GU/RENAL Flashcards
Describe the pelvic nerve
The pelvic nerve releases acetylcholine to stimulate muscarinic (M3) receptors and through receptors to cause detrusor muscle contraction and urination ( a parasympathetic mechanism).
Describe the pudendal nerve
The pudendal nerve releases acetylcholine to stimulate nicotinic receptors to cause relaxation of the external urethral sphincter and urination (A parasympathetic mechanism).
Describe hypogastric nerve
The hypogastric nerve releases no epinephrine to stimulate beta receptors of the bladder to inhibit urination (keeps the bladder from spilling and urinating) and cause bladder relaxation (a sympathetic mechanism)
Which nerve allows us to void urine?
Pudendal nerve
What nerve and neurotransmitters allow us to sympathetically “hold it”?
The hypogastric nerve working with NE and B3 receptors
Anticholinergics can cause
Urinary retention and therefore urinary stasis could breed bacteria
What is the term cholinergic?
The term Cholinergic refers to those receptors which respond to the transmitter acetylcholine and are mostly parasympathetic. Think rest and digest, so inhibition of these receptors slows secretions, especially those that eat and digestion
What does it mean for something to be anticholinergic?
Anti-secretions
Can’t see, can’t pee, can’t spit, and can’t poop
Define Anti-spasmodic and anticholinergic medications
An anti-spasmodic (Synonym: Spasmolytic) That suppresses muscle spasms and acts to relax the bladder by inhibiting the muscarinic action of acetylcholine on smooth muscle the effect is to prevent spasms of the stomach, intestine, or urinary bladder
80 year old female with urinary incontinence/overactive bladder, wet her pants in church. What is a first-time med that could work here?
Antispasmodics
Anticholinergic that inhibits contraction of the bladder and given by pill (typically oxybutynin)
These are some examples of antispasmodic and anticholinergic medications
Oxybutynin
Tolterodine
Name some examples of conditions that antispasmodic medications account for
Overactive bladder, muscle spasms, breathing problems, diarrhea, gastrointestinal cramps, movement disorders, and others
Define erectile dysfunction medications
Enhances the effects of nitric oxide. Nitric oxide plays a key role and facilitating erections by relaxing the vascular muscle of the penis to facilitate an increase in blood vessel diameter and blood flow to the penis
What are some examples of erectile dysfunction medications?
Sildenafil
Tadalafil
Alprostadil
Defined the alpha one antagonist medication’s
The alpha-1 adrenergic receptor antagonist (Also called alpha-blockers) Or a family of agents that bind to an inhibit type one alpha-adrenergic receptors and thus inhibit smooth muscle contraction
What are some examples of alpha-one antagonist medications?
Doxazosin
Prazosin
Terazosin
Tamsulosin
Define the five alpha-reductase inhibitors
Used in BPH to shrink the size of the prostate. Stops the conversion of testosterone to dihydrotestosterone (DHT). DHT stimulates prostate growth and inhibits hair growth
Define the B3 agonist and give some examples
Shrinks the prostate
Mirabegron
What are some example examples of five alpha-reductase inhibitors?
Finasteride
Dutasteride
Define dysuria medication
Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. MLA in cystitis is unknown
What are some examples of dysuria medications?
Phenazopyridine HCl
Pentosan polysulfate sodium
Define cholinergic agonist medication’s
Cholinergic drugs enhance the effects of acetylcholine on muscarinic receptors, by increasing the actions of the parasympathetic nervous system
What are some examples of cholinergic agonist medications?
Bethanechol
What is bethanechol?
It is for a neurogenic bladder with loss of strength and urinary muscle muscles and helps to treat urinary retention; helps people pee!-Stimulating colonic receptors and therefore bladder control
Define LH-RH agonist medication and give an example
And men, LHRH agonists cause the testicles to stop making testosterone. And women, they caused the ovaries to stop making estrogen and progesterone.
Leuprolide (Lupron)
Define posterior pituitary hormone medication and give an example
Medications to assist the posterior pituitary which recruits the hormone oxytocin. Oxytocin increases uterine contractions and antidiuretic hormone (ADH) which increases reabsorption of water by the tubes of the kidney.
Oxytocin (Pitocin)
Define dysuria medications and give an example
Medications to assist with painful or difficult urination and cystitis pain
Phenazopyridine HCl (Pyridium)
What is Lupron?
