ED, BPH, Urinary Incontinence Flashcards Preview

1. Exams - Semester 3 > ED, BPH, Urinary Incontinence > Flashcards

Flashcards in ED, BPH, Urinary Incontinence Deck (83):
1

what is the most common cause of ED

decreased blood flow
diseases: DM, HTN, Heart Dz

2

what are other causes of ED

Hormone- low testosterone
Psychological-Stress, anxiety,depression

3

what meds cause sexual dysfunction

BP Med
Antipsychotics
Antidepressants
BPH
Opiods
Nicotine
Excess alcohol

4

What is the #1 reason people stop SSRI or SNRI?

sexual dysfunction

5

what is the goal of therapy with ED tx?

increase quantity and quality of sex
Tx should not be used for pt's without ED!!!

6

What are physical Tx for ED?

lifestyle modifications if no effect then use devices or meds

7

How do you Tx psychological ED?

psychotherapy or Behavioral therapy

8

How do you tx drug ED?

D/C offending agent or reduce dose of offending agent

9

Patient with organic ED was prescribed oral PDEi and has been ineffective, what is the next treatment option?

Intracavernosal therapy

10

What are the 2 tx options for Organic ED

Oral PDEi & Vacuum erection device

11

What is the onset of:
Sildenafil, Vardenafil, Tadalafil

Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr

12

If patient's current tx of intracavernosal therapy is not working, what can be considered next?

intraurethral alprostadil

13

Which drug is a PDE-6 inhibitor
Sildenafil, Vardenafil, Tadalafil?

Sildenafil (Viagra)
Vardenafil (Levitra)-minimally

14

What is the onset of:
Sildenafil, Vardenafil, Tadalafil

Sildenafil: 30min- 1hr
Vardenafil: 1hr
Tadalafil: 2hr

15

What is the MOA of PDEi?

they inhibit PDE enzymes which slows the breakdown of cGMP, allowing for the depression of Ca++ which results in smooth muscle relaxation leading to an erection

16

What is the Duration of:
Sildenafil, Vardenafil, Tadalafil

Sildenafil: 4hr
Vardenafil: 4hr
Tadalafil: 24-36hr

17

What are some Rx unapproved agents used in the treatment of ED?

Phentolamine
Papaverine
Trazodone

18

What does the depression of Ca++ cause?

Smooth muscle relaxation resulting in an erection

19

What are the 2 drug to drug interactions for PDEi's?

ETOH and Nitrates

20

What are the 2 rare, yet serious ADRs?

Non-arteritic anterior optic neuropathy (NAION) & priaprism

21

What are some Rx unapproved agents used in ED?

Phentolamine
Papaverine
Trazodone

22

what is the MOA of alprostadil?

increase cAMP

23

At what age does BPH affect most men?

over the age of 60

24

what are ADR of alprostadil?

injection site rxn
fibrous deposits
curvature of penis

25

what are the two types of alprostadil used in ED?

Intracavernous injections (caverject or Edex)
Intraurethral (MUSE)

26

what is the MOA of alprostadil?

increase cAMP

27

what type of receptor is in the stromal and capsule layer?

α 1 receptors

28

What is the onset and duration of alprostadil?

onset: 5-15min
Duration: related to dose
14-44min

29

what are ADR of alprostadil?

injection site rxn
fibrous deposits
curvature of penis

30

what is the difference between Static vs. Dynamic

Static- physical block- permanent enlargement of tissue
Dynamic- muscle contaction- effect urethral lumen

31

what are complications of untreated BPH?

AKI
Gross hematuria
Overflow urinary incontinence
UTI
Bladder diverticula
bladder stones
long standing obstruction lead to renal failure

32

What are some PE findings that correlates with a clinical presentation of BPH?

elevated PSA (>1.4 ng/mL)
elevated BUN, SCr (w/ obstruction)
increased PVRV (>25-50 mL)
decreased urine flow rate (<10 mL/s)

33

Name the 2 5-ARI's

Finasteride & Dutasteride

34

what is the Tx for severe Sx of BPH?

Surgery

35

what type of receptor is in the stromal and capsule layer?

α 1 receptors

36

what are 3rd generation α 1 adrenergic antagonists?

Tamsulosin
Silodosin

37

what is the difference between 2nd and 3rd generation?

time to symptom relief decreased
Receptor selectivity which is greater in 3rd generation
2nd generation need to be taken multiple times a day where 3rd gens are only daily

38

ADR of α 1 adrenergic antagonists?

Floppy iris syndrome
hypotension, syncope with 1st dose, muscle weakness,

39

Urinary Incontinence epidemiology?

