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Theraputics Winter > ED And BPH √ > Flashcards

ED And BPH √ Flashcards

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1
Q

ED Risk factors

A

Peripheral Vascular Disease
HTN
Hyperlipidemia
Diabetes
Psychiatric disorders
Age

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2
Q

What are ED lifestyle changes

A

x tobacco and alch
exercise, diet and wt loss

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3
Q

ED guidelines

A
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4
Q

Sildenafil dosing and name

A

Viagra 50mg 1 hr before
Max dose of 100mg

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5
Q

Vardenafil dosing and name

A

Levitra 10 mg po 1 hr before sex

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6
Q

Vardenafil dissolving dosing and name

A

Staxyn 10mg dissolve on tongue 1 hr before

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7
Q

Tadalafil dosing and name

A

Ciailis 10 mg po 30 mins before

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8
Q

Avanafil dosing and name

A

Stendra 100mg po 30 mins before

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9
Q

When to double dose for pt on PDE-5i?

A

After 7-8 times failed double dose except staxyn

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10
Q

Side effect for PDE-5i

A

MAJOR
Hypotension
Headache and flushing
Loss of blue-green color (sildenafil, tadalafil and Avanafil)
Erection longer than 4 hours

VERY RARE
Hearing lose
Sudden blindness
QT prolong (only vardenafil)

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11
Q

Which PDE-5i prolongs QTC

A

Vardenafil

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12
Q

Which PDE-5i causes loss of blue-green color?

A

Sildenafil, Tadalafil and Avanafil

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13
Q

DDI for PDE5

A

Nitrates (bc of hypotension)
Grapefruits
Vardenafil (1A or Type 3 antiarrhythmics)

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14
Q

When is testosterone indicated, and what are the 3 formulations?

A

Only in hypogonadism (< 300ng/dl)
Testosterone patch (androderm)
Testosterone gel 1% (androGel)
Testosterone cypionate IM (Depo-testosterone)

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15
Q

Androderm dosing

A

Testosterone patch 4mg on upper arm, back abdomen or thigh qHS

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16
Q

AndroGel dosing

A

5-10 gm to shoulder, upper arm or abdomen qAM

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17
Q

Depo-testosterone dosing

A

Injection 100-200 mg IM q2-4 weeks

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18
Q

When do I adjust testosterone for therapy

A

Increase if trough <450 ng/dL
decrease if trough >600 ng/dL

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19
Q

Testosterone side effects

A

Sodium retention
Hyperlipidemia
Mood swings
Hepatotoxicity

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20
Q

How many hours after testosterone gel or patch application can i go in the water?

A

3 hours

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21
Q

What are the 2 Alprostadil doseage forms?

A

Intracavernosal injections (Caverject)
Intraurethral pill (Muse)

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22
Q

Caverject dose

A

Aloprostadil injection 10mcg 5-10mins before sex

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23
Q

Muse dosing

A

250 mcg intraurethrally 5 - 10mins before sex

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24
Q

4 Adverse reactions with PGE-1

A

Hematoma and infection with Caverject
injection site pain
Uncommon hypotension dizzy bc of localization
Prolonged erection rare

