men's health (AS) Flashcards
LUTS
lower urinary tract symptoms
3 group of symptoms of LUTS
- storage
- voiding
- post-micturition
storage symptoms of LUTS
functional abnormality
- urinary urgency
- frequency
- nocturia
- urinary incontinence
- needing to urinate just after passing urine
voiding symtoms of LUTS
often due to detrusor underactivity
- hesitancy weak or intermittent stream
- straining
- incomplete emptying
- terminal dribbling
post-micturition (after urination) symptoms of LUTS
post-micturition dribble
sensation of incomplete emptying
BPH
benign prostatic hyperplasia
What is BPH?
hyperplastic changes - abnormalities at the cellular level
What symptoms are common with BPH?
voiding symptoms
treatment of voiding symptoms (1st line)
- reassurance and lifestyle symptoms
- pelvic floor training, bladder training, pads, waterproof pants
treatment of moderate/severe voiding symptoms
alpha blockers
examples of alpha blockers
alfuzosin
doxazosin
tamulosin
terazosin
How are alpha blockers taken?
first dose at night (1st dose hypotension)
review at 4-6 weeks then 6-12 months
titrate cautiously
side effects of alpha blockers
dizziness (used for hpt) fatigue postural hypotensiom nasal congestion ED abnormal ejactulation drowziness
What is used to treat an enlarged prostate?
5-alpha reductase inhibitor
- dutasteride 500mcg daily
- finasteride 5mg daily
When are 5-alpha reductase inhibitors reviewed?
3-6 monts and then every 6-12 months
How long does it take for response to be seen with 5-alpha reductase inhibitors?
6 months
side effects with 5-alpha reductase inhibitors
sexual problems (dec with duration) breast tenderness/enlargement
counselling with 5-alpha reductase inhibitors (contraception)
- use condom if partner pregnant/likely to become pregnant
- women shouldn’t handle crushed/broken tabs/capsules if pregnant/planning
What is erictile dysfunction?
the persistent inability to attain and maintain an erection sifficient to permit satisfactory sexual performance
causes of ED
- ADRs
- psycholigical (mental health/relationship issues)
- physical
physical causes of ED
- vasculogenic - CVD, hpt, hyperlipidaemia, DM, smoking
- neurogenic - MS, PD, tumours, stroke, spinal disorders, DM, alcoholism, surgery
- anatomical - Peyronie’s disease, penile fracture, congenital curvature of penis
- hormonal - hypogonadism, hyperthyroidism, Cushing’s, hypopituitarism, hyperprolactinaemia
drug causes of ED
diuretics antihypertensives fibrates antipsychotics antidepressants histamine antagonists hormones cytotoxics anti-arrhythmics anti-convulsants
3 stages of ED disgnosis
- history (medical, psycholodgical, surgical, social)
- examination (physical of genitalia, gynaecomastia, reduced body hair, rectal if enlarged prostate)
- investigation (10yr CV risk, free testosterone levels, hormone imbalances?)
treatment for ED
phosphodiesterase-5-inhibitors
- sildenafil
- tadalafil
- verdenafil
dose of phosphodiesterase-5-inhibitors
Rx lowest dose and titrate up if ineffective
counselling for ED drugs
they are not initiators and require sexual stimulation for facilitate an erection
goudance for PDE-5 inhibitors for ED
man should receive 8 doses of PDE-5 I at a maximum dose with sexual stimulation before being classified as a non-responder
When should PDE-5-I be used with caution?
- recent MI, severe HF - vasodilation/sexual activity not recommended
- hypotension
- recent stroke
- hepatic/renal impairment
adverse effects with PDE-5 inhibitors
- n&v
- headache
- flushing
- dizziness
- > these common
- visual disturbances
- prolonges, painful erection
- palpitations, tachycardia, hypersensitivity rxns, hearing loss
lifestyle advice for ED
- weight loss
- smoking cessation
- healthy diet
- exercise
- stress relief
- don’t drink more than 14 units of alcohol per week
- limit cycling
dose of silfenafil
50mg at least 1hr before sexual activity
- longer if taken with food
- increased to max dose of 100mg OD
- reduced to 25mg OD (if s/e)
dose adjustments for sildenafil when CrCl < 30 ml/min or impaired hepatic function
25mg starting dose
increase to 50mg then 100mg based on efficacy and tolerance
sildenafil dose for CrCl 30-80ml/min
no dose adjustment needed
How is sildenafil prescribed?
generically
When is branded sildenafil prescribed?
- DM, MS, parkinsons, prostate cancer…
- dialysis for renal failure
- pelvic surgery, kidney transplant…
sildenafil switched from POM to P
sildenafil 50mg tabs (Viagra Connect 50mg)
licenced over 18yrs
consultation with pharmacist
counselling points for sildenafil
- take 1 50mg tablet 60mins before sexual activity
- maximun of one per day
- for it to be effective sexual stimulation is required
- if taken with food it may delay the onset of activity
- may effect ability to drive/use machinery due to dizziness, altered vision
