Male Sexual Dysfunction and Benign Prostatic Hyperplasia Flashcards
First line therapy for erectile dysfunction
PDE-5 inhibitors- sildenafil, tadalafil, vardenafil, avanafil
What raises PDE-5 inhibitor levels and should be avoided?
grapefruit juice
High fat meals will delay absorption of what PDE-5 inhibitors?
avanafil, sildenafil, and vardenafil
NOT tadalafil
Take this PDE-5 inhibitor 15-30 minutes before sexual activity
avanafil
Take which PDE-5 inhibitors 1 hour before sexual activity
sildenafil, tadalafil, vardenafil
When taking a PDE-5 inhibitor, warn patients to seek medical attention…
Sudden loss of vision, hearing loss, when an erection lasts more than 4 hours
Advise men who experience which symptoms during sex and should discuss with their provider
angina, lightheadedness, pain
When taking PDE-5 inhibitors, instruct patients to avid which medication
nitrates
Mechanism of Action of sildenafil
increases and preserves cGMP levels in the penis, making erection harder and longer lasting by relaxation of penile arterial and trabecular smooth muscle
Adverse effects of sildenafil
hypotension, priapism, nonarteritic ischemic optic neuropathy, sudden heating loss, headache, flushing, indigestion, dizziness, vertigo, and tinnitus
Reduce dosage of PDE-5 inhibitors if taking…
CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin) because they suppress the metabolism
__________ prolongs the QT interval. Do not prescribe for men taking class I or III antidysrhythmic drugs
vardenafil
Do not combine this PDE-5 inhibitor with alpha blockers, doing so can cause serious decrease in blood pressure
vardenafil
PDE-5 inhibitors should be used with caution by men with which conditions?
MI or stroke within last 6 months, resting hypotension, resting hypertension, heart failure, unstable angina
This PDE-5 inhibitor effects last for 36 hours
tadalafil
This PDE-5 inhibitor has the fastest onset of action
avanafil
PDE-5 inhibitor approved for daily dose
tadalafil
Men with severe hepatic insufficiency should not use this drug. Dosage should be reduced in men with moderate renal or hepatic insufficiency.
tadalafil
Monitoring for PDE-5 inhibitors
heart rate, blood pressure, eye exams, tinnitus, vertigo, hear loss, pulmonary edema
Appropriate therapy for men with very large prostates (mechanical obstruction)
5 alpha reductase inhibitors
Appropriate therapy for men with small prostates (dynamic obstruction_
alpha blockers
two 5 alpha reductase inhibitors that reduce prostate size after several months
finasteride and dutasteride
Finasteride (proscar) mechanism of action
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
Finasteride adverse reactions
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
Difference between Dutasteride and finasteride
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
Dutasteride mechanism of action
Dutasteride inhibits 5 alpha reductase in reproductive tissues AND in skin and liver
Dutasteride adverse effects
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
Monitoring 5 alpha reductase inhibitors
Baseline PSA
Repeat PSA at 6 months, if there is no decrease, evaluate for prostate cancer
Alpha adrenergic antagonists approved for BPH:
alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax)
Alpha adrenergic antagonist mechanism of action
blockade of alpha receptors relaxes smooth muscle in the bladder neck, prostate capsule, and prostatic urethra thereby decreasing dynamic obstruction
Dynamic obstruction is the major contributor to symptoms in patients with relatively mild prostatic enlargement _________ are preferred over ________ in men
alpha blockers/5 alpha reductase inhibitors
______ do not decrease prostate size
alpha blockers
Selective for alpha receptors
silodosin and tamsulosin
nonselective alpha blockers
alfuzosin, terazosin, doxazosin
Promote vasodilation and can thereby lower blood pressure
nonselective alpha blockers: alfuzosin, terazosin, doxazosin
A patient with BPH with hypotension or no blood pressure issues should be prescribed which alpha antatagonist?
silodosin or tamsulosin
A patient with hypertension and BPH should be prescribed which alpha antagonist?
nonselective alpha blockers: alfuzosin, terazosin, doxazosin
Alpha adrenergic antagonists not safe during pregnancy…
doxazosin and terazosin
Beers criteria for BPH meds:
alpha blockers doxazosin and terazosin are potentially inappropriate medications for patients 65 or older
Alpha blockers adverse effects
nonselective: hypotension, fainting, dizziness, somnolence, nasal congestion
selective: abnormal ejaculation
Do not reduce levels of PSA
Men anticipating cataract surgery should_____ due to increased risk for intraoperative floppy-iris syndrome
postpone alpha blocker therapy and if already taking alpha blocker, consult ophthalmologist
Nonselective alpha blockers should be used with caution when also taking which other medications?
nitrates, antihypertensive drugs, PDE-5 inhibitors,
CYP3A4 inhibitors (with alfuzosin and silodosin)
Combining an alpha blocker with a 5 alpha reductase inhibitor works by:
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
______ approved for men who have BPH by itself or BPH combined with ED. But it does not improve urinary flow
tadalafil
