Genitourinary & Nephrology

Question 1

Pathophys of Erection

Answer 1

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

NO –> inc. cGMP
PDE –> in. cAMP

Both cGMP and cAMP decrease Calcium

Question 2

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

Answer 2

1. DM
2. HTN
3. Heart Disease

Question 3

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

Answer 3

SSRI/SNRI

Question 4

Blood pressure meds that can cause sexual dysfunction

Answer 4

1. BB
2. Clonidine
3. Methyldopa

Question 5

Antipsychotics that can cause sexual dysfunction

Answer 5

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

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

Question 6

BPH Meds that can cause ED

Answer 6

Finasteride
Dutasteride
Silodosin

Question 7

Opoids that can cause ED

Answer 7

ALL OF THEM

Methadone to a higher extent

Question 8

Can nicotine and excessive alcohol cause ED?

Answer 8

YES!

Question 9

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

Answer 9

A higher score

Severe ED: Score of 5-7

Question 10

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?

Answer 10

Intracavernosal therapy

Question 11

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

Answer 11

Intraurethral alprostadil

Question 12

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?

Answer 12

Penile prosthesis

Question 13

Explain the pathophysiology of phosphodiesterase inhibitors?

Answer 13

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

Question 14

What should be avoided while using phosphodiesterase inhibitors?

Answer 14

Alcohol and nitrates

Question 15

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?

Answer 15

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

Question 16

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

Answer 16

Sildenafil (Viagra)

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

Question 17

What 2 doses does alprostadil come in?

Answer 17

1. ) Intracanvernous injection (Caverject or Edex)

2. ) Intraurethral (MUSE)

Question 18

MOA of Alprostadil

Answer 18

Increases cAMP which decreases Ca+

Question 19

Onset and duration of Alprostadil

Answer 19

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

Question 20

Adverse reactions of alprostadil?

Answer 20

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

Question 21

Functions of the prostate (2)

Answer 21

1. Produce ejaculation fluids (40% of them)

2. Antibacterial secretions

Question 22

What are the 3 layers of the prostate gland?

Answer 22

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

Question 23

2 periods of growth of the prostate gland

Answer 23

1. Puberty - 25yo

2. 40yo - end of life

Question 24

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

Answer 24

Androgen receptors

alpha-1 receptors

Question 25

Static v. Dynamic in BPH

Answer 25

Static - physical block; permanent enlargement of tissue Dynamic - muscle contraction; effect urethral lumen

Question 26

Medications that can induce BPH

Answer 26

1. Testosterone | 2. Alpha agonist - pseudoephedrine, ephedrine, phenylephrine

Question 27

Medications that have adverse effects that mimic BPH

Answer 27

1. Anticholinergics (antihistamines, phenothiazine, TCAs) | 2. Diuretics (large doses)

Question 28

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

Answer 28

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

Question 29

T/F: alpha one antagonists relax smooth muscle

Answer 29

True 5-alpha reducates inhibitors do not relax smooth muscle

Question 30

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

Answer 30

False 5-alpha reductase inhibitors halt disease progression

Question 31

Which BPH drug can produce cardiovascular adverse effects

Answer 31

alpha 1 antagonists

Question 32

2nd generation alpha 1 adrenergic antagonists

Answer 32

Prazosin Terazosin Doxazosin Alfuzosin

Question 33

3rd generation alpha 1 adrenergic antagonists

Answer 33

Tamsulosin | Silodosin

Question 34

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

Answer 34

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)

Question 35

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

Answer 35

Floppy Iris Syndrome

Question 36

ADRs of alpha 1 adrenergic antagonists

Answer 36

``` Dizziness Hypotension Syncope Muscle weakness HA ```

Question 37

Finasteride and Dutasteride are _________________.

Answer 37

5-alpha reductase inhibitors

Question 38

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

Answer 38

Dutasteride Finasteride

Question 39

ADR of 5-alpha reductase inhibitors

Answer 39

Sexual dysfunction

Question 40

Most common herbal product used for BPH

Answer 40

Saw palmetto

Question 41

3 Types of Urinary Incontinence

Answer 41

1. Stress 2. Urge 3. Overflow

Question 42

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

Answer 42

Urge

Question 43

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?

Answer 43

Overflow

Question 44

Medications that induce or worsen UI?

Answer 44

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

Question 45

First line for Stress UI

Answer 45

Duloxetine (Cymbalta)

Question 46

First line for Overactive Bladder UI

Answer 46

Anticholinergic (Oxybutynin)

Question 47

2nd line for stress UI?

Answer 47

Alpha adrenergic agonists: | --Pseudoephedrine and phenylephrine