GU Pharm Exam Study Guide PDF

Male/General GU Erectile Dysfunction (ED): Understand the pharmacology of PDE-5 inhibitors (e.g., Benign Prostatic Hyperplasia (BPH): Review alpha-blockers (e.g., tamsulosin) and sildenafil, tadalafil), including their mechanism, side effects, and contraindications. 5-alpha-reductase inhib...

Male/General GU Erectile Dysfunction (ED): Understand the pharmacology of PDE-5 inhibitors (e.g., Benign Prostatic Hyperplasia (BPH): Review alpha-blockers (e.g., tamsulosin) and sildenafil, tadalafil), including their mechanism, side effects, and contraindications. 5-alpha-reductase inhibitors, focusing on their mechanism, efficacy, and adverse effects. PDE-5 inhibitors: avanafil, sildenafil, tadalafil, vardenafil Alpha blockers: tamsulosin, alfuzosin, doxazosin, terazosin MOA: MOA: block a-adrenergic receptors → relax bladder & prostate smooth muscle inhibit PDE-5 → ↓ cGMP degradation → ↑ NO effects → vasodilation & penile erection Efficacy: work on DYNAMIC sx of BPH ADR (6 major): HA, flushing, nausea, back pain, hypotension, priapism 1st line for most BPH pts Quickly effective (days–wks) WARNINGS: stop drug immediately if… (2) a-(1A) antagonists more effective that 5-ARIs both short & long term 1. Sudden vision loss (NAION) ↑ urinary flow rate 2. Sudden ↓ or loss of hearing ↓ PVR, detrusor overactivity, obstruction CI (3): ADR (3): 1. Uncontrolled/mod/severe CV stuff (6): angina, arrhythmias, HTN, HF, valvular dz, 1. CV: 1st dose syncope, orthostatic hypotension, dizziness cardiomyopathy a. Tera > doxa >> alfu > tamsu 2. Recent MI 2. Sperm count & viscosity 3. Ophthalmic d/o (4): glaucoma, mac degen, diabetic retinopathy, eye a. ↓ w/ tamsulosin trauma/surgery b. No change w/ alfuzosin 3. EjD a. Tamsu > tera Drug-specific ADRs & CIs: Avanafil 5-ARIs: dutasteride, finasteride CI: CrCl sphincter pressure General MOA: ↓ involuntary detrusor muscle activity Sudden urge to urinate → involuntary micturition Med tx: anticholinergics/antimuscarinics, beta-3 adrenergic agonists, botox General ADRs: Dry mouth (worse w/ IR formulation) Overflow incontinence Constipation Overfull bladder 2/2 improper emptying d/t… (2) Some have other GI issues (nausea, dyspepsia) ○ Poor bladder contractility Some have HA, dizziness, somnolence, dry eyes ○ Obstruction Med tx: alpha blockers, PDE-5 inhibitors Additional ADRs + other stuff: Oxybutynin IR Stress incontinence ADR: orthostatic hypotension, wt gain ↑ abd pressure d/t cough, sneeze, laugh, lifting, etc Med tx (from CM): topical estrogens may help peri/postmenopausal women w/ Oxybutynin ER atrophic vaginitis DDI: other anticholinergics, CYP3A4 inhibitors, AChE inhibitors Tolterodine IR Monitor for QT prolongation if also taking certain antiarrhythmics DDI: CYP3A4 inhibitors CI: hypersensitivity to fesoterodine fumarate If RENAL or HEPATIC impairment → ↓ dose NOT recommended w/ severe RENAL or HEPATIC impairment Tolterodine ER Monitor for QT prolongation if also taking certain antiarrhythmics If RENAL or HEPATIC impairment → ↓ dose NOT recommended w/ severe RENAL or HEPATIC impairment Fesoterodine fumarate If severe RENAL impairment or taking potent CYP3A4 inhibitors ○ → max 4 mg daily NOT recommended w/ severe HEPATIC impairment Trospium chloride Alc may ↑ drowsiness caused by anticholinergics If RENAL impairment → ↓ dose NOT recommended w/ severe RENAL impairment Solifenacin ADR: UTI, blurred vision, QT prolongation DDI: CYP3A4 inhibitors & inducers If severe RENAL or mod HEPATIC impairment → ↓ dose AVOID in severe HEPATIC impairment (child-pugh class C)  Darifenacin DDI: flecainide, thioridazine, TCAs If mod HEPATIC impairment (class B) or taking potent CYP3A4 inhibitors ○ → max 7.5 mg daily AVOID in severe HEPATIC impairment (child-pugh class C) Urinary Tract Infections (UTIs): Review common antibiotics used for UTIs, and Drug Monitoring and Toxicity: Review the monitoring parameters for medications in the considerations for antibiotic