GU Flashcards
what is the MC cause of erectile dysfunction?
decreased blood flow
DM, HTN, heart dz
What are some other causes of erectile dysfunction
hormone imbalance
psychological issues
Medication induced sexual dysfunction
blood pressure medications antipsychotic antidepressants BPH opoids
what could be found on physical exam for erectile dysfunction
Hypogonadism
Penile disease
Enlarged prostate
Hypertension, diabetes
What are 2 goals of treatment for erectile dysfunction
Increase quantity and quality of sexual intercourse
Treatments should not be used for patients without erectile dysfunction
2 non pharmacological agents used to treat erectile dysfunction
penile prosthetic device
vacuum erection device
What is important for vacuum erection device
Takes about 30 min for the pt to get an optimal
Erection and cannot be left on for more than 60 min
Pts on anticoags are not recommended
Contraindicated in sickle cell anemia
MOA of phosphodiasterase inhibitors
Inhibits phosphodiesterase enzymes; slows the breakdown of cGMP – allowing for the depression of Ca+ – smooth muscle relaxation – erection
2 drug interactions for phosphodiasterase inhibitors
Alcohol and Nitrates
2 rare side effects with phosphodiasterase inhibitors
nonarteritic anterior optic neuropathy (NAION)
priaprism
MOA of Prostaglandin E1
Increases cAMP which ↓ Ca+
Side effects of Prostaglandin E1
injection site reactions, fibrous deposits, curvature of the penis
2 types of Alprostadil
Intracanvernous injection (Caverject or Edex)– inject into penis Intraurethral (MUSE)
Unapproved agents for erectile dysfunction– 3 prescriptions
Phentolamine
Papaverine
Trazodone
Unapproved agents for erectile dysfunction– 3 herbal agents
Yohimbine
Wild Yam
Dehydroepiandosterone (DHEA)
Epidemiology of BPH
Mostly effects men over the age of 60 years old
Most common benign neoplasm in men
40% of all men experience enlarged prostate and BPH symptoms
20% of all men require treatment for BPH symptoms
3 layers of the prostate
Epithelial (glandular)
Stromal (smooth muscle)
Capsule (fibrous)
function of the prostate
Produce ejaculation fluids (40%)
Antibacterial secretions
2 stages of growth of the prostate
Puberty – 25
40 – rest of life
What is found in the Epithelial tissue layer of the prostate
Androgen receptors ( 5 alpha reductase)
Testosterone converted to dihydrotestosterone (androgen) (aka DHT)
Causes enlargement of the prostate
Stromal and Capsule layers of the prostate
α 1 receptors
Bind norepinephrine
Cause muscle contraction
Symptoms for BPH
Urinary frequency Urinary urgency Urinary intermittency Nocturia Decreased force of stream Hesitancy Straining
Signs for BPH
Digital rectal exam with enlarged prostate Elevated PSA (>1.4 ng/mL) Elevated BUN, SCr With obstruction Increased post-void residual (>25-50 mL) Urine flow rate (<10 mL/s)
Medications that induce BPH
Testosterone
α agonist
Pseudoephedrine, ephedrine, phenylephrine
Anticholinergic
Antihistamines, phenothiazine, tricyclic antidepressants
Large doses of diuretics
Complications of untreated BPH
Acute Kidney Injury Gross hematuria Overflow urinary incontinence or unstable bladder Recurrent UTI Bladder diverticula Bladder stones
What are 6 nonpharmacological treatments used in BPH
Watchful waiting Behavior Modification Medication review Restriction fluids close to bed time Minimize caffeine and alcohol Bladder training
alpha 1 anatgonists
relax smooth muscle
onset= 1-6 weeks
has cardiovascular side effects
5 alpha reductase inhibitor
decreases prostate size halts disease progression onset- 3-6 months decreases PSA sexual dysfunction
what are 3 differences between 2nd generation and 3rd generation for alpha 1 andrenergic antagonists
Time to symptom relief decreased
From 2-6 weeks to several days (3rd gen quicker)
Receptor selectivity
↑ uroselection in 3rd generation
Frequency
2nd – multiply times a day, 3rd – daily
alpha 1 andrenergic antagonists side effects
Dizziness, hypotension, syncope with first dose, muscle weakness, headache
Rare serious
Floppy iris syndrome
2 5-alpha reductase Inhibitors
Finasteride – more selective for prostatic enzymes
Dutasteride – blocks more conversion lower level of DHT
Herbal products for BPH
Saw palmetto+ = MC that you will probably see
Epidemiology for Urinary incontinence
Women
Increase with age
< 25 years old 20%, 25-60 years old 30%, >60 years old 40%
Due to pregnancy
Men
Not as common
Increase with age
About 9% overall
Clinical presentation for stress
Urethral underactivity
Occurs during exertion – exercise, coughing, sneezing
clinical presentation for urge
Overactive bladder and /or detrusor muscle
Associated with frequency, urgency, nocturia, and enuresis
Clinical presentation for overflow
Overactive urethral and/or underactive bladder
Bladder fills but unable to empty, strain, hesitancy, decrease force of stream
Medications induce or worsen UI
Diuretics α receptor antagonist Sedation hypnotics Antidepressants, Tricyclic Alcohol ACE-I
Nonpharmacological treatments for UI
decrease risk factors
bladder training
urine collection
pelvic floor exercise
first line treatment for UI stress
Duloxetine (Cymbalta) 1st line
Adverse reactions: headache, dry mouth, fatigue
Side effects improve over time
second line treatment for UI stress
α – adrenergic agonists 2nd line
Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE)
What is first line treatment for an over active bladder?
Anticholinergic – 1st line
Oxybutynin (Ditropan)
Dosage forms – Oral: IR and XL, Dermal: TDS and gel
Adverse reactions: dizziness, dry mouth, constipation, nausea
What is tolterodine used for?
over active bladder
Dosage forms – Oral: IR and LA
Adverse reactions: dry mouth
Less in LA dosage form
