Genitourinary & Nephrology Flashcards

1
Q

Pathophys of Erection

A

Acetylcholine –> Inc. NO and inc. PDE (prostaglandin E)

NO –> inc. cGMP
PDE –> in. cAMP

Both cGMP and cAMP decrease Calcium

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2
Q

Diseases that decrease blood flow, resulting in common organic causes of ED

A
  1. DM
  2. HTN
  3. Heart Disease
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3
Q

The #1 reason patient’s stop taking their ____ is because of sexual dysfunction.

A

SSRI/SNRI

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4
Q

Blood pressure meds that can cause sexual dysfunction

A
  1. BB
  2. Clonidine
  3. Methyldopa
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5
Q

Antipsychotics that can cause sexual dysfunction

A
  1. Haloperidol
  2. Chlorpromazine
  3. Thioridazine
  4. Fluphenazine

Basically all 1st generations and SSRI/SNRI’s (but less than 1st gens)

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6
Q

BPH Meds that can cause ED

A

Finasteride
Dutasteride
Silodosin

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7
Q

Opoids that can cause ED

A

ALL OF THEM

Methadone to a higher extent

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8
Q

Can nicotine and excessive alcohol cause ED?

A

YES!

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9
Q

The International Index of Erectile Function (IIEF): is it better to have a higher score or a lower score?

A

A higher score

Severe ED: Score of 5-7

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10
Q

If a patient is on an oral phosphodiesterase inhibitor and has not been reporting improvements in sexual function then what is a 2nd line tx option?

A

Intracavernosal therapy

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11
Q

If a pt undergoes intracavernosal therapy but does not seem to be improving then what is the next (3rd line) tx for ED?

A

Intraurethral alprostadil

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12
Q

If a pt undergoes intraurethral alprostadil therapy but does not seemt o be improving then what is the next (last line) therapy option for ED?

A

Penile prosthesis

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13
Q

Explain the pathophysiology of phosphodiesterase inhibitors?

A

Inhibits phosphodiesterase which slows down the breakdown of cGMP. This allows for the depression of calcium which relaxes smooth muscle –> erection!

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14
Q

What should be avoided while using phosphodiesterase inhibitors?

A

Alcohol and nitrates

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15
Q

A pt really wants to be put on a PDE inhibitor for his ED but it is also imperative that he takes his vasodilators. What should you council him on in regards of timing of these medications?

A

SPACE THEM OUT!

With Viagra and Levitra wait 24 hrs after taking the ED med before taking the nitrate.

If taking Cialis wait 48 hours

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16
Q

Which PDE inhibits both PDE-5 and PDE-6? What is the importance of PDE-6?

A

Sildenafil (Viagra)

PDE-6 is connected to rods and cones so if pt has visual changes they need to stop taking sildenafil (Viagra)

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17
Q

What 2 doses does alprostadil come in?

A
  1. ) Intracanvernous injection (Caverject or Edex)

2. ) Intraurethral (MUSE)

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18
Q

MOA of Alprostadil

A

Increases cAMP which decreases Ca+

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19
Q

Onset and duration of Alprostadil

A

Onset: 5-15 minutes
Duration: 14-44 minutes (depending on dosage)

20
Q

Adverse reactions of alprostadil?

A
  1. Injection site reactions
  2. Fibrous deposits
  3. Curvature of penis
21
Q

Functions of the prostate (2)

A
  1. Produce ejaculation fluids (40% of them)

2. Antibacterial secretions

22
Q

What are the 3 layers of the prostate gland?

A
  1. Epithelial (glandular)
  2. Stromal (smooth muscle)
  3. Capsule (fibrous)
23
Q

2 periods of growth of the prostate gland

A
  1. Puberty - 25yo

2. 40yo - end of life

24
Q

Epithelial (glandular) tissue has ____ receptors while both stromal and capsule tissue has ____ receptors

A

Androgen receptors

alpha-1 receptors

25
Q

Static v. Dynamic in BPH

A

Static - physical block; permanent enlargement of tissue

Dynamic - muscle contraction; effect urethral lumen

26
Q

Medications that can induce BPH

A
  1. Testosterone

2. Alpha agonist - pseudoephedrine, ephedrine, phenylephrine

27
Q

Medications that have adverse effects that mimic BPH

A
  1. Anticholinergics (antihistamines, phenothiazine, TCAs)

2. Diuretics (large doses)

28
Q

Nonpharmacologic tx of BPH: What is entailed under “behavioral modification”?

A
  1. Medications review
  2. Restriction of fluids close to bedtime
  3. Minimize caffeine and ETOH
  4. Bladder training (frequently empty the bladder)
29
Q

T/F: alpha one antagonists relax smooth muscle

A

True

5-alpha reducates inhibitors do not relax smooth muscle

30
Q

T/F: alpha 1 antagonists halt disease progression of BPH

A

False

5-alpha reductase inhibitors halt disease progression

31
Q

Which BPH drug can produce cardiovascular adverse effects

A

alpha 1 antagonists

32
Q

2nd generation alpha 1 adrenergic antagonists

A

Prazosin
Terazosin
Doxazosin
Alfuzosin

33
Q

3rd generation alpha 1 adrenergic antagonists

A

Tamsulosin

Silodosin

34
Q

Differences between 2nd and 3rd generation alpha 1 adrenergic antagonists

A
  1. Time to sx relief is decreased from 2-6 weeks –> several days
  2. Receptor selectivity (inc. uroselection in 3rd generation)
  3. Frequency (3rd is once a day which increases pt adherence)
35
Q

What is a rare but serious side effect of alpha 1 adrenergic antagonists

A

Floppy Iris Syndrome

36
Q

ADRs of alpha 1 adrenergic antagonists

A
Dizziness
Hypotension
Syncope
Muscle weakness
HA
37
Q

Finasteride and Dutasteride are _________________.

A

5-alpha reductase inhibitors

38
Q

____ blocks conversion of testosterone to DHT more while _____ is more selective for prostatic enzymes and therefore has less adverse reactions.

A

Dutasteride

Finasteride

39
Q

ADR of 5-alpha reductase inhibitors

A

Sexual dysfunction

40
Q

Most common herbal product used for BPH

A

Saw palmetto

41
Q

3 Types of Urinary Incontinence

A
  1. Stress
  2. Urge
  3. Overflow
42
Q

A pt presents with frequency, urgency, nocturia, and enuresis (wetting the bed). What type of UI is this?

A

Urge

43
Q

A pt presents with strain, hesitancy, dec. force of stream and having a sense of not emptying the bladder. What type of UI is this?

A

Overflow

44
Q

Medications that induce or worsen UI?

A
  1. Diuretics
  2. Alpha receptor antagonists
  3. Sedation hypnotics
  4. Antidepressants (TCA)
  5. ETOH
  6. ACEi –> d/t cough side effect
45
Q

First line for Stress UI

A

Duloxetine (Cymbalta)

46
Q

First line for Overactive Bladder UI

A

Anticholinergic (Oxybutynin)

47
Q

2nd line for stress UI?

A

Alpha adrenergic agonists:

–Pseudoephedrine and phenylephrine