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Exam 9 > Men's Health > Flashcards

Men's Health Flashcards

(118 cards)

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1
Q

The main role of the prostate is what

A

sexual function and fertility

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2
Q

What are the 4 zones of the prostate? What are the two to know and why?

A

Anterior, Peripheral, central, transition
Peripheral is 70% of the volume and is where most of the prostate cancer happens
Transition zone is 10% of volume and correlates with BPH

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3
Q

What is BPH

A

Benign prostatic hyperplasia-> proliferation of epithelial and smooth muscle cells in transition zone.

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4
Q

What symptoms does BPH tend to correlate with?

A

urinary symptoms, but that’s not always accurate

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5
Q

___ is one of the most common reasons for urology referral and up to 30% of men will receive treatment

A

BPH

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6
Q

BPH is now called ____

A

Lower urinary tract symptoms.

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7
Q

What are causes of lower urinary tract symptoms besides prostate enlargement

A

bladder instability, decreased bladder compliance, decreased bladder capacity, pelvic floor/neuro changes

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8
Q

What are the two big buckets of symptoms that patients with LUTS will experience?

A 
Voiding symptoms (hesitancy, decreased stream, incomplete emptying)
Storage (frequency, urgency, dysuria, nocturia)
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9
Q

What is the first thing to evaluate in a patient that is experiencing LUTS? What are other good non urological things to check?

A

medications!!

Then infection, behavior (caffeine), D2M, stones or strictures, neuro, cancer

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10
Q

The prostate exam (does/does not) correlate with degree of symptoms. It (can/cannot) help predict response to medical therapy

A

does not

can help!

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11
Q

What two things should be ordered on blood work for LUTS

A 
serum creatinine (kidney problems)
PSA
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12
Q

What is PSA

A

enzyme that liquefies the seminal fluid after ejactulation. it is a rough indicator of prostate size and can be elevated in BPH and prostate cancer.

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13
Q

What does the Post-Void residual test look at?

A

ability for bladder to empty.

This will be due to squeeze, obstruction, or both. (a large volume does not mean 100% that there is an obstruction)

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14
Q

The Urodynamics test is really only ordered by ___ because it is reserved for ____

A

urology, complex patients
this is a pressure flow study that is good for patients with previous surgery, large volume residuals, incontinence, overactive bladder, or neuro problems

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15
Q

Cystoscopy should be done if _____ is present to rule out _____

A

hematuria, cancer

This can find the pathology

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16
Q

What are the severity levels of the IPSS/AUA Sx score

A

out of 35
mild 0-7
moderate 7-15
severe >15

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17
Q

With a mild score on the IPSS/AUA, what is the indicated treatment?

A

watchful waiting

reduce fluid intake, limit EtOH and caffeine, avoid cold and allergy meds (anti-his), double voiding, quit smoking

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18
Q

With a moderate score on the IPSS/AUA, what is the indicated treatment?

A

nonsurgical

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19
Q

With a severe score on the IPSS/AUA, what is the indicated treatment?

A

surgery, this is from very serious things like retention, recurrent UTIs, hematuria, stones, renal insufficiency

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20
Q

α blocker MOA for moderate IPSS/AUA score

A

relax muscle of prostate and bladder neck, urine flows more easily.

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21
Q

______ are first line therapy for moderate IPSS/AUA and gland <40g.

A

α blockers

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22
Q

onset of effect from α blockers is _____

A

within several weeks

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23
Q

What are side effects of α blockers

A

dizziness and low BP after sitting or standing up

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24
Q

What are the non selective α-1a antagonists

A

terazosin, doxazosin, prazosin (not used)

