men's health

Question 1

post-void residual normal and abnormal volumes

Answer 1

normal is less than 50-100

abnormal is over 200

Question 2

normal and abnormal urine velocity

Answer 2

normal is 20-25 ml/sec

abnormal is less than 12-15 ml/sec

Question 3

neurologic control of bladder

Answer 3

PSNS (ACh, M3) causes detrusor constriction and bladder emptying
SNS (adrenergic) facilitates urine storage (B2 and B3-R in detrusor -> relaxation; alpha-1 in internal sphincter -> contraction)
somatic control via pudendal nerve

Question 4

behavioral modifications for tx of urinary incontinence

Answer 4

toilet assistance - regular scheduling, caregiver
bladder training - education, scheduled voiding, positive reinforcement
pelvic mm rehab (Kegel)
biofeedback

Question 5

MOA of drugs for overactive bladder

Answer 5

stop spontaneous detrusor contractions - anti-ACh

Question 6

differences in drugs for OAB

Answer 6

muscarinic receptor specificity, lipophilicty (CNS effects), metabolism, and dosage form

Question 7

oxybutinin

Answer 7

anti-ACh for OAB
most ACh ADRs (dry mouth, etc.)
available short- and long-acting oral tabs, transdermal patches, topical gel

Question 8

tolterodine

Answer 8

anti-ACh for OAB

more selective M3-blocker vs oxybutinin

Question 9

trospium

Answer 9

anti-ACh for OAB

Question 10

fesoteridine

Answer 10

anti-ACh for OAB

Question 11

solifenacin

Answer 11

anti-ACh for OAB

Question 12

darifenacin

Answer 12

anti-ACh for OAB

Question 13

mirebegron

Answer 13

first oral B3 agonist for OAB

Question 14

onabotulinumtoxinA

Answer 14

injected into detrusor during cystoscopy to block ACh release at NMJ for OAB
lasts 19-24 weeks

Question 15

drugs that can cause or exacerbate urinary incontinence

Answer 15

urinary retention: anti-ACh, anti-depressants, anti-psychotics, B-agonists, CCB, opioids
polyuria, freq, urgency: EtOH, caffeine, diuretics
urethral relax: a-blockers
mm relaxer: sedatives, hypnotics

Question 16

tissues of prostate

Answer 16

epithelial/ glandular: makes secretions, under androgen control
stroma: SM with a1-receptors

Question 17

5-a-reductase

Answer 17

converts testosterone to DHT in prostate, beginning at puberty -> rapid growth and enlargement of prostate

Question 18

normal and BPH ratio of stroma:epithelial tissue

Answer 18

normal 2:1, BPH 5:1

Question 19

drugs for BPH

Answer 19

non-selective a1-blockers, selective a1-blockers, 5a-reductase inhibitors, PDE5 inhibitors, herbal products

Question 20

doxazosin

Answer 20

non-selective a1-blocker for BPH

Question 21

terazosin

Answer 21

non-selective a1-blocker for BPH

Question 22

alfuzosin

Answer 22

non-selective a1-blocker for BPH

Question 23

tamsulosin

Answer 23

selective a1-blocker for BPH

*may cause “floppy iris syndrome” - don’t give before cataract surgery

Question 24

silodosin

Answer 24

selective a1-blocker for BPH

Question 25

finasteride

Answer 25

5a-reductase inhibitor for BPH | *caution in pregnancy: anti-androgenic effects

Question 26

dutasteride

Answer 26

5a-reductase inhibitor for BPH | *caution in pregnancy: anti-androgenic effects

Question 27

tadalafil

Answer 27

PDE5 inhibitor for BPH | *interacts with a1-blocker -> hypotension

Question 28

saw palmetto

Answer 28

herbal product used for BPH

Question 29

acute prostatitis: pathogens and tx

Answer 29

similar pathogens as those that cause UTIs, identify with urine culture 4 wk therapy of TMP-SMX or FQs if allergy or if G- bacteria (not sensitive to TMP-SMX)

Question 30

PDE5 MOA

Answer 30

prevents breakdown cGMP, which decreases cellular Ca in arterial SM in penis -> SM relaxation = inflow of blood into intercavernosal trabeculae = erection

Question 31

sildenafil

Answer 31

PDE5 inhibitor for ED

Question 32

ADR sildenafil

Answer 32

common: HA, facial flushing, nasal congestion, dyspepsia severe: priapism, hearing loss, vision disturbance (blue), sudden vision loss

Question 33

sildenafil drug interactions

Answer 33

CI with nitrates like NTG, isosorbide -> too much cGMP = hypotension caution with CYP 3A4 inhibitors = increased drug level and ADRs

Question 34

tadalafil

Answer 34

PDE5 inhibitor for ED

Question 35

ADR tadalafil

Answer 35

common: flushing, HA, congestion, dyspepsia unique: back pain or muscle aches (PDE11 inhibition in sk mm) vision disturbances rare compared to other PDE5 inhibitors

Question 36

meds that can cause ED

Answer 36

BBs, central anti-HTN (clonidine, methyldopa), digoxin, spironolactone, thiazides, most antidepressants, typical antipsychotics, anticonvulsants, lithium, 5a-reductase inhibitors, EtOH, cimetidine, opioids, corticosteroids

Question 37

FDA-approved drugs for low testosterone

Answer 37

NONE for low T without associated medical condition

Question 38

primary hypogonadism

Answer 38

late-onset, "andropause" slow loss of T is natural in aging s/s: loss of libido, impotence, loss mm mass and strength, fatigue, depression, inability to concentrate

Question 39

secondary hypogonadism

Answer 39

causes include obesity, metabolic syndrome, DM, some meds

Question 40

who should be treated with testosterone replacement therapy

Answer 40

should only be men with clinical symptoms and low T levels (less than 200; normal 270-1070)

Question 41

oral testosterone product use

Answer 41

rarely used d/t hepatic effects

Question 42

forms of artificial testosterone

Answer 42

oral (rarely used), depot injection, TD patch, TD gel, TD solution, subQ pellets, buccal tablet

Question 43

adverse effects of T replacement therapy

Answer 43

increased prostate and breast ca, inc prostate growth, polycythemia, infertility, hepatic toxicity, CV toxicity, thrombophlebitis, lower HDL