Genitourinary & Electrolytes

Question 1

Which medications may contribute to or exacerbate BPH symptoms?

Answer 1

-Testosterone
-Decongestants
-Anticholinergic drugs (antihistamines, TCAs)
-Diuretics
-Caffeine
-Alcohol

Question 2

How do you interpret International Prostate Symptom Score?

Answer 2

-0-7 = Mild

-8-19 = Moderate

-20-35 = Severe

Question 3

What is first-line treatment for moderate-to-severe BPH without complications?

Answer 3

Alpha-1 Antagonists

Question 4

What are side effects on non-selective alpha-1 antagonists (terazosin, doxazosin)?

Answer 4

-Hypotension
-Syncope

Question 5

What alpha-1 antagonists are uroselective?

Answer 5

-Tamsulosin
-Silodosin
-Alfuzosin

Question 6

What is a serious potential concern for patients taking alpha-1 antagonists?

Answer 6

Intraoperative floppy iris syndrome during cataract surgery

Question 7

What is second-line treatment for moderate-to-severe BPH without complications?

Answer 7

5-Alpha-Reductase Inhibitors

*Effective for patients with larger prostates (PSA > 1.5)

Question 8

What 5-alpha-reductase inhibitors are available?

Answer 8

-Finasteride
-Dutasteride

Question 9

What are common side effects of 5-alpha-reductase inhibitors?

Answer 9

-Decreased libido
-Irregular ejaculation

Question 10

What is first-line treatment for men w/ large prostates (> 40) and moderate-to-severe BPH?

Answer 10

5-Alpha-Reductase Inhibitors + Alpha-1 Antagonists

Question 11

When should PDE-5 inhibitors be considered for BPH management?

Answer 11

-Concomitant ED
-Alternative in those w/ lack or or incomplete response to alpha-1 antagonist

Question 12

What are some reversible causes of urinary incontinence?

Answer 12

DIAPPERS
-Delirium
-Infection (UTI/pyelo)
-Atrophic vaginitis/urethritis
-Psych disorders
-Pharmacologic agents
-Excessive urine output (DM)
-Restricted mobility
-Stool impaction

Question 13

What is the recommended first-line treatment for all patients with urinary incontinence?

Answer 13

Non-pharm interventions
-Avoid aspartame, spicy/citrus foods, caffeine, carbonated beverages
-Avoid constipation
-Smoking cessation
-Scheduled/timed voiding
-Pelvic floor exercises

Question 14

What medication may be used off-label for stress incontinence?

Answer 14

Duloxetine

Question 15

What is the first-line treatment for OAB?

Answer 15

Antimuscarinic Agents
-Oxybutynin
-Tolterodine
-Fesoterodine
-Trospium
-Solifenacin
-Darifenacin

Question 16

What are side effects of antimuscarinic agents?

Answer 16

-Dry mouth
-Dry eyes
-Constipation
-Urinary retention
-Cognitive impairment
-Dizziness
-Vision changes
-Headache
-Thirst

Question 17

What is the second-line treatment for OAB?

Answer 17

B3-Adrenergic Agonists
-Mirabegron
-Vibegron

Question 18

What are side effects of mirabegron?

Answer 18

-HTN
-UTI
-Nasopharyngitis
-Headache

Question 19

Which antimuscarinic agents require renal dose adjustments?

Answer 19

-Tolterodine
-Fesoterodine
-Trospium

Question 20

Which antimuscarinic agent is associated with the most side effects?

Answer 20

Oxybutynin

Question 21

What medications may be associated with ED?

Answer 21

-Beta blockers
-Verapamil
-SSRIs
-Thiazides
-TCAs
-Antipsychotics
-SNRIs
-Lithium

Question 22

What is first-line treatment of ED?

Answer 22

PDE-5 Inhibitors
-Sildenafil
-Vardenafil
-Avanafil
-Tadalafil

Question 23

Which PDE-5 inhibitors require dose adjustments in older patients (> 65 years)?

Answer 23

-Sildenafil
-Vardenafil

Question 24

Which PDE-5 inhibitors require dose adjustments in renal impairment?

Answer 24

-Sildenafil
-Tadalafil

Question 25

Which PDE-5 inhibitor is approved for once daily dosing (in addition to PRN)?

Answer 25

Tadalafil

Question 26

What are contraindications/precautions to PDE-5 inhibitor therapy?

Answer 26

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

Question 27

What are common side effects of PDE-5 inhibitors?

Answer 27

-Headache -Flushing -Hypotension/dizziness -Back/limb pain (tadalafil)

Question 28

What are rare/serious side effects of PDE-5 inhibitors?

Answer 28

-Hearing loss -Reversible blue-green color discrimination -Light sensitivity -Irreversible nonarteritic ischemic optic neuropathy

Question 29

What is second-line treatment of ED?

Answer 29

Intraurethral alprostadil

Question 30

What are contraindications to intraurethral alprostadil?

Answer 30

-Pregnant partner -Sickle cell disease -Men taking any anticoagulants

Question 31

What medications can be associated with hypo-K?

Answer 31

-Insulin -Albuterol -Caffeine -HCTZ/Chlorthalidone -Furosemide/Torsemide

Question 32

When is K repletion indicated in patients with hypo-K?

Answer 32

K < 3 OR K < 3-3.5 in those w/ underlying cardiac conditions that predispose them to arrhythmia

Question 33

What is the recommended dosing for K repletion?

Answer 33

40-100 mEq

Question 34

What are symptoms of hypo-Na?

Answer 34

-Inattention -Posture/gait abnormalities -Nausea -Malaise -Headache -Lethargy

Question 35

What level is consistent with vitamin D deficiency?

Answer 35

< 30 ng/mL

Question 36

Which form of vitamin D is more potent?

Answer 36

Cholecalciferol (D3)

Question 37

What is the treatment recommendation for vitamin D repletion for levels < 20?

Answer 37

50,000 IU of D2 or D3 once weekly x 8 weeks OR 6000 IU of D2 or D3 daily x 8 weeks

Question 38

What is the treatment recommendation for vitamin D repletion for levels 20-29?

Answer 38

1000-2000 IU of D3 daily

Question 39

Which form of calcium is poorly absorbed with PPIs or H2 blockers?

Answer 39

Calcium carbonate