Male GU

Question 1

What are the drugs prescribed for lower urinary tract symptoms (LUTS)?

Answer 1

α- adrenergic-receptor blockers
5α-reductase inhibitors
Phosphodiesterase-5 inhibitor agents (PDE-5 inhibitor)

Question 2

What are the drugs used for overactive bladder symptoms?

Answer 2

Anticholinergic (antimuscarinic) agents
Beta-3 adrenergic receptor agonist

Question 3

What are the non-selective alpha blockers?

Answer 3

Alfuzosin
Doxazosin
Terazosin

Question 4

What are the selective alpha blockers?

Answer 4

Tamsulosin
Silodosin

Question 5

What other problems do non-selective agents help?

Answer 5

antihypertension a long with voiding symptoms

Question 6

What are the adverse effects of non-selective alpha blockers?

Answer 6

Syncope
Hypotension
Dizziness
Sedation
Fatigue

Question 7

What are the 5α-reductase inhibitors drugs?

Answer 7

Finasteride (blocks type 2 5αRA isoenzyme)
Dutasteride (blocks type 1 & 2 5αRA isoenzyme)

Question 8

What is the mechanism of action of 5α-reductase inhibitors?

Answer 8

block the conversion of testosterone to its active metabolite, dihydrotestosterone, shrink the prostate and inhibit further prostatic growth.

Question 9

What are the adverse effects of 5αRA Inhibitors?

Answer 9

Decreased libido, erectile dysfunction, decreased ejaculation, gynecomastia, increased risk for aggressive prostate CA, Reduces PSA, but may invalidate PSA screening for risk of prostate CA

Question 10

What drug is the PDE-5 Inhibitors?

Answer 10

Tadalafil

Question 11

What is the mechanism of action of PDE-5 Inhibitors?

Answer 11

Increases in c-AMP, c-GMP lead to smooth muscle relaxation
May slow prostate growth

Question 12

What are the adverse effects of PDE-5 Inihibitors?

Answer 12

Increased sensitivity for erection
Headache
Flushing
Nausea/dyspepsia
Back pain
URI, nasopharyngitis
Myalgia
Contraindicated in men taking nitrates

Question 13

What are the selective M3 Antimuscarinic agents?

Answer 13

Darifenacin
Solifenacin

Question 14

What are the non-selective M2/M3 receptor agents?

Answer 14

Trospium chloride
Oxybutynin
Tolterodine
Fesoterodine

Question 15

What are the mechanism of action of the antimuscarinic agents?

Answer 15

Inhibit receptors in bladder detrusor muscle
Effective for overactive bladder symptoms
Good results when combined with α blockers

Question 16

What are the adverse effects of antimuscarinic agents?

Answer 16

effects increased for non-selective agents
Dry eyes
Dry mouth
Constipation
Tachycardia
Drowsiness/decreased cognitive function
Urinary retention for both selective and non-selective
Contraindicated in persons with narrow-angle glaucoma

Question 17

What are Beta-3 Receptors used for?

Answer 17

Activates beta-3 adrenergic receptors located in bladder wall causing relaxation
Indicated for overactive bladder symptoms associated with BPH
May combine beta-3 adrenoceptor with antimuscarinic if refractory to monotherapy

Question 18

What is the benefit of Beta-3 adrenoceptor drugs?

Answer 18

Less risk for urinary retention than the antimuscarinic agents

Question 19

What caution needs to be taken when prescribing beta-3 adrenoreceptors?

Answer 19

Caution in frail adult with OAB

Question 20

What action needs to be taken to assess BPH symptoms?

Answer 20

If “bother” is moderate to severe, discuss benefits vs risks of medications. Use AUA Symptom Score to assess “bother

Question 21

Which of the five classes of drugs for the treatment of BPH is associated with an increased risk for aggressive prostate cancer?

Answer 21

5α-reductase inhibitors

Question 22

What is a good tool for providers to use in assessing a man’s “bother” with BPH-associated symptoms?

Answer 22

AUA Symptom Score

Question 23

Which drug can be useful for ED as well as for BPH symptoms?

Answer 23

PDE-5 inhibitors, specifically Tadalfil (Cialis)

Question 24

Treating what risk factors can also improve ED?

Answer 24

Cardiovascular (smoking, obesity, HTN, and dsyslipidemia)

Question 25

What is the primary drug class to treat ED?

Answer 25

PDE-5 inhibitors

Question 26

What are the PDE-5 inhibitors?

Answer 26

Sildenafil (Viagra) Vardinafil (Levitra) Tadalafil (Cialis) Avanafil (Stendra)

Question 27

What is the intracavernosal injectable ED drug?

Answer 27

alprostadil

Question 28

What is the mechanism of action of Sildenafil?

Answer 28

Selectively inhibits PDE5 leading to engorgement of the penis and a longer erection

Question 29

What are the adverse effects of Sildenafil?

Answer 29

Headache Hypotension Priapism Have little to no effect on men who do not have ED

Question 30

What are the drug interactions of PDE-5 inhibitors?

Answer 30

Nitrates Alpha blockers Inhibitors of cytochrome P450 (CYP3A4)

Question 31

What is the mechanism of action of Vardenafil?

Answer 31

Mild/moderate ED Sexual stimulation required to activate response

Question 32

What are the adverse effects of Vardenafil?

Answer 32

Headache Flushing

Question 33

How should Vardenafil be taken?

Answer 33

It is to be taken on an empty stomach approximately 1 hour before sexual activity.

Question 34

How long does the effects of Verdenafil last?

Answer 34

Increased sensitivity for erections may last 24 hours.

Question 35

What is the mechanism of action of Tadalfil?

Answer 35

most effective for mild-to-moderate ED of varying etiologies, including both organic and psychogenic causes.

Question 36

When does Tadalfil not work?

Answer 36

Absence of sexual stimulation

Question 37

How long do the effects of Tadalafil last?

Answer 37

. Increased sensitivity for erections may last 36 hours with intermittent dosing.

Question 38

What else can Tadalafil be used for?

Answer 38

BPH

Question 39

What drug can be given with Tadalafil?

Answer 39

Tamsulosin

Question 40

What are the adverse effects of Tadalafil?

Answer 40

Headache Dyspepsia Back pain

Question 41

What is the mechanism of action of Avanafil?

Answer 41

inhibits cGMP degradation and thereby enhances the effects of nitric oxide in smooth muscle relaxation of the corpus cavernosum

Question 42

What are the adverse effects of Avanafil?

Answer 42

Headache Flushing Nasal congestion

Question 43

When should testosterone be prescribed?

Answer 43

ONLY to a man who has clinical symptoms and signs consistent with androgen deficiency and a distinctly subnormal serum testosterone.

Question 44

When is testosterone contraindicated?

Answer 44

contraindicated in persons with prostate cancer, prostate nodules, elevated PSA, high risk for prostate cancer, hematocrit >50%, untreated sleep apnea, and heart failure.

Question 45

PDE-5 inhibitors are contraindicated in patients taking ___________ of any form, regularly or intermittently, as the combination can lead to severe hypotension.

Answer 45

Nitrates of any kind

Question 46

Which PDE-5 inhibitor has the longest duration of action: sildenafil, vardenafil, tadalafil, avanafil?

Answer 46

Tadalafil has a longer duration of action

Question 47

T/F: Testosterone replacement therapy may be considered as an alternative to PDE-5 inhibitors in persons with ED and CV

Answer 47

FALSE: Testosterone replacement therapy is ONLY recommended in men with unequivocally documented hypogonadism. It is contraindicated in persons with heart failure.