BPH and ED pharm

Question 1

drugs that can exacerbate BPH

Answer 1

antihistamines
TCAs
phenothiazines
anticholinergics
testosterone
alpha agonists

Question 2

alpha adrenergic blockers treat ____

Answer 2

BPH

Question 3

alpha adrenergic blockers affect on bladder

Answer 3

relax the urethra and reduce smooth muscle contractions in the prostate

Question 4

alpha adrenergic blockers onset

Answer 4

rapid onset and immediate relief of symptoms

Question 5

alpha adrenergic blockers adverse effects

Answer 5

dizziness
orthostatic hypotension
syncope
retrograde ejaculation

Question 6

can cause intraoperative floppy iris syndrome during cataract surgery

Answer 6

alpha adrenergic blockers

Question 7

what is intraoperative floppy iris syndrome

Answer 7

a complication of cataract surgery that can occur while taking alpha adrenergic blockers.

iris prolapse through surgical incision

Question 8

how to initiate therapy with alpha adrenergic blockers

Answer 8

titrate dose over several weeks to minimize side effects
take first dose at bedtime
beware drug interactions

Question 9

CYP3A4 inducers that increase metabolism of alpha blockers

Answer 9

carbamazepine
phenytoin
rifampin

Question 10

CYP3A4 inhibitors that increase serum concentration of alpha blockers

Answer 10

ketoconazole
ritonavir
itraconazole

Question 11

avoid this rx until after cataract surgery

Answer 11

alpha blockers

Question 12

5a reductase inhibitors

Answer 12

finasteride

dutasteride

Question 13

5a reductase inhibitors MOA

Answer 13

inhibition of 5alpha reductase prevents conversion of testosterone to DHT which decreases prostate growth and provides obstruction relief over time

Question 14

does not immediately relieve LUTS

Answer 14

5a reductase inhibitors

Question 15

use for pts with large prostate volume (>40g)

Answer 15

5a reductase inhibitors

Question 16

5a reductase inhibitors adverse effects

Answer 16

decreased libido 
ED
gynecomastia
decreases serum PSA by 50%
preggos should not touch semen

Question 17

reduces prostate related hematuria

Answer 17

finasteride

Question 18

can decrease serum PSA by 50%

Answer 18

5a reductase inhibitors

Question 19

which 5a reductase inhibitor is a CY3A4 inhibitor?

Answer 19

dutasteride

Question 20

what should you tell a patient taking 5a reductase inhibitor?

Answer 20

emphasize adherence (d/c may cause relapse) and that rx may take 6 months to see effect

Question 21

which BPH rx stops disease progression?

Answer 21

5a reductase inhibitors

Question 22

which BPH has cardiovascular adverse effects

Answer 22

a blockers

Question 23

when should you use combination 5a reductase inhibitor and alpha blocker?

Answer 23

in pts with irritative LUTS and prostate enlargement

Question 24

phosphodiesterase-5 inhibitors

Answer 24

tadalafil (cialis)
sildenafil (viagra)
vardenafil (levitra)

Question 25

phosphodiesterase-5 inhibitors MOA

Answer 25

inhibits PDE5 in bladder prostate and urethra, increase NO vasodilation increases cGMP and increases smooth muscle relaxation

Question 26

desired effect of phosphodiesterase-5 inhibitors

Answer 26

increased blood flow in corpus cavernous to increase penis size during erection

Question 27

erectile dysfunction causes

Answer 27

``` PENIS Psychological, Endocrine, Neurogenic, Insufficient blood flow, Substance use. ```

Question 28

erectile dysfunction

Answer 28

consistent inability to gain/maintain penile erection with sufficient rigidity for intercourse not a symptom of aging

Question 29

what leads to prolonged erection

Answer 29

after penis swells and elongates, the corporal tissue compresses venues to decease outflow and prolong erection

Question 30

PDE-5 inhibitors ____ PDE5 which____cGMP and ____ NO vasodilation leading to ______

Answer 30

inhibit increases increases prolonged erection

Question 31

PDE5 contraindications

Answer 31

nitrates due to risk of hypotension | CVD

Question 32

PDE5 adverse effects

Answer 32

headache dizziness flushing dyspepsia visual disturbance

Question 33

rare side effects from PDE5 inhibitors

Answer 33

hearing loss priapism optic neuropathy

Question 34

what should a pt taking PDE5 inhibitor and alpha blocker be counseled on?

Answer 34

take alpha blocker 4 hours apart to avoid orthostatic hypotension

Question 35

T replacement

Answer 35

low testosterone | hypogonadism causing ED

Question 36

contraindicated for T replacement

Answer 36

``` prostate cancer breast cancer LUTS erythrocytosis (Hct>50%) sleep apnea HF ```

Question 37

testosterone patient counseling

Answer 37

wash hands after application | allow area to dry, do not get area wet for 5 hours

Question 38

alprostadil

Answer 38

prostaglandin that enhances smooth muscle relaxation resulting in filling of corpora and erection

Question 39

alprostadil pt counseling

Answer 39

first application done in office to see technique may have some bleeding burning can be alleviated by a little rubbing!

Question 40

non-pharm ED treatment

Answer 40

reduce alcohol, smoking, drugs vacuum devices surgical devices