Uro Flashcards
Causes of ED
Vascular disease, diabetes, medication, depression, prostate surgery complications, psychological factors
Treatment for ED
Penal implants, injections, or suppositories, oral agents
PDE 5 inhibitors
For ED
All drugs are equally effective with similar side effect profile
MOA- smooth muscle relaxation of corpus cavernosum->increased blood flow mediated by nitric oxide->activates cyclic GMP->smooth muscle relaxation via reduced intracellular calcium, inhibit enzyme PDE 5 which breaks down cGMP in corpus cavernosum enhancing blood flow only effective with sexual stimulation
Drugs- sildenafil (viagra, also used for PH) prototype
Others-tadalfil (cialis, also used for BPH, PH), vardenafil (levitra, staxyn), avanafil (stendra)
Admin- take on an empty stomach at least one hour before sexual activity, high fat food can cause interaction
AE- headache, flushing, nasal, stuffiness, visual disturbances, transient hearing loss priapism
Caution in patient cardiovascular disease or risk for cardiovascular disease
alpha blockers can potentiate hypotension, along with vasodilators
Contraindicated with nitrates
Synthetic prostaglandin
Alprostadil
Allows smooth muscle relaxation in corpus cavernosum
Admin- intraurethral suppositories or intrapenile
Suppositories 5-10 minutes inset, 2-25 minute for infection, last 30-60 minutes
AE-rare, hypotension, headache local pain, priaprism
BPH
Non malignant prostate growth
Tx-alpha blockers, PDE5 inhibitor (cialis), 5 alpha reductase inhibitor
Alpha blockers
MOA-relax smooth muscle in prostate improve urine outflow, blocks alpha 1A and 1B
Selective vs non selective
Tamsulosin-selective no systemic BP effect
Terazosin-non selective, systemic BP response
Others- terazosin (hytrin), non selective, doxazosin (cardura) non selective, alfuzosin (uroxatral) non selective, prazosin (minipress) non selective Not FDA approved for BPH, tamsulosin (flomax) selective, silodosin (rapaflo) selective, avoid in severe CKD
AE-dizziness, fatigue, nasal, congestion, headache, drowsiness, orthostatic, hypotension, nonselective agents, need to be given at night can affect ejaculatory, ducks impairment, muscle contraction, inhibition of ejaculation, and retrograde ejaculation, do not affect sexual function
Drug-drug- interacts with the verapamil, diltiazem may increase levels, tegretol, Dilantin, St. John’s wort,
Uroxatrol may prolong QT especially with biaxin; levaquin, cipro; avelox, class 3 antiarrthymics, cyclosporine increase rapaflo
5 alpha redutase inhibitor
Agents- finasteride (proscar), durasteride (avodart)
MOA- inhibits a conversion of testosterone to dihydro testosterone reducing prostate size only works if prostate is inflamed, often used in combination for Alpha. Blockers finasteride can also be used low doses for alopecia.
AE- decrease ejaculation libido, ED, gynecomastia
Those who are pregnant or a childbearing age should not handle due to teratogenic effect on the baby specifically males
Testosterone deficiency
Include testosterone levels in ED assessment
Deficiency can contribute to male hypogonadism, osteoporosis, and sexual dysfunction
Urinary incontinence
Involuntary urine loss leading to hygienic social issues increases with age more common, a woman, but it affects both genders equally after age 80
Nervous system conduction
PNS (cholinergic) increases bladder contractions
SNS (adrenergic) regular bladder base increases internal sphincter contract
Somatic nerves- control, your general, diaphragm and external sphincter
Functional incontinence
Outside influence with intact LUT function
Detrusor overactivity
Common cause of geriatric urine incontinence, bladder contracts, involuntarily
Two types one with normal contraction, bladder empties most contents and one with impaired contraction residual urine remains post contraction
TX- bladder training encourage patient to avoid regular intervals and gradually increase the intervals, can also use anticholinergic or smooth muscle relaxants
Agents- propantheline, dicyclomine, TCAs,Ditropan, antimuscarinics such as oxybutynin, tolterodone (Detrol), trospium (Sanctura), darifenacin (enablex), solifenacin (vesicare)
Side effects- xerostomia, confusion, constipation, urinary retention.
Beta 3 agonist-mirabergin (myrbetriq)
Botox, sacral nerve stimulation, percutaneous tibial nerve stimulation
Detrusor under activity
Weak bladder contraction, leading to overflow incontinence, rare in geriatrics
Can be caused by neurogenic issues, nerve damage, long-standing obstruction
Outlet incompetence
Also known as stress incontinence
Common in woman involuntary urine loss was physical activity, coughing due to weakening of pelvic floor support structures
TX- weight loss, kegels, vaginal cones, biofeedback, fluid intake adjustment, frequent voiding, estrogen oral or topical, alpha agonist like pseudoephedrine, pelvic muscle exercises, periurethral injection, artificial sphincter, sling operations
Outlet obstruction
Common and elderly men leading into urinary retention and overflow incontinence due to BPH, tumor or structures
Mixed incontinence
Many women experience both urge and stress treatment may vary
