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Theraputics Winter > ED And BPH > Flashcards

ED And BPH Flashcards

1
Q

ED Risk factors

A

Peripheral Vascular Disease
HTN
Hyperlipidemia
Diabetes
Psychiatric disorders
Age

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2
Q

Signs of ED

A

Index score (25 normal - 1 severe)
Low testosterone <300, small balls, low body hair, Gynecomastia

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3
Q

what are ED lifestyle changes

A

x tobacco and alch
Lower cardio vascular risk

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4
Q

ED guidelines

A
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5
Q

Sildenafil dosing and name

A

Viagra 50mg PO hr before

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6
Q

Vardenafil dosing and name

A

Levitra 10 mg po 1 hr before sex

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7
Q

Vardenafil dissolving dosing and name

A

Staxyn 10mg dissolve on tongue 1 hr before

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8
Q

Tadalafin dosing and name

A

Ciailis 10 mg po 30 mins before

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9
Q

Avanafil dosing and name

A

Stendra 100mg po 30 mins before

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10
Q

When to double dose for pt on PDE-5?

A

After 7-8 times to max limit (staxyn is at max at 10)

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11
Q

dosing considerations for PDE-5

A
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12
Q

Side effect for PDE-5

A

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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13
Q

DDI for PDE5

A

Nitrates
Grapefruits
Vardenafil (1A or Type 3 antiarrhytmics)

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14
Q

When is testosterone indicated and what are the meds we use to treat?

A

Only in hypogonadism
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

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16
Q

AndroGel dosing

A

5-10gm to shoulder, upper arm or abdomen

17
Q

Depo-testosterone dosing

A

Injection 100-200 mg IM q2-4 weeks

18
Q

When do changes doses for testosterone?

A

Use trough levels/ pt feedback
Patch collects prior to week 2
IM collect prior to 4th dose
Increase <450
Decrease >600

19
Q

Testosterone side effects and most important ones?

A

Sodium retention
Hyperlipidemia
Mood swings
Hepatotoxicity
IMPORTANCE
HF
History of MI or stroke
AVOID in untreated prostate cnacer

20
Q

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

A

3 hours

21
Q

Alprostadil doseage forms?

A

Intracavernosal injections
Intraurethral pill

22
Q

Caverject dose

A

Aloprostadil injection 10mcg 5-10mins before sex

23
Q

Muse dosing

A

250 mcg intraurethrally 5 - 10mins before sex

24
Q

Adverse reactions with PDE-1

A

Hematoma and infection with Caverject
Uncommon hypotestion dizzy bc of localization
Prolonged errection rare

25
Q

What do we use to quantify BPH?

A

> 20gm
1.5 serum antigen
American Urological Association (AUA)
≤7 mild
8-19 moderate severe
≥ 20 severe

26
Q

Goal of therapy for BPH?

A

Symptom control
Decrease AUA by 3
Delay surgical intervention

27
Q

Lifestyle recommendation?

A

Diet, no caffeine, no drink before sleep

28
Q

BPH flow chart for treatment?

A
29
Q

Alpha 1 antagonist for BPH?

A

All the zosins
Prazosin, terazosin, doxazosin (Carduara and XL), alfuzosin, tamsulosin (Flomax), Silodosin (rapaflo)

30
Q

When to increase dose for BPH Alpha 1 antagonist?

A

After 2-7 days no effective
7-14 for prazosin, carduara XL or tamsulosin

31
Q

Which mediations are uroselective for BPH and what is the benefit?

A

Tamsulosin
Silodosin
Less hypotesntion

32
Q

Adverse reactions for Alpha 1 antagonists?

A

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

33
Q

What are the 5alpha -reductase inhibitors and what is the place in therapy for BPH?

A

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

34
Q

Adverse reactions for 5 Alpha inhibitors?

A

ED
Decrease sex drive
Man boobs
X - pregnancy, women wanting to get pregnant can not handle
X - men and their semen

35
Q

PDE we can use in BPH and what is their role?

A

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

36
Q

What antochlinergics can we use for BPH and what is their place in therapy

A

BPH and only in pts with irritation symptoms or post-void volume of 100-150ml
Solifenacin ( Vesicare) 5-10mg limit <30 at 5
Tolterodine (detrol) 1-2mg limit <30 at 1

37
Q

Adverse effects for BPH anticholinergics?

A

Solifenacin if on 3A4 inhibitor limit to 5mg QD

38
Q

BPH beta 3 Agonists role in therapy?

A

Same as anticholinergics ( irritative symptoms but dont need to worry about pee retention)
Mirabegron (myrbetriq) 25-50mg limit 15-30 to 25
Vibegron (Gemtesa) 75mg avoid 15 clcr

Theraputics Winter (12 decks)

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