It treats endometriosis where the endometrial and uterine tissue growth is outside of their uterus, and it also treats prostate cancer
What family of drugs are erectile dysfunction meds a part of?
PDE-5 inhibitors like Viagra, Cialis, and Levitra
What are phosphodiesterase type five inhibitors?
A drug used to block the degradation action of cGMP-specific phosphodiesterase type 5 on cyclic GMP in the smooth muscle cells lining the blood vessels supplying various tissues
Define spasm
An involuntary contraction of the muscles
How does cyclic GMP work?
These drugs dilate the corpora cavernosa of the penis, facilitating erection with sexual stimulation, and are used in the treatment of erectile dysfunction. When we inhibit the conversion of GMP, we will increase cGMP and increase salicylic acid to cause vasodilation.
Where else are PDE5 receptors also present?
In the smooth muscle of the walls of the arterials within the lungs, Sildenafil and Tadalafil dilate those vessels and are FDA-approved for the treatment of pulmonary hypertension
A 65-year-old Caucasian male presents to your clinic with a history of BPH and hypertension, what prescription would you give them?
Alpha Blockers- Terazosin
How do alpha-adrenergic agonists a.k.a. alpha-blockers work?
They block norepinephrine from binding with smooth muscle receptors which results in vasodilation and lowering of blood pressure
What are some examples of selective alpha blockers and where do they mostly work?
Prazosin
Terazosin
Doxazosin
Tamsulosin
Work in: vascular smooth muscle, bladder neck, and prostate gland
What are some examples of non-selective alpha-blockers and where do they mostly work?
Phentolamine
Phenoxynenzamine
Block Alpha-1 Receptors and block alpha-2 receptors
Most pharmacologic products target what kind of receptors?
Alpha-1 receptors
But not in pregnancy
Why are LH-RH antagonists important?
A substance that blocks the pituitary gland from making hormones called follicle stimulating hormone or FSH and luteinizing hormone or LH
How do LH-RH antagonists work in men?
In men, this causes the testicles to stop making testosterone
How do LH-RH antagonists work in women?
In women, this causes the ovaries to start making estrogen and progesterone. Some LHRH antagonists are used to treat advanced prostate cancer. They are also used to treat certain gynecological conditions and are being studied in the treatment of hormone-sensitive breast cancer.
LH-RH antagonists are also called what?
Also called GnRH antagonist, nitro and releasing hormone antagonist, and luteinizing hormone-releasing hormone antagonist
Which medication is basically chemical castration?
LH-RH antagonists, because it stops the production of testosterone. We use this in instances of prostate cancer and keep it at bay.
What supplement puts patients at higher risk of prostate cancer?
Testosterone supplements
What is the pathophysiology of the posterior pituitary hormones?
Which posterior pituitary hormone is responsible for childbirth?
Oxytocin is a hormone and Neurotransmitter that is involved in childbirth and breast-feeding. Associated with empathy, trust, sexual activity, and relationship building. It is sometimes referred to as the love hormone, because levels of oxytocin increased during hugging and orgasm.It may also have benefits as a treatment for a number of conditions, including depression, anxiety, and intestinal problems.
Oxytocin is also important in what in women and childbirth?
Helps bond mom and baby and is important for milk production (too much would stop milk production)
In men who have too much oxytocin, what happens?
BPH may occur
Where is oxytocin produced?
Oxytocin is produced in the hypothalamus part of the brain and females usually have higher level levels than males
How is oxytocin delivered?
Delivered through an IV and will gradually raise the level of Pitocin until they are regular contractions about every 2 to 3 minutes
What is Phenasopyridine?
An oral urinary analgesic. It is available over-the-counter and lower strengths, and with a prescription for higher strengths
How is Bethanechol used as a cholinergic agent?
Generally used to increase smooth muscle tone, as in the G.I. tract following abdominal surgery or in urinary retention and absence of obstruction. Stimulates contraction of the bladder and expulsion of urine
And mostly postoperatively
How is atropine used as an anticholinergic agent?
Given preoperatively prevent voiding of the bowel and bladder during surgery
What are the different types of diuretics?
Carbonic anhydrase inhibitors, loop diuretics, thiazide diuretics, potassium-sparing diuretics, and osmotic diuretics
What is the most potent type of diuretic?
Loop diuretics
How do diuretics work?