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25
What are the selective α-1a antagonists?
tamsulosin, alfuzosin, silodosin
26
Which α 1 antagonist is bad to use if CrCl is <30mL
silodosin . its a selectoive α-1a antagonist | Also be careful in people with sever liver dysfunction
27
What is MOA of α-1 antagonists
block NE on α 1 receptors (α-1a in prostate) on tissues and smooth muscle-> SM relaxation, counter obstruction-> enhance urine outflow-> decrease PVR
28
α-1 antagonists work ____ but they do not ______
quickly (benefit with continued use) | prevent need for prostate surgery, decrease prostate size or PSA levels
29
Non selective α-1 antagonists block receptors ______ (location). For dosing, they should be ______
outside prostate | started with low dose and titrated to effective dose
30
α-1b receptors bound by non selective α 1 antagonists cause AEs:
hypotension, first dose syncope, dizziness
31
Full effect for non selective α 1 antagonists may take ____
several weeks bc of the slow dose titration
32
Selective α-1 antagonists are selective for the 1a receptors on ______
stromal and capsule
33
Selective α-1 antagonists have a _______ risk of hypotension because: Dosing (does/does not) require titration
decreased, selective for prostate 1a receptors | does not require a dose titration
34
Selective α-1 antagonists can be used with _______ medications and is safe to use in patients with _____
anti-HTN meds | CVD (angina, HTN, ppl taking anti-hypertensives)
35
The effect from selective α-1 antagonists will be seen in ____
1 week
36
_____ is a selective α-1 antagonist that requires no dose changes based on renal or liver dysfunction
tamsulosin
37
What are AEs with selective alpha1 antagonists:
tiredness, asthenia, anejaculation (silodosin especially) | floppy iris syndrome (block 1a receptors at iris dilator muscles-> worse with tamsulosin)
38
5-α-reductase inhibitors cause the prostate to ____ and decrease PSA levels by ____
shrink, 50% | this can help reduce urinary retension and the need for surgery and risk for prostate cancer
39
5-α-reductase inhibitors take ____ months for effect and have AEs:
4-6 months | decreased sex drive or difficulty with erection or ejaculation
40
The two main used 5ARIs are
finasteride and dutasteride
41
5ARIs are indicated when prostate size ____ and need to be take at least __ months for benefit.
>40-50gm | 6months
42
5ARIs (do/do not) need dose adjustments in renal or liver dx due to ___
do not, few drug interactions
43
5ARIs cause more _____ than α-1 antagonists. There are three main domains affected, what are they
sexual dysfunction erectile dysfunction: decreased NO ejaculatory dysfunction: decreased prostatic secretions gynecomastia: increased testosterone->estrogen in peripheral tissues
44
Phosphodiesterase Type 5 inhibitors MOA:
inhibit PDE5 enzyme-> up cGMP-> more SM relax in prostate
45
What are the commonly used PD5is
``` tadalafil sidelafil (viagra) ```
46
The greatest benefit of PD5i's is when used in combination with _____
α-1 antagonist
47
Urge predominant symptoms best medication to use are___ and ___
anticholinergic/antimuscarinic (not retaining) | β-3 agonist
48
What are the commonly used β 3 agonists
mirabegron and vibegron
49
MOA of anticholinergics for use with urge
decreased detrusor contractions and improve storage
50
Greatest benefit with anticholinergic medications for urge symptoms is when they are used with ____
α 1 antagonists
51
anticholinergic dosing ?
effect in 1-2 weeks, start low titrate slow
52
Caution use in anticholinergic medication in ____
older patients
53
MOA of β 3 agonists
β3 in bladder detrusor-> increase cAMP-> detrusor relax
54
β 3 agonists are good for geriatrics because
there are few side effects
55
If a patient wants to take palmetto what to tell them
sure, there's no real effect
56
What is the gold standard surgery for LUTS
Transurethral resection of the prostate
57
Serum PSA a ______ increases overtime with both ___ and ____
serine protease | BPH and prostate cancer
58
What are the main classifications for ED
psychogenic, neurologic, hormonal, arterial, venous
59
What is the physiology of an erection?
sinusoidal smooth muscle relax + compress venous plexus-> up blood flow-> intracavernosal pressure over 100mmHg
60
What is detumescence
breakdown of second messengers by phosphodiesterase and sympathetic discharge
61
What are big 4 risk factors for ED
hypertension, hyperlipidemia, diabetes disorders, smoking
62
What are vascular disease causes of ED
aterosclerosis (smoking, DM, DL, HTN, obesity), venous leaks, pelvic or perineal trauma (cycling)
63
ED is a likely indicator of _______ and could be an early warning sign for _________
heart disease | increased risk of MI or stroke
64
men with ED had _____ the risk of heart attack
twice the risk
65
In men with DM, risk of ED is __ higher than non DM. Factors that contribute are
4 fold. Age, duration of DM, glycemic control, diabetic complications DM patients have a more severe less responsive to therapy
66
for HTN and ED, it is correlated to ___ and unrelated to ____
underlying vascular dz | side effects of HTN meds
67
smoking increases risk of ED __ fold. this is due to two potential mechanisms:
2 fold | impaired endothelium dependent smooth muscle relax, venoocclusive dysfunction
68
What drugs could affect ED
``` antidepressants and antipsychotics β blockers Thiazide diuretics spironolactone cimetidine (histamine-> antiandrogen) Ketoconazole, cyproterone acetate ```
69
SHIM questionnaire looks at what
sexual health inventory for men
70
what physical exam should be done for ED
GU exam, assess breasts for gynecomastia, hair distribution, palpate distal pulses, genital and perineal sensation
71
What labs should be ordered when ED is suspected
