ED, BPH, Urinary Incontinence Flashcards by Arton Azizi

what is the most common cause of ED

decreased blood flow

diseases: DM, HTN, Heart Dz

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what are other causes of ED

Hormone- low testosterone

Psychological-Stress, anxiety,depression

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what meds cause sexual dysfunction

BP Med
Antipsychotics
Antidepressants
BPH
Opiods
Nicotine 
Excess alcohol

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

sexual dysfunction

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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!!!

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What are physical Tx for ED?

lifestyle modifications if no effect then use devices or meds

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How do you Tx psychological ED?

psychotherapy or Behavioral therapy

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How do you tx drug ED?

D/C offending agent or reduce dose of offending agent

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

Intracavernosal therapy

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What are the 2 tx options for Organic ED

Oral PDEi & Vacuum erection device

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What is the onset of:

Sildenafil, Vardenafil, Tadalafil

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

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

intraurethral alprostadil

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Which drug is a PDE-6 inhibitor

Sildenafil, Vardenafil, Tadalafil?

Sildenafil (Viagra)

Vardenafil (Levitra)-minimally

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What is the onset of:

Sildenafil, Vardenafil, Tadalafil

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

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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

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What is the Duration of:

Sildenafil, Vardenafil, Tadalafil

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

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

Phentolamine
Papaverine
Trazodone

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What does the depression of Ca++ cause?

Smooth muscle relaxation resulting in an erection

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

ETOH and Nitrates

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What are the 2 rare, yet serious ADRs?

Non-arteritic anterior optic neuropathy (NAION) & priaprism

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What are some Rx unapproved agents used in ED?

Phentolamine
Papaverine
Trazodone

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what is the MOA of alprostadil?

increase cAMP

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At what age does BPH affect most men?

over the age of 60

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what are ADR of alprostadil?

injection site rxn
fibrous deposits
curvature of penis

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what are the two types of alprostadil used in ED?

``` Intracavernous injections (caverject or Edex) Intraurethral (MUSE) ```

what is the MOA of alprostadil?

increase cAMP

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

α 1 receptors

What is the onset and duration of alprostadil?

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

what are ADR of alprostadil?

injection site rxn fibrous deposits curvature of penis

what is the difference between Static vs. Dynamic

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

what are complications of untreated BPH?

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

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) ```

Name the 2 5-ARI's

Finasteride & Dutasteride

what is the Tx for severe Sx of BPH?

Surgery

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

α 1 receptors

what are 3rd generation α 1 adrenergic antagonists?

Tamsulosin | Silodosin

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

ADR of α 1 adrenergic antagonists?

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

Urinary Incontinence epidemiology?

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

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

causes enlargement of the prostate

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

cause muscle contraction

what is overflow incontinence?

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

what is 1st line Tx for STRESS incontinence?

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

what is 2nd line for STRESS incontinence?

α-adrenergic agonists Pseudoephedrine Phenylephrine

what are complications of untreated BPH?

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

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

When would watchful waiting be an appropriate treatment of BPH?

If the patient is only experiencing mild symptoms

What is the Tx for mild Sx of BPH?

watchful waiting

what it the Tx of moderate Sx of BPH?

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

what is the Tx for severe Sx of BPH?

Surgery

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)

Name the 2 5-ARi's

Finasteride & Dutasteride

Which 5-ARI is more selective for prostate enzymes?

Finasteride

Which drug blocks more conversion of testosterone to DHT?

Dutasteride

Dutasteride blocks more conversion resulting in a ______level of DHT

lower

What is the frequency of dosing for 5ARIs?

once daily

what are 2nd generation α 1 adrenergic antagonists?

Prazosin, Terazosin, Doxazosin, Alfuzosin

what are 3rd generation α 1 adrenergic antagonists?

Tamsulosin | Silodosin

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

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

sexual dysfunction

Which 5ARI requires special handling and why?

Finasteride, because it can be absorbed through the skin

ADR of α 1 adrenergic antagonists?

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

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

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

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

saw palmetto

Urinary Incontinence epidemiology?

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

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

What are the 6 medications that induce or worsen UI?

``` Diuretics Alpha receptor antagonists sedation hypnotics TCAs (antidepressants) ACEi ```

What is stress incontinence and when does it happen?

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

what is Urge incontinence?

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

what is overflow incontinence?

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

How do ACEi's induce or worsen UI?

d/t the AE of coughing --> exertional

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

``` decrease RFs bladder training pelvic floor exercise urine collection physical therapy ```

what is 1st line Tx for urinary incontinence?

Duloxetine- cymbalata

what is 2nd line for urinary incontinence?

α-adrenergic agonists Pseudoephedrine Phenylephrine

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

maintain healthy wt constipation prevention fluid modification caffeine & ETOH reduction

what is 1st line for overactive bladder?

Anticholinergic Oxybutynin Tolterodine

What is bladder training?

scheduled toileting every 2 hours

How can PT help to treat UIs?

improves strength

What is a pelvic floor exercise?

Kegel exercises

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

5ARIs

Which pharm tx of BPH relaxes smooth muscle?

Alpha 1 antagonists

Which pharm tx of BPH does NOT decrease PSA?

Alpha 1 antagonists

Did Sean Do good work?

Hell yea

ED, BPH, Urinary Incontinence Flashcards

(83 cards)