men's health (AS)

Question 1

LUTS

Answer 1

lower urinary tract symptoms

Question 2

3 group of symptoms of LUTS

Answer 2

1. storage
2. voiding
3. post-micturition

Question 3

storage symptoms of LUTS

Answer 3

functional abnormality

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

Question 4

voiding symtoms of LUTS

Answer 4

often due to detrusor underactivity

• hesitancy weak or intermittent stream
• straining
• incomplete emptying
• terminal dribbling

Question 5

post-micturition (after urination) symptoms of LUTS

Answer 5

post-micturition dribble

sensation of incomplete emptying

Question 6

BPH

Answer 6

benign prostatic hyperplasia

Question 7

What is BPH?

Answer 7

hyperplastic changes - abnormalities at the cellular level

Question 8

What symptoms are common with BPH?

Answer 8

voiding symptoms

Question 9

treatment of voiding symptoms (1st line)

Answer 9

• reassurance and lifestyle symptoms

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

Question 10

treatment of moderate/severe voiding symptoms

Answer 10

alpha blockers

Question 11

examples of alpha blockers

Answer 11

alfuzosin
doxazosin
tamulosin
terazosin

Question 12

How are alpha blockers taken?

Answer 12

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

Question 13

side effects of alpha blockers

Answer 13

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

Question 14

What is used to treat an enlarged prostate?

Answer 14

5-alpha reductase inhibitor

• dutasteride 500mcg daily
• finasteride 5mg daily

Question 15

When are 5-alpha reductase inhibitors reviewed?

Answer 15

3-6 monts and then every 6-12 months

Question 16

How long does it take for response to be seen with 5-alpha reductase inhibitors?

Answer 16

6 months

Question 17

side effects with 5-alpha reductase inhibitors

Answer 17

sexual problems (dec with duration)
breast tenderness/enlargement

Question 18

counselling with 5-alpha reductase inhibitors (contraception)

Answer 18

• use condom if partner pregnant/likely to become pregnant

- women shouldn’t handle crushed/broken tabs/capsules if pregnant/planning

Question 19

What is erictile dysfunction?

Answer 19

the persistent inability to attain and maintain an erection sifficient to permit satisfactory sexual performance

Question 20

causes of ED

Answer 20

• ADRs
• psycholigical (mental health/relationship issues)
• physical

Question 21

physical causes of ED

Answer 21

• 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

Question 22

drug causes of ED

Answer 22

diuretics
antihypertensives
fibrates
antipsychotics
antidepressants
histamine antagonists
hormones
cytotoxics
anti-arrhythmics
anti-convulsants

Question 23

3 stages of ED disgnosis

Answer 23

• 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?)

Question 24

treatment for ED

Answer 24

phosphodiesterase-5-inhibitors

• sildenafil
• tadalafil
• verdenafil

Question 25

dose of phosphodiesterase-5-inhibitors

Answer 25

Rx lowest dose and titrate up if ineffective

Question 26

counselling for ED drugs

Answer 26

they are not initiators and require sexual stimulation for facilitate an erection

Question 27

goudance for PDE-5 inhibitors for ED

Answer 27

man should receive 8 doses of PDE-5 I at a maximum dose with sexual stimulation before being classified as a non-responder

Question 28

When should PDE-5-I be used with caution?

Answer 28

• recent MI, severe HF - vasodilation/sexual activity not recommended
• hypotension
• recent stroke
• hepatic/renal impairment

Question 29

adverse effects with PDE-5 inhibitors

Answer 29

• n&v
• headache
• flushing
• dizziness
• > these common
• visual disturbances
• prolonges, painful erection
• palpitations, tachycardia, hypersensitivity rxns, hearing loss

Question 30

lifestyle advice for ED

Answer 30

• weight loss
• smoking cessation
• healthy diet
• exercise
• stress relief
• don’t drink more than 14 units of alcohol per week
• limit cycling

Question 31

dose of silfenafil

Answer 31

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)

Question 32

dose adjustments for sildenafil when CrCl < 30 ml/min or impaired hepatic function

Answer 32

25mg starting dose

increase to 50mg then 100mg based on efficacy and tolerance

Question 33

sildenafil dose for CrCl 30-80ml/min

Answer 33

no dose adjustment needed

Question 34

How is sildenafil prescribed?

Answer 34

generically

Question 35

When is branded sildenafil prescribed?

Answer 35

• DM, MS, parkinsons, prostate cancer…
• dialysis for renal failure
• pelvic surgery, kidney transplant…

Question 36

sildenafil switched from POM to P

Answer 36

sildenafil 50mg tabs (Viagra Connect 50mg)
licenced over 18yrs
consultation with pharmacist

Question 37

counselling points for sildenafil

Answer 37

• 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