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704 Geriatrics > Urology > Flashcards

Urology Flashcards

1
Q

What drugs can affect continence?

A
  • a-agonists/antagonists
  • Alcohol
  • Anticholinergics
  • CCB
  • Diuretics
  • Narcotics
  • Antidepressants
  • Antipsychotics
  • Sedative/hypnotics
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2
Q

What exams should be done for incontinence?

A
  • Digital rectal/pelvic exam
  • Neuro exam
  • PVR
  • Cystoscopy
  • U/A with micro
  • Serum BUN/Cr
  • PSA
  • History
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3
Q

What is desmopressin nasal spray (Noctiva) for?

A

Nocturnal polyuria adults (awakening 2x per night)

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4
Q

What monitoring should be done for Noctiva?

A

Na+ (can cause hyponatremia)

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5
Q

What are some causes of urge incontinence (AOB)?

A
  • a-blockers in women
  • Estrogen use in women
  • Cystitis
  • Stones
  • Tumor
  • Neurologic issues***
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6
Q

How should we treat OAB?

A

Smooth muscle relaxants (anti-muscarinic)

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7
Q

Which anti-muscarinic drugs have low BBB crossing?

A
  • Trospium
  • Tolterodine
  • Fesoterodine
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8
Q

Which anti-muscarinic drugs are better and why?

A

Darifenacin and Solifenacin

They are M3 specific, which causes less CNS side effects

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9
Q

What are dose-dependent side effects of smooth muscle relaxants?

A
  • Anticholinergic stuff
  • Confusion/delirium/dementia**
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10
Q

What is the hierarchy for smooth muscle relaxant drugs for OAB?

A
  1. Solifenacin (best efficacy and low dry mouth risk)
  2. ER tolterodine (less risk of dry mouth than IR)
  3. Fesoterodine (good efficacy but has dry mouth and high risk of discontinuation)
  4. IR tolterodine (less risk of dry mouth than oxybutynin)
  5. Oxybutynin (just sucks in general)
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11
Q

What are the best smooth muscle relaxant drugs for OAB?

A

Solifenacin and ER tolteradine

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12
Q

Who should not use imipramine or other TCAs for OAB?

A

Elderly at risk for orthostasis, cardiac arrhythmias, or other anti-cholinergic effects

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13
Q

When is Botox indicated for OAB?

A

Failure or intolerance to anticholinergic medication for NEUROLOGIC-related OAB

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14
Q

What is the biggest problem with Botox for OAB?

A

High infection risk and transient urinary retention

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15
Q

When should Mirabegron be avoided and why?

A

Those with high blood pressure

It can cause sinus tachycardia and hypertension

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16
Q

Vibegron is well-tolerated, but what are the biggest concerns with it?

A

Infections
- URI, UTI, bronchitis, nasopharyngitis

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17
Q

What benefit does vibegron have over mirabegron?

A

NO BP WARNING!!

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18
Q

What is the 1st line treatment for OAB?

A

Behavioral therapies

+/- pharm if necessary

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19
Q

T/F: Antimuscarinics and B3-agonists should be avoided together

A

FALSE: can be used together for refractory cases

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20
Q

What are some treatments for stress incontinence? (increase intra-urethral pressure)

A
  • Pseudoephedrine
  • Midodrine
  • Estrogen (vaginal application)
  • Duloxetine 40 mg BID (OFF-LABEL)
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21
Q

How can we treat overflow incontinence?

A

Bethanechol
- increase bladder tone but efficacy in question

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22
Q

What are symptoms of BPH?

A
  • Incomplete emptying
  • Frequency
  • Intermittency
  • Urgency
  • Weak stream
  • Straining
  • Nocturia
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23
Q

What are non-pharm options for BPH?

A
  • Incontinent pads
  • TURP
  • Urethral dilation
  • Foley catheters
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24
Q

What is the hierarchy for a-1 blockade strength of BPH drugs?

A

Terazosin > doxazosin > prazosin

25
Q

T/F: Alpha blockade drugs can be used to treat BPH AND lower blood pressure

A

FALSE: they have been proven ineffective for lowering BP

26
Q

What are adverse effects of a-1 blockers?

A
  • Postural hypotension
  • Dizziness/vertigo
  • Blurred vision
  • Drowsiness
  • Asthenia (weakness)
  • “First dose” effect (syncope)
27
Q

What is the potency hierarchy for a1A-selective blockers?

