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Therapeutics > Exam 5 lecture 2 > Flashcards

Exam 5 lecture 2 Flashcards

1
Q

PDE 5 inhibitor contraindications

A

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

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2
Q

Most common reason for patients to be considered non-responders for PDE 5 inhibitors

A

Patients were using the PDE 5 inhibitors in sub optimal conditions

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3
Q

Name PDE5 inhibitor drugs

A

Viagra, ciallis, tadalafil

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4
Q

Patient education for PDE 5 I

A

-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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5
Q

Avoid vacuum erection devices in patients with

A

sickle cell anemia

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6
Q

How does transurethral therapy work?

A

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

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7
Q

Pellets vs injection for transurethral therapy

A

Pellets are more acceptable to patients
Injection is less effective

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8
Q

Directions for transurethral therapy

A

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

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9
Q

What method is the best for neurogenic ED

A

Intracavernosal ED (technique must be taught)

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10
Q

Potential side effects of intracavernosal injection

A

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

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11
Q

max injections for intracavernousal injection

A

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

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12
Q

Drug induced priapism caused by

A

ED drugs
anti depressants
anti psychotics
anti coagulants
cocaine

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13
Q

Two types of priapism

A

Ischemic (painful)
non-ischemic

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14
Q

Treatment of non-ischemic priapism

A

Ice pack and cold compression

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15
Q

Treatment of ischemic priapism

A

saline irrigation
blood aspiration

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16
Q

peyronies disease symptoms

A

Bent penis
pain in penis
palpable penile plaques

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17
Q

What drug treats peyronies disease

A

xiaflex

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18
Q

prostate cancer is very common in what demographic

A

Black men

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19
Q

Risk factors for prostate cancer

A

age
african ancestry
family history

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20
Q

Most common type of cancer in men

A

prostate

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21
Q

2nd leading cause of death in men for cancers

A

prostate (most men who have it do not die from it)

22
Q

PSA level scores of men and interpretation

A

below 4= most men do not have prostate cancer
4-10= borderline
>10 = 50% chance of prostate cancer

23
Q

decrease in urine force in 50 y/o, 75 y/o and 80 y/0

A

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

24
Q

Prostate glands contain what receptors

A

alpha receptors

25
Q

how does Norepinephrine affect alpha receptors

A

NE results in contraction of a-receptors, this results in smooth muscle contraction, this narrows urethra

26
Q

type II a-reductase in prostate gland characteristics

A

-Testosterone to DHT conversion
-responsible for prostate enlargement and growth

27
Q

What are some obstructive symptoms of BPH

A

decreased force of stream
hesitancy to initiate voiding
strain or push to urinate

28
Q

Irritating symptoms of BPH

A

Nocturia and increased frequency

29
Q

what constitutes as nocturia

A

2 or more voids per night

30
Q

How is BPH diagnosed

A

Flow rate/ bladder scan

31
Q

How do you tell if BPH is mild, moderate or severe

A

Mild- AUA<7
moderate- AUA 8-19
severe- 20-35

32
Q

treatment of mild BPH

A

nothing

33
Q

treatment of moderate BPH with ED

A

alpha-adrenergic antagonist, PDE-I or both

34
Q

treatment of moderate BPH and increased PSA

A

5 alpha-reductase inhibitors
5alpha-reductase inhibitor+alpha adrenergic agonist

35
Q

treatment of moderate BPH with predominant irritable voiding symptoms

A

alpha- adrenergic agonist + anticholinergic agents

36
Q

treatment of severe BPH

A

minimally invasive surgery of prostate

37
Q

what to avoid in severe BPH? why?

A

anti cholinergic drugs, this is because it decreases contractility of bladder detrusor muscle resulting in urinary retention

38
Q

anticholinergic drug examples

A

benadryl
antidepressants

39
Q

what percent of men with BPH have an OAB

A

1/2

40
Q

men with BPH and predominant irritative symptoms treatment

A

anticholinergic + antimuscarinic

41
Q

antimuscarinics should be avoided in BPH patients with

A

post void residual>200 ml or max urine flow rate< 5 ml/sec

42
Q

how does alpha-1 adrenergic blockade treat moderate BPH

A

relaxes smooth muscle tone of prostate gland and bladder neck

43
Q

how does alpha 1 a adrenergic blockade affect size of prostate gland

A

it does not reduce the size of prostate gland

44
Q

alpha 1 adrenergic blocker drugs

A

Terazosin
Doxazosin (all end with sin)
(do not crush)

45
Q

key dosing info and side effects of a-1 adrenergiic blockers

A

Swallow whole, do not crush, take 1/2 hours after same meal every day
retrograde ejaculation, dizziness, hypotension

46
Q

what has been seen in patients with a-1 blockers like flomax

A

intra operative floppy iris syndrome

47
Q

example of PDE-I drug and when is it indicated

A

Tadalafil, viagra, ciallis
indicated when patient has BPH and ED

48
Q

When should we not use PDE-I

A

CRCL<30 ml/min

49
Q

how do PDE-I drugs work

A

they relax smooth muscle tone of prostate gland and bladder neck

50
Q

Hormonal therapy decreases prostate size by____ and men with prostate greater than _____ grams benefit most. How long can onset be

A

20-25%
40 grams
6 months

51
Q

5-a reductase inhibitors MOA

A

they decrease DHT production

52
Q

5-a reductase drug names

A

dutasteride and finasteride

Therapeutics (46 decks)

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