resistance. GU and reproductive system, especially regarding renal function. (See main UTI charts for dosing) *see box above for anticholinergic/antimuscarinic renal & hepatic considerations Acute uncomplicated cystitis: Monitoring parameters for all GU drugs (esp regarding renal fxn): 1st line: 1. Nitrofurantoin Male GU + General urinary 2. Trimethoprim-sulfamethoxazole (Bactrim) Tolterodine IR & ER 3. Fosfomycin ○ QT prolongation if also taking certain antiarrhythmics 4. Trimethoprim Mirabegron ○ ↑ BP 2nd line: ○ Urinary retention 1. Amoxicillin-clavulanate (Augmentin) ○ Drug level monitoring is advised for certain meds w/ narrow 2. Cephalexin therapeutic ranges such as thioridazine, flecainide, & propafenone 3. Cefpodoxime Nitrofurantoin 4. Cefadroxil ○ Baseline SCr ○ Baseline BUN 3rd line: reserved for development of resistance ○ Avoid use if CrCl 35 yo + smoker ADR (2 major): hyperK, polymenorrhea 2. Migraine w/ aura NOT recommended in pregnancy d/t feminization of male fetuses 3. Uncontrolled HTN 4. Ischemic stroke Clomiphene 5. VTE Indication: ovulation induction 6. DM w/ vascular dz ADR (3): risk of multiple pregnancy, vasomotor sx, GI issues CI: only 1 listed in the “contraceptives” lecture, but MANY CIs listed for COC use in Letrozole dysmenorrhea (BP is from “contraceptives” lec, other 4 red bolded CIs are from “MHT”) Indication: ovulation induction 1. BP ≥160/100 ADR: edema, hot flashes, bone pain 2. Pregnancy CI: pregnancy 3. Undiagnosed vaginal bleeding 4. Known or suspected breast malignancy  5. Hepatic adenomas or carcinomas or active liver dz Dysmenorrhea: 6. Active thrombophlebitis, current or previous hx of thromboembolic d/o, or In order from 1st → last line tx: cerebrovascular dz 1. Nonpharm (e.g. topical heat) 7. Carcinoma of the endometrium or other known or suspected estrogen-dependent 2. Monthly NSAIDs at sx onset neoplasia a. GI issues, renal dysfxn, inhibits platelet aggregation, ↑ risk of CV events 8. Cerebrovascular or coronary artery dz 3. COC x 2-3 cycles 9. Cholestatic jaundice of pregnancy or jaundice w/ prior pill use a. ↑ BP, fluid retention/weight gain, VTE 10. DM w/ vascular involvement b. CI: many (see L column for details) 11. HA w/ focal neurological sx 4. DMPA or LNG-IUS 12. Uncontrolled HTN a. DMPA: 13. Thrombogenic rhythm d/o or valvulopathies i. Menstrual irregularities, wt gain ii. CI: breast CA, pregnancy, undx’d vaginal bleeding, liver dz, VTE DDI: many… iii. BBW: bone loss b. LNG-IUS Specific Pt Counseling: i. Menstrual irregularities, PID If miss 1 tablet ii. CI: similar to DMPA + MANY more such as… ○ → take ASAP, continue rest as rx’d (no backup req) 1. Uterine anomaly If miss ≥2 consecutive tablets 2. PID ○ → take 1 tab ASAP, discard other missed tabs, continue tablets as 3. uterine/cervical neoplasia scheduled 4. Acute cervicitis/vaginitis If missed tablets in the last week of hormonal tablets ○ → finish remaining active tabs, skip placebo tabs, then start new pack ○ Use additional non-hormonal contraception until active hormone tablets have been taken for 7 consecutive days (This info is exactly what deepti had in her flow charts, but a little diff from what tracey had in her CM contraceptives lecture…) Hormone Replacement Therapy (HRT): Know the indications, risks, and benefits Labor Suppressants (Tocolytics): Understand medications like magnesium sulfate for associated with HRT in postmenopausal women. preterm labor, including side effects and monitoring requirements. Types (2): Preterm labor = 20-37 weeks gestation Unopposed estrogen → women w/ hx hysterectomy Combo estrogen + progestin → women w/ intact uterus who need progestin to Tocolytics (nifedipine, mag sulfate) → prolong pregnancy/delay labor 48 hrs–1 week prevent estrogen-assoc endometrial hyperplasia Criteria for starting tocolytics (2) Regular uterine contractions HRT Indications (2): women w/ no CI to MHT & are… Cervical change 1. Within 10 yrs of menopause From flow chart: 2.