Prevents reabsorption of sodium, chloride, and water to aim to decrease blood pressure
How do carbonic anhydrase inhibitors work and what is an example?
This is the weakest type of diuretic. They work at the proximal convoluted tubal to prevent reabsorption NaHCO3, So less sodium.
Ex: Acetazolamide
What is the MOA of carbonic anhydrase inhibitors?
Reduce reabsorption of bicarbonate and the proximal convoluted tubule. Weak diuretic
How do loop diuretics work and what is an example?
Loop diuretics work in the kidneys significantly by blocking the absorption of sodium in the kidneys.
Ex: Furosemide
What do thiazide diuretics do and what is an example?
Work in the kidneys and mildly blocks reabsorption of sodium in the kidneys
Ex: Hydrochlorothiazide
What is the MOA of loop diuretics?
Work on the thick ascending limb of the loop of Henley; prevent sodium reabsorption into the plasma (To prevent the absorption of water) to then decrease reabsorption of water
In regards to aldosterone inhibitors (spironolactone), what is the MOA?
Normally, adrenal glands secrete aldosterone (steroid) that binds to receptors in the collecting duct of the kidney that create new Na/K pumps to stimulate the reabsorption of Na and secretion of K (therefore spironolactone turns off this mechanism to “save” the K and prevent the reabsorption of Na)
What is the MOA of thiazide diuretics?
Work on the distal convoluted tubule to prevent Na reabsorption, and increase ure reabsorption to increase plasma uric acid levels (ex: risk of gout arthritis)
What do potassium-sparing diuretics do and what is an example?
Works in kidneys by manipulating sodium and potassium exchange or by blocking aldosterone. Usually used in combination with Loop and Thiazide diuretics.
Ex: Triamterene and Spironolactone
73-year-old male patient with an overactive bladder, we think maybe prescribe him an anticholinergic, what should we be worried about?
An enlarged prostate
What is the MOA of potassium-sparing diuretics?
Decreased excretion of K compared to other diuretics, work on collecting duct and distal convoluted tubule.
How do osmotic diuretics work and what is an example?
Works in kidneys-decrease water reabsorption
Used mostly for: reduction of intracranial pressure and increase urinary production for ingestion of toxins
Production in urine. Production in acute kidney damage.
Ex: Mannitol
The patient in the hospital comes in and is on oxybutynin and mirabegron, what are we worried about?
The anticholinergic was not completely effective, and so they added another medication
A 53-year-old man patient with concerns about ED and comes to you and has ruled out mechanical and metabolic causes, decided to prescribe a PDE-5 Inhibitor. What are we worried about?
The combinations of these meds with alpha-blockers cause profound hypotension
A 60-year-old male patient who has recently gotten remarried they are sexually active and he wants to be more spontaneous, what can we prescribe that allows him to be spontaneous for up to two days?
Tadalafil
A man comes into the ER with his wife and his penis is enlarged and he gave himself a shot and it wont go down, what med do he use?
Alprostadil
82-year-old female patient with an overactive bladder and you put her on medication and weeks later she is brought by to the ER for confusion, what did you put her on and what could we change her to?
We put her on an anticholinergic and we will switch her to mirabegron
All alpha-blockers have what safety warning?
May cause profound hypotension if used with PDE5 inhibitors such as Sildenafil
What hormone in the hypothalamus will promote the secretion of FSH and LH?
Gonadotroponin releasing hormone
Which hormone is known as the “love hormone” and is a neurotransmitter made from the posterior pituitary?
Oxytocin
When secreted, it affects other parts of the brain
Stimulates lactation and labor
What is an HCTZ substitute?
Chlorthalidone
What class of medication is Mannitol?
Osmotic diuretic for intracranial hemorrhage or as a laxative for babies
What drugs are HCTZ used primarily in combination with?
Potassium-sparing diuretics
Most commonly Triamterene
Vasopressin is used to treat what?
Diabetes insipidus, which is the voiding of large amounts of dilute urine and the consequence of that is that sodium goes up because you’re getting rid of all the water in excess sodium.
How do we treat massive water loss in critically ill patients?
We match their fluid loss, usually with hypotonic fluids to help lower sodium. We may also treat them with desmopressin, which is a vasopressin analog.
Patients with diabetes insipidus, what can we put them on and send them home?
We can tell them to hydrate really well and send them home with desmopressin.
