Week 8

Question 1

Type of incontinence where muscles of the bladder are weakened with force to include cough, sneezing, heavy lifting, or prolapsed pelvic organs.

Answer 1

Stress

Question 2

Type of incontinence with strong sudden urge to urinate and patient is unable to control urine resulting in involuntary release sooner than expected.

Answer 2

Urge

Question 3

What nerve maintains external sphincter and pelvic muscle tone?

Answer 3

Pudenal

Question 4

What nerve stimulates bladder contraction?

Answer 4

Pelvic nerve

Question 5

What nerve stimulates internal sphincter closure and detrusor relaxation?

Answer 5

Hypogastric

Question 6

Overactive bladder characteristic:

Answer 6

Nocturnal at a minimum of 2 times per night

Urinary urgency and frequency of at least 8 times in a 24-hour period

Question 7

First line therapy in overactive bladder overview:

Answer 7

Anticholinergics/ antimuscarinics

Question 8

MOA of anticholinergics:

Answer 8

Cause an increase bladder capacity and initial urge to void.

Question 9

Side effects of anticholinergics:

Answer 9

Dry mouth, urinary retention, constipation, vision changes, cognitive impairment

Question 10

Anticholinergic medications:

Answer 10

Oxybutin (ditropan) 
Tolterodine (Detrol)
Darifenacin ( enablex)
Solifenacin (vesicare)
Fesosterodine (toviaz)

Question 11

What other medications can be used with overactive bladder?

Answer 11

TCAs, SNRIs, Alpha adrenergic antagonists

Question 12

What is used in enuresis in children?

Answer 12

TCAs

Question 13

Example of a TCA:

Answer 13

Imipramine (tofranil)

Question 14

What is the MOA of SNRIs for overactive bladder?

Answer 14

Enhances urinary sphincter tone, improves bladder control and urinary storage.

Question 15

Factors that worsen the condition of overactive bladder?

Answer 15

Stroke
Spinal cord injury 
Diabetes 
Sleep apnea
Depression
Estrogen deficiency 
UTI
Urinary obstruction

Question 16

Complicated UTIs:

Answer 16

Men under 16, pregnancy, post menopause

Question 17

First line therapy in pyelonephritis:

Answer 17

Fluoroquinolones 10-14 days treatment

Question 18

First line therapy in uncomplicated UTI:

Answer 18

Bactrim 3 day course not with sulfa allergy

Trimethoprim with sulfa allergies 100 mg BID for 3 days

Question 19

First line therapy for UTI in pregnancy:

Answer 19

Macrobid 100mg BID for 5-7 days

Question 20

What is considered recurrent UTIs?

Answer 20

More than 2 UTIs in 6 months

Question 21

What system controls the initiation of the male erection?

Answer 21

Parasympathetic nervous system

Question 22

First line treatment for erectile dysfunction?

Answer 22

PDE-5 inhibitors

Question 23

MOA of PDE-5 inhibitors?

Answer 23

Inhibits the breakdown of responses involved in obtaining and sustaining an erection

Question 24

Examples of PDE-5 inhibitors:

Answer 24

Cialis 5-20mg/d
Viagra 25-100 mg/d
Levitra 5-20 mg/d

Question 25

What cannot be used with PDE-5 inhibitors?

Answer 25

Nitrates - due to hypotension effects

Question 26

Side effects of PDE-5 inhibitors?

Answer 26

Priapism, ha, flushing, nasal congestion, dyspepsia

Question 27

First line medications for BPH:

Answer 27

Alpha adrenergic blockers or 5 alpha reductase inhibitor

Question 28

What is the MOA of a 5 alpha reductase inhibitor?

Answer 28

Inhibits conversion of testosterone to DHT, decreasing the size of the prostate.

Question 29

5 alpha reductase inhibitor examples:

Answer 29

Proscar (finasteride) | Avodart (dutasteride)

Question 30

MOA of alpha adrenergic inhibitor:

Answer 30

Relaxed smooth muscle of the prostate and bladder, considered functional antihypertensives due to its action

Question 31

Examples of alpha adrenergic inhibitor:

Answer 31

Hytrin (terazosin) Cardura (doxazosin) Flomax (tamulosin)

Question 32

Third line treatment of BPH:

Answer 32

Combo therapy of 5 alpha reductase inhibitor and alpha blocker

Question 33

When to take hytrin?

Answer 33

Take at night to avoid postural hypotension

Question 34

Higher doses of flomax may cause:

Answer 34

Erectile dysfunction

Question 35

Proscar and avodart May take up to ___ months to see improvement of symptoms.

Answer 35

6 months

Question 36

Nonpharmacological therapies for BPH:

Answer 36

``` Weight loss Low-fat diet Avoid fluid intake 1-2 hours before bed Avoid caffeine, diuretics, alcohol, which can excite the bladder High-fiber diet Increase water intake ```

Question 37

Supplements for BPH:

Answer 37

Saw palmetto Pygeum Zinc