Genitourinary Disorders

Question 1

Alpha1 adrenergic antagonists

Answer 1

Alfuzosin, Doxazosin, Silodosin, Terazosin, Tamsulosin (Flomax) - relax smooth muscles to reduce BPH sx
-start working within days-weeks
-1st dose syncope, dose at bedtime
-dizziness, headache, congestion, sexual dysfxn
-can cause floppy iris syndrome which complicates cataract surgery- better to get the surgery done first
-tamsulosin, alfuzosin, silodosin = more selective so fewer vascular s/e

Question 2

5-alpha reductase inhibitors

Answer 2

Finasteride (Proscar), Dutasteride (Avodart)
-start working after many months to years by decreasing size of prostate to reduce BPH sx
-pregnant women should not handle
-avoid grapefruit juice

Question 3

PDE5 inhibitors

Answer 3

Tadalafil (Cialis) 5mg daily also relaxes smooth muscle to relieve BPH sx

Question 4

Meds that worsen BPH

Answer 4

Decongestants, antimuscarinics, diuretics
Caffeine, alcohol

Question 5

Meds for stress incontinence in women

Answer 5

1st line: pelvic floor muscle training
vaginal estrogen if postmenopausal w atrophy
duloxetine not recommended, AE: inc HR/BP, dry mouth, nausea, constipation, flushing

Question 6

Meds for urge incontinence in women

Answer 6

1st line: pelvic floor muscle training
2nd line:
-antimuscarinics (darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, trospium) anticholinergic s/e and inc IOP [dari and soli have less s/e due to being more specific]
-beta adrenergic agonist (mirabegron) s/e: HTN, nasopharyngitis, UTIs, headache, QT

Question 7

Meds for incontinence in children

Answer 7

desmopressin
-limit fluid intake before bedtime
-avoid in kidney disease, diabetes, ileitis, cystic fibrosis
-trial 1w, can continue f6m
in refractory cases may combine w oxybutynin, tolterodine