A

Silodosin&raquo_space; Alfuzosin ~ Tamsulosin

28
Q

Which a1A-blockers cause the most and least ejaculatory dysfunction?

A

Silodosin causes the most

Alfuzosin does not cause it

29
Q

What are the 5-a reductase drugs we have for BPH?

A

Finasteride (type II, <50% symptom improvement)
Dutasteride (type I and II, more potent)

30
Q

How long does finasteride therapy last?

A

3-6 months

31
Q

Between finasteride and dutasteride, which drug has more symptom improvement?

A

Dutasteride

32
Q

Which drugs should be avoided in BPH and why?

A
  • TCAs
  • Diphenhydramine
  • Disopyramide
  • Pseudoephedrine
  • Ephedrine
  • Anticholinergics

THEY CAUSE URINARY RETENTION - harder to contract detrusor muscle

33
Q

What drug combo may be better than monotherapy to treat UT symptoms and erectile dysfunction

A

Sildenafil and alfuzosin

34
Q

What is ENTADFI?

A

The first FDA approved combo product with finasteride and tadalafil

35
Q

T/F: Saw Palmetto is ineffective for BPH

A

TRUE

36
Q

When should we try a PDE5 for BPH?

A
  • Initial therapy if the patient also has ED
  • After failing an alpha blocker
37
Q

When should we consider 5ARI addition for BPH?

A

Prostate >30cc

38
Q

What is last-line therapy for BPH?

A

Surgery

39
Q

What is the questionnaire used to categorize ED?

A

IIEF-5

40
Q

What are risk factors for ED?

A
  • Diabetes
  • Tobacco
  • Lower urinary tract symptoms
  • CV disease
  • Depression/stress
41
Q

What drugs can cause ED?

A
  • Thiazide diuretics
  • Beta blockers (not nebivolol)
  • Cardiac/cholesterol drugs
  • Antidepressants
  • H2 antagonists
  • Hormones
  • Recreational drugs
  • Anticholinergics
  • Immunomodulators
  • Cytotoxic drugs (cancer)
  • Tranquilizers
  • Sedative hypnotics
  • Opioids*
  • Long-term NSAIDs*
42
Q

T/F: Number of medications has a positive association with ED

A

TRUE

43
Q

What is the first-line drug class for ED pharmacotherapy?

A

PDE-5

44
Q

When should PDE5 dose reductions be necessary?

A

With CYP3A4 inhibitors

45
Q

What are contraindications to PDE5 therapy?

A
  • Concomitant nitrate therapy
  • Uncontrolled HTN
  • Severe congestive HF
  • Recent MI
  • Heart disease
  • High-risk arrhythmias
  • Obstructive cardiomyopathy
  • Unstable angina
46
Q

What are precautions with PDE5?

A
  • Hypotension
  • Additive effects with a-blockers
  • Can cause GERD
47
Q

What PDE5 has the shortest onset?

A

Avanafil

48
Q

What PDE5 has the longest onset?

A

Vardenafil

49
Q

What is the longest acting PDE5?

A

Tadalafil

50
Q

Which PDE5 has the most vision changes associated?

A

Sildenafil (3-11%)

51
Q

What is “the little blue pill” or “Vitamin V”?

A

Sildenafil

52
Q

What is “the weekender”?

A

Tadalafil

53
Q

What is “the quickie”?

A

Avanafil

54
Q

What PDE5s are affected by high fat meals?

A

Sildenafil and Vardenafil

55
Q

What is first line treatment for erectile dysfunction?

A
  • Treat underlying disease
  • Discontinue contributing medications
  • Remove risk factors
  • Give testosterone for hypogonadism
56
Q

Patient says PDE5 is not working. What should you do?

A
  • Make sure they get the timing correct
  • Let them know they can take up to 8 doses until effect
  • Consider titrating up dosage
57
Q

What is second-line pharmacotherapy for ED?

A
  • Vacuum erection device
  • Intracavernosal or intraurethral alprostadil
58
Q

What are other possible drug therapy options for ED?

A
  • Yohimbine, Phentolamine (adrenergic agonists)
  • Androgens
  • Apomorphine
  • Trazodone*

704 Geriatrics (