Male Sexual Dysfunction and Benign Prostatic Hyperplasia

Question 1

First line therapy for erectile dysfunction

Answer 1

PDE-5 inhibitors- sildenafil, tadalafil, vardenafil, avanafil

Question 2

What raises PDE-5 inhibitor levels and should be avoided?

Answer 2

grapefruit juice

Question 3

High fat meals will delay absorption of what PDE-5 inhibitors?

Answer 3

avanafil, sildenafil, and vardenafil

NOT tadalafil

Question 4

Take this PDE-5 inhibitor 15-30 minutes before sexual activity

Answer 4

avanafil

Question 5

Take which PDE-5 inhibitors 1 hour before sexual activity

Answer 5

sildenafil, tadalafil, vardenafil

Question 6

When taking a PDE-5 inhibitor, warn patients to seek medical attention…

Answer 6

Sudden loss of vision, hearing loss, when an erection lasts more than 4 hours

Question 7

Advise men who experience which symptoms during sex and should discuss with their provider

Answer 7

angina, lightheadedness, pain

Question 8

When taking PDE-5 inhibitors, instruct patients to avid which medication

Answer 8

nitrates

Question 9

Mechanism of Action of sildenafil

Answer 9

increases and preserves cGMP levels in the penis, making erection harder and longer lasting by relaxation of penile arterial and trabecular smooth muscle

Question 10

Adverse effects of sildenafil

Answer 10

hypotension, priapism, nonarteritic ischemic optic neuropathy, sudden heating loss, headache, flushing, indigestion, dizziness, vertigo, and tinnitus

Question 11

Reduce dosage of PDE-5 inhibitors if taking…

Answer 11

CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin) because they suppress the metabolism

Question 12

__________ prolongs the QT interval. Do not prescribe for men taking class I or III antidysrhythmic drugs

Answer 12

vardenafil

Question 13

Do not combine this PDE-5 inhibitor with alpha blockers, doing so can cause serious decrease in blood pressure

Answer 13

vardenafil

Question 14

PDE-5 inhibitors should be used with caution by men with which conditions?

Answer 14

MI or stroke within last 6 months, resting hypotension, resting hypertension, heart failure, unstable angina

Question 15

This PDE-5 inhibitor effects last for 36 hours

Answer 15

tadalafil

Question 16

This PDE-5 inhibitor has the fastest onset of action

Answer 16

avanafil

Question 17

PDE-5 inhibitor approved for daily dose

Answer 17

tadalafil

Question 18

Men with severe hepatic insufficiency should not use this drug. Dosage should be reduced in men with moderate renal or hepatic insufficiency.

Answer 18

tadalafil

Question 19

Monitoring for PDE-5 inhibitors

Answer 19

heart rate, blood pressure, eye exams, tinnitus, vertigo, hear loss, pulmonary edema

Question 20

Appropriate therapy for men with very large prostates (mechanical obstruction)

Answer 20

5 alpha reductase inhibitors

Question 21

Appropriate therapy for men with small prostates (dynamic obstruction_

Answer 21

alpha blockers

Question 22

two 5 alpha reductase inhibitors that reduce prostate size after several months

Answer 22

finasteride and dutasteride

Question 23

Finasteride (proscar) mechanism of action

Answer 23

inhibits 5 alpha reductase, an enzyme that converts testosterone to dihydrotestosterone (DHT). Decreasing DHT availability promotes regression of prostate epithelial tissue and decreases mechanical obstruction of the urethra

Question 24

Finasteride adverse reactions

Answer 24

protects against low grade prostate cancer and increases likelihood of high-grade cancer
decrease in ejaculate volume and libido, gynecomastia
teratogenic- women shouldn’t handle tablet, men shouldn’t donate blood for 1 month after stopping
decrease in PSA, if no decrease, patient should be evaluated for cancer

Question 25

Difference between Dutasteride and finasteride

Answer 25

reduction of circulating DHT is more complete and dutasteride has longer half life (5 weeks), it takes months to clear drug after dosing has stopped

Question 26

Dutasteride mechanism of action

Answer 26

Dutasteride inhibits 5 alpha reductase in reproductive tissues AND in skin and liver

Question 27

Dutasteride adverse effects

Answer 27

reduced ejaculate volume and libido, decline in PSA
teratogenic- women shouldn’t handle tablet, men shouldn’t donate blood for 6 months after stopping
protects against low grade prostate cancer and increases likelihood of high-grade cancer

capsule should be swallowed with full glass of water due to irritation to oropharyngeal mucosa

Question 28

Monitoring 5 alpha reductase inhibitors

Answer 28

Baseline PSA

Repeat PSA at 6 months, if there is no decrease, evaluate for prostate cancer

Question 29

Alpha adrenergic antagonists approved for BPH:

Answer 29

alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax)

Question 30

Alpha adrenergic antagonist mechanism of action

Answer 30

blockade of alpha receptors relaxes smooth muscle in the bladder neck, prostate capsule, and prostatic urethra thereby decreasing dynamic obstruction

Question 31

Dynamic obstruction is the major contributor to symptoms in patients with relatively mild prostatic enlargement _________ are preferred over ________ in men

Answer 31

alpha blockers/5 alpha reductase inhibitors

Question 32

______ do not decrease prostate size

Answer 32

alpha blockers

Question 33

Selective for alpha receptors

Answer 33

silodosin and tamsulosin

Question 34

nonselective alpha blockers

Answer 34

alfuzosin, terazosin, doxazosin

Question 35

Promote vasodilation and can thereby lower blood pressure

Answer 35

nonselective alpha blockers: alfuzosin, terazosin, doxazosin

Question 36

A patient with BPH with hypotension or no blood pressure issues should be prescribed which alpha antatagonist?

Answer 36

silodosin or tamsulosin

Question 37

A patient with hypertension and BPH should be prescribed which alpha antagonist?

Answer 37

nonselective alpha blockers: alfuzosin, terazosin, doxazosin

Question 38

Alpha adrenergic antagonists not safe during pregnancy…

Answer 38

doxazosin and terazosin

Question 39

Beers criteria for BPH meds:

Answer 39

alpha blockers doxazosin and terazosin are potentially inappropriate medications for patients 65 or older

Question 40

Alpha blockers adverse effects

Answer 40

nonselective: hypotension, fainting, dizziness, somnolence, nasal congestion
selective: abnormal ejaculation
Do not reduce levels of PSA

Question 41

Men anticipating cataract surgery should_____ due to increased risk for intraoperative floppy-iris syndrome

Answer 41

postpone alpha blocker therapy and if already taking alpha blocker, consult ophthalmologist

Question 42

Nonselective alpha blockers should be used with caution when also taking which other medications?

Answer 42

nitrates, antihypertensive drugs, PDE-5 inhibitors,

CYP3A4 inhibitors (with alfuzosin and silodosin)

Question 43

Combining an alpha blocker with a 5 alpha reductase inhibitor works by:

Answer 43

alpha blocker provides rapid symptomatic relief by relaxing prostate related smooth muscle while the 5 alpha reductase inhibitor provides additional symptomatic relief by shrinking the prostate and delay disease progression

Question 44

______ approved for men who have BPH by itself or BPH combined with ED. But it does not improve urinary flow

Answer 44

tadalafil