men's health Flashcards
post-void residual normal and abnormal volumes
normal is less than 50-100
abnormal is over 200
normal and abnormal urine velocity
normal is 20-25 ml/sec
abnormal is less than 12-15 ml/sec
neurologic control of bladder
PSNS (ACh, M3) causes detrusor constriction and bladder emptying
SNS (adrenergic) facilitates urine storage (B2 and B3-R in detrusor -> relaxation; alpha-1 in internal sphincter -> contraction)
somatic control via pudendal nerve
behavioral modifications for tx of urinary incontinence
toilet assistance - regular scheduling, caregiver
bladder training - education, scheduled voiding, positive reinforcement
pelvic mm rehab (Kegel)
biofeedback
MOA of drugs for overactive bladder
stop spontaneous detrusor contractions - anti-ACh
differences in drugs for OAB
muscarinic receptor specificity, lipophilicty (CNS effects), metabolism, and dosage form
oxybutinin
anti-ACh for OAB
most ACh ADRs (dry mouth, etc.)
available short- and long-acting oral tabs, transdermal patches, topical gel
tolterodine
anti-ACh for OAB
more selective M3-blocker vs oxybutinin
trospium
anti-ACh for OAB
fesoteridine
anti-ACh for OAB
solifenacin
anti-ACh for OAB
darifenacin
anti-ACh for OAB
mirebegron
first oral B3 agonist for OAB
onabotulinumtoxinA
injected into detrusor during cystoscopy to block ACh release at NMJ for OAB
lasts 19-24 weeks
drugs that can cause or exacerbate urinary incontinence
urinary retention: anti-ACh, anti-depressants, anti-psychotics, B-agonists, CCB, opioids
polyuria, freq, urgency: EtOH, caffeine, diuretics
urethral relax: a-blockers
mm relaxer: sedatives, hypnotics
tissues of prostate
epithelial/ glandular: makes secretions, under androgen control
stroma: SM with a1-receptors
5-a-reductase
converts testosterone to DHT in prostate, beginning at puberty -> rapid growth and enlargement of prostate
normal and BPH ratio of stroma:epithelial tissue
normal 2:1, BPH 5:1
drugs for BPH
non-selective a1-blockers, selective a1-blockers, 5a-reductase inhibitors, PDE5 inhibitors, herbal products
doxazosin
non-selective a1-blocker for BPH
terazosin
non-selective a1-blocker for BPH
alfuzosin
non-selective a1-blocker for BPH
tamsulosin
selective a1-blocker for BPH
*may cause “floppy iris syndrome” - don’t give before cataract surgery
silodosin
selective a1-blocker for BPH
finasteride
5a-reductase inhibitor for BPH
*caution in pregnancy: anti-androgenic effects
dutasteride
5a-reductase inhibitor for BPH
*caution in pregnancy: anti-androgenic effects
tadalafil
PDE5 inhibitor for BPH
*interacts with a1-blocker -> hypotension
saw palmetto
herbal product used for BPH
acute prostatitis: pathogens and tx
similar pathogens as those that cause UTIs, identify with urine culture
4 wk therapy of TMP-SMX or FQs if allergy or if G- bacteria (not sensitive to TMP-SMX)
PDE5 MOA
prevents breakdown cGMP, which decreases cellular Ca in arterial SM in penis -> SM relaxation = inflow of blood into intercavernosal trabeculae = erection
sildenafil
PDE5 inhibitor for ED
ADR sildenafil
common: HA, facial flushing, nasal congestion, dyspepsia
severe: priapism, hearing loss, vision disturbance (blue), sudden vision loss
sildenafil drug interactions
CI with nitrates like NTG, isosorbide -> too much cGMP = hypotension
caution with CYP 3A4 inhibitors = increased drug level and ADRs
tadalafil
PDE5 inhibitor for ED
ADR tadalafil
common: flushing, HA, congestion, dyspepsia
unique: back pain or muscle aches (PDE11 inhibition in sk mm)
vision disturbances rare compared to other PDE5 inhibitors
meds that can cause ED
BBs, central anti-HTN (clonidine, methyldopa), digoxin, spironolactone, thiazides, most antidepressants, typical antipsychotics, anticonvulsants, lithium, 5a-reductase inhibitors, EtOH, cimetidine, opioids, corticosteroids
FDA-approved drugs for low testosterone
NONE for low T without associated medical condition
primary hypogonadism
late-onset, “andropause”
slow loss of T is natural in aging
s/s: loss of libido, impotence, loss mm mass and strength, fatigue, depression, inability to concentrate
secondary hypogonadism
causes include obesity, metabolic syndrome, DM, some meds
who should be treated with testosterone replacement therapy
should only be men with clinical symptoms and low T levels (less than 200; normal 270-1070)
oral testosterone product use
rarely used d/t hepatic effects
forms of artificial testosterone
oral (rarely used), depot injection, TD patch, TD gel, TD solution, subQ pellets, buccal tablet
adverse effects of T replacement therapy
increased prostate and breast ca, inc prostate growth, polycythemia, infertility, hepatic toxicity, CV toxicity, thrombophlebitis, lower HDL
