Genitourinary & Nephrology Flashcards Preview

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Flashcards in Genitourinary & Nephrology Deck (47):
1

Pathophys of Erection

Acetylcholine --> Inc. NO and inc. PDE (prostaglandin E)

NO --> inc. cGMP
PDE --> in. cAMP

Both cGMP and cAMP decrease Calcium

2

Diseases that decrease blood flow, resulting in common organic causes of ED

1. DM
2. HTN
3. Heart Disease

3

The #1 reason patient's stop taking their ____ is because of sexual dysfunction.

SSRI/SNRI

4

Blood pressure meds that can cause sexual dysfunction

1. BB
2. Clonidine
3. Methyldopa

5

Antipsychotics that can cause sexual dysfunction

1. Haloperidol
2. Chlorpromazine
3. Thioridazine
4. Fluphenazine

Basically all 1st generations and SSRI/SNRI's (but less than 1st gens)

6

BPH Meds that can cause ED

Finasteride
Dutasteride
Silodosin

7

Opoids that can cause ED

ALL OF THEM

Methadone to a higher extent

8

Can nicotine and excessive alcohol cause ED?

YES!

9

The International Index of Erectile Function (IIEF): is it better to have a higher score or a lower score?

A higher score

Severe ED: Score of 5-7

10

If a patient is on an oral phosphodiesterase inhibitor and has not been reporting improvements in sexual function then what is a 2nd line tx option?

Intracavernosal therapy

11

If a pt undergoes intracavernosal therapy but does not seem to be improving then what is the next (3rd line) tx for ED?

Intraurethral alprostadil

12

If a pt undergoes intraurethral alprostadil therapy but does not seemt o be improving then what is the next (last line) therapy option for ED?

Penile prosthesis

13

Explain the pathophysiology of phosphodiesterase inhibitors?

Inhibits phosphodiesterase which slows down the breakdown of cGMP. This allows for the depression of calcium which relaxes smooth muscle --> erection!

14

What should be avoided while using phosphodiesterase inhibitors?

Alcohol and nitrates

15

A pt really wants to be put on a PDE inhibitor for his ED but it is also imperative that he takes his vasodilators. What should you council him on in regards of timing of these medications?

SPACE THEM OUT!

With Viagra and Levitra wait 24 hrs after taking the ED med before taking the nitrate.

If taking Cialis wait 48 hours

16

Which PDE inhibits both PDE-5 and PDE-6? What is the importance of PDE-6?

Sildenafil (Viagra)

PDE-6 is connected to rods and cones so if pt has visual changes they need to stop taking sildenafil (Viagra)

17

What 2 doses does alprostadil come in?

1.) Intracanvernous injection (Caverject or Edex)

2.) Intraurethral (MUSE)

18

MOA of Alprostadil

Increases cAMP which decreases Ca+

19

Onset and duration of Alprostadil

Onset: 5-15 minutes
Duration: 14-44 minutes (depending on dosage)

20

Adverse reactions of alprostadil?

1. Injection site reactions
2. Fibrous deposits
3. Curvature of penis

21

Functions of the prostate (2)

1. Produce ejaculation fluids (40% of them)

2. Antibacterial secretions

22

What are the 3 layers of the prostate gland?

1. Epithelial (glandular)
2. Stromal (smooth muscle)
3. Capsule (fibrous)

23

2 periods of growth of the prostate gland

1. Puberty - 25yo
2. 40yo - end of life

24

Epithelial (glandular) tissue has ____ receptors while both stromal and capsule tissue has ____ receptors

Androgen receptors

alpha-1 receptors

25

Static v. Dynamic in BPH

Static - physical block; permanent enlargement of tissue

Dynamic - muscle contraction; effect urethral lumen

26

Medications that can induce BPH

1. Testosterone
2. Alpha agonist - pseudoephedrine, ephedrine, phenylephrine

27

Medications that have adverse effects that mimic BPH

1. Anticholinergics (antihistamines, phenothiazine, TCAs)

2. Diuretics (large doses)

28

Nonpharmacologic tx of BPH: What is entailed under "behavioral modification"?

1. Medications review
2. Restriction of fluids close to bedtime
3. Minimize caffeine and ETOH
4. Bladder training (frequently empty the bladder)

29

T/F: alpha one antagonists relax smooth muscle

True

5-alpha reducates inhibitors do not relax smooth muscle

30

T/F: alpha 1 antagonists halt disease progression of BPH

False

5-alpha reductase inhibitors halt disease progression

31

Which BPH drug can produce cardiovascular adverse effects

alpha 1 antagonists

32

2nd generation alpha 1 adrenergic antagonists

Prazosin
Terazosin
Doxazosin
Alfuzosin

33

3rd generation alpha 1 adrenergic antagonists

Tamsulosin
Silodosin

34

Differences between 2nd and 3rd generation alpha 1 adrenergic antagonists

1. Time to sx relief is decreased from 2-6 weeks --> several days

2. Receptor selectivity (inc. uroselection in 3rd generation)

3. Frequency (3rd is once a day which increases pt adherence)

35

What is a rare but serious side effect of alpha 1 adrenergic antagonists

Floppy Iris Syndrome

36

ADRs of alpha 1 adrenergic antagonists

Dizziness
Hypotension
Syncope
Muscle weakness
HA

37

Finasteride and Dutasteride are _________________.

5-alpha reductase inhibitors

38

____ blocks conversion of testosterone to DHT more while _____ is more selective for prostatic enzymes and therefore has less adverse reactions.

Dutasteride

Finasteride

39

ADR of 5-alpha reductase inhibitors

Sexual dysfunction

40

Most common herbal product used for BPH

Saw palmetto

41

3 Types of Urinary Incontinence

1. Stress
2. Urge
3. Overflow

42

A pt presents with frequency, urgency, nocturia, and enuresis (wetting the bed). What type of UI is this?

Urge

43

A pt presents with strain, hesitancy, dec. force of stream and having a sense of not emptying the bladder. What type of UI is this?

Overflow

44

Medications that induce or worsen UI?

1. Diuretics
2. Alpha receptor antagonists
3. Sedation hypnotics
4. Antidepressants (TCA)
5. ETOH
6. ACEi --> d/t cough side effect

45

First line for Stress UI

Duloxetine (Cymbalta)

46

First line for Overactive Bladder UI

Anticholinergic (Oxybutynin)

47

2nd line for stress UI?

Alpha adrenergic agonists:
--Pseudoephedrine and phenylephrine