UA, CBC, fasting glucose, creatinine, lipid panel, testosterone
72
What are first line therapies for ED
modify reversible causes, oral medication
73
what are second line therapies for ED
vacuum therapy, penile injections, urethral suppository, penile impants
74
What are the third line therapies for ED
there are none
75
What are psychogenic causes of ED
performance anxiety, depression | loss libido, impaired NO
76
what are neurogenic causes of ED
stroke ,spinal cord injury, diabetic retinopathy | lack of nerve impulse
77
what are hormonal causes of ED
hypogonadism, hyperprolactinoma | not enough NO
78
What are vasuculogenic causes of ed
atherosclerosis, hypertension
79
what medications cause ED
anti-HTN, antidepressants, alcohol, tobacco | central suppression, vascular insufficiency
80
What are the approved phosphodiesterase type 5 inhibitors used for ED
viagra (sildenafil citrate), levitra/staxyn (vardenafil), cialis (tadalafil), stendra (avanafil)
81
PK feutres for sildenafil and vardenafil
1 hr to effect, short duration of action. use on demand do not take within 2 hours of fatty meal
82
PK features for avenafil
up to 30 minutes onset, short duration. | food doesn't affect.
83
Tadalafil PK features
take 2 hours before intercouse. can get daily dose. duration of action up to 36hrs.
84
Important to dose phosphodiesterase type 5 ___
high. increase to max dose for optimal sucess
85
What are adverse effects of phosphodiesterase type 5 inhibitors
increases with does. vasodilation -> facial flushing, dyspepsia, nasal congestion, dizziness. priapism (persistent erection), hypotension increased light sensitivity (not tadalafil). inhibition of PDE6 isoenzyme in photoreceptors of retinal rods and cones
86
The worse for AE: light sensitivity in PD5I? the best?
worse is sildenafil | best is tadalafil
87
Tadalafil specific AE
lower back and limb muscle pain | inhibition of PDE11 isoenzyme in striated muscle cells
88
What is penile injection therapy
smooth muscle relaxing mediation injected directly into penis (papaverine, phentolamine, PGE1)
89
What is transurethral alprostaldil
smooth muscle relaxing urethra suppository mimics physiology of erection
90
What are indications for penile impants
oral drug failure, scarred penis, peyronies disease, severe venous leak
91
What are the 3 different penile impact models
malleable/semirigid rods | mechanical rod, inflatable
92
What are the two requirements to have testosterone deficiency syndrome
deficiency in testosterone and relevant symptoms
93
Low testosterone is seen in men with ____
HTN, dyslipidemia, DM, obesity
94
What are the sexual symptoms of TDS
decreased desire, activity, sexual thoughts, morning erections erectile dysfunciton, delayed ejaculations, smaller volume of ejaculation
95
Physical symptoms of TDS
inability to perform vigorous activity, decreased muscle strength, fatigue, hot flushes, sweats
96
Symptoms of TDS suggestive of osteoporosis
low trauma fractures, height loss, decreased bone mineral density
97
Cognitive symtoms of TDS
impaired concentration, impaired verbal memory, impaired spatial performance
98
What is a vacuum erection device
draw blood to penis, contraction band to keep blood in penis
99
What are the primary causes of TDS
testicular failure (aging- obesity, systemic illness, meds, anorchia, cryptorchidism, genetic-Klinefelter's, malnutrition, neurodegenerative, respiratory, trauma, viral orchitis)
100
What is a congenital cause of TDS? what is a acquired cause of TDS
kallman's syndrome | pituitary adenoma
101
Late onset hypogonadism is associated with:
poor bone health, increased fat composition, depression
102
What are causes of secondary TDS
``` chronic dx (cirrosis), feedback inhibition due to rising estrogen (EtOH, steroid use, obesity), hormonal deficiency, inflammatory (Crohn's dz, arthritis), genetic disorders (prayer willis, kallmann) *obstructive sleep apnea*? ```
103
What are drugs associated with low T
antiarrhythmics, anticonvulsants, antifungals, chemotherapeutic agents, estrogen, gonadotropin releasing hormone agonists/antagonits, opiates, phenothiazine antipsychotics, progestins, statins, steroids, thiazide diuretics, ulcer drugs
104
Lab test for diagnosis low T
plasma total testosterone test (morning same before 9AM) plasma free or bioavaoiable testosterone test (non protein bound) LH, FSH, prolactin, estradiol, hematocrit, PSA
105
Testosterone replacement therapy delivery systems
IM, transdermal patches and gels, nasal swab, buccal patch, pellet implants, oral
106
risks for Low T therapy
hepatotoxicity, edema in patients with CVD, CKD, CLD, gynecomastia, increased RBC, fix the sleep apnea
107
Contraindications for low T therapy
breast cancer, advanced protest obstruction with voiding
108
AEs for Low T oral tablets
liver and cholesterole effects
109
AE for pellet impants for low T
in office procedure, infection, expulsion of pellet
110
AE of intramuscular injections
fluctuations in mood or libido | polycythemia
111
AEs for transdermal patches
skin reactions at application
112
AE for transdermal gel
risk or tester one transfer to partner
113
AE for buccal patch
gum irritation, halitosis
114
Probably no association between testosterone levels and _______
incidence of prostate cancer
115
studies suggest no risk in administering testosterone to men with _____
prostate cancer
116
Montitoring low T includes
weight, peripheral edema, gynecomastia, BPH, sleep problems, libido, lab test (testosterone, Hgb/Hct, PSA, estradiol, Liver function)
117
There is some studies that believe testosterone is associated with
increased risk of cardiac events. controversial at best
118
Bioavailable testosterone levels ____ with each decade
diminish

Exam 9 (8 decks)

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