Urology

Question 1

M3 receptor

Answer 1

overactive bladder (OAB)

Question 2

B2 adrenergic receptor

Answer 2

urinary retention

Question 3

common causes of incontinence

Answer 3

● obstruction (BPH)
● impaired bladder contraction (DM, MS, spinal injuries, detrusor hyperactivity)
● incompetent sphincter (stress incontinence)
● bladder inflammation (UTI)
● bladder stones
● malignancy (bladder CA)

Question 4

common medications affecting continence

Answer 4

alpha agonists/antagonists, alcohol, anticholinergics, cholinesterase inhibitors, CCBs, diuretics, narcotics, antidepressants, antipsychotics, sedative-hypnotics

Question 5

urinary incontinence physical exam

Answer 5

rectal or pelvic exam, neurologic exam, PVR

Question 6

nocturnal polyuria treatment

Answer 6

desmospressin nasal spray (Noctiva)

Question 7

desmopressin for nocturnal polyuria indication

Answer 7

nocturnal polyuria adults that wake up >/2x per night to void

Question 8

desmopressin warnings and monitoring

Answer 8

fluid retention, hyponatremia, nasal conditions
monitor sodium levels

Question 9

CI to desmopressin

Answer 9

hyponatremia, polydipsia, use of loop diuretics, use of glucocorticoids, eGFR < 50 mL/min/1.73m2, SIADH, Class 2-4 CHF, uncontrolled HTN

Question 10

desmopressin dosing

Answer 10

age 50-65: 1 spray (1.66 mcg) 30 min before bed
age >/65: 1 spray (0.83 mcg) 30 minutes before bed (↑ to 1.66 mcg after 1 week if Na wnl)

Question 11

darifenacin (enablex) and solifenacin (Vesicare) MOA

Answer 11

M3 specific → reduce ADEs

Question 12

darifenacin (enablex) dosing

Answer 12

7.5 mg qd
max 15 mg
3A4 and 2D6 substrate

Question 13

solifenacin (Vesicare) dosing

Answer 13

5 mg qd
max 10 mg
3A4 substrate

Question 14

oxybutynin, tolterodine, trospium, fesoterodine MOA

Answer 14

anti-muscarinic

Question 15

OAB medications

Answer 15

oxybutynin, tolterodine, trospium, fesoterodine, darifenacin, solifenacin

Question 16

OAB meds that din’t cross the BBB

Answer 16

tolterodine, trospium, and fesoterodine

Question 17

adverse effects of SM relaxants (OAB meds)

Answer 17

dry mouth, dry eyes/blurred vision, urinary retention, palpitations, constipation, dizziness/drowsiness, confusion/delirium/dementia

Question 18

which anticholinergic drug for OAB

Answer 18

solifenacin > IR tolterodine
ER oxybutynin or tolterodine > IR
IR tolerodine > oxybutynin
fesoterodine > ER tolterodine

Question 19

other agents used for OAB

Answer 19

imipramine or botox

Question 20

urinary retention meds (B3 adrenergic receptor agonists)

Answer 20

mirabegron (myrbetriq) and vibegron (gemtesa)

Question 21

mirabegrin and vibegron MOA

Answer 21

detrusor muscle relaxation

Question 22

mirabegrin and vibegron AEs

Answer 22

nausea, HA, diarrhea, constipation, dizziness, tachycardia
HTN warning not in vibegron

Question 23

OAB 1st line treatment

Answer 23

behavioral therapies (bladder training, fluid management)

Question 24

OAB 2nd line treatment

Answer 24

oral anti-muscarinics or B3-agonsits
ER>IR

Question 25

stress incontinence definition

Answer 25

involuntary leakage with stress: intra-abdominal pressure (sneeze, cough, laugh)

Question 26

stress incontinence treatment

Answer 26

increase intra-urethral pressure alpha receptor agonist pseudoephedrine and midodrine estrogen replacement

Question 27

stress incontinence estrogen replacement

Answer 27

causes proliferation of urethral mucosa, improves mucosal outflow, vaginal application acceptable

Question 28

overflow incontinence definition

Answer 28

leak urine throughout the day "weight" of urine (BPH, neuropathies, anticholinergics)

Question 29

overflow incontinence treatment

Answer 29

bethanechol (urecholine) stimulates muscarinic receptors and bladder tone

Question 30

BPH definition

Answer 30

proliferation of stromal and epithelial cells due to hormonal and aging process (↑ prostate size)

Question 31

BPH symptoms

Answer 31

incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia

Question 32

BPH non-pharm management

Answer 32

incontinent pads, TURP, urethral dilation, foley catheters

Question 33

BPH treatment

Answer 33

alpha 1 blockers terazosin > doxazosin > prazosin alpha 1A specific blockers silodosin > > alfuzosin > tamsulosin

Question 34

a1 blockers AE

Answer 34

hypotension, dizziness/vertigo, blurred vision, drowsiness, asthenia (rare in a1a specific blockers)

Question 35

5-a-reductase inhibitors (decrease DHT)

Answer 35

finasteride (proscar) and dutasteride (avodart)

Question 36

5-a-reductase inhibitors AEs

Answer 36

impotence, libido, ejaculation volume, gynecomastia

Question 37

drugs to avoid in BPH

Answer 37

TCAs, diphenhydramine, disopyramide, pseudoephedrine, ephedrine, anticholinergic

Question 38

saw palmetto

Answer 38

does not improve symptoms or measures of BPH

Question 39

how to determine severity of ED

Answer 39

IIEF-5 questionnaire

Question 40

drugs associated with ED

Answer 40

diuretics, anti-hypertensives, cardiac or cholesterol drugs, cytotoxic agents, anticholinergics, recreational drugs

Question 41

ED and analgesics

Answer 41

opioids and NSAIDs are associated with ED

Question 42

drugs for ED and their wait time for nitrates

Answer 42

PDE5 inhibitors sildenafil- little blue, 24 hr vardenafil- 24 hr tadalafil- the weekender (24-36hrs), 48hr avanafil- the quickie (15 min onset), 24 hr

Question 43

if PDE5 ineffective?

Answer 43

make sure to give 7-8 doses before deciding