mens health in practice Flashcards
why is the promotion of mens health so important?
• 2x more likely to have inadequate health
literacy
• 2x less likely to attend a GP practice
• Evidence that males socially construct health
as a feminine concern
• 2x more likely to take meds without reading
PIL
• More likely to purchase online
how more likely are women to go into a pharmacy than men?
Research suggests that men, on average, visit
the community pharmacy 4x per year, while
the average for women is 18x (NPA)
what are LUTS?
lower urinary tract symptoms
what are the 3 groups that LUTS are divided into?
Storage
Functional abnormality -Urinary urgency, frequency, nocturia, urinary incontinence,
needing to urinate just after passing urine
Voiding
Often due to detrusor underactivity –hesitancy, weak or intermittent stream,
straining, incomplete emptying, terminal dribbling
Post-micturition
Post-micturition dribble, sensation of incomplete emptying
what is BPH?
Benign prostatic hyperplasia
how do you investigate BPH?
A biopsy of the prostate shows histologic signs of hyperplastic
changes (abnormalities at the cellular level).
how many men with BPH have luts?
a quarter
what is the predominant problem with BPH?
voiding sympytoms
what is the most common cause of BPH?
voiding symptoms
how do you treat voiding symptoms in BPH?
Reassurance and lifestyle advice
• Pelvic floor training, bladder training, pads, waterproof pants etc.
how do you treat moderate- severe BPH sympytoms?
• Alpha blocker e.g. alfuzosin, doxazosin, tamsulosin or terazosin
• Review at 4-6 weeks then 6-12 months
• First dose at night (1st dose hypotension)
•
which alpha blocker for BPH can be bought OTC?
tamsulosin
what are the common side effects of alpha blocker treatment for BPH?
Dizziness, fatigue, postural hypotension, nasal congestion, ED,
abnormal ejaculation, drowsiness
what do you offer someone with an enlarged prostate?
- Offer a 5-alpha reductase inhibitor
- Dutasteride 500 micrograms daily or finasteride 5mg daily
- Review after 3-6 months and then every 6-12 months
- Need to be given for up to 6 months before response seen
what are the common side effects of 5-alpha reductase inhibitors?
• Sexual problems (decreasing with duration), breast
tenderness/enlargement
what extra precautions should be taken for those using 5-alpha reductase inhibitors?
• Use a condom if partner is pregnant or likely to become pregnant
• Women should not handle crushed or broken tablets or leaking
capsules if they are pregnant or planning pregnancy
what is erectile dysfunction?
Erectile dysfunction is defined as the persistent inability to attain and
maintain an erection sufficient to permit satisfactory sexual
performance
what are the common causes of ED?
adverse drug effects
psychological- mental health or relationship issues
physical: hormononal, anatomical ,neuro. vasculogenic
what are the drugs that cause ED?
diuretics- thiazides, spironolactone anti-hypertensives- e.g. methyldopa fibrates- clofibrate antipyschotics- phenothiazines antidepressants- tricyclics histamine-h2 antagonists hormones and hormone modifying drugs-oestrogen cytotocis- methotrexate anti-arrhythmic and anti-convulsnats
how do you diagnose ED?
history-
examination
investigation-10 year CVD risk
free testosterone levels
how do you manage ED?
switch medication that may cause it
give phosphodiesterase-5-inhibitor
what are the availible phosphodiesterase-5 inhibitors?
– Sildenafil (Viagra)
– Tadalafil(Cialis)
– verdenafil- levitra
how do you prescribe a phosphodiesterase-5 inhibitor?
Prescribe the lower dose and consider titrating upwards if ineffective
what does PDE-5 inihibitors require to work?
PDE-5 inhibitors are not initiators of erection but require sexual
stimulation in order to facilitate erection.
what would be classed as a non-responder?
A man with erectile dysfunction should receive eight doses of a PDE-5
inhibitor at a maximum dose with sexual stimulation before being
classified as a non-responder.
what are contraindications and cautions for PDE-5 inhibitors?
• Prescribed nitrates
• Vasodilation or sexual activity not recommended –recent MI, severe HF
etc.
• Hypotension
• Recent stroke
• Hepatic/renal impairment –check individual drugs
what are the side effects of PDE-5 inihibitors?
- Common –N&V, headache, flushing, dizziness
- Visual disturbances
- Prolonged and painful erection
- Palpitations, tachycardia, hypersensitivity reactions, hearing loss
what lifestyle advise would you advise for someone with ED?
• Encourage;
–Weight loss, smoking cessation, healthy diet,
exercise, stress relief
• Don’t
–Drink more than 14 unites of alcohol per week,
? limit cycling
what is the dosing like for sildenafil ?
• 50mg at least 1hour before sexual activity
• Longer if taken with food
• Increased to a maximum dose of 100mg once daily, or reduced
to 25mg once daily.
what is the creatinine clearance needed for sildenafil?
Creatinine clearance [CrCl] 30–80 ml/min, no dose adjustment is
needed.
CrCl less than 30 ml/min or impaired hepatic function, a 25mg
starting dose should be considered, increased to 50mg, then
100mg based on efficacy and tolerance.
how is prescribing on the NHS for PDE-5 inhibitors done?
Branded products are not prescribable on an NHS prescription except:
• Diabetes, MS, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic
injury, single-gene neurological disease, spina bifida, or spinal cord injury.
– Are receiving renal dialysis for renal failure.
– Have had radical pelvic surgery, prostatectomy (including transurethral
resection of the prostrate), or a kidney transplant.
– Were receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® at the
expense of the NHS on 14September1998.
what class is sildenafil?
Reclassified by the MHRA from POM to P (Nov
17)
• Sildenafil 50mg tablets (Viagra Connect 50mg)
• Licenced over 18 years of age
• Consultation with pharmacist
what counselling points would you give for viagra?
• Take one 50mg tablet approx. 60 minutes
before sexual activity
• Maximum of one per day
• In order to be effective sexual stimulation is
required
• If taken with food it may delay the onset of
activity
• May effect ability to drive and use machines,
due to dizziness, altered vision
