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Pharm III - Exam 1 > GU > Flashcards

GU Flashcards

1
Q

Physiology of a flaccid penis

A

Arterial blood flow in is equal to venous blood flow out

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2
Q

Physiology of an erect penis

A

Arterial blood flow in is greater than venous blood flow out

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3
Q

MC cause of ED

A

Decreased blood flow like in DM, HTN, heart disease

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4
Q

Other causes of ED

A
  • Hormone imbalance (low T)

- Psych (stress, anxiety, depression)

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5
Q

What meds can cause ED?

A
  • BP meds
  • Antipsychotic (1st generation)
  • Antidepressants
  • BPH meds
  • Opioids
  • Nicotine
  • Excessive ETOH
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6
Q

Which BP meds can cause ED?

A

Beta blockers
Clonidine
Methyldopa

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7
Q

Which antipsychotics can cause ED?

A 
(1st generation)
Haloperidol
Chlorpromazine
Thioridazine
Fluphenazine
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8
Q

Which antidepressants can cause ED?

A

SSRIs and SNRIs

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9
Q

Which BPH meds can cause ED?

A

Finasteride
Dutasteride
Silodosin

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10
Q

Which opioid is more likely to cause ED?

A

Methadone

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11
Q

What can be used in the patient history to quantify erectile dysfunction?

A

International Index of Erectile Function (IIEF) questionnaire

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12
Q

Which PDE inhibitors inhibit PDE-6 in addition to PDE-5?

A

Sildenafil

Vardenafil (minimally)

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13
Q

Which PDE inhibitor does NOT inhibit PDE-6?

A

Tadalafil

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14
Q

Which PDE inhibitor has the longest onset time?

A

Tadalafil (2 hours)

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15
Q

Which PDE inhibitor has the shortest onset time?

A

Sildenafil

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16
Q

Which PDE inhibitor has the longest duration time?

A

Tadalafil (24-36 hrs)

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17
Q

Which PDE inhibitor is NOT affected by a fatty meal?

A

Tadalafil

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18
Q

Which PDE inhibitor is given in a higher dose?

A

Sildenafil

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19
Q

PDE inhibitors MOA

A
  • Inhibits PDE enzymes
  • Slows break down of cGMP
  • Allows for depression of Ca
  • Smooth muscle relaxation leading to erection
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20
Q

Which drugs interact with PDE inhibitors?

A

Alcohol and nitrates

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21
Q

Rare serious ADR of PDE inhibitors?

A
  • Nonarteritic anterior optic neuropathy (NAION)

- Priaprism (erection more than 4 hrs)

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22
Q

What is alprostadil?

A
  • PGE1 for ED

- Intracavernous injection or intraurethral

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23
Q

MOA of alprostadil

A

Increases cAMP which decreases Ca and causes smooth muscle relaxation (erection)

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24
Q

Onset time of alprostadil?

A

5-15 minutes

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25
Q

ADRs of alprostadil

A
  • Injection site reactions
  • Fibrous deposits
  • Curvature of penis
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26
Q

Unapproved prescription agents for ED

A
  • Phentolamine
  • Papaverine
  • Trazodone
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27
Q

Unapproved herbal agents for ED

A
  • Yohimbine
  • Wild Yam
  • Dehydroepiandosterone (DHEA)
28
Q

What is the MC benign neoplasm in men?

A

BPH

29
Q

Functions of the prostate

A
  • Produce ejaculation fluids (40%)

- Antibacterial secretions

30
Q

Layers of the prostate

A
  • Epithelial (glandular, androgen receptors)
  • Stromal (smooth muscle, a1 receptors)
  • Capsule (fibrous, a1 receptors)
31
Q

Where are androgen receptors located in the prostate? What do they bind?

A
  • Epithelial (glandular) layer

- Bind 5a reductase (converts T to DHT)

32
Q

Where are a1 receptors located in the prostate? What do they bind?

