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Pharm III - Exam 1 > GU > Flashcards

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1
Q

Physiology of a flaccid penis

A

Arterial blood flow in is equal to venous blood flow out

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2
Q

Physiology of an erect penis

A

Arterial blood flow in is greater than venous blood flow out

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3
Q

MC cause of ED

A

Decreased blood flow like in DM, HTN, heart disease

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4
Q

Other causes of ED

A
  • Hormone imbalance (low T)

- Psych (stress, anxiety, depression)

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5
Q

What meds can cause ED?

A
  • BP meds
  • Antipsychotic (1st generation)
  • Antidepressants
  • BPH meds
  • Opioids
  • Nicotine
  • Excessive ETOH
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6
Q

Which BP meds can cause ED?

A

Beta blockers
Clonidine
Methyldopa

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7
Q

Which antipsychotics can cause ED?

A 
(1st generation)
Haloperidol
Chlorpromazine
Thioridazine
Fluphenazine
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8
Q

Which antidepressants can cause ED?

A

SSRIs and SNRIs

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9
Q

Which BPH meds can cause ED?

A

Finasteride
Dutasteride
Silodosin

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10
Q

Which opioid is more likely to cause ED?

A

Methadone

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11
Q

What can be used in the patient history to quantify erectile dysfunction?

A

International Index of Erectile Function (IIEF) questionnaire

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12
Q

Which PDE inhibitors inhibit PDE-6 in addition to PDE-5?

A

Sildenafil

Vardenafil (minimally)

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13
Q

Which PDE inhibitor does NOT inhibit PDE-6?

A

Tadalafil

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14
Q

Which PDE inhibitor has the longest onset time?

A

Tadalafil (2 hours)

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15
Q

Which PDE inhibitor has the shortest onset time?

A

Sildenafil

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16
Q

Which PDE inhibitor has the longest duration time?

A

Tadalafil (24-36 hrs)

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17
Q

Which PDE inhibitor is NOT affected by a fatty meal?

A

Tadalafil

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18
Q

Which PDE inhibitor is given in a higher dose?

A

Sildenafil

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19
Q

PDE inhibitors MOA

A
  • Inhibits PDE enzymes
  • Slows break down of cGMP
  • Allows for depression of Ca
  • Smooth muscle relaxation leading to erection
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20
Q

Which drugs interact with PDE inhibitors?

A

Alcohol and nitrates

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21
Q

Rare serious ADR of PDE inhibitors?

A
  • Nonarteritic anterior optic neuropathy (NAION)

- Priaprism (erection more than 4 hrs)

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22
Q

What is alprostadil?

A
  • PGE1 for ED

- Intracavernous injection or intraurethral

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23
Q

MOA of alprostadil

A

Increases cAMP which decreases Ca and causes smooth muscle relaxation (erection)

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24
Q

Onset time of alprostadil?

A

5-15 minutes

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25
ADRs of alprostadil
- Injection site reactions - Fibrous deposits - Curvature of penis
26
Unapproved prescription agents for ED
- Phentolamine - Papaverine - Trazodone
27
Unapproved herbal agents for ED
- Yohimbine - Wild Yam - Dehydroepiandosterone (DHEA)
28
What is the MC benign neoplasm in men?
BPH
29
Functions of the prostate
- Produce ejaculation fluids (40%) | - Antibacterial secretions
30
Layers of the prostate
- Epithelial (glandular, androgen receptors) - Stromal (smooth muscle, a1 receptors) - Capsule (fibrous, a1 receptors)
31
Where are androgen receptors located in the prostate? What do they bind?
- Epithelial (glandular) layer | - Bind 5a reductase (converts T to DHT)
32
Where are a1 receptors located in the prostate? What do they bind?
- Stromal (smooth muscle) and capsule (fibrous) layers | - Bind norepi (cause muscle contraction)
33
Static BPH
- Physical block | - Permanent enlargement of tissue
34
Dynamic BPH
- Muscle contraction | - Affects urethral lumen
35
What meds affect the prostate and could induce BPH?
- Testosterone | - Alpha agonists (ephedrine, pseudoephedrine, phenylephrine)
36
What meds mimic BPH symptoms?
- Anticholinergics (antihistaines, phenothiazine, TCAs) | - Large doses of diuretics
37
What are behavior modification treatments of BPH?
- Med review - Restrict fluids close to bed - Minimize caffeine/alcohol - Bladder training (frequent emptying)
38
Which BPH drug class relaxes smooth muscle of the prostate?
a1 antagonists
39
Which BPH drug class decreases prostate size?
5a reductase inhibitors
40
Which BPH drug class halts disease progress?
5a reductase inhibitors
41
Which BPH drug class has a shorter peak onset time?
a1 antagonists (1-6 weeks)
42
Which BPH drug class decreases PSA?
5a reductase inhibitor
43
Which BPH drug class has better efficacy?
Neither - they are equal (except 5a reductase inhibitor will reduce an enlarged prostate)
44
Which BPH drug class is more likely to cause sexual dysfunction?
5a reductase inhibitors
45
Which BPH drug class may have cardiovascular ADRs?
a1 antagonists
46
What are 2nd generation a1 antagonists?
Prazosin, terazosin, doxazosin
47
What are 3rd generation a1 antagonists?
Tamsulosin | Silodosin
48
What are the differences between 2nd and 3rd generation a1 antagonists?
- Time to symptom relief decreased - Increased receptor selectivity - Only taken once a day
49
ADRs of a1 antagonists
- Dizziness - Hypotension - Syncope w/first dose - Muscle weakness - HA
50
Rare serious ADR of a1 antagonists
Floppy iris syndrome
51
What meds can cause floppy iris syndrome?
a1 antagonists (used for BPH)
52
What agents are 5a reductase inhibitors?
Finasteride | Dutasteride
53
Which 5a reductase inhibitor is more selective for prostatic enzymes?
Finasteride
54
Which 5a reductase inhibitor blocks more conversion resulting in a lower level of DHT?
Dutasteride
55
Which 5a reductase inhibitor requires special handling?
Finasteride (can be absorbed through the skin)
56
MC herbal product for BPH?
Saw palmetto
57
When does the first sensation to void occur in the normal urinary cycle?
When bladder is half full
58
What are the types of urinary incontinence?
Stress Urge Overflow
59
Describe stress UI
- Under active urethra | - Occurs during exertion (exercise, cough, sneeze)
60
Describe urge UI
- OAB and/or detrusor muscle | - A/w frequency, urgency, nocturia, enuresis
61
Describe overflow UI
- Overactive urethra and/or underactive bladder | - Bladder fills but unable to empty
62
What are meds that can induce or worsen UI?
- Diuretics - a receptor blockers - Sedation hypnotics - TCAs - Alcohol - ACEI (due to cough)
63
Treatment of stress UI
- Duloxetine (1st line) | - a agonists (pseudoephedrine)
64
ADRs of duloxetine
HA Dry mouth Fatigue
65
ADRs of a agonists
Dizziness, confusion, urinary retention, photosensitivity
66
Treatment of OAB UI
Anticholinergic (1st line) - Oxybutynin - Tolterodine
67
What is the 1st line treatment of OAB UI?
Anticholinergic (oxybutynin or tolterodine)

Pharm III - Exam 1 (2 decks)

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