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25
What 3 criteria do we use to diagnose BPH?
1. >30gm on rectal exam 2. >1.5ng serum antigen 3. American Urological Association (AUA) <7 mild 8-19 Moderate severe ≥ 20 severe
26
4 Goals of therapy for BPH?
Symptom control Decrease AUA by >3 Delay surgical intervention reduce risk of complication
27
Lifestyle recommendation for BPH?
healthy diet pee before bedtime restrict fluids before bedtime exercise AVOID caffeine and excessive alcohol
28
BPH flow chart for treatment?
29
Alpha 1 antagonist for BPH?
All the zosins Prazosin, terazosin, doxazosin (Carduara and XL), alfuzosin, tamsulosin (Flomax), Silodosin (rapaflo)
30
Prazosin Dosing
Minipress - 0.5 mg BID max 5mg BID
31
Doxazosin Dosing
Cardura XL - 4 mg QD 8 mg QD max
32
Tamsulosin Dosing
Flomax - 0.4 mg QD 0.8 mg QD max
33
Silodosin dosing
Rapaflo - 8 mg QD max if 30 - 50 Crcl reduce to 4 mg
34
When to increase dose for BPH Alpha 1 antagonist?
After 2-7 days no effective 7-14 for prazosin, carduara XL or tamsulosin
35
Which mediations are uroselective for BPH and what is the benefit?
Tamsulosin Silodosin Less hypotesntion
36
When do we titrate for Alpha 1 Antagonist
2-7 days double dose if on (Prazosin, Cardura XL or Tamsulosin) 7-14 days
37
What is the dosing consideration for Silodosin?
CrCl - 30-50 max dose is 4 mg QD
38
Adverse reactions for Alpha 1 antagonists?
Hypotension Floppy iris syndrome ( was on Naplex) Retrograde ejaculations with uroselective agents (tam and silo) CONTRA Alfuzosin - HEPATIC Silodosin HEPATIC CLCr <30 DDI Silodosin with 3A4 inhibitors
39
What do I avoid with Afluzosin with
Moderate to severe Hepatic impairment
40
What are the 5alpha -reductase inhibitors and what is the place in therapy for BPH?
When oversized bc helps with reduction in 6-12 months ( 6 months 50% if not need to reevaluate P cancer) Finasteride (Proscar) 5mg Dutasteride (Avodart) .5mg
41
Finasteride Dosing
Prosper - 5 mg QD
42
Dutasteride Dosing
Avodart - 0.5 mg QD
43
Adverse reactions for 5 Alpha inhibitors?
ED Decrease sex drive Man boobs X - pregnancy, women wanting to get pregnant can not handle X - men and their semen
44
Which people should avoid contact with 5 Alpha Inhibitors?
Pregnant people or those wishing to become is also in the Semen of the men as well
45
How long does it take for 5 Alpha inhibitors to take effect
6 - 12 months
46
PDE we can use in BPH and what is their role?
Tadalafil (Cialis) used if have ED with a moderate- severe AUA score 5mg QD 2.5mg for CLCr 30-50 X CLCr <30 Avoid sever hepatic impairment
47
What anticholinergics can we use for BPH and what is their place in therapy
BPH and only in pts with irritation symptoms or post-void volume of 100-150ml
48
Solifenacin dosing
anticholinergic (Vesicare) 5-10mg limit <30 or moderate Hepatic impariment at 5 mg
49
Tolterodine Dosing
anticholinergic (Detrol) 1-2mg limit <30 or moderate Hepatic impairment at 1 mg
50
What do we limit our dose to if the patient is on Solifenacin and a 3A4 inhibitor
Solifenacin if on 3A4 inhibitor limited to 5mg QD SICK FOLKS
51
beta 3 Agonists role in therapy?
Same as anticholinergics ( irritative symptoms but dont need to worry about pee retention)
52
Mirabegron Dosing
(myrbetriq) 25-50mg CrCl 15-30 or moderate hepatic - 25 mg X CrCl 15 or severe hepatic
53
Vibegron Dosing
(Gemtesa) 75mg X Avoid CrCl 15 or severe hepatic
54
Meds that cause ED
SAD MEN FAIL" S – Spironolactone A – Alpha-2 agonists (e.g., clonidine) D – Dopamine antagonists (e.g., antipsychotics) M – Medications for prostate issues (e.g., finasteride, dutasteride) E – Estrogens N – Narcotics/CNS depressants (e.g., opioids, sedatives, alcohol) F – Finasteride (and other 5-alpha reductase inhibitors) A – Anticholinergics (e.g., antihistamines, tricyclic antidepressants) I – Increased beta-blockers (e.g., propranolol, metoprolol) L – Loop diuretics (e.g., furosemide)
55
Index of Erectile Function (IIEF) scores
22-25 = normal 17-21 = mild dysfunction 12-16 mild-moderate dysfunction 8-11 = moderate dysfunction 1-7 = severe dysfunction
56
2 goals of ED Therapy
improve sex life increase IIEF by 4 points minimum goal of 20
57
Signs of Hypogonadism
morning Serum test <300 with 4 instances small balls decrease body hair man boobs
58
Patient education for PDE-5i
still need stimulation Sildenafil/ vardenafil - take on an empty stomach max 1 dose daily greater than 4 hrs seek care
59
When should I collect the trough for the testosterone patch?
prior to 2 week dose
60
When should I collect the trough for the testosterone injection?
prior to 4th dose
61
What are the 4 patient education for testosterone patch
1. cover application sites 2. wash hands after use 3. Women and children avoid contact with the area 4. no swimming or showering within 3 hours of application
62
Testosterone contraindications
Heart Failure MI UNTREATED prostate cancer
63
What are the 3 patient educations for testosterone gel
1. rotate the site every 7 days 2. avoid swimming/ showering for 3 hours after application 3. females and children should avoid contact in unwashed areas
64
What are the 4 patient educations for PGE1
inject at a 90-degree angle wash hands before use can use Tylenol for penile pain after injection apply pressure to avoid hematoma
65
what are the 2 patient education for intrauethral
massage penis after insertion void prior to insertion to moisten the urethra
66
PDE-5i Dosing considerations?
67
If a patient complains about ED med taking to long to work which med would you switch them to?
Cialis 10mg 30 mins before
68
What patient do I need to avoid Testosterone in absolutely
Untreated Prostate Cancer
69
What is the problem with alprostadil titration
all physician office
70
AUA scores
<7 mild 8-19 Moderate severe ≥ 20 severe

Theraputics Winter (16 decks)

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