Women increases with age
years old 40%
Men
not as common
increases with age

40

what happens to testosterone when it is converted to dihydrotestosterone in the epithelial tissue?

causes enlargement of the prostate

41

what happens when the α 1 receptors bind norepi in the stromal and capsule layer?

cause muscle contraction

42

what is overflow incontinence?

overactive uretheral and or under active bladder
bladder fill but unable to empty, strain, hesitancy, decrease force of stream

43

what is 1st line Tx for STRESS incontinence?

Duloxetine- cymbalata
Side effects: HA, dry mouth, fatigue

44

what is 2nd line for STRESS incontinence?

α-adrenergic agonists
Pseudoephedrine
Phenylephrine

45

what are complications of untreated BPH?

AKI
Gross hematuria
Overflow urinary incontinence
UTI
Bladder diverticula
bladder stones
long standing obstruction lead to renal failure

46

What does the AUA BPH symptom score index assess?

questionnaire that assess symptoms of BPH, a higher score = patient is greatly effected by symptoms of BPH

47

When would watchful waiting be an appropriate treatment of BPH?

If the patient is only experiencing mild symptoms

48

What is the Tx for mild Sx of BPH?

watchful waiting

49

what it the Tx of moderate Sx of BPH?

α-adrenergic antagnoist or 5α- reductase inhibitor. If no response surgery!

50

what is the Tx for severe Sx of BPH?

Surgery

51

What are some behavioral modifications that can be done as a non-pharmacologic treatment to BPH?

Med review
restrict fluids close to bed time
min. caffeine & ETOH
bladder training (frequent emptying)

52

Name the 2 5-ARi's

Finasteride & Dutasteride

53

Which 5-ARI is more selective for prostate enzymes?

Finasteride

54

Which drug blocks more conversion of testosterone to DHT?

Dutasteride

55

Dutasteride blocks more conversion resulting in a ______level of DHT

lower

56

What is the frequency of dosing for 5ARIs?

once daily

57

what are 2nd generation α 1 adrenergic antagonists?

Prazosin, Terazosin, Doxazosin, Alfuzosin

58

what are 3rd generation α 1 adrenergic antagonists?

Tamsulosin
Silodosin

59

what is the difference between 2nd and 3rd generation?

time to symptom relief decreased
Receptor selectivity which is greater in 3rd generation
2nd generation need to be taken multiple times a day where 3rd gens are only daily

60

What adverse reaction is associated with the 5ARI's?

sexual dysfunction

61

Which 5ARI requires special handling and why?

Finasteride, because it can be absorbed through the skin

62

ADR of α 1 adrenergic antagonists?

Floppy iris syndrome
hypotension, syncope with 1st dose, muscle weakness,

63

What are some herbal products used in the treatment of ED?

Saw palmetto
stinging nettle
S. African Stargrass
pumpkin seed
african plum

64

What is the most common herbal product used to treat ED?

saw palmetto

65

Urinary Incontinence epidemiology?

Women increases with age
years old 40%
Men
not as common
increases with age

66

What is the normal urinary cycle?
When is the first sensation to void?
When do you experience a high desire to void?

Empty bladder --> 1/2 full --> full --> urination

first sensation to void when bladder is 1/2 full
High desire to void when bladder is full

67

What are the 6 medications that induce or worsen UI?

Diuretics
Alpha receptor antagonists
sedation hypnotics
TCAs (antidepressants)
ACEi

68

What is stress incontinence and when does it happen?

Urethral under activity
Occurs during exertion-exercise, coughing, sneezing

69

what is Urge incontinence?

overactive bladder and or detrusor muscle
associated with frequency, urgency, nocturia, and enuresis

70

what is overflow incontinence?

overactive uretheral and or under active bladder
bladder fill but unable to empty, strain, hesitancy, decrease force of stream

71

How do ACEi's induce or worsen UI?

d/t the AE of coughing --> exertional

72

What are the 5 types of non-pharmacologic treatment of UI?

decrease RFs
bladder training
pelvic floor exercise
urine collection
physical therapy

73

what is 1st line Tx for urinary incontinence?

Duloxetine- cymbalata

74

what is 2nd line for urinary incontinence?

α-adrenergic agonists
Pseudoephedrine
Phenylephrine

75

How can you decrease risk factors of UI in effort to treat non-pharmacologically?

maintain healthy wt
constipation prevention
fluid modification
caffeine & ETOH reduction

76

what is 1st line for overactive bladder?

Anticholinergic
Oxybutynin
Tolterodine

77

What is bladder training?

scheduled toileting every 2 hours

78

How can PT help to treat UIs?

improves strength

79

What is a pelvic floor exercise?

Kegel exercises

80

Which BPH pharm treatment halts disease progress and decreases the prostate size?

5ARIs

81

Which pharm tx of BPH relaxes smooth muscle?

Alpha 1 antagonists

82

Which pharm tx of BPH does NOT decrease PSA?

Alpha 1 antagonists

83

Did Sean Do good work?

Hell yea