A
  • Stromal (smooth muscle) and capsule (fibrous) layers

- Bind norepi (cause muscle contraction)

33
Q

Static BPH

A
  • Physical block

- Permanent enlargement of tissue

34
Q

Dynamic BPH

A
  • Muscle contraction

- Affects urethral lumen

35
Q

What meds affect the prostate and could induce BPH?

A
  • Testosterone

- Alpha agonists (ephedrine, pseudoephedrine, phenylephrine)

36
Q

What meds mimic BPH symptoms?

A
  • Anticholinergics (antihistaines, phenothiazine, TCAs)

- Large doses of diuretics

37
Q

What are behavior modification treatments of BPH?

A
  • Med review
  • Restrict fluids close to bed
  • Minimize caffeine/alcohol
  • Bladder training (frequent emptying)
38
Q

Which BPH drug class relaxes smooth muscle of the prostate?

A

a1 antagonists

39
Q

Which BPH drug class decreases prostate size?

A

5a reductase inhibitors

40
Q

Which BPH drug class halts disease progress?

A

5a reductase inhibitors

41
Q

Which BPH drug class has a shorter peak onset time?

A

a1 antagonists (1-6 weeks)

42
Q

Which BPH drug class decreases PSA?

A

5a reductase inhibitor

43
Q

Which BPH drug class has better efficacy?

A

Neither - they are equal (except 5a reductase inhibitor will reduce an enlarged prostate)

44
Q

Which BPH drug class is more likely to cause sexual dysfunction?

A

5a reductase inhibitors

45
Q

Which BPH drug class may have cardiovascular ADRs?

A

a1 antagonists

46
Q

What are 2nd generation a1 antagonists?

A

Prazosin, terazosin, doxazosin

47
Q

What are 3rd generation a1 antagonists?

A

Tamsulosin

Silodosin

48
Q

What are the differences between 2nd and 3rd generation a1 antagonists?

A
  • Time to symptom relief decreased
  • Increased receptor selectivity
  • Only taken once a day
49
Q

ADRs of a1 antagonists

A
  • Dizziness
  • Hypotension
  • Syncope w/first dose
  • Muscle weakness
  • HA
50
Q

Rare serious ADR of a1 antagonists

A

Floppy iris syndrome

51
Q

What meds can cause floppy iris syndrome?

A

a1 antagonists (used for BPH)

52
Q

What agents are 5a reductase inhibitors?

A

Finasteride

Dutasteride

53
Q

Which 5a reductase inhibitor is more selective for prostatic enzymes?

A

Finasteride

54
Q

Which 5a reductase inhibitor blocks more conversion resulting in a lower level of DHT?

A

Dutasteride

55
Q

Which 5a reductase inhibitor requires special handling?

A

Finasteride (can be absorbed through the skin)

56
Q

MC herbal product for BPH?

A

Saw palmetto

57
Q

When does the first sensation to void occur in the normal urinary cycle?

A

When bladder is half full

58
Q

What are the types of urinary incontinence?

A

Stress
Urge
Overflow

59
Q

Describe stress UI

A
  • Under active urethra

- Occurs during exertion (exercise, cough, sneeze)

60
Q

Describe urge UI

A
  • OAB and/or detrusor muscle

- A/w frequency, urgency, nocturia, enuresis

61
Q

Describe overflow UI

A
  • Overactive urethra and/or underactive bladder

- Bladder fills but unable to empty

62
Q

What are meds that can induce or worsen UI?

A
  • Diuretics
  • a receptor blockers
  • Sedation hypnotics
  • TCAs
  • Alcohol
  • ACEI (due to cough)
63
Q

Treatment of stress UI

A
  • Duloxetine (1st line)

- a agonists (pseudoephedrine)

64
Q

ADRs of duloxetine

A

HA
Dry mouth
Fatigue

65
Q

ADRs of a agonists

A

Dizziness, confusion, urinary retention, photosensitivity

66
Q

Treatment of OAB UI

A

Anticholinergic (1st line)

  • Oxybutynin
  • Tolterodine
67
Q

What is the 1st line treatment of OAB UI?

A

Anticholinergic (oxybutynin or tolterodine)

Pharm III - Exam 1 (2 decks)

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