Which two antispasmodic drugs are Ach antagonists that relax the smooth muslce in the bladder to inhibit involuntary contraction of the detrusor muscle?
Oxybutynin and Tolterodine
If a 67 year old man came into the office complaining of dribbling of urine, what would we want to give him?
An antispasmodic for overactive bladder like oxybutynin or Tolterodine
If a patient already has inflammation of the GU tract, specifically prostatic hypertrophy or if they have symptoms of GI irritation or erosion, or are taking lots of potassium, What medications are contraindicated?
NSAIDs, antihistamines, antidepressants, and decongestants
What beta-3 agonist is contraindicated in patients with BPH, bladder obstruction, or uncontrolled HTN?
Mirabegron
Which medication is a B3 adrenergic receptor agonist that works on the parasympathetic nervous system?
Mirabegron
Sildenafil is a type of ED medication that works on what receptors in the body?
It works on PDE-5 receptors to stimulate secretion of nitric oxide which helps to cause arterial dilation of the blood vessels by increasing cGMP
Because sildenafil causes dialtion of the arteries, what heart conditions can it cause?
MI, sudden death, Stroke, ventricular arrhythmias
All ED medications are contraindicated if take with what other class of medications?
alpha blockers
Pts typically complain about what in regards to Sildenafil’s effectiveness and timeliness
It only last abotu 3-5 hours and it starts to feel like they have to stop with their partner or they have to plan really far ahead.
When pt want to take an ED medication, but one that just lasts longer and we want to give them one with the same MOA, side effects, and warnings, what can we give them?
Tildenafil
When all the pill forms of ED medications are no longer successful, there is another injectable medication, but it can be rather uncomfortable to patients, because they must inject it directly into the penis, what is it?
Alprostadil (Caverject Impulse)
Which ED medication relaxes arterial smooth muscle, causing vasodilation and therefore is a prostaglandin analog that can also cause penile fibrosis or Peyronie’s disease?
Alprostadil (Caverject impulse)
With an injectable prostaglandin analog, we never want to take what meds in addition to it?
Sildenafil, Tadalafil, or alpha blockers
Alpha blockers are contraindicted when patients are taking what other medication class?
ED medications
What medication is a alpha-1 antagonizes that works on peripheral receptors for BPH, but is used more commonly for PTSD nightmares?
Prazosin
Which medication is indicated for BPH and nephrolithiasis, but has a side effect of abnormal ejaculation?
Tamsulosin
If a pregnant woman has PTSD nightmares, what medication can we put her on?
There is caution advised with Prazosin but the risk of fetal harm is not suspected.
What medication is a alpha-1A antagonist that relaxes smooth muscle to improve urine flow in patients with BPH?
Tamsulosin
A 55 yr M comes into the office with complaints of HTN and BPH, we want to put him on an alpha blocker, but what side effects should we warn him about?
We would put him on Terazosin but warn him about orthostatic hypotension, syncope, and tell him not to take any ED medications with it.
Which alpha blocker has an indication primarily for HTN but can cause syncope and orthostatic hypotension?
Doxasozin
Which class of medications is really dangerous for pregnant women to be around and even handle?
5-alpha reductase inhibitors
Your patient from 3 weeks ago comes back into the office complaining of extreme nocturia, gynecomastia, abnormal ejaculation, and excessive hair growth. What medication did you recently try with him for his symptomatic BPH?
Finasteride
What are the very serious reactions with putting patients on a 5-alpha reductase inhibitor?
prostate cancer and infertility
Which medication class works by infereing with the conversion of testosterone to dihydrotestosterone?
5 alpha reductase inhibitors
We have a 63 yr M patient with symptomatic BPH. We would like to place him on an 5-alpha reductase inhibitor that has a decently** long half life of about 5 weeks.** What medication would that be and what is it’s safety warning?
Dutasteride. Patients on Dutasteride must avoid blood donation during treatment and for at least 6 months following discontinuation. They won’t see any improvement for awhile.
When placing patients on Dutasteride, what side effects should we warn them about?
nocturia, ejaculate volume decrease, sperm count decrease
What medication class is indicated for prostate cancer and can be a really sensitive topic, as it is basically chemical castration?
LH-RH Antagonists
What medication works to antagonize the gonadotropin release of FSH and LH to saturate the hypothalamus to downgrade the release of FSH and LH to therefore suppress ovarian and testicular steroidogenesis to slow the progression of reproductive cancers?
