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Pharm Renal & GU > GU > Flashcards

GU Flashcards

1
Q

what is the MC cause of erectile dysfunction?

A

decreased blood flow

DM, HTN, heart dz

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2
Q

What are some other causes of erectile dysfunction

A

hormone imbalance

psychological issues

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3
Q

Medication induced sexual dysfunction

A 
blood pressure medications
antipsychotic
antidepressants
BPH
opoids
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4
Q

what could be found on physical exam for erectile dysfunction

A

Hypogonadism
Penile disease
Enlarged prostate
Hypertension, diabetes

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5
Q

What are 2 goals of treatment for erectile dysfunction

A

Increase quantity and quality of sexual intercourse

Treatments should not be used for patients without erectile dysfunction

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6
Q

2 non pharmacological agents used to treat erectile dysfunction

A

penile prosthetic device

vacuum erection device

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7
Q

What is important for vacuum erection device

A

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

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8
Q

MOA of phosphodiasterase inhibitors

A

Inhibits phosphodiesterase enzymes; slows the breakdown of cGMP – allowing for the depression of Ca+ – smooth muscle relaxation – erection

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9
Q

2 drug interactions for phosphodiasterase inhibitors

A

Alcohol and Nitrates

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10
Q

2 rare side effects with phosphodiasterase inhibitors

A

nonarteritic anterior optic neuropathy (NAION)

priaprism

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11
Q

MOA of Prostaglandin E1

A

Increases cAMP which ↓ Ca+

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12
Q

Side effects of Prostaglandin E1

A

injection site reactions, fibrous deposits, curvature of the penis

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13
Q

2 types of Alprostadil

A 
Intracanvernous injection (Caverject or Edex)– inject into penis
Intraurethral (MUSE)
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14
Q

Unapproved agents for erectile dysfunction– 3 prescriptions

A

Phentolamine
Papaverine
Trazodone

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15
Q

Unapproved agents for erectile dysfunction– 3 herbal agents

A

Yohimbine
Wild Yam
Dehydroepiandosterone (DHEA)

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16
Q

Epidemiology of BPH

A

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

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17
Q

3 layers of the prostate

A

Epithelial (glandular)
Stromal (smooth muscle)
Capsule (fibrous)

18
Q

function of the prostate

A

Produce ejaculation fluids (40%)

Antibacterial secretions

19
Q

2 stages of growth of the prostate

A

Puberty – 25

40 – rest of life

20
Q

What is found in the Epithelial tissue layer of the prostate

A

Androgen receptors ( 5 alpha reductase)
Testosterone converted to dihydrotestosterone (androgen) (aka DHT)
Causes enlargement of the prostate

21
Q

Stromal and Capsule layers of the prostate

A

α 1 receptors
Bind norepinephrine
Cause muscle contraction

22
Q

Symptoms for BPH

A 
Urinary frequency
Urinary urgency
Urinary intermittency
Nocturia
Decreased force of stream
Hesitancy
Straining
23
Q

Signs for BPH

A 
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)
24
Q

Medications that induce BPH

A

Testosterone
α agonist
Pseudoephedrine, ephedrine, phenylephrine
Anticholinergic
Antihistamines, phenothiazine, tricyclic antidepressants
Large doses of diuretics

25
Q

Complications of untreated BPH

A 
Acute Kidney Injury
Gross hematuria
Overflow urinary incontinence or unstable bladder
Recurrent UTI
Bladder diverticula
Bladder stones
26
Q

What are 6 nonpharmacological treatments used in BPH

A 
Watchful waiting
Behavior Modification
Medication review
Restriction fluids close to bed time
Minimize caffeine and alcohol
Bladder training
27
Q

alpha 1 anatgonists

A

relax smooth muscle
onset= 1-6 weeks
has cardiovascular side effects

28
Q

5 alpha reductase inhibitor

A 
decreases prostate size
halts disease progression
onset- 3-6 months
decreases PSA
sexual dysfunction
29
Q

what are 3 differences between 2nd generation and 3rd generation for alpha 1 andrenergic antagonists

A

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

30
Q

alpha 1 andrenergic antagonists side effects

A

Dizziness, hypotension, syncope with first dose, muscle weakness, headache
Rare serious
Floppy iris syndrome

31
Q

2 5-alpha reductase Inhibitors

A

Finasteride – more selective for prostatic enzymes

Dutasteride – blocks more conversion  lower level of DHT

32
Q

Herbal products for BPH

A

Saw palmetto+ = MC that you will probably see

33
Q

Epidemiology for Urinary incontinence

A

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

34
Q

Clinical presentation for stress

A

Urethral underactivity

Occurs during exertion – exercise, coughing, sneezing

35
Q

clinical presentation for urge

A

Overactive bladder and /or detrusor muscle

Associated with frequency, urgency, nocturia, and enuresis

36
Q

Clinical presentation for overflow

A

Overactive urethral and/or underactive bladder

Bladder fills but unable to empty, strain, hesitancy, decrease force of stream

37
Q

Medications induce or worsen UI

A 
Diuretics
α receptor antagonist
Sedation hypnotics
Antidepressants, Tricyclic
Alcohol
ACE-I
38
Q

Nonpharmacological treatments for UI

A

decrease risk factors
bladder training
urine collection
pelvic floor exercise

39
Q

first line treatment for UI stress

A

Duloxetine (Cymbalta) 1st line
Adverse reactions: headache, dry mouth, fatigue
Side effects improve over time

40
Q

second line treatment for UI stress

A

α – adrenergic agonists 2nd line

Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE)

41
Q

What is first line treatment for an over active bladder?

A

Anticholinergic – 1st line
Oxybutynin (Ditropan)
Dosage forms – Oral: IR and XL, Dermal: TDS and gel
Adverse reactions: dizziness, dry mouth, constipation, nausea

42
Q

What is tolterodine used for?

A

over active bladder
Dosage forms – Oral: IR and LA
Adverse reactions: dry mouth
Less in LA dosage form

Pharm Renal & GU (2 decks)

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