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1. Exams - Semester 3 > ED, BPH, Urinary Incontinence > Flashcards

ED, BPH, Urinary Incontinence Flashcards

1
Q

what is the most common cause of ED

A

decreased blood flow

diseases: DM, HTN, Heart Dz

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2
Q

what are other causes of ED

A

Hormone- low testosterone

Psychological-Stress, anxiety,depression

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3
Q

what meds cause sexual dysfunction

A 
BP Med
Antipsychotics
Antidepressants
BPH
Opiods
Nicotine 
Excess alcohol
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4
Q

What is the #1 reason people stop SSRI or SNRI?

A

sexual dysfunction

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5
Q

what is the goal of therapy with ED tx?

A

increase quantity and quality of sex

Tx should not be used for pt’s without ED!!!

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6
Q

What are physical Tx for ED?

A

lifestyle modifications if no effect then use devices or meds

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7
Q

How do you Tx psychological ED?

A

psychotherapy or Behavioral therapy

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8
Q

How do you tx drug ED?

A

D/C offending agent or reduce dose of offending agent

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9
Q

Patient with organic ED was prescribed oral PDEi and has been ineffective, what is the next treatment option?

A

Intracavernosal therapy

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10
Q

What are the 2 tx options for Organic ED

A

Oral PDEi & Vacuum erection device

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11
Q

What is the onset of:

Sildenafil, Vardenafil, Tadalafil

A

Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr

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12
Q

If patient’s current tx of intracavernosal therapy is not working, what can be considered next?

A

intraurethral alprostadil

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13
Q

Which drug is a PDE-6 inhibitor

Sildenafil, Vardenafil, Tadalafil?

A

Sildenafil (Viagra)

Vardenafil (Levitra)-minimally

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14
Q

What is the onset of:

Sildenafil, Vardenafil, Tadalafil

A

Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr

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15
Q

What is the MOA of PDEi?

A

they inhibit PDE enzymes which slows the breakdown of cGMP, allowing for the depression of Ca++ which results in smooth muscle relaxation leading to an erection

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16
Q

What is the Duration of:

Sildenafil, Vardenafil, Tadalafil

A

Sildenafil: 4hr
Vardenafil: 4hr
Tadalafil: 24-36hr

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17
Q

What are some Rx unapproved agents used in the treatment of ED?

A

Phentolamine
Papaverine
Trazodone

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18
Q

What does the depression of Ca++ cause?

A

Smooth muscle relaxation resulting in an erection

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19
Q

What are the 2 drug to drug interactions for PDEi’s?

A

ETOH and Nitrates

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20
Q

What are the 2 rare, yet serious ADRs?

A

Non-arteritic anterior optic neuropathy (NAION) & priaprism

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21
Q

What are some Rx unapproved agents used in ED?

A

Phentolamine
Papaverine
Trazodone

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22
Q

what is the MOA of alprostadil?

A

increase cAMP

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23
Q

At what age does BPH affect most men?

A

over the age of 60

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24
Q

what are ADR of alprostadil?

A

injection site rxn
fibrous deposits
curvature of penis

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25
Q

what are the two types of alprostadil used in ED?

A 
Intracavernous injections (caverject or Edex)
Intraurethral (MUSE)
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26
Q

what is the MOA of alprostadil?

A

increase cAMP

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27
Q

what type of receptor is in the stromal and capsule layer?

A

α 1 receptors

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28
Q

What is the onset and duration of alprostadil?

A

onset: 5-15min
Duration: related to dose
14-44min

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29
Q

what are ADR of alprostadil?

A

injection site rxn
fibrous deposits
curvature of penis

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30
Q

what is the difference between Static vs. Dynamic

A

Static- physical block- permanent enlargement of tissue

Dynamic- muscle contaction- effect urethral lumen

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31
Q

what are complications of untreated BPH?

A 
AKI
Gross hematuria
Overflow urinary incontinence
UTI
Bladder diverticula 
bladder stones
long standing obstruction lead to renal failure
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32
Q

What are some PE findings that correlates with a clinical presentation of BPH?

A 
elevated PSA (>1.4 ng/mL)
elevated BUN, SCr (w/ obstruction)
increased PVRV (>25-50 mL)
decreased urine flow rate (<10 mL/s)
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33
Q

Name the 2 5-ARI’s

A

Finasteride & Dutasteride

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34
Q

what is the Tx for severe Sx of BPH?

35
Q

what type of receptor is in the stromal and capsule layer?

A

α 1 receptors

36
Q

what are 3rd generation α 1 adrenergic antagonists?

A

Tamsulosin

Silodosin

37
Q

what is the difference between 2nd and 3rd generation?

A

time to symptom relief decreased
Receptor selectivity which is greater in 3rd generation
2nd generation need to be taken multiple times a day where 3rd gens are only daily

38
Q

ADR of α 1 adrenergic antagonists?

A

Floppy iris syndrome

hypotension, syncope with 1st dose, muscle weakness,

39
Q

Urinary Incontinence epidemiology?

A 
Women increases with age
 years old 40%
Men
not as common 
increases with age
40
Q

what happens to testosterone when it is converted to dihydrotestosterone in the epithelial tissue?

A

causes enlargement of the prostate

41
Q

what happens when the α 1 receptors bind norepi in the stromal and capsule layer?

