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Theraputics Winter > ED And BPH √ > Flashcards

ED And BPH √ Flashcards

1
Q

ED Risk factors

A

Peripheral Vascular Disease
HTN
Hyperlipidemia
Diabetes
Psychiatric disorders
Age

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2
Q

What are ED lifestyle changes

A

x tobacco and alch
exercise, diet and wt loss

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3
Q

ED guidelines

A
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4
Q

Sildenafil dosing and name

A

Viagra 50mg 1 hr before
Max dose of 100mg

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5
Q

Vardenafil dosing and name

A

Levitra 10 mg po 1 hr before sex

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6
Q

Vardenafil dissolving dosing and name

A

Staxyn 10mg dissolve on tongue 1 hr before

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7
Q

Tadalafin dosing and name

A

Ciailis 10 mg po 30 mins before

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8
Q

Avanafil dosing and name

A

Stendra 100mg po 30 mins before

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9
Q

When to double dose for pt on PDE-5i?

A

After 7-8 times failed double dose except staxyn

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10
Q

Side effect for PDE-5i

A

MAJOR
Hypotension
Headache and flushing
Loss of blue-green color (sildenafil, tadalafil and Avanafil)
Erection longer than 4 hours

VERY RARE
Hearing lose
Sudden blindness
QT prolong (only vardenafil)

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11
Q

Which PDE-5i prolongs QTC

A

Vardenafil

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12
Q

Which PDE-5i causes loss of blue-green color?

A

Sildenafil, Tadalafil and Avanafil

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13
Q

DDI for PDE5

A

Nitrates (bc of hypotension)
Grapefruits
Vardenafil (1A or Type 3 antiarrhythmics)

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14
Q

When is testosterone indicated, and what are the 3 formulations?

A

Only in hypogonadism
Testosterone patch (androderm)
Testosterone gel 1% (androGel)
Testosterone cypionate IM (Depo-testosterone)

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15
Q

Androderm dosing

A

Testosterone patch 4mg on upper arm, back abdomen or thigh qHS

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16
Q

AndroGel dosing

A

5-10 gm to shoulder, upper arm or abdomen qAM

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17
Q

Depo-testosterone dosing

A

Injection 100-200 mg IM q2-4 weeks

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18
Q

When do I adjust testosterone for therapy

A

Increase if trough <450 ng/dL
decrease if trough >600 ng/dL

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19
Q

Testosterone side effects

A

Sodium retention
Hyperlipidemia
Mood swings
Hepatotoxicity

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20
Q

How many hours after testosterone gel or patch application can i go in the water?

A

3 hours

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21
Q

What are the 2 Alprostadil doseage forms?

A

Intracavernosal injections (Caverject)
Intraurethral pill (Muse)

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22
Q

Caverject dose

A

Aloprostadil injection 10mcg 5-10mins before sex

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23
Q

Muse dosing

A

250 mcg intraurethrally 5 - 10mins before sex

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24
Q

4 Adverse reactions with PGE-1

A

Hematoma and infection with Caverject
injection site pain
Uncommon hypotension dizzy bc of localization
Prolonged erection rare

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25
Q

What 3 criteria do we use to diagnose BPH?

A
  1. > 30gm on rectal exam
  2. > 1.5ng serum antigen
  3. American Urological Association (AUA)
    <7 mild
    8-19 Moderate severe
    ≥ 20 severe
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26
Q

4 Goals of therapy for BPH?

A

Symptom control
Decrease AUA by >3
Delay surgical intervention
reduce risk of complication

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27
Q

Lifestyle recommendation?

A

healthy diet
pee before bedtime
restrict fluids before bedtime
exercise
AVOID
caffeine and excessive alcohol

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28
Q

BPH flow chart for treatment?

A
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29
Q

Alpha 1 antagonist for BPH?

A

All the zosins
Prazosin, terazosin, doxazosin (Carduara and XL), alfuzosin, tamsulosin (Flomax), Silodosin (rapaflo)

30
Q

Prazosin Dosing

A

Minipress - 0.5 mg BID

31
Q

Doxazosin Dosing

A

Cardura XL - 4 mg QD

32
Q

Tamsulosin Dosing

A

Flomax - 0.4 mg QD

33
Q

Silodosin dosing

A

Rapaflo - 8 mg QD

34
Q

When to increase dose for BPH Alpha 1 antagonist?

A

After 2-7 days no effective
7-14 for prazosin, carduara XL or tamsulosin

35
Q

Which mediations are uroselective for BPH and what is the benefit?

A

Tamsulosin
Silodosin
Less hypotesntion

36
Q

When do we titrate for Alpha 1 Antagonist

A

2-7 days double dose if on (Prazosin, Cardura XL or Tamsulosin) 7-14 days

37
Q

What is the dosing consideration for Silodosin?

A

CrCl - 30-50 max dose is 4 mg QD

38
Q

Adverse reactions for Alpha 1 antagonists?

