Exam 5 lecture 2 Flashcards by Matti Daniel

PDE 5 inhibitor contraindications

-Contraindicated for patients taking Oral/transdermal nitrates
-patients on a-blockers
Patients wit CAD

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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

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Name PDE5 inhibitor drugs

Viagra, ciallis, tadalafil

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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

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Avoid vacuum erection devices in patients with

sickle cell anemia

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How does transurethral therapy work?

Prostaglandin E stimulates receptors in smooth muscle, this stimulates adenylyl cyclase–>ATP–>CAMP conversion

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Pellets vs injection for transurethral therapy

Pellets are more acceptable to patients
Injection is less effective

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Directions for transurethral therapy

Urinate first
inject suppository
roll penis for 10-30 seconds
Max of 2 doses per day

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What method is the best for neurogenic ED

Intracavernosal ED (technique must be taught)

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Potential side effects of intracavernosal injection

Local irritation
penile pain
risk of priaprism (long erection)
Cavernous plagues in area of injection

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max injections for intracavernousal injection

1 inj/day 3x per week
no sexual stimulation required

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Drug induced priapism caused by

ED drugs
anti depressants
anti psychotics
anti coagulants
cocaine

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Two types of priapism

Ischemic (painful)
non-ischemic

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Treatment of non-ischemic priapism

Ice pack and cold compression

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Treatment of ischemic priapism

saline irrigation
blood aspiration

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peyronies disease symptoms

Bent penis
pain in penis
palpable penile plaques

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What drug treats peyronies disease

xiaflex

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prostate cancer is very common in what demographic

Black men

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Risk factors for prostate cancer

age
african ancestry
family history

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Most common type of cancer in men

prostate

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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