Geriatrics - Urinary Incontinence, Benign Prostatic Hyperplasia & Erectile Dysfunction Flashcards
Explain the voiding (parasympathetic) phase of urination?
Ach release activates M3 and cause detrusor muscle contraction
Explain the storage (sympathetic) phase of urination?
NE release activates beta-3 and causes detrusor muscle relaxation
What are common causes of urinary incontinence?
urethral obstruction, impaired bladder contraction, sphincter incompetence, bladder inflammation/stones/malignancy
What are common medications affecting urinary incontinence?
alpha agoni/antagonists, alcohol, anticholinergics, cholinesterase inhibitor, CCBs, diuretics, narcotics, antidepressants, antipsychotics, sedative/hypnotics
What is treatment for nocturnal polyuria?
desmopressin (nasal)
What medication class treats urge incontinence (overactive bladder, OAB)?
smooth muscle relaxants
Which smooth muscle relaxants are M3-receptor specific? (2)
darifenacin, solifenacin
Which smooth muscle relaxant can come as an OTC product?
oxybutynin (patch)
Which smooth muscle relaxants have somewhat reduced BBB crossing? (3)
tolterodine, fesoterodine, trospium
Which smooth muscle relaxants are not that effective nor first-line for OAB? (4)
dicyclomine, flavoxate, propantheline, hyoscyamine
What are AEs of smooth muscle relaxants?
delirium, mydriasis, flushing, xerostomia, hyperthermia
What type of formulation of tolterodine minimizes AEs?
ER product
What are alternative agents used in OAB treatment? (3)
imipramine (or other TCAs), onabotulinumtoxinA (Botox), beta-3 agonists (mirabegron)
What are AEs for mirabegron (Myrbetriq)? (3)
GI, HTN, sinus tachycardia
What are AEs for vibegron (Gemtesa)? (3)
bronchitis, URI, UTI
What is first-line treatment for OAB? 2nd-line?
behavioral therapies +/- pharm; everything lol
What medications can treat stress incontinence? (3)
alpha-agonists, estrogens (replacement therapy), duloxetine (NOT FDA)
What are examples of alpha-agonists used in stress incontinence treatment? (2)
pseudoephedrine, midodrine
What is treatment for overflow incontinence?
bethanechol (Urecholine)
What are AEs of bethanechol (Urecholine)?
cholinergic effects
What are symptoms of BPH?
incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia
Rank the strength for alpha-1 blockers?
tera > doxa > prazosin
What are AEs of alpha blockers?
postural hypotension, blurred vision, drowsiness, asthenia, syncope, ejaculatory dysfunction
What treatment takes about 3-6 months of therapy before its effect is seen for BPH?
5-alpha-reductase inhibitors (finasteride, dutasteride)
What are AEs of 5-alpha-reductase inhibitors? (4)
impotence, decreased libido, ejaculation volume, gynecomastia
What is a CI for 5-alpha-reductase inhibitors?
pregnancy!
What medications should be avoided in BPH? (5)
TCAs, diphenhydramine, disopyramide, ephedrine/pseudoephedrine, anticholinergics
What is the MOA for tadalafil?
PDE5 inhibitor, mechanism not established
What is the combination product of finasteride and tadalafil?
Entadfi
What OTC supplement is not recommended for BPH?
saw palmetto
What is first-line treatment for BPH? 2nd-line (or if prostate >30 cc)?
alpha blocker; switch to PDE5 inhibitor or add alpha-reductase inhibitor
Explain how an erection occurs with relation to PDE5 inhibitors?
PDE5is prevent breakdown of cGMP molecules preventing venous dilation and blood outflow
Explain drugs associated with erectile dysfunction (ED)?
Thiazide diuretics, beta-blockers (except nebivolol), opioids, and NSAIDs may adversely influence ED; ACEi/ARBs and CCBs have no relevant (or even a positive) effect on ED
What are treatments for ED? (8)
androgens, phosphodiesterase inhibitors, adrenergic-receptor antagonists (yohimbine, phentolamine), apomorphine, trazodone, intracavernous therapy (papaverine, phentolamine, alprostadil, vasoactive intestinal polypeptide), transurethral therapy, transdermal medications
What is a CI for PDE5 inhibitors?
nitrate therapy
What patients are considered low risk for PDE5i initiation?
has asymptomatic CVD with well-controlled HTN, mild CHF (I or II), and an MI > 8 weeks ago
What patients are considered medium risk for PDE5i initiation?
has stable angina, moderate CHF (III), and Hx of MACE (especially within past 2-8 weeks)
What patients are considered high risk for PDE5i initiation?
has unstable or refractory angina, uncontrolled HTN, severe CHF (IV), just bad heart stuff lmao
Rank the onset time for the PDE5is?
avanfil < tadalafil ~ sildenafil < vardenafil
Rank the duration for the PDE5is?
sildenafil < vardenafil ~ avanafil < tadalafil
What is first-line treatment for ED? 2nd-line (or if failure otherwise)?
PDE5is, vacuum erection devices/alprostadil/penile prosthesis
