GU

Question 1

what is the MC cause of erectile dysfunction?

Answer 1

decreased blood flow

DM, HTN, heart dz

Question 2

What are some other causes of erectile dysfunction

Answer 2

hormone imbalance

psychological issues

Question 3

Medication induced sexual dysfunction

Answer 3

blood pressure medications
antipsychotic
antidepressants
BPH
opoids

Question 4

what could be found on physical exam for erectile dysfunction

Answer 4

Hypogonadism
Penile disease
Enlarged prostate
Hypertension, diabetes

Question 5

What are 2 goals of treatment for erectile dysfunction

Answer 5

Increase quantity and quality of sexual intercourse

Treatments should not be used for patients without erectile dysfunction

Question 6

2 non pharmacological agents used to treat erectile dysfunction

Answer 6

penile prosthetic device

vacuum erection device

Question 7

What is important for vacuum erection device

Answer 7

Takes about 30 min for the pt to get an optimal
Erection and cannot be left on for more than 60 min
Pts on anticoags are not recommended
Contraindicated in sickle cell anemia

Question 8

MOA of phosphodiasterase inhibitors

Answer 8

Inhibits phosphodiesterase enzymes; slows the breakdown of cGMP – allowing for the depression of Ca+ – smooth muscle relaxation – erection

Question 9

2 drug interactions for phosphodiasterase inhibitors

Answer 9

Alcohol and Nitrates

Question 10

2 rare side effects with phosphodiasterase inhibitors

Answer 10

nonarteritic anterior optic neuropathy (NAION)

priaprism

Question 11

MOA of Prostaglandin E1

Answer 11

Increases cAMP which ↓ Ca+

Question 12

Side effects of Prostaglandin E1

Answer 12

injection site reactions, fibrous deposits, curvature of the penis

Question 13

2 types of Alprostadil

Answer 13

Intracanvernous injection (Caverject or Edex)– inject into penis
Intraurethral (MUSE)

Question 14

Unapproved agents for erectile dysfunction– 3 prescriptions

Answer 14

Phentolamine
Papaverine
Trazodone

Question 15

Unapproved agents for erectile dysfunction– 3 herbal agents

Answer 15

Yohimbine
Wild Yam
Dehydroepiandosterone (DHEA)

Question 16

Epidemiology of BPH

Answer 16

Mostly effects men over the age of 60 years old
Most common benign neoplasm in men
40% of all men experience enlarged prostate and BPH symptoms
20% of all men require treatment for BPH symptoms

Question 17

3 layers of the prostate

Answer 17

Epithelial (glandular)
Stromal (smooth muscle)
Capsule (fibrous)

Question 18

function of the prostate

Answer 18

Produce ejaculation fluids (40%)

Antibacterial secretions

Question 19

2 stages of growth of the prostate

Answer 19

Puberty – 25

40 – rest of life

Question 20

What is found in the Epithelial tissue layer of the prostate

Answer 20

Androgen receptors ( 5 alpha reductase)
Testosterone converted to dihydrotestosterone (androgen) (aka DHT)
Causes enlargement of the prostate

Question 21

Stromal and Capsule layers of the prostate

Answer 21

α 1 receptors
Bind norepinephrine
Cause muscle contraction

Question 22

Symptoms for BPH

Answer 22

Urinary frequency
Urinary urgency
Urinary intermittency
Nocturia
Decreased force of stream
Hesitancy
Straining

Question 23

Signs for BPH

Answer 23

Digital rectal exam with enlarged prostate
Elevated PSA (>1.4 ng/mL)
Elevated BUN, SCr 
With obstruction
Increased post-void residual (>25-50 mL)
Urine flow rate (<10 mL/s)

Question 24

Medications that induce BPH

Answer 24

Testosterone
α agonist
Pseudoephedrine, ephedrine, phenylephrine
Anticholinergic
Antihistamines, phenothiazine, tricyclic antidepressants
Large doses of diuretics

Question 25

Complications of untreated BPH

Answer 25

``` Acute Kidney Injury Gross hematuria Overflow urinary incontinence or unstable bladder Recurrent UTI Bladder diverticula Bladder stones ```

Question 26

What are 6 nonpharmacological treatments used in BPH

Answer 26

``` Watchful waiting Behavior Modification Medication review Restriction fluids close to bed time Minimize caffeine and alcohol Bladder training ```

Question 27

alpha 1 anatgonists

Answer 27

relax smooth muscle onset= 1-6 weeks has cardiovascular side effects

Question 28

5 alpha reductase inhibitor

Answer 28

``` decreases prostate size halts disease progression onset- 3-6 months decreases PSA sexual dysfunction ```

Question 29

what are 3 differences between 2nd generation and 3rd generation for alpha 1 andrenergic antagonists

Answer 29

Time to symptom relief decreased From 2-6 weeks to several days (3rd gen quicker) Receptor selectivity ↑ uroselection in 3rd generation Frequency 2nd – multiply times a day, 3rd – daily

Question 30

alpha 1 andrenergic antagonists side effects

Answer 30

Dizziness, hypotension, syncope with first dose, muscle weakness, headache Rare serious Floppy iris syndrome

Question 31

2 5-alpha reductase Inhibitors

Answer 31

Finasteride – more selective for prostatic enzymes | Dutasteride – blocks more conversion  lower level of DHT

Question 32

Herbal products for BPH

Answer 32

Saw palmetto+ = MC that you will probably see

Question 33

Epidemiology for Urinary incontinence

Answer 33

Women Increase with age < 25 years old 20%, 25-60 years old 30%, >60 years old 40% Due to pregnancy Men Not as common Increase with age About 9% overall

Question 34

Clinical presentation for stress

Answer 34

Urethral underactivity | Occurs during exertion – exercise, coughing, sneezing

Question 35

clinical presentation for urge

Answer 35

Overactive bladder and /or detrusor muscle | Associated with frequency, urgency, nocturia, and enuresis

Question 36

Clinical presentation for overflow

Answer 36

Overactive urethral and/or underactive bladder | Bladder fills but unable to empty, strain, hesitancy, decrease force of stream

Question 37

Medications induce or worsen UI

Answer 37

``` Diuretics α receptor antagonist Sedation hypnotics Antidepressants, Tricyclic Alcohol ACE-I ```

Question 38

Nonpharmacological treatments for UI

Answer 38

decrease risk factors bladder training urine collection pelvic floor exercise

Question 39

first line treatment for UI stress

Answer 39

Duloxetine (Cymbalta) 1st line Adverse reactions: headache, dry mouth, fatigue Side effects improve over time

Question 40

second line treatment for UI stress

Answer 40

α – adrenergic agonists 2nd line | Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE)

Question 41

What is first line treatment for an over active bladder?

Answer 41

Anticholinergic – 1st line Oxybutynin (Ditropan) Dosage forms – Oral: IR and XL, Dermal: TDS and gel Adverse reactions: dizziness, dry mouth, constipation, nausea

Question 42

What is tolterodine used for?

Answer 42

over active bladder Dosage forms – Oral: IR and LA Adverse reactions: dry mouth Less in LA dosage form