Urology Flashcards
1st line for ED
lifestyle changes
1st line pharm therapy for ED
PDE-5 Inhibitors
MOA: PDE-5 Inhibitors
inhibit PDE-5 and thus breakdown of cGMP = more blood flow = erection
class: Sildenafil, tadalafil, vardenafil, avanafil
PDE-5 Inhibitors
PDE-5 Inhibitors interactions
nitrates
which PDE-5 Inhibitor can be taken QD at low dose?
tadalafil (Cialis)
AEs: Common: HA, flushing, rhinorrhea
o Less common: abdominal/back pain, indigestion, hypotension, dizziness
§ Ask about low BP, look at other BP meds
§ If combined w/ alpha-blockers increases risk of hypotension
* Selective alpha-blockers are okay (tamsulosin, silodosin, alfuzosin)
o Priapism: painful, prolonged erection lasting 2-4 hours or more in absence of sexual arousal (go to ER)
o Rare: blurry vision, photophobia
PDE-5 Inhibitors
AE: blue vision
viagara
contras: PDE-5 Inhibitors
DO NOT GIVE to any man who takes or has access to and might take nitroglycerine medications
§ Can lead to fatal hypotension (vasodilation, decreasing perfusion, coronary perfusion, death)
§ Specifically ask about hx of MI, CAD, angina
§ Specifically ask about nitrate medications
* Nitroglycerin, nitrostat, isosorbide mononitrate
pt counseling for PDE-5 Inhibitors
Impact of high-fat meals – don’t eat a fatty meal before
o Need for sexual stimulation – won’t work w/o stimulation
o Single trial no adequate: 6-8 attempts w/ a medication and specific dose, may increase after
onset 15 min - 60 min. most last 4 hrs
Alprostadil MOA
prostaglandin analog that stimulates production of cAMP leading to muscle relaxation and increased
blood flow
* Can be injected into corpora cavernosa
* Can be inserted as a pellet into urethra
how to dx low testosterone
<300
§ Two separate lab draws before 10 AM on separate days
AEs: Gynecomastia, dyslipidemia, polycythemia, acne
§ Weight gain, HTN, edema, and CHF exacerbations also occur d/t sodium retention
testosterone
testosterone contras
Prostate cancer (fueled by testosterone), erythrocytosis, uncontrolled heart failure, sleep apnea,
liver failure
is BPH related to prostate cancer?
no
prostate is mostly ___ tissue
muscular/stromal
which class: relax smooth muscle, making it easier to void
§ Relaxation of bladder neck, prostatic urethra, and prostate smooth muscle
Alpha1-adrenergic antagonists
1st line for BPH
Alpha1-adrenergic antagonists
peak effect of Alpha1-adrenergic antagonists
after several weeks
most uroselective Alpha1-adrenergic antagonists
Tamsulosin (Flomax) and silodosin (Rapaflo)
counseling for Tamsulosin (Flomax)
Take 30 min after a meal to decrease risk of hypotension, after dinner preferred.
don’t take decongestants
AEs: hypotension, retrograde ejaculation, nasal congestion, floppy iris syndrome
Alpha1-adrenergic antagonists
5 Alpha-Reductase Inhibitors (5ARI) MOA
inhibits conversion of testosterone to dihydrotestosterone therefore preventing/reversing growth of
glandular (epithelial) tissue
how long does it take 5 Alpha-Reductase Inhibitors (5ARI) to work
6 months
class: Finasteride (Proscar) and dutasteride (Avodart)
5 Alpha-Reductase Inhibitors (5ARI)
AEs: Decreased libido, ED, gynecomastia (rare), osteoporosis (rare and dose-related)
5 Alpha-Reductase Inhibitors (5ARI)
counseling for 5 Alpha-Reductase Inhibitors (5ARI)
pregnant women should not touch the pills
always order ____ for workup of nocturnal enuresis
urinalysis
age consideration for pharm treatment of noctural enuresis
> 6 y/o
Desmopressin, imipramine, anticholinergics (oxybutynin) treat ___
nocturnal enuresis
MOA: Synthetic analog of vasopressin (ADH)
o Increases water reabsorption at the collecting duct reducing production of urine
o Administer 1 hr before bed to decrease urine production while asleep
desmopressin
class: Oxybutynin, Tolterodine
anticholinergics
1st line for urinary urge incontinence
antimuscarinics
MOA: Antimuscarinics
competitively inhibit effects of muscarinic receptors on detrusor muscle cells
§ Decrease tone and motility of smooth muscle in bladder
class: Oxybutynin, tolterotine, tropium chloride, solifenacin, danifenacin, fesoterodine
antimuscarinics
contras: antimuscarinics
Acute angle glaucoma
§ Urinary retention
§ Gastric retention/gastroparesis
§ Myasthenia gravis
antimuscarinics interactions
Potassium supplements – may increase risk of gastric irritation and ulcer
AEs: HTN, nasopharyngitis, UTI, HA
* No anticholinergic SEs, no risk for retention
Mirabegron (Myrbetriq)
AEs: hyponatremia
Desmopressin (DDAVP)
treatment for adult nocturia
anticholinergics, Desmopressin (DDAVP)
