Genitourinary & Electrolytes Flashcards
Which medications may contribute to or exacerbate BPH symptoms?
-Testosterone
-Decongestants
-Anticholinergic drugs (antihistamines, TCAs)
-Diuretics
-Caffeine
-Alcohol
How do you interpret International Prostate Symptom Score?
-0-7 = Mild
-8-19 = Moderate
-20-35 = Severe
What is first-line treatment for moderate-to-severe BPH without complications?
Alpha-1 Antagonists
What are side effects on non-selective alpha-1 antagonists (terazosin, doxazosin)?
-Hypotension
-Syncope
What alpha-1 antagonists are uroselective?
-Tamsulosin
-Silodosin
-Alfuzosin
What is a serious potential concern for patients taking alpha-1 antagonists?
Intraoperative floppy iris syndrome during cataract surgery
What is second-line treatment for moderate-to-severe BPH without complications?
5-Alpha-Reductase Inhibitors
*Effective for patients with larger prostates (PSA > 1.5)
What 5-alpha-reductase inhibitors are available?
-Finasteride
-Dutasteride
What are common side effects of 5-alpha-reductase inhibitors?
-Decreased libido
-Irregular ejaculation
What is first-line treatment for men w/ large prostates (> 40) and moderate-to-severe BPH?
5-Alpha-Reductase Inhibitors + Alpha-1 Antagonists
When should PDE-5 inhibitors be considered for BPH management?
-Concomitant ED
-Alternative in those w/ lack or or incomplete response to alpha-1 antagonist
What are some reversible causes of urinary incontinence?
DIAPPERS
-Delirium
-Infection (UTI/pyelo)
-Atrophic vaginitis/urethritis
-Psych disorders
-Pharmacologic agents
-Excessive urine output (DM)
-Restricted mobility
-Stool impaction
What is the recommended first-line treatment for all patients with urinary incontinence?
Non-pharm interventions
-Avoid aspartame, spicy/citrus foods, caffeine, carbonated beverages
-Avoid constipation
-Smoking cessation
-Scheduled/timed voiding
-Pelvic floor exercises
What medication may be used off-label for stress incontinence?
Duloxetine
What is the first-line treatment for OAB?
Antimuscarinic Agents
-Oxybutynin
-Tolterodine
-Fesoterodine
-Trospium
-Solifenacin
-Darifenacin
What are side effects of antimuscarinic agents?
-Dry mouth
-Dry eyes
-Constipation
-Urinary retention
-Cognitive impairment
-Dizziness
-Vision changes
-Headache
-Thirst
What is the second-line treatment for OAB?
B3-Adrenergic Agonists
-Mirabegron
-Vibegron
What are side effects of mirabegron?
-HTN
-UTI
-Nasopharyngitis
-Headache
Which antimuscarinic agents require renal dose adjustments?
-Tolterodine
-Fesoterodine
-Trospium
Which antimuscarinic agent is associated with the most side effects?
Oxybutynin
What medications may be associated with ED?
-Beta blockers
-Verapamil
-SSRIs
-Thiazides
-TCAs
-Antipsychotics
-SNRIs
-Lithium
What is first-line treatment of ED?
PDE-5 Inhibitors
-Sildenafil
-Vardenafil
-Avanafil
-Tadalafil
Which PDE-5 inhibitors require dose adjustments in older patients (> 65 years)?
-Sildenafil
-Vardenafil
Which PDE-5 inhibitors require dose adjustments in renal impairment?
-Sildenafil
-Tadalafil
Which PDE-5 inhibitor is approved for once daily dosing (in addition to PRN)?
Tadalafil
What are contraindications/precautions to PDE-5 inhibitor therapy?
Use of any type of nitrate due to risk of HoTN
-Avoid for 24 hours after taking sildenafil & vardenafil
-Avoid for 12 hours after taking avanafil
-Avoid for 48 hours after taking tadalafil
Use of alpha-1 antagonist therapy due to risk of HoTN
What are common side effects of PDE-5 inhibitors?
-Headache
-Flushing
-Hypotension/dizziness
-Back/limb pain (tadalafil)
What are rare/serious side effects of PDE-5 inhibitors?
-Hearing loss
-Reversible blue-green color discrimination
-Light sensitivity
-Irreversible nonarteritic ischemic optic neuropathy
What is second-line treatment of ED?
Intraurethral alprostadil
What are contraindications to intraurethral alprostadil?
-Pregnant partner
-Sickle cell disease
-Men taking any anticoagulants
What medications can be associated with hypo-K?
-Insulin
-Albuterol
-Caffeine
-HCTZ/Chlorthalidone
-Furosemide/Torsemide
When is K repletion indicated in patients with hypo-K?
K < 3
OR
K < 3-3.5 in those w/ underlying cardiac conditions that predispose them to arrhythmia
What is the recommended dosing for K repletion?
40-100 mEq
What are symptoms of hypo-Na?
-Inattention
-Posture/gait abnormalities
-Nausea
-Malaise
-Headache
-Lethargy
What level is consistent with vitamin D deficiency?
< 30 ng/mL
Which form of vitamin D is more potent?
Cholecalciferol (D3)
What is the treatment recommendation for vitamin D repletion for levels < 20?
50,000 IU of D2 or D3 once weekly x 8 weeks
OR
6000 IU of D2 or D3 daily x 8 weeks
What is the treatment recommendation for vitamin D repletion for levels 20-29?
1000-2000 IU of D3 daily
Which form of calcium is poorly absorbed with PPIs or H2 blockers?
Calcium carbonate