Leuprolide
We want to be careful with using leuprolide in women, because it can have what harmful side effect?
bone density loss. Women are already prone to osteoporosis
Oxytocin is secreted by what area of the brain?
The posterior pituiatry
What hormone binds to oxytocin receptors in the myometrium to increase intracellular calcium to stimulate uterine contractions?
Oxytocin
If Oxytocin work by promoting uterine contractions, what must be its indications?
labor induction or augmentation, abortion adjunct
What posterior pituitary hormone has serious reactions of uterine hypertonicity, tetany, rupture, laceration, and abruption of the placenta?
Oxytocin
What is the BB warning associated with oxytocin?
This medication is not for elective labor induction and is not indicated for labor induction without medical indications (person must be 2 weeks past due)
Which OTC medication is indicated for dysuria that works as a topical analgesic to reduce pain, but may alarm some patients, because it can turn their urien red/orange?
Phenazopyridine (Pyridium or AZO)
Why can’t we do a UA on a person who is currently taking Phenazsopyridine?
Because their urine is dicolored from the medication
We warn patients not to use Phenazopyridine chronically due to what potential complication?
methemoglobinemia
Which medication adheres to the bladder wall acting as a buffer against cell permeability and irritating penetration, by exerting a weak anticoagulant activity like LMWH?
Pentosan polysulfate sodium
Which dysuria medication is used for pain associated with interstitial cystitis, but has a common reaction of rectal bleeding?
Pentosan polysulfate sodium (Ellison)
Which medication is a coloninergic agent used for urinary retention and neurogenic bladder?
Bethanechol
Because cholinergic agents cause increased sphincter activity and G.I. motility , what serious reactions and contraindications may they have?
Serious reactions may be Broncos spasm, hypotension, tachycardia.
Contraindications would be bladder neck obstruction, bladder, surgery, or G.I. obstruction
Which class of diuretics is the most potent?
Loop diuretics
Which medication is primarily indicated for edema and works by inhibiting the loop of Henle and proximal and distal, convoluted, tubule, sodium and chloride reabsorption?
Furosemide (lasix)
What is the main safety warning for Lasix?
Severe fluid and electrolyte depletion
Which type of diuretic is generally a first line treatment for hypertension and African-Americans?
Thiazide diuretics
Which medication class works by inhibiting the DCT sodium and chloride reabsorption?
Thiazide diuretics
After thiizide diuretics and African-Americans, what other medication class may be useful for hypertension?
CCBs
Hydrochlorothiazide retains calcium, so it also may be useful in what other patient population?
Patients with osteoporosis
Which medication antagonizes aldosterone specific mineral corticoid receptors primarily in the DCT to decrease sodium and water absorption and increase potassium?
Spironolactone
We use this potassium sparing diuretic, usually in combination with another type of diuretic for conditions like CHF, cirrhosis, nephrotic syndrome, and hypertension?
Spironolactone
What medication prevents re-absorption of too much salt and keeps potassium levels from getting too low, but can also cause electrolyte abnormalities like hyperkalemia?
Spironolactone
What medication is contraindicated and patient with Addison’s disease because Addison’s disease affects the bodies balance of water, sodium and potassium?
Spironolactone
Which medication is primarily indicated for edema and hypertension, and works by inhibiting sodium reabsorption at the DCT to decrease water absorption and increase potassium retention?
Triamterene
What potassium sparing diuretic has a blackbox warning for hyperkalemia and ask us to monitor for BUN and creatinine electrolytes, especially potassium at baseline because it can cause ventricular arrhythmias and hyperkalemia?
Triamterene
What hormone is produced in the hypothalamus but is stored and secreted in the posterior pituitary?
oxytocin
62-year-old M with ED, taking sildenafil and working, but he wants something that lasts longer, give him?
tadalafil
72 yr F, complains about urinary frequency and nocturia, overactive bladder, discomfort at church, wants a medication to help, what would help?
an antispamodics
oxybutinin (Diptropan)
Tolterodine
paraplegic, in and out cath due to a neurogenic bladder and has urinary retention, what medication and class can we prescribe?
Cholinergic agonists, Bethanechol
Which medication can we give post-op after surgery?
Bethanechol
58 yr M with diabetes, vascular disease, HTN, he has ED put him on sildenafil and tried another PDE-5 inhibitor, what else can we try?
