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GU2 - Urology > ED, BHP, Prostatitis > Flashcards

ED, BHP, Prostatitis Flashcards

1
Q

What is the treatment of choice if primary hypogonadism is the cause of erectile dysfunction

A

androgen therapy

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2
Q

Contraindications for androgen therapy

A
  1. prostate cancer

2. obstruction of bladder neck by prostatic hypertrophy

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3
Q

What are the 6 types of androgen therapy

A
  1. Oral (rarely used)
  2. Buccal mucoadhesives
  3. Injectables
  4. Transdermal preparations
  5. Implantable subcutaneous pellets
  6. Gel
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4
Q

name for testosterone buccal mucoadhesive

A

Striant

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5
Q

Three types of injectable testosterone and dosing

A
  • Testosterone cypionate (Depo-Testosterone) q 2-3 weeks
  • Testosterone enanthate (Delatestryl) q 2-3 weeks
  • Testosterone undecoanoate (Aveed) q 10 weeks
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6
Q

What is special about Aveed injectable

A
  • Must be done in clinic by certified professionals, 30 min monitoring after ea injection
  • Risk of POME (pulmonary oil microembolism)
  • risk of anaphylaxis
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7
Q

Disadvantage to injectables

A
  • tendency to produce uneven effects between doses

- pain associated with IM injection

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8
Q

Transdermal testosterone preparations

  • name
  • ADR
A

Androderm

  • skin irritation
  • contact dermatitis
  • itching
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9
Q

Implantable subcutaneous testosterone pellets

  • name
  • where implanted
  • disadvantage
A
  • Testopel
  • fat tissue of buttocks
  • less flexible dosing (once it’s in it’s in)
  • if have complication, pellets have to be sx removed
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10
Q

Testosterone Gel

  • name
  • disadvantage
A
  • Androgel
  • Virilization of women and children
  • counsel men to cover application site with clothing to avoid contact with others
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11
Q

How to monitor effectiveness of androgen therapy

A

Baseline, f/u after therapy initiation, then yearly:

  • Testosterone
  • Hematocrit
  • Serum lipid values
  • LFTs
  • PSA and DRE
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12
Q

What are the 7 therapy options for ED if not primary hypogonadism (in order of selection)

A
  1. Comorbidities and psychosexual dysfunction
  2. Phosphodiesterase-5 inhibitors (PDE-5)
  3. Intra-urethral Alprostadil
  4. Intravacernous Vasoactive Drug injections
  5. Vacuum constriction
  6. Semi-rigid/inflatable prosthesis
  7. vascular surgery
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13
Q

PDE5 Inhibitors

- how fit into tx selection

A
  • 1st line if ED not caused by comorbidities, medications, primary hypogonadism
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14
Q

List the 4 PDE5 inhibitors

A
  1. Sildenafil citrate (Viagra)
  2. Vardenafil (Levitra or Staxyn)
  3. Tadalafil (Cialis)
  4. Avanafil (Stendra)

*all considered equal, some work better in some people

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15
Q

ADR PDE5 inhibitors

A

Mild to moderate, self limiting, more common in higher doses

  • HA
  • Flushing
  • Dyspepsia
  • Nasal congestions
  • Hypotension (uncommon, CV assessment should be done before therapy)
  • Acute hearing loss (rare)
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16
Q

PDE5 Inhibitors contraindications

A

Use with short- or long-acting nitrate drugs – potentiate hypotensive effects, risk of severe hypotension and MI or stroke

  • Viagra 24 hours before or after nitrate
  • Cialis 48 hours before/after nitrate
  • Levitra and Stendra no official standard but probably 24 hours
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17
Q

Intra-urethral Alprostadil

- name

A

MUSE - medicated urethral system for erection

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18
Q

Intra-urethral Alprostadil

- advantages

A
  • ED associated with neurogenic, vasculogenic, psychogenic, mixed etiologies
  • Local application
  • minimal systemic effects
  • rarity of drug interactions
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19
Q

Intra-urethral Alprostadil

- Disadvantages

A
  • inconsistent results
  • penile pain
  • urethral pain/burning
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20
Q

Intra-urethral Alprostadil

  • best results when used with what?
  • where should therapy be initiated?
A
  1. Effectiveness is increased with concurrent use of Actis, penile-constricting device
  2. Therapy should be initiated in physicians office due to complicaitons of urethral bleeding, vasovagal reflex, hypotension, priaprism
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21
Q

Intracavernous vasoactive drug injection

- what is the only approved drug by FDA in US?

A

Alprostadil

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22
Q

Intracavernous vasoactive drug injection of alprostadil

  • success
  • low rates of what common ADRs
A
  • erection in more than 70% men

- relatively low rate priapism and fibrosis

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23
Q

Intracavernous vasoactive drug injection of alprostadil

- 4 common ADR

A
  • penile pain
  • hematoma
  • fibrosis (pressure on injection site for 5 min to avoid)
  • priaprism
24
Q

Where inject Intracavernous vasoactive drug?

A
  • dorso-lateral aspect of proximal third of penis
  • avoid visible veins
  • switch sides
  • max 1 per 24 hours
25
Q

What are the three injectible intracavernous vasoactive drugs used?

