Urology Pharm

Question 1

What are the major differences between the alpha-1 blockers and 5 alpha reducatase inhibitors

Answer 1

Alpha 1s are best at reducing symptoms. 5-alpha are best at reducing size and don’t cause orthostatic hypotension

Question 2

Where are alpha-1 receptors located?

Answer 2

base of bladder and prostate

Question 3

Which alpha-1 blockers cause more BP lowering effects than the others?

Answer 3

Terazosin (Hytrin) and Doxazosin (Cardura)

Question 4

What are the initial prescription instructions for alpha-1s?

Answer 4

start at a small dose at bedtime and titrate up slowly over several weeks

Question 5

How long might it take to notice reduction symptoms from 5 alpha reductase inhibitors?

Answer 5

up to a yr

Question 6

What should you use when interpreting PSA results in patients on 5 alpha reductase inhibitors?

Answer 6

use a factor of 2 in first 24 months of therapy and then 2.5 there after

Question 7

Name the phosphodiasterase inhibitors

Answer 7

Tadalafil (Cialis), Vardenafil (Levitra), Sildenafil (Viagra), Avanafil (Stendra)

Question 8

What can happen if phosphodiasterase inhibitors are combined with nitrates or alpha-1 blockers?

Answer 8

severe hypotension

Question 9

Which phosphodiasterase inhibitor can cause transient blue vision and may increase risk for nonarteritic ischemic optic neuropathy?

Answer 9

sildenafil (Viagra)

Question 10

In general how long before intercourse should phosphodiasterase inhibitors be taken?

Answer 10

60 min

Question 11

Which phosphodiasterase inhibitor has a 36 hr duration compared to 8-12 hrs for the others?

Answer 11

Tadalafil (Cialis)

Question 12

How long should you hold nitrates even if the patient is having an MI and they’ve used a PDE-5 recently?

Answer 12

24 hours after use of a PDE-5 or for 48 hours if used taldafil (Cialis)

Question 13

Can work in 3 different ways: binding to the androgen receptor, Act in tissues that express the enzyme 5-alpha reductase, and act as estrogen after converting to estradiol

Answer 13

testosterone

Question 14

What is testosterone not used to treat?

Answer 14

impaired spermatogenesis

Question 15

What do you need to screen for before prescribing testosterone?

Answer 15

prostate cancer in men over 50, erythrocytosis, and sleep apnea

Question 16

good first choice of therapy for testosterone replacement. Well tolerated. Achieves normal testosterone levels in most. educate regarding transfer onto others

Answer 16

transdermal gel

Question 17

How long after starting testosterone therapy do you need to check serum levels?

Answer 17

2-3 months

Question 18

How long after starting testosterone therapy do you need to check PSA and DRE?

Answer 18

3-6 months then yearly

Question 19

Name the urinary tract analgesic used for symptomatic relief of urinary burning, itching, frequency and urgency associated with UTI or post urologic procedures

Answer 19

Phenazopyridine (Pyridium)

Question 20

Side effects of Phenazopyridine (Pyridium)

Answer 20

skin/sclera yellow and urine bright orange

Question 21

Max amount of time you can use Phenazopyridine (Pyridium)

Answer 21

more than 2 days

Question 22

Most commonly used muscarinic antagonists that increase bladder capacity and block release of Ach resulting in decreased urgency

Answer 22

Oxybutynin (Ditropan) (Ditropan XL) or Tolterodine (Detrol) (Detrol LA)

Question 23

CI for muscarinic antagonists

Answer 23

dementia, gastric retention, angle closure glaucoma

Question 24

How long does it take for muscarinic antagonists to take effect?

Answer 24

4-6 weeks