Alprostadil
patient has HTN, diabetes, high cholesterol, EKG with peaked T waves, what medications may this patient be on?
potassium-sparing liek Spironolactone or triamterene
62 yr old African American M, HTN and start medication, which?
HCTZ
If a patient cannot take HCTZ due to gout or a sulfa allergy, what medication would be next?
CCB like amlodipine
Patient with CHF, diabetes, HTN, bilateral lower extremity edema, what medication and class can we use to treat edema?
Loop diuretics are most potent
Lasix
In cardio, we have three strategies for lowering blood pressure?
lower CO
decrease systemic vascular resistance
decrease blood volume
What class of medications lowers blood volume?
diuretics
Pt on a diuretic to reduce edema, side effects of lasix?
severe potassium electrolyte depletion and orthostatic hypotension
Pt has HTN and ED and there is a class of medication that lowers systemic vascular resistance that is contraindicated in conjunction, what are they?
alpha-blockers, because PDE-5 and them together can cause severe hypotension
Pt fell at home, down for 12 hours, and had muscle tissue injury and caused rhabdomyolysis, the treatment is saline diuresis, but we don’t want them retaining too much fluid and getting fluid overload
we would want to give him a loop diuretic to take off some of the excess fluid quickly
Pt HTN w/ no meds, what would be the best first-line HTN med and they have a history of Addison’s disease, what med is contraindicated?
Spironolactone
Pregnant female comes in after water broken, contractions 45 minutes apart, baby decline HR, need med to stimulate labor
Produced in hypothalamus and stored/secreted by posterior pituitary
Oxytocin levels rise when someone gives you a hug
There are two conditions where we tend to use fluids and diuretics, what are they?
rhabdomyolysis and hypercalcemia
Pt 64 YR M with HTN and BPH, nocturia, what single medication will treat both?
Use an alpha blocker
Terazosin
Pt complains of 10/10 abdominal from the use of oxytocin, what is a complication of pitocin?
uterine rupture
Pt with overactive bladder, using a medication that blocks the muscarinic receptors that blocks the detrusor muscle of the smooth muscle, what is an example?
Oxybutynin
Toltardene
Pt with chronic pelvic pain and treating with medication that has similar effect of LMWH, what is it?
Pentosan polysulfate
Pt had bowel resection with atropine pre-op to prevent bowel contraction and post-op they are having urinary retention, don’t want to use a foley cath for risk of hospital acquired UTI, what medication can we prescribe?
Bethacholine
Cholinergic agent
Pt with dysuria, frequency, give them an analgesic, what test do you order before prescribing?
UA to look for infection
Phenazopyridine (Pyridium)
Pt in ER 48 yr M with priapism after ED medication, what medication?
any ED med can cause priapism
Pt 84 yr F is taking tadalafil, what is the indication for women?
pulmonary hypertension
Tadalafil and Sidalafil with women can be used for?
pulmonary hypertension
82 YR F complaining of urinary frequency, and incontinence, started on oxybutynin, The daughter brought her back because she is more confused than normal, she was put on an anticholinergic and may have what other sx?
dry mouth
Pt has ED, prescribed sildenafil, he asks how long it will last.
3-5 hours
Pt with flank pain radiating to the groin, we did imaging and saw a kidney stone, in addition to pain meds, what other medication can help them pass this kidney stone?
Tamsulosin
82 yo female with urinary frequency, overactive bladder, started on oxybutynin but now has confusion → anticholinergic effects
Dry mouth is most common side effect
There are four alpha-blockers we studied, which is not indicated for HTN?
Tamsulosin
Pt with HTN, and we placed him on a potassium-sparing diuretic comes back to you complaining of gynecomastia, what is he on?
Spironolactone
CHF has 3 days of N/V/D, not septic but dehydrated, which med should you discontinue
hold the diuretic, so furosemide
67 YR M was recently diagnosed with prostate cancer that the oncologist put him on, but his wife calls and says his moods are all over the place and he is crying all the time, what medication is he likely on?
Leuprolide (Lupron)
the initial increase in LH and FSH causing emotional outburst
Which meds enhance the effects of nitric oxide?
PDE-5
Increase cGMP
We may want to add an alpha blocker to increase the efficacy of what class of medications?
5-alpha reductase inhibitors