A
  • Alprostadil
  • papaverine
  • phentolamine
26
Q

papaverine ADR (2)

A
  • priapism

- corporal fibrosis

27
Q

phentolamine ADR (2)

A
  • hypotension

- reflex tachycardia

28
Q

Vacuum constriction

A

vacuum is applied to penis for a few minutes, causing tumescence and ridigidy which is sustained using a constricting ring at the base of the penis

29
Q

Two surgery options

A
  1. Penile prosthesis implantation

2. Vascular surgery

30
Q

Disadvantage to penile prosthesis

A
  • unnatural erection

- risk of infection

31
Q

Advantage to vascular surgery

A

May be curative, esp for young men with congenital or traumatic erectile dysfunction with focal arterial occlusion but no vascular dz

32
Q

Dosing recommendation for tadalafil (Cialis)

A
  • 10 mg before planned sexual activity
  • May increase to 20 or decrease to 5 based on efficacy and tolerability
  • Duration of action is 36 hours
  • OR daily dose 2.5 mg (or 5mg) without regard to sexual activity
33
Q

Tadalafil drug interactions (2)

A
  1. Long and short acting nitrates – hypotension

2. Stabilize on alpha-blocker before initiating tadalafil therapy, start with 5 mg dose to avoid hypotensive response

34
Q

Lab tests prior to initiation of and to monitor ED therapy

A
  1. urinalysis: evaluate for potential infection/organic problems causing ED
  2. CBC - infection
  3. Glucose - DM
  4. Cr - renal fn
  5. fasting lipid profile: atherogenic cause, monitor androgen therapy
  6. serum T
35
Q

Serum testosterone

  • level to be considered hypogonadal
  • what is needed for dx of testosterone deficiency
A
  • <300 ng/dL

- TWO morning serum measurements <300

36
Q

List the 3 drug types currently approved by FDA for management of pts with prostatic hyperplasia

A
  1. Alpha-blockers
  2. 5-alpha reductase inhibitor therapy
  3. PDE5
37
Q

List the 5 types of alpha-blockers

  • non-selective
  • selective
A

all are “-zosins”

Non-selective:

  • Terazosin (Hytrin) –
  • Doxazosin (Cardura)

Selective:

  • Tamsulosin (Flomax) –
  • Alfuzosin (Uroxatral)
  • Silodosin (Rapaflo)
38
Q

alpha-blockers ADR

A
  • dizziness (MC)
  • orthostatic hypotension (MC): first dose effect, worse when used with other antihypertensives
  • lower ejaculate volume (more common in selective)
39
Q

Alpha-blockers ADR

A
  • Use carefully with PDE-5 Inhibitors: unacceptable reductions in BP, orthostatic hypotension
40
Q

Alpha-blockers Contraindications

A

Planned cataract surgery – may develop intraoperative floppy iris syndrome (retinal detachment, lens problems, endophthalmitis post-operatively)

41
Q

How long does it take Alpha-blockers to take effect

A

2-6 weeks before benefits can be adequately assessed

42
Q

5-Alpha Reductase Inhibitors

- when use

A

sx of BPH with enlarged prostate glands

43
Q

5-Alpha Reductase Inhibitors

- two types

A

“-asteride”

  • Finasteride (Proscar)
  • Dutasteride (Avodart)
44
Q

5-Alpha Reductase Inhibitors how long to take effect

A

might take 6-12 months for full expression to be noted

45
Q

5-Alpha Reductase Inhibitors

ADRs (5)

A
  • Erectile dysfunction
  • Decreased volume of ejaculate
  • Decreased libido
  • Gynecomastia
  • **Preg women should not handle due to risk to male fetus
46
Q

5-Alpha Reductase Inhibitors and prostate cancer

A

May lower risk of less life-threatening prostate cancer and increase risk of more life-threatening prostate cancer → DRE and PSA super important

47
Q

PDE5 Inhibitors

- which one

A

Tadalafil (Cialis) is the only one approved by FDA for BPH in US

48
Q

When use Tadalafil for BPH

A
  • Use in those who do not get adequate relief from alpha-blocker alone OR men with ED and mild BPH
49
Q

How dose tadalafil if adding to alpha-blocker therapy

A

Start lowest dose and titrate up to avoid hypotension

50
Q

What is the role of OTC preparations in the management of prostatic hyperplasia: saw palmetto, beta sitosterol, and pygeum.

A

None really - lack of published data

51
Q

Doxazosin dosing in BPH

A
  • Starting dose: 1 mg daily

- Maintenance dose: 1-8 mg daily

52
Q

Tamsulosin dosing in BPH

A
  • Starting dose: 0.4 mg daily

- Maintenance dose: 0.4-0.8 mg daily

53
Q

Most common bacterial cause of acute and chronic bacterial prostatitis

A
  • Acute: E. coli (klebsiella pneumonia and proteus mirabilis)
  • Chronic: E. coli
54
Q

2 abx and duration to treat acute prostatitis

A
  1. Trimethoprim/sulfamethoxazole (Bactrim)
  2. Fluorquinolone (Cipro)
    - Duration: 4 weeks
55
Q

2 abx and duration to treat chronic prostatitis

A
  1. Fluoroquinolone (1st line)
  2. Trimethoprim/sulfamethoxazole (Bactrim)
    - Duration: 4-6 weeks, up to 12 weeks
56
Q

Two antibiotics that may be used for long-term suppressive therapy for patients with recurrent prostatitis

A
  1. Cipro (500 mg three times weekly)

2. Bactrim (regular strength daily)

GU2 - Urology (10 decks)

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