Geriatrics - Urinary Incontinence, Benign Prostatic Hyperplasia & Erectile Dysfunction

Question 1

Explain the voiding (parasympathetic) phase of urination?

Answer 1

Ach release activates M3 and cause detrusor muscle contraction

Question 2

Explain the storage (sympathetic) phase of urination?

Answer 2

NE release activates beta-3 and causes detrusor muscle relaxation

Question 3

What are common causes of urinary incontinence?

Answer 3

urethral obstruction, impaired bladder contraction, sphincter incompetence, bladder inflammation/stones/malignancy

Question 4

What are common medications affecting urinary incontinence?

Answer 4

alpha agoni/antagonists, alcohol, anticholinergics, cholinesterase inhibitor, CCBs, diuretics, narcotics, antidepressants, antipsychotics, sedative/hypnotics

Question 5

What is treatment for nocturnal polyuria?

Answer 5

desmopressin (nasal)

Question 6

What medication class treats urge incontinence (overactive bladder, OAB)?

Answer 6

smooth muscle relaxants

Question 7

Which smooth muscle relaxants are M3-receptor specific? (2)

Answer 7

darifenacin, solifenacin

Question 8

Which smooth muscle relaxant can come as an OTC product?

Answer 8

oxybutynin (patch)

Question 9

Which smooth muscle relaxants have somewhat reduced BBB crossing? (3)

Answer 9

tolterodine, fesoterodine, trospium

Question 10

Which smooth muscle relaxants are not that effective nor first-line for OAB? (4)

Answer 10

dicyclomine, flavoxate, propantheline, hyoscyamine

Question 11

What are AEs of smooth muscle relaxants?

Answer 11

delirium, mydriasis, flushing, xerostomia, hyperthermia

Question 12

What type of formulation of tolterodine minimizes AEs?

Answer 12

ER product

Question 13

What are alternative agents used in OAB treatment? (3)

Answer 13

imipramine (or other TCAs), onabotulinumtoxinA (Botox), beta-3 agonists (mirabegron)

Question 14

What are AEs for mirabegron (Myrbetriq)? (3)

Answer 14

GI, HTN, sinus tachycardia

Question 15

What are AEs for vibegron (Gemtesa)? (3)

Answer 15

bronchitis, URI, UTI

Question 16

What is first-line treatment for OAB? 2nd-line?

Answer 16

behavioral therapies +/- pharm; everything lol

Question 17

What medications can treat stress incontinence? (3)

Answer 17

alpha-agonists, estrogens (replacement therapy), duloxetine (NOT FDA)

Question 18

What are examples of alpha-agonists used in stress incontinence treatment? (2)

Answer 18

pseudoephedrine, midodrine

Question 19

What is treatment for overflow incontinence?

Answer 19

bethanechol (Urecholine)

Question 20

What are AEs of bethanechol (Urecholine)?

Answer 20

cholinergic effects

Question 21

What are symptoms of BPH?

Answer 21

incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia

Question 22

Rank the strength for alpha-1 blockers?

Answer 22

tera > doxa > prazosin

Question 23

What are AEs of alpha blockers?

Answer 23

postural hypotension, blurred vision, drowsiness, asthenia, syncope, ejaculatory dysfunction

Question 24

What treatment takes about 3-6 months of therapy before its effect is seen for BPH?

Answer 24

5-alpha-reductase inhibitors (finasteride, dutasteride)

Question 25

What are AEs of 5-alpha-reductase inhibitors? (4)

Answer 25

impotence, decreased libido, ejaculation volume, gynecomastia

Question 26

What is a CI for 5-alpha-reductase inhibitors?

Answer 26

pregnancy!

Question 27

What medications should be avoided in BPH? (5)

Answer 27

TCAs, diphenhydramine, disopyramide, ephedrine/pseudoephedrine, anticholinergics

Question 28

What is the MOA for tadalafil?

Answer 28

PDE5 inhibitor, mechanism not established

Question 29

What is the combination product of finasteride and tadalafil?

Answer 29

Entadfi

Question 30

What OTC supplement is not recommended for BPH?

Answer 30

saw palmetto

Question 31

What is first-line treatment for BPH? 2nd-line (or if prostate >30 cc)?

Answer 31

alpha blocker; switch to PDE5 inhibitor or add alpha-reductase inhibitor

Question 32

Explain how an erection occurs with relation to PDE5 inhibitors?

Answer 32

PDE5is prevent breakdown of cGMP molecules preventing venous dilation and blood outflow

Question 33

Explain drugs associated with erectile dysfunction (ED)?

Answer 33

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

Question 34

What are treatments for ED? (8)

Answer 34

androgens, phosphodiesterase inhibitors, adrenergic-receptor antagonists (yohimbine, phentolamine), apomorphine, trazodone, intracavernous therapy (papaverine, phentolamine, alprostadil, vasoactive intestinal polypeptide), transurethral therapy, transdermal medications

Question 35

What is a CI for PDE5 inhibitors?

Answer 35

nitrate therapy

Question 36

What patients are considered low risk for PDE5i initiation?

Answer 36

has asymptomatic CVD with well-controlled HTN, mild CHF (I or II), and an MI > 8 weeks ago

Question 37

What patients are considered medium risk for PDE5i initiation?

Answer 37

has stable angina, moderate CHF (III), and Hx of MACE (especially within past 2-8 weeks)

Question 38

What patients are considered high risk for PDE5i initiation?

Answer 38

has unstable or refractory angina, uncontrolled HTN, severe CHF (IV), just bad heart stuff lmao

Question 39

Rank the onset time for the PDE5is?

Answer 39

avanfil < tadalafil ~ sildenafil < vardenafil

Question 40

Rank the duration for the PDE5is?

Answer 40

sildenafil < vardenafil ~ avanafil < tadalafil

Question 41

What is first-line treatment for ED? 2nd-line (or if failure otherwise)?

Answer 41

PDE5is, vacuum erection devices/alprostadil/penile prosthesis