A

Hypotension
Floppy iris syndrome ( was on Naplex)
Retrograde ejaculations with uroselective agents (tam and silo)
CONTRA
Alfuzosin - HEPATIC
Silodosin HEPATIC CLCr <30
DDI
Silodosin with 3A4 inhibitors

39
Q

What do I avoid with Afluzosin with

A

Moderate to severe Hepatic impairment

40
Q

What are the 5alpha -reductase inhibitors and what is the place in therapy for BPH?

A

When oversized bc helps with reduction in 6-12 months ( 6 months 50% if not need to reevaluate P cancer)
Finasteride (Proscar) 5mg
Dutasteride (Avodart) .5mg

41
Q

Finasteride Dosing

A

Prosper - 5 mg QD

42
Q

Dutasteride Dosing

A

Avodart - 0.5 mg QD

43
Q

Adverse reactions for 5 Alpha inhibitors?

A

ED
Decrease sex drive
Man boobs
X - pregnancy, women wanting to get pregnant can not handle
X - men and their semen

44
Q

Which people should avoid contact with 5 Alpha Inhibitors?

A

Pregnant people or those wishing to become
is also in the Semen of the men as well

45
Q

How long does it take for 5 Alpha inhibitors to take effect

A

6 - 12 months

46
Q

PDE we can use in BPH and what is their role?

A

Tadalafil (Cialis) used if have ED with a moderate- severe AUA score
5mg QD
2.5mg for CLCr 30-50
X CLCr <30
Avoid sever hepatic impairment

47
Q

What anticholinergics can we use for BPH and what is their place in therapy

A

BPH and only in pts with irritation symptoms or post-void volume of 100-150ml

48
Q

Solifenacin dosing

A

(Vesicare) 5-10mg limit <30 or moderate Hepatic impariment at 5 mg

49
Q

Tolterodine Dosing

A

(Detrol) 1-2mg limit <30 or moderate Hepatic impairment at 1 mg

50
Q

What do we limit our dose to if the patient is on Solifenacin and a 3A4 inhibitor

A

Solifenacin if on 3A4 inhibitor limited to 5mg QD
SICK FOLKS

51
Q

beta 3 Agonists role in therapy?

A

Same as anticholinergics ( irritative symptoms but dont need to worry about pee retention)

52
Q

Mirabegron Dosing

A

(myrbetriq) 25-50mg
CrCl 15-30 or moderate hepatic - 25 mg
X CrCl 15 or severe hepatic

53
Q

Vibegron Dosing

A

(Gemtesa) 75mg
X Avoid CrCl 15 or severe hepatic

54
Q

Meds that cause ED

A

SAD MEN FAIL”

S – Spironolactone
A – Alpha-2 agonists (e.g., clonidine)
D – Dopamine antagonists (e.g., antipsychotics)
M – Medications for prostate issues (e.g., finasteride, dutasteride)
E – Estrogens
N – Narcotics/CNS depressants (e.g., opioids, sedatives, alcohol)
F – Finasteride (and other 5-alpha reductase inhibitors)
A – Anticholinergics (e.g., antihistamines, tricyclic antidepressants)
I – Increased beta-blockers (e.g., propranolol, metoprolol)
L – Loop diuretics (e.g., furosemide)

55
Q

Index of Erectile Function (IIEF) scores

A

22-25 = normal
17-21 = mild dysfunction
12-16 mild-moderate dysfunction
8-11 = moderate dysfunction
1-7 = severe dysfunction

56
Q

2 goals of ED Therapy

A

improve sex life
increase IIEF by 4 points minimum
goal of 20

57
Q

Signs of Hypogonadism

A

morning Serum test <300 with 4 instances
small balls
decrease body hair
man boobs

58
Q

Patient education for PDE-5i

A

still need stimulation
Sildenafil/ vardenafil - take on an empty stomach
max 1 dose daily
greater than 4 hrs seek care

59
Q

When should I collect the trough for the testosterone patch?

A

prior to 2 week dose

60
Q

When should I collect the trough for the testosterone injection?

A

prior to 4th dose

61
Q

What are the 4 patient education for testosterone patch

A
  1. cover application sites
  2. wash hands after use
  3. Women and children avoid contact with the area
  4. no swimming or showering within 3 hours of application
62
Q

Testosterone contraindications

A

Heart Failure
MI
UNTREATED prostate cancer

63
Q

What are the 3 patient educations for testosterone gel

A
  1. rotate the site every 7 days
  2. avoid swimming/ showering for 3 hours after application
  3. females and children should avoid contact in unwashed areas
64
Q

What are the 4 patient educations for PGE1

A

inject at a 90-degree angle
wash hands before use
can use Tylenol for penile pain
after injection apply pressure to avoid hematoma

65
Q

what are the 2 patient education for intrauethral

A

massage penis after insertion
void prior to insertion to moisten the urethra

66
Q

PDE-5i Dosing considerations?

A
67
Q

If a patient complains about ED med taking to long to work which med would you switch them to?

A

Cialis 10mg 30 mins before

68
Q

What patient do I need to avoid Testosterone in absolutely

A

Untreated Prostate Cancer

69
Q

What is the problem with alprostadil titration

A

all physician office

70
Q

AUA scores

A

<7 mild
8-19 Moderate severe
≥ 20 severe

Theraputics Winter (15 decks)

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