men's health (AS) Flashcards by Sarah Ramsbottom

LUTS

lower urinary tract symptoms

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3 group of symptoms of LUTS

storage
voiding
post-micturition

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storage symptoms of LUTS

functional abnormality

urinary urgency
frequency
nocturia
urinary incontinence
needing to urinate just after passing urine

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voiding symtoms of LUTS

often due to detrusor underactivity

hesitancy weak or intermittent stream
straining
incomplete emptying
terminal dribbling

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post-micturition (after urination) symptoms of LUTS

post-micturition dribble

sensation of incomplete emptying

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BPH

benign prostatic hyperplasia

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What is BPH?

hyperplastic changes - abnormalities at the cellular level

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What symptoms are common with BPH?

voiding symptoms

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treatment of voiding symptoms (1st line)

reassurance and lifestyle symptoms

- pelvic floor training, bladder training, pads, waterproof pants

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treatment of moderate/severe voiding symptoms

alpha blockers

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examples of alpha blockers

alfuzosin
doxazosin
tamulosin
terazosin

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How are alpha blockers taken?

first dose at night (1st dose hypotension)
review at 4-6 weeks then 6-12 months
titrate cautiously

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side effects of alpha blockers

dizziness (used for hpt)
fatigue
postural hypotensiom
nasal congestion
ED
abnormal ejactulation
drowziness

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What is used to treat an enlarged prostate?

5-alpha reductase inhibitor

dutasteride 500mcg daily
finasteride 5mg daily

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When are 5-alpha reductase inhibitors reviewed?

3-6 monts and then every 6-12 months

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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