mens health in practice

Question 1

why is the promotion of mens health so important?

Answer 1

• 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

Question 2

how more likely are women to go into a pharmacy than men?

Answer 2

Research suggests that men, on average, visit
the community pharmacy 4x per year, while
the average for women is 18x (NPA)

Question 3

what are LUTS?

Answer 3

lower urinary tract symptoms

Question 4

what are the 3 groups that LUTS are divided into?

Answer 4

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

Question 5

what is BPH?

Answer 5

Benign prostatic hyperplasia

Question 6

how do you investigate BPH?

Answer 6

A biopsy of the prostate shows histologic signs of hyperplastic
changes (abnormalities at the cellular level).

Question 7

how many men with BPH have luts?

Answer 7

a quarter

Question 8

what is the predominant problem with BPH?

Answer 8

voiding sympytoms

Question 9

what is the most common cause of BPH?

Answer 9

voiding symptoms

Question 10

how do you treat voiding symptoms in BPH?

Answer 10

Reassurance and lifestyle advice

• Pelvic floor training, bladder training, pads, waterproof pants etc.

Question 11

how do you treat moderate- severe BPH sympytoms?

Answer 11

• 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)
•

Question 12

which alpha blocker for BPH can be bought OTC?

Answer 12

tamsulosin

Question 13

what are the common side effects of alpha blocker treatment for BPH?

Answer 13

Dizziness, fatigue, postural hypotension, nasal congestion, ED,
abnormal ejaculation, drowsiness

Question 14

what do you offer someone with an enlarged prostate?

Answer 14

• 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

Question 15

what are the common side effects of 5-alpha reductase inhibitors?

Answer 15

• Sexual problems (decreasing with duration), breast

tenderness/enlargement

Question 16

what extra precautions should be taken for those using 5-alpha reductase inhibitors?

Answer 16

• 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

Question 17

what is erectile dysfunction?

Answer 17

Erectile dysfunction is defined as the persistent inability to attain and
maintain an erection sufficient to permit satisfactory sexual
performance

Question 18

what are the common causes of ED?

Answer 18

adverse drug effects
psychological- mental health or relationship issues
physical: hormononal, anatomical ,neuro. vasculogenic

Question 19

what are the drugs that cause ED?

Answer 19

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

Question 20

how do you diagnose ED?

Answer 20

history-
examination
investigation-10 year CVD risk
free testosterone levels

Question 21

how do you manage ED?

Answer 21

switch medication that may cause it

give phosphodiesterase-5-inhibitor

Question 22

what are the availible phosphodiesterase-5 inhibitors?

Answer 22

– Sildenafil (Viagra)
– Tadalafil(Cialis)
– verdenafil- levitra

Question 23

how do you prescribe a phosphodiesterase-5 inhibitor?

Answer 23

Prescribe the lower dose and consider titrating upwards if ineffective

Question 24

what does PDE-5 inihibitors require to work?

Answer 24

PDE-5 inhibitors are not initiators of erection but require sexual
stimulation in order to facilitate erection.

Question 25

what would be classed as a non-responder?

Answer 25

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.

Question 26

what are contraindications and cautions for PDE-5 inhibitors?

Answer 26

• Prescribed nitrates
• Vasodilation or sexual activity not recommended –recent MI, severe HF
etc.
• Hypotension
• Recent stroke
• Hepatic/renal impairment –check individual drugs

Question 27

what are the side effects of PDE-5 inihibitors?

Answer 27

• Common –N&V, headache, flushing, dizziness
• Visual disturbances
• Prolonged and painful erection
• Palpitations, tachycardia, hypersensitivity reactions, hearing loss

Question 28

what lifestyle advise would you advise for someone with ED?

Answer 28

• Encourage;
–Weight loss, smoking cessation, healthy diet,
exercise, stress relief
• Don’t
–Drink more than 14 unites of alcohol per week,
? limit cycling

Question 29

what is the dosing like for sildenafil ?

Answer 29

• 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.

Question 30

what is the creatinine clearance needed for sildenafil?

Answer 30

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.

Question 31

how is prescribing on the NHS for PDE-5 inhibitors done?

Answer 31

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.

Question 32

what class is sildenafil?

Answer 32

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

Question 33

what counselling points would you give for viagra?

Answer 33

• 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