of the compensatory response to vasodilation)

Question 5

5 alpha reductase inhibitors e.g. _____, are indicated for 2nd line rx of:

Answer 5

• finasteride
• BPH (improves LUTS symptoms and reduce need for surgery)
• dose 5mg daily

Question 6

5 alpha reductase inhibitors e.g. finasteride, MOA for BPH rx:

Answer 6

• reduce size of gland
• inhibition of the intracellular 5-AR enzyme means testosterone is not converted to more active DHT (which stimulates prostatic growth) so it thereby improves urinary flow
• but can take several months

Question 7

2 SEs of 5 alpha reductase inhibitors e.g. finasteride (relates to the anti-androgen action)..

Answer 7

• impotence & reduced libido. but these are usually transitory
• breast tenderness and gynaecomastia, increased risk of breast cancer in men on finasteride
• hair growth (can improve male-pattern baldness)

Question 8

What is a bizarre CI of 5 alpha reductase inhibitors e.g. finasteride..?

Answer 8

-CI: PREGANT WOMEN DON’T TAKE THEM/BE EXPOSED TO THEM (by handling broken tablets or through semen during unprotected sex with a man on these drugs..) as exposure to a male fetus -> abnormal external genitalia development

Question 9

In hormonal contraception, oestrogen +/ progesterone are given to suppress what to prevent what?

Answer 9

-suppress FSH/LH so prevent ovulation

Question 10

All forms of oestrogen and progesterone are contraindicated in patients with what?

Answer 10

CI: BREAST CANCER

Question 11

Sildenafil is a PDE-5 inhibitor used to treat erectile dysfunction or what condition in the lungs?

Answer 11

-Primary pulmonary hypertension

Question 12

How does sildenafil act?

Answer 12

• inhibits PDE-5
• found in SM of corpus cavernosa/lung arterioles
• PDE-5 usually would break down cGMP, so sildenafil increases cGMP conc
• this improves penile blood flow/erection quality / pulmonary blood flow

Question 13

As sildenafil is a vasodilator, suggest 3 SEs associated with it’s use:
NB: visual colour distortion should prompt urgent medical review as should priapism due to failure of erection to subside=

Answer 13

• flushing
• headache
• dizziness
• nasal congestion
• hypotension, tachycardia, palpitations

Question 14

Sildenafil has a small associated risk of vascular events

suggest 2 CIs for its use and 1 caution:

Answer 14

CI: STROKE
CI: ACS, CI: CVS DISEASE
CI: NITRATES/NICORANDIL that increase NO conc
Caution: hepatic/renal impairment

Question 15

Oxybutinin and tolteradine, solifenacin belong to what class of medication

Answer 15

Antimuscarinics (for genitourinary use)

Question 16

what GU pathology are antimuscarinics like oxybutynin and tolteradine used for?

Answer 16

-reduce urinary frequency, urgency and urge incontinence in OVERACTIVE BLADDER (if bladder training is ineffective)

Question 17

Mechanism of antimuscarinics (e.g. oxybutynin, tolteradine) for OVERACTIVE BLADDER?

Answer 17

• competitively inhibit Ach on muscarinic receptors (m3)
• blocking this promotes bladder relaxation (increases bladder capacity)
• reduces symptoms

Question 18

Give 3 SEs of the antimuscarincs used to treat Overactive Bladder:

Answer 18

• dry mouth
• tachycardia
• constipation
• blurred vision

Question 19

What is the one CI to antimuscarinic use in Overactive Bladder hence what is an important part of assessment before prescribing?

Answer 19

-CI: URINARY TRACT INFECTION

Therefore: must do urinalysis before prescribing

Question 20

What is the com