Bladder

Question 1

Bladder first

Answer 1

tier: exercise, lifestyle, and complementary therapies

Question 2

Bladder second

Answer 2

tier: pharmacotherapies
Anti-muscarinic agents
Beta-adrenergic therapy
Initial agent depends on side effect profile and insurance coverage

Question 3

Anti-muscarinics most

Answer 3

Most commonly prescribed

Question 4

Anti-muscarinics act primarly

Answer 4

Act primarily by increasing bladder capacity and decreasing urgency through blockade of muscarinic receptor stimulation by acetylcholine during bladder storage

Question 5

Anti-muscarinics start

Answer 5

Start lowest dose and titrate up (if needed) after 2 weeks

Question 6

Anti-muscarinics f/u

Answer 6

Start lowest dose and titrate up (if needed) after 2 weeks

Question 7

Anti-muscarinics CI

Answer 7

CI: uncontrolled tachyarrhythmias, myasthenia gravis, gastric retention and narrow angle-closure glaucoma

Question 8

Anti-muscarinics AE

Answer 8

AE: urinary retention, dry mouth, constipation, blurred vision for near objects, tachycardia, drowsiness, and decreased cognitive function

Question 9

Beta3-adrenoceptor agonist (mirabegron

Answer 9

Promotes selective beta receptor stimulation of the detrusor muscle to enhance smooth muscle relaxation.

Question 10

Mirabegron - Initial medication and as different choice for patients who do not tolerate or respond to antimuscarinic medications

Answer 10

Are at risk for central nervous system side effects (eg, dementia), orr have a contraindication to antimuscarinic medication.

Question 11

Mirabegron maybe useful

Answer 11

for patients already taking a cholinesterase inhibitor for whom it is preferable to avoid adding antimuscarinic agents.

Question 12

Mirabegron has similar efficacy to

Answer 12

antimuscarinics but may be somewhat better tolerated.

Question 13

Mirabegron - Close monitoring

Answer 13

Close monitoring – monitor for new-onset urinary retention by measuring at f/u in 4 to 6 weeks or has any new symptoms

Question 14

Mirabegron adverse effects

Answer 14

– CI in severe or uncontrolled HTN
HTN – monitor BP
Dry mouth, constipation
Urinary retention

Question 15

Can use anti-muscarinic and

Answer 15

beta 3 agonist medications together

Question 16

BPH increases as men

Answer 16

age and can contribute to urinary symptoms that may benefit from medical or surgical treatment.

Question 17

treatements for BPH

Answer 17

Lifestyle modifications
Alpha-adrenergic receptor blockers
Phosphodiesterase type 5 inhibitors
5-alpha reductase inhibitors to prevent progression

Question 18

Alpha-adrenergic receptor blockers initial

Answer 18

therapy in most patients with LUTS/BPH

Question 19

Alpha-adrenergic receptor blockers bladdder outlet

Answer 19

outlet obstruction (BOO) is primarily mediated by alpha-1 adrenergic receptors located on prostatic smooth muscle, which are upregulated in the stromal glandular hyperplasia seen in BPH.

Question 20

Alpha-adrenergic receptor blockers blcoking

Answer 20

signaling through the alpha-adrenergic receptorsleads to relaxation of the smooth muscle of the bladder neck and the prostatic urethra.

Question 21

Alpha-adrenergic blockers - SE

Answer 21

SE: dizziness and rhinitis; hypotension

Question 22

Alpha-adrenergic blockers - Agents with greater

Answer 22

Agents with greater selectivity have fewer systemic SE but are associated with a higher frequency of retrograde or anejaculation (8 to 28 percent).

Question 23

Alpha-adrenergic blockers patietns

Answer 23

prescribed alpha-1adrenergicblockers should be counseled about the possibility of intraoperative floppy iris syndrome (IFIS).

Question 24

Phosphodiesterase type 5 inhibitors - used in men with

Answer 24

Used in men with BPH-related symptoms and ED

Question 25

Phosphodiesterase type 5 inhibitors reproted adverse

Answer 25

Reported adverse effects with PDE5 inhibitors are relatively rare, with the more commonly reported effects consisting of headache, flushing, dyspepsia, nasal congestion, back pain, myalgias, and sinusitis.

Question 26

Phosphodiesterase type 5 inhibitors there is an increased risk of

Answer 26

hypotension in patients also using certain alpha-adrenergic blockers

Question 27

In men with low post-void residual urine volumes

Answer 27

and irritative symptoms, anticholinergics or beta-3 agonists are a reasonable alternative to alpha-1 adrenergic antagonists for initial medical therapy

Question 28

In men with demonstrated benign prostatic enlargement (BPE), treatment with

Answer 28

In men with demonstrated benign prostatic enlargement (BPE), treatment with

Question 29

For patients with low post-void residual urine

Answer 29

volumes and irritative symptoms (eg, frequency, urgency) that persist during monotherapy with an alpha-1 adrenergic antagonist or anticholinergic agents, we use combination treatment with alpha-1 adrenergic antagonists and anticholinergic agents or beta-3 agonists