Editing Functional: Pharmacological Management of LUTS (section)

===== Pharmacology =====
*'''<span style="color:#ff0000">Anti-cholinergics can be classified as tertiary vs. quaternary amines</span>'''
** '''<span style="color:#ff0000">Tertiary amines</span>'''
*** '''<span style="color:#ff0000">Oxybutynin, tolterodine, fesoterodine, solifenacin, darifenacin,</span>''' atropine, imidafenacin, and propiverine
*** '''Well absorbed from the GI tract'''
*** '''Theoretically able to pass into the central nervous system (CNS)'''
**** '''Factors that increase the likelihood of an anti-cholinergic passing through the blood-brain barrier (3):'''
****# '''High lipophilicity'''
****# '''Small molecular size'''
****# '''Low electrical charge'''
** '''<span style="color:#ff0000">Quaternary amines</span>'''
*** '''<span style="color:#ff0000">Trospium and propantheline</span>'''
*** '''Not well absorbed from the GI tract'''
*** '''<span style="color:#ff0000">Pass into the CNS to a limited extent, and have a low incidence of CNS side effects</span>'''
* '''<span style="color:#ff0000">Metabolism</span>'''
** '''<span style="color:#ff0000">Many metabolized by the P450 enzyme system to active and/or inactive metabolites.</span>'''
*** Most commonly involved P450 enzymes are CYP2D6 and CYP3A4
*** Metabolic conversion creates '''a risk for drug-drug interactions; coadministration of a potent inhibitor of this enzyme (e.g., ketoconazole) may lead to an increase in the circulating drug'''