A

cause muscle contraction

42
Q

what is overflow incontinence?

A

overactive uretheral and or under active bladder

bladder fill but unable to empty, strain, hesitancy, decrease force of stream

43
Q

what is 1st line Tx for STRESS incontinence?

A

Duloxetine- cymbalata

Side effects: HA, dry mouth, fatigue

44
Q

what is 2nd line for STRESS incontinence?

A

α-adrenergic agonists
Pseudoephedrine
Phenylephrine

45
Q

what are complications of untreated BPH?

A 
AKI
Gross hematuria
Overflow urinary incontinence
UTI
Bladder diverticula 
bladder stones
long standing obstruction lead to renal failure
46
Q

What does the AUA BPH symptom score index assess?

A

questionnaire that assess symptoms of BPH, a higher score = patient is greatly effected by symptoms of BPH

47
Q

When would watchful waiting be an appropriate treatment of BPH?

A

If the patient is only experiencing mild symptoms

48
Q

What is the Tx for mild Sx of BPH?

A

watchful waiting

49
Q

what it the Tx of moderate Sx of BPH?

A

α-adrenergic antagnoist or 5α- reductase inhibitor. If no response surgery!

50
Q

what is the Tx for severe Sx of BPH?

51
Q

What are some behavioral modifications that can be done as a non-pharmacologic treatment to BPH?

A

Med review
restrict fluids close to bed time
min. caffeine & ETOH
bladder training (frequent emptying)

52
Q

Name the 2 5-ARi’s

A

Finasteride & Dutasteride

53
Q

Which 5-ARI is more selective for prostate enzymes?

A

Finasteride

54
Q

Which drug blocks more conversion of testosterone to DHT?

A

Dutasteride

55
Q

Dutasteride blocks more conversion resulting in a ______level of DHT

56
Q

What is the frequency of dosing for 5ARIs?

A

once daily

57
Q

what are 2nd generation α 1 adrenergic antagonists?

A

Prazosin, Terazosin, Doxazosin, Alfuzosin

58
Q

what are 3rd generation α 1 adrenergic antagonists?

A

Tamsulosin

Silodosin

59
Q

what is the difference between 2nd and 3rd generation?

A

time to symptom relief decreased
Receptor selectivity which is greater in 3rd generation
2nd generation need to be taken multiple times a day where 3rd gens are only daily

60
Q

What adverse reaction is associated with the 5ARI’s?

A

sexual dysfunction

61
Q

Which 5ARI requires special handling and why?

A

Finasteride, because it can be absorbed through the skin

62
Q

ADR of α 1 adrenergic antagonists?

A

Floppy iris syndrome

hypotension, syncope with 1st dose, muscle weakness,

63
Q

What are some herbal products used in the treatment of ED?

A 
Saw palmetto
stinging nettle
S. African Stargrass
pumpkin seed
african plum
64
Q

What is the most common herbal product used to treat ED?

A

saw palmetto

65
Q

Urinary Incontinence epidemiology?

A 
Women increases with age
 years old 40%
Men
not as common 
increases with age
66
Q

What is the normal urinary cycle?
When is the first sensation to void?
When do you experience a high desire to void?

A

Empty bladder –> 1/2 full –> full –> urination

first sensation to void when bladder is 1/2 full
High desire to void when bladder is full

67
Q

What are the 6 medications that induce or worsen UI?

A 
Diuretics
Alpha receptor antagonists
sedation hypnotics
TCAs (antidepressants)
ACEi
68
Q

What is stress incontinence and when does it happen?

A

Urethral under activity

Occurs during exertion-exercise, coughing, sneezing

69
Q

what is Urge incontinence?

A

overactive bladder and or detrusor muscle

associated with frequency, urgency, nocturia, and enuresis

70
Q

what is overflow incontinence?

A

overactive uretheral and or under active bladder

bladder fill but unable to empty, strain, hesitancy, decrease force of stream

71
Q

How do ACEi’s induce or worsen UI?

A

d/t the AE of coughing –> exertional

72
Q

What are the 5 types of non-pharmacologic treatment of UI?

A 
decrease RFs
bladder training
pelvic floor exercise
urine collection
physical therapy
73
Q

what is 1st line Tx for urinary incontinence?

A

Duloxetine- cymbalata

74
Q

what is 2nd line for urinary incontinence?

A

α-adrenergic agonists
Pseudoephedrine
Phenylephrine

75
Q

How can you decrease risk factors of UI in effort to treat non-pharmacologically?

A

maintain healthy wt
constipation prevention
fluid modification
caffeine & ETOH reduction

76
Q

what is 1st line for overactive bladder?

A

Anticholinergic
Oxybutynin
Tolterodine

77
Q

What is bladder training?

A

scheduled toileting every 2 hours

78
Q

How can PT help to treat UIs?

A

improves strength

79
Q

What is a pelvic floor exercise?

A

Kegel exercises

80
Q

Which BPH pharm treatment halts disease progress and decreases the prostate size?

81
Q

Which pharm tx of BPH relaxes smooth muscle?

A

Alpha 1 antagonists

82
Q

Which pharm tx of BPH does NOT decrease PSA?

A

Alpha 1 antagonists

83
Q

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1. Exams - Semester 3 (21 decks)

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