Exam 2 lecture 8 Flashcards Preview

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Flashcards in Exam 2 lecture 8 Deck (57)
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1
Q

drug dosing is mostly based on

A

CrCl

2
Q

PK changes

A
  • bioavailability (absorption)
  • drug distributio
  • metabolism (Phase 1 & II slowed)
  • renal elimination
3
Q

volume of distribution

A
  • reduction in tissue binding
  • body composition altered
  • protein binding (decreased binding of acidic drugs, altered binding of basic drugs)
4
Q

normal phenytoin concentration

A
  • 10-20mcg/mL
  • 90% bound normally
  • low albumin-> difference in ratio
5
Q

renal elimination

A
  • decreased glomerular filtration, renal tubular secretion & reabsorption
  • accumulation of metabolites
  • efficacy (codein, procainamide)
  • toxicity (meperidine, propoxyphene)
6
Q

pts on dialysis have CrCl of

A
7
Q

intermittent dialysis

A

maintains a high concentration until dialysis then drops

8
Q

continuous dialysis

A

more like normal kidney function

9
Q

drug characteristics that affect removal in HD

A
  • MW
  • water solubility
  • protein binding
  • Vd
10
Q

PD is

A

not as effective as HD at removing substances

11
Q

Metformin is contraindicated with

A

SCr>1.4 in females 1.5 in males

- risk of lactic acidosis

12
Q

drugs needing dose adjusted

A
  • warfarin, LMWH
  • phenytoin
  • spironolactone, digoxin, procainamide
  • NSAIDs, meperidine, morphine
  • insulin, glyburide, metformin
  • ABX: AGs, cephs, PCN, FQs, vanc
  • gout: colchicine & allopurinol
13
Q

Metformin is contraindicated with

A

SCr>1.4 in females 1.5 in males

- risk of lactic acidosis

14
Q

is overactive bladder (OAB) more common in M/F ?

A

=

15
Q

is OAB with incontinence more common in M/F?

A

females

16
Q

urge urinary incontinence

A
  • OAB

- detrusor contracts during filling phase

17
Q

stress urinary incontinence

A
  • urethra or urethral sphincters cannot sufficiently impede urine flow
18
Q

overflow incontinence

A
  • bladder underactivity

- bladder outlet obstruction (BOO)

19
Q

functional

A

unrelated to urethral or bladder capability

20
Q

symptoms of urge urinary incontinence

A
  • frequency (>8Xday) & urgency
  • nocturia (>1/night) &/or enuresis (nocturnal incontinence)
  • usually large volume due to complete emptying
21
Q

stress urinary incontinence

A
  • urethral underactivity
  • UI during activities
  • small volume
22
Q

overflow incontinence

A
  • bladder is full but unable to empty
  • bladder underactivity (loss of function of detruser muscle)
  • BOO(BPH)
  • difficulty initiating stream, dribbling, small amounts of urine leaking constantly
23
Q

pelvic floor muscle rehab is used in

A

stress UI

24
Q

bladder training is used in

A

urge UI

25
Q

urge UI treatment

A
  • anticholinergics/ antispasmodics 1st line (oxybutynin or tolterodine)
  • oxybutynin IR (ditropan): gold standard
26
Q

adverse effect of oxybutynin

A

orthostatic hypotension

27
Q

oxybutynin IR

A
  • ditropan

- 2.5-5mg PO 2-3x/day

28
Q

oxybutinin ER

A
  • ditropan XL
  • 5-10mg PO QD
  • decreased ADE
29
Q

oxybutynin transdermal

A
  • oxytrol

- OTC

30
Q

tolterodine

A
  • detrol, detrol LA
  • IR: 2mg PO BID
  • ER: 4mg PO QD
  • alternative 1st line for urge UI
  • no orthostatic hypotension
31
Q

fesoterodine

A
  • toviaz

- alt 1st line for urge UI

32
Q

solifenacin

A
  • vesicare

- urge UI

33
Q

darifenacin

A
  • enablex

- urge UI

34
Q

trospium

A
  • sanctura

- urge UI

35
Q

mirabegron

A
  • myrbetriq
  • beta3 agonist
  • consider in those intolerant of anticholinergic effects
  • 25-50mgPO QD
  • urge UI
36
Q

tricyclic antidepressents

A
  • urge UI
  • reserved in those with a concurrent indication (peripheral neuropathy, depression)
  • orthostatic hypotension
  • overdoses are potentially life-threatening
  • desipramine & nortiptyline preferred due to
37
Q

tricyclic antidepressents

A
  • urge UI
  • reserved in those with a concurrent indication (peripheral neuropathy, depression)
  • orthostatic hypotension
  • overdoses are potentially life-threatening
  • desipramine & nortiptyline preferred due to decreased side effects
38
Q

duloxetine

A
  • cymbalta
  • 1st line is stress UI
  • 40mg PO BID
39
Q

alpha-adrenergic agonist

A
  • stress UI
  • pseudoephedrin 15-60mg TID
  • phenylephrine 10mg QID
40
Q

topical estrogens

A
  • Stress UI in combo with urethritis or vaginitis due to estrogen deficiency
41
Q

overflow incontinence treatment

A
  • intermittent self catherization 3-4X/day

- bethanechol: rarely used

42
Q

epithelial tissue of prostate

A

produces prostatic secretions

43
Q

stromal tissue of postate

A

smooth muscle c ontraction if alpha-adrenergic receptor stimulated

44
Q

capsule tissue of prostate

A
  • fibrous, connective tissue that also contracts when alpha-adrenergic receptor stimulated
45
Q

pathophys of BPH

A
  • static factors: growing prostate
  • dynamic factors: alpha stimulation
  • detrusor factors: 2* to BOO
46
Q

symptoms of BPH

A
  • obstructive: diminished stream, urinary hesitancy, incomplete bladder voiding
  • irritative: urinary frequency & urgency, nocturia
47
Q

mild BPH

A
  • aymptomatic

- peak urinary flow rate 25-50mL

48
Q

moderate BPH

A
  • all of mild plus obstructive or irritative voiding symtoms
49
Q

severe BPH

A
  • all of moderate plus one or more complication of BPH
50
Q

mild BPH treatment

A
  • watchful waiting

- behavior modification

51
Q

severe BPH symptoms & complications treattment

A

surgery

52
Q

alpha- adrenergic antagonists

A
  • do not reduce prostate side

- relax intrinsic urethral sphincter & prostatic smooth muscle

53
Q

3rd generation alpha blockers

A
  • tamsulosin (flomax) & silodosin
54
Q

2nd generation alpha blockers

A

prazosin, terazosin (Hytrin), doxazosine (Cadura), alfuzosin

  • terazosin & doxazosin 1 mg PO at bedtime
  • orthostatic hypotension
55
Q

3rd generation alpha blockers

A
  • tamsulosin (flomax) & silodosin
  • tamsulosin 0.4mg PO QD
  • avoid in sulfa allergy
  • good in pts at risk for hypotension
56
Q

5- alpha reductive inhibitors

A
  • reduce size of prostate
  • decrease intraprostatic DHT & SDHT
  • takes 6-12 months to take effect
  • second line in sexually active men
  • pregnancy X
  • dutasteride (Avodart) 0.5mg PO QD
  • finasteride (proscar) 5mg PO QD
57
Q

BPH treatment not commonly used

A
  • GNrh antagonists

- antiandrogens