male GU Flashcards
When symptomatic how does BPH present?
UTI symptoms, hesitancy, intermittency, weak stream, Straining, incomplete emptying,
How does BPH appear on exam?
Nontender, symmetrically enlarged prostate
What medications are used for LUTS symptoms?
Adrenergic receptor blockers, reductase inhibitors, PDE 5 inhibitors
What medications are used to treat overactive bladder symptoms
Anticholinergic agents (antimuscarinic) and beta 3 adrenergic receptor agonist
What exerts the same effect a a sympathetic agonist on the prostate?
A choleric/muscatinic receptor
What are the nonselective blockers for BPH
Alfuzosin, doxazosin, terazosin
What are the selective blocker meds for BPH
Tamsulosin and silodosin
When are therapeutic effects observed on BPH treatment?
Within 1 week
which class of drugs would you use for BPH if you also wanted antihypertensive affects?
Non selective agents
What are the adverse effects of nonselective blockers
Syncope, hypotension, dizziness, sedations, and fatigue
How do 5a reductase inhibitors work?
They block the conversion of testosterone to its active metabolite of dihydrotestosterone to shrink the prostate and inhibit further growth
By how much % does the 5a reductase inhibitors reduce prostate size by?
25%
When are 5 reductinase inhibitors indicated?
When PSA is greater than. 1.5ng/ml
Which 5a reductase inhibitors block type 2 isoenzymes
Finasteride
Which 5a reductase inhibitor blocks both type 1 and type 2 isoenzymes
Dustateride
What are the adverse effects of 5 RA inhibitors?
Decreased libido, ED, decreased ejaculation, gynecomastia, increased risk for PC and masking PSA for PC
What is the % of reduction in PSA levels while on 5RAI
50% after 6 months
What are PFE 5 inhibitors used to treat?
ED and BPH
What is the approved PDE5 inhibitors that work for both BPH and ED
Tadalafil
What are the adverse effects of PDE 5 inhibitors
Increased sensitivity for erection, headaches, flushing, nausea, dyspepsia, back pain, URI, myalgia, and not allowed with nitrates
How do antimuscarinic agents work?
Inhibit receptors in the bladder destructor muscle and decreasing the overactive bladder component
What should you pair with antimuscarinic agents to get better results?
Alpha blockers
What are the selective M3 antimuscarinic agents
Darifenacin and solifenacin
What are the non selective M2 and M3 receptor agents
Trospium chloride, oxybutynin, tolrterodine, and fesoterodine
Which class of antimuscarinic agents has more side effects?
Nonselective
What are the side effects of antimuscarinic nonselective agents?
Dry eye, dry mouth, constipation, tachycardia, drowsiness
What is the most common side effect in all antimuscarinic meds?
Urinary retention and mydriadis
How do beta 3 Adrenalin agonists work?
They activate beta 3 Adrenergic receptors on the bladder wall causing relaxation.
Which class of meds has less risk for urinary retention?
Beta 3
What can combine beta 3 with if patients don’t respond to mono therapy
Antimuscarinic agents
Which patients should you use caution in when prescribing beta 3 Adrenergic agonists in?
Frail adults with overactive bladder
Which of the five classes of drugs for the treatment of BPH is associated with an increased risk for aggressive prostate cancer
5 alpha receptor inhibitors
What is a good tool to use to assess a man’s bother with BPH associated symptoms?
AUA symptom score
Which drug can be used for ED as well as BPH symptoms
The PDE5 inhibitor tadalfil
Treating what factors may improve ED symptoms?
CV risk factors
What are the four PDE5 inhibitors used for ED?
Sildenafil, tadalafil, vardinafil, avanafil and the injection alprostadil
What are the cardiovascular risk also associated with ED?
Smoking, obesity, hypertension, dyslipidemia
What are the adverse effects of PDE5s
Headache, hypotension, priapism
What drugs to PDE5 inhibitors interact with?
Nitrates, alpha blockers, and CYP3A4
What is the most effective drug for mild to moderate ED?
Vardenafil
Which PDE5 should you avoid use in for risk of priapism?
Avanafil
Which diseases are most likely to have priapism?
Sickle cell anemia, multiple myeloma, leukemia
What is hypngonadism?
A decrease in either sperm production or testosterone production.
When is testosterone indicated?
Unequivocal testosterone levels and ED
What is testosterone contraindicated in?
Prostate cancer, elevated PSA, HCT of greater than 50%, untreated sleep apnea, and heart failure
What is a grade 2B ED of the endocrine society?
Men with symptomatic androgen deficiency in order to induce and maintain secondary sex characteristics and to improve their sexual function, muscle mass, strength, and bone density.
What group of people are most at risk for prostate cancer?
African Americans with a immediate family member with prostate cancer
PDE – five inhibitors are contraindicated and patients taking_______ of any form regularly or intermittently as the combination can lead to severe hypotension
Nitrates
Which PDE – five inhibitor has the longest duration of action, sildenafil, vardenafil Tadalafil or avanafil
Tadalfil
True or false testosterone replacement therapy may be considered as an alternative to a PDE – five inhibitors and people with ED and CV disease
False. It is only in hypnogonadism
