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PHM704 > Geriatrics - Urology > Flashcards

Geriatrics - Urology Flashcards

1
Q

Incontinence - Causes

A

urethral obstruction (BPH)
impaired bladder contraction (DM, MS, detrusor hyperactivity)
incompetent sphincter (stress)
bladder inflammation (UTI)
bladder stones (UTI, obstruction)
malignancy

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2
Q

Incontinence - Potential Drug Causes

A

alpha-blockers & alpha-agonists
alcohol
anticholinergics
cholinesterase inhibitors
calcium channel blockers
diuretics
narcotics
antidepressants
antipsychotics
sedative-hypnotics

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3
Q

Nocturnal Polyuria - Treatment

A

desmopressin nasal spray

indication: wakening 2 or more times per night to urinate

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4
Q

Desmopressin Nasal Spray - Monitoring

A

sodium levels

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5
Q

Desmopressin Nasal Spray - CIs

A

hyponatremia
polydipsia
primary enuresis
concomitant diuretics or steroids
eGFR < 50
NYHA class II-IV
uncontrolled hypertension
SIADH

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6
Q

Overactive Bladder - Causes

A

potentially alpha-blockers in women
potentially estrogens 30-60 mg
cystitis
stones
tumor
neurologic impairment

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7
Q

OAB - Smooth Muscle Relaxants

A

oxybutynin
tolterodine
trospium
darifenacin
solifenacin
dicyclomine
hyoscyamine

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8
Q

OAB Drugs - Less CNS Effects

A

tolterodine
trospium
darifenacin
solifenacin
fesoterodine

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9
Q

OAB Drugs - Adverse Effects

A

dose-dependent:
dry mouth & eyes
urinary retention
palpitations
constipation
dizziness
confusion / delirium / dementia

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10
Q

OAB - Other Drugs

A

TCAs (imipramine)
botox - IM injection with inadequate response or intolerance to ACh medication

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11
Q

OAB - Beta-3 Adrenergic Receptor Agonists

A

mirabegron
AEs: nausea, headache, hypertension, constipation, sinus tachycardia

vibegron
AEs: nausea, headache, diarrhea, URI, UTI

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12
Q

OAB - First-Line Treatment

A

behavioral therapies

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13
Q

OAB - Second-Line Treatment

A

PO antimuscarinics or beta-3 agonists
ER better than IR
combination antimuscarinic & beta-3 agonist if refractory to monotherapy

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14
Q

Stress Incontinence - Alpha Receptor Agonists

A

increase intra-urethral pressure

pseudoephedrine 15-30 mg TID
midodrine 2.5-5 mg TID

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15
Q

Stress Incontinence - Estrogen Replacement

A

proliferation of urethral mucosa -> improves mucosal outflow resistance

vaginal application acceptable

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16
Q

Stress Incontinence - Other Drugs

A

duloxetine 40 mg BID

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17
Q

Overflow Incontinence - Causes

A

BPH
neuropathies
anticholinergics

18
Q

Overflow Incontinence - Drugs

A

bethanechol 10 mg TID
stimulates muscarinic receptors

AEs: cramping, diarrhea, salivation, orthostasis, urgency, bronchial constriction

19
Q

BPH - Etiology

A

proliferation of stromal & epithelial cells due to hormonal and aging processes -> increased prostate size

20
Q

BPH - Symptoms

A

incomplete emptying
frequency
intermittency
urgency
weak stream
straining
nocturia

21
Q

BPH - Non-Pharmacological Management

A

incontinence pads
TURP
urethral dilation
Foley catheter
surgeries

22
Q

BPH - Alpha-1 Blockers

A

silodosin
tamsulosin
alfuzosin
terazosin
doxazosin
prazosin

23
Q

Alpha-1 Blockers - Adverse Effects

A

postural hypotension
dizziness
blurred vision
asthenia

24
Q

Alpha-1 Selective Blockers

A

silodosin (most selective)
alfuzosin
tamsulosin

25
Q

Alpha-1 Selective Blockers - Adverse Effects

A

floppy iris syndrome
ejaculatory dysfunction
DDIs (450-metabolized)

26
Q

BPH - 5-Alpha-Reductase Inhibitors

A

finasteride
dutasteride

27
Q

5-Alpha-Reductase Inhibitors - Adverse Effects

A

impotence
libido
ejaculation volume
gynecomastia
pregnancy X

28
Q

BPH - Drugs to Avoid

A

pseudoephedrine
ACh drugs

29
Q

BPH - PDE-5 Inhibitor

A

tadalafil 5 mg QD

cannot combine with alpha-blockers (symptomatic hypotension)

30
Q

Erectile Dysfunction - Risk Factors

A

metabolic syndrome
DM
BPH
CV disease
tobacco smoking
central neurologic conditions
spinal cord injury
depression
endocrinologic conditions

31
Q

ED - Potentially Worsening Drugs

A

diuretics
antihypertensive drugs
digoxin
gemfibrozil
H2RAs
cytotoxic agents
immunomodulators
ACh drugs
alcohol, cocaine
opioids, NSAIDs

32
Q

ED - Treatment

A

androgens
PDE5 inhibitors
adrenergic receptor antagonists
apomorphine
trazodone
intracavernous therapy
transurethral therapy

33
Q

ED - PDE-5 Inhibitors

A

sildenafil
tadalafil
vardenafil
avanafil

34
Q

PDE-5 Inhibitors - Precautions

A

CYP3A4 DDIs
additive effects with alpha-blockers
GERD

CI: concurrent nitrate therapy, MI or stroke within 2 weeks, cardiac arrhythmias, uncontrolled hypertension, unstable angina

35
Q

Sildenafil - Dosing & PK

A

25-100 mg
onset 30-60 min
duration 2-4 hrs
high-fat meal lowers effect
wait time w/ nitrates 24 hrs
blurred vision common

36
Q

Vardenafil - Dosing & PK

A

5-20 mg
onset 60 min
duration 4-6 hrs
high-fat meal lowers effect
wait time w/ nitrates 24 hrs

37
Q

Tadalafil - Dosing & PK

A

5-20 mg
onset 30-45 min
duration 24-36 hrs
high-fat meal - no effect
wait time w/nitrates 48 hrs

38
Q

Avanafil - Dosing & PK

A

50-200 mg
onset 15 min
duration 4-6 hrs
wait time w/nitrates 12-24 hrs

39
Q

ED - Guidelines

A
  1. treat underlying diseases, remove medications that could contribute
  2. testosterone if hypogonadism
  3. PDE5 inhibitors for at least 7-8 doses
  4. vacuum erection device
  5. intracavernous or intraurethral alprostadil
  6. penile prosthesis
40
Q

OAB - Antimuscarinics CIs

A

narrow angle glaucoma

caution: delayed gastric emptying or urinary retention

PHM704 (16 decks)

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