Men - Bladder disorder Flashcards
(20 cards)
What are lower urinary tract symptoms in males?
voiding symptoms - weak or intermittent urinary stream, straining, hesitancy, terminal dribbling, and incomplete emptying
storage symptoms - urinary frequency, urgency, urgency incontinence, and nocturia
post-micturition symptoms - post-micturition dribbling, and sensation of incomplete emptying
What are the treatment options for LUTS in males?
1st line - alpha blockers: doxazosin, alfuzosin
anti-muscarinics or beta3 agonists can be added for those who continue to experience symptoms
- oxybutynin
- mirabegron, vibegron
5α-reductase inhibitor: finasteride, dutasteride
phosphodiesterase type-5 inhibitor: tadalafil
When are 5α-reductase inhibitor added to treatment?
moderate to severe LUTS + enlarged prostate (>30 g) +/- raised prostate specific antigen level (>1.4 ng/mL)
high risk of disease progression
can be used with an alpha blocker
When are phosphodiesterase type-5 inhibitors used in LUTS?
males with both erectile dysfunction and moderate to severe LUTS
can be used instead of alpha blockers
What are the advantages and disadvantages of alpha blockers?
advantages: effective at treating voiding and storage symptoms, fast onset (hours to days)
disadvantages: do not alter progression of BPH, takes weeks to develop full effects
Which alpha blockers are more likely to cause postural hypotension?
doxazosin
terazosin
Which alpha blocker has the highest risk for occurrence of floppy iris syndrome?
tamsulosin
What are the advantages of 5α-reductase inhibitors?
5ARIs reduce prostate size, the risk of acute urinary retention, and the need for BPH surgery
What monitoring is needed for mirabegron?
blood pressure
CI in severe uncontrolled hypertension
What are the side effects if antimuscarinics?
dry mouth
constipation
blurred vision
drowsiness, dizziness
tachycardia
When are antimuscarinics CI?
myasthenia graves
glaucoma
paralytic ileus
severe UC
When should antimuscarinic use in urinary incontinence be reviewed?
every 4–6 weeks until symptoms stabilise, and then every 6–12 months.
What are the side effects of alpha blockers?
hypotension: postural hypotension
dizziness, fainting, tachycardia, blurred vision
intra-operative floppy iris syndrome: issue for cataract surgery
What is counselling for alpha blockers?
take 1st dose at night due to risk of 1st dose postural hypotension
What is an MHRA warning for finasteride?
risk of psychiatric side effects and of sexual side effects: may persist after discontinuation
depression, suicidal thoughts, and sexual dysfunction (including decreased libido and erectile dysfunction)
discontinue
What are side effects of 5α-reductase inhibitors?
breast disorder: male breast cancer
sexual dysfunction
What are counselling points for 5α-reductase inhibitors?
report changes in breast tissue such as lumps, pain, or nipple discharge.
Women of childbearing potential should avoid handling
- crushed or broken tablets of finasteride.
- leaking capsules of dutasteride
Is contraception required when taking 5α-reductase inhibitors?
are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant.
What are the monitoring requirements for 5α-reductase inhibitors?
need regular evaluation for prostate cancer
What are the main drug interactions for alpha blockers?
phosphodiesterase type-5 inhibitors: increased risk of hypotensive effects
