Exam 5 lecture 2 Flashcards
PDE 5 inhibitor contraindications
-Contraindicated for patients taking Oral/transdermal nitrates
-patients on a-blockers
Patients wit CAD
Most common reason for patients to be considered non-responders for PDE 5 inhibitors
Patients were using the PDE 5 inhibitors in sub optimal conditions
Name PDE5 inhibitor drugs
Viagra, ciallis, tadalafil
Patient education for PDE 5 I
-Take PRN or daily (1-2 Hrs before intercourse)
- Dosing with respect to meals ( meals slow absorption)
- report erections lasting >4 Hrs
- report visual/hearing complaints
- report palpitations or dizziness
- avoid with nitrates
use for pulmonary HTN- CLARIFY USE
Avoid vacuum erection devices in patients with
sickle cell anemia
How does transurethral therapy work?
Prostaglandin E stimulates receptors in smooth muscle, this stimulates adenylyl cyclase–>ATP–>CAMP conversion
Pellets vs injection for transurethral therapy
Pellets are more acceptable to patients
Injection is less effective
Directions for transurethral therapy
Urinate first
inject suppository
roll penis for 10-30 seconds
Max of 2 doses per day
What method is the best for neurogenic ED
Intracavernosal ED (technique must be taught)
Potential side effects of intracavernosal injection
Local irritation
penile pain
risk of priaprism (long erection)
Cavernous plagues in area of injection
max injections for intracavernousal injection
1 inj/day 3x per week
no sexual stimulation required
Drug induced priapism caused by
ED drugs
anti depressants
anti psychotics
anti coagulants
cocaine
Two types of priapism
Ischemic (painful)
non-ischemic
Treatment of non-ischemic priapism
Ice pack and cold compression
Treatment of ischemic priapism
saline irrigation
blood aspiration
peyronies disease symptoms
Bent penis
pain in penis
palpable penile plaques
What drug treats peyronies disease
xiaflex
prostate cancer is very common in what demographic
Black men
Risk factors for prostate cancer
age
african ancestry
family history
Most common type of cancer in men
prostate
2nd leading cause of death in men for cancers
prostate (most men who have it do not die from it)
PSA level scores of men and interpretation
below 4= most men do not have prostate cancer
4-10= borderline
>10 = 50% chance of prostate cancer
decrease in urine force in 50 y/o, 75 y/o and 80 y/0
50 y/o- 25% notice a decrease in force of urine
75y/o- 50% notice a decline in force of urine
80 y/o- 90% notice a decline in force of urine
Prostate glands contain what receptors
alpha receptors
how does Norepinephrine affect alpha receptors
NE results in contraction of a-receptors, this results in smooth muscle contraction, this narrows urethra
type II a-reductase in prostate gland characteristics
-Testosterone to DHT conversion
-responsible for prostate enlargement and growth
What are some obstructive symptoms of BPH
decreased force of stream
hesitancy to initiate voiding
strain or push to urinate
Irritating symptoms of BPH
Nocturia and increased frequency
what constitutes as nocturia
2 or more voids per night
How is BPH diagnosed
Flow rate/ bladder scan
How do you tell if BPH is mild, moderate or severe
Mild- AUA<7
moderate- AUA 8-19
severe- 20-35
treatment of mild BPH
nothing
treatment of moderate BPH with ED
alpha-adrenergic antagonist, PDE-I or both
treatment of moderate BPH and increased PSA
5 alpha-reductase inhibitors
5alpha-reductase inhibitor+alpha adrenergic agonist
treatment of moderate BPH with predominant irritable voiding symptoms
alpha- adrenergic agonist + anticholinergic agents
treatment of severe BPH
minimally invasive surgery of prostate
what to avoid in severe BPH? why?
anti cholinergic drugs, this is because it decreases contractility of bladder detrusor muscle resulting in urinary retention
anticholinergic drug examples
benadryl
antidepressants
what percent of men with BPH have an OAB
1/2
men with BPH and predominant irritative symptoms treatment
anticholinergic + antimuscarinic
antimuscarinics should be avoided in BPH patients with
post void residual>200 ml or max urine flow rate< 5 ml/sec
how does alpha-1 adrenergic blockade treat moderate BPH
relaxes smooth muscle tone of prostate gland and bladder neck
how does alpha 1 a adrenergic blockade affect size of prostate gland
it does not reduce the size of prostate gland
alpha 1 adrenergic blocker drugs
Terazosin
Doxazosin (all end with sin)
(do not crush)
key dosing info and side effects of a-1 adrenergiic blockers
Swallow whole, do not crush, take 1/2 hours after same meal every day
retrograde ejaculation, dizziness, hypotension
what has been seen in patients with a-1 blockers like flomax
intra operative floppy iris syndrome
example of PDE-I drug and when is it indicated
Tadalafil, viagra, ciallis
indicated when patient has BPH and ED
When should we not use PDE-I
CRCL<30 ml/min
how do PDE-I drugs work
they relax smooth muscle tone of prostate gland and bladder neck
Hormonal therapy decreases prostate size by____ and men with prostate greater than _____ grams benefit most. How long can onset be
20-25%
40 grams
6 months
5-a reductase inhibitors MOA
they decrease DHT production
5-a reductase drug names
dutasteride and finasteride
