Pharmacology

Question 1

Alpha 1 blockers

Answer 1

More effective that 5-alpha reductase inhibitors for short and long term mgmt.
Relax smooth muscle in bladder neck

Question 2

2 popular Alpha 1 blockers

Answer 2

Terazosin (Hytrin)

Doxazosin (Cardura)

Question 3

do 5-alpha reductase inhibitors cause orthostatic hypotension?

Answer 3

No

Question 4

5-alpha reductase inhibitors (5-ARI)

Answer 4

Only med to decrease prostate size and decrease need for surgery
Finasteride (Proscar)
Dutasteride (Avodart) (more potent)

Question 5

5-ARI SE

Answer 5

Decreased libido

Ejaculatory or erectile problems

Question 6

5-ARI PSA levels

Answer 6

double in first 2 years of therapy

Multiply 2.5 after that

Question 7

Which group cause hypotension?

Answer 7

Alpha blockers

Question 8

Phosphodiesterase inhibitors (PDE inhibitors)

Answer 8

SIldenafil (viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)

Question 9

PDE inhibitor CI

Answer 9

Men taking nitrates

Caution w/ alpha 1 blockers

Question 10

PDE inhibitor SE

Answer 10

Severe hypotension
Flushing, HA, dyspepsia
Transient blue vision (viagra)
Hearing loss, priapism

Question 11

When should PDE inhibitors be taken?

Answer 11

60 mins prior to exercise
Duration is generally 8-12 hrs
Cialis has 36 hour duration

Question 12

Indications for testosterone therapy

Answer 12

Decreased libido
Decreased AM erections
Loss of body hair
Low bone density
Gynecomastia
Small testes
Decreased muscle mass

Question 13

How long does it take for testosterone therapy to improve symptoms?

Answer 13

3-6 months

Question 14

Does testosterone treat impaired spermatogenesis?

Answer 14

No, it impairs it MORE.

Question 15

Testosterone SE

Answer 15

Polycythemia
Worsening BPH
ACNE
Increased PSA
Increased risk of prostate CA
Fluid retention
Worsening OSA
Possible CVA events

Question 16

Testosterone CI

Answer 16

Known prostate, breast CA
Severe lower urinary tract symptoms
HCT > 50
Untreated severe OSA
PSA > 4.0

Question 17

Testosterone first choice route

Answer 17

Transdermal gel

Well-tolerated

Question 18

IM testosterone

Answer 18

One gluteal IM injection every 2 weeks

Depo-testosterone, delatestry

Question 19

Phenazopyridine (Pyridium)

Answer 19

Urinary tract alangesic
Relief of burning, itching, frequency and urgency associated w/ UTI or procedures
Cannot use if GFR < 50

Question 20

Pyridium considerations

Answer 20

Dont use for more than 2 days
May yellow skin, sclera
Turns urine bright orange
Does not treat infxn

Question 21

Antimuscarinic MOA

Answer 21

Increased bladder capacity
Decreased urge, frequency
Decrease incontinent episodes

Question 22

How long to antimuscarinics take to work?

Answer 22

4 weeks

Question 23

Antimuscarinic SE

Answer 23

Anticholinergic effects

Many D/C med by 6 months

Question 24

Most commonly prescribed antimuscarinics

Answer 24

Oxybutynin (Ditropan)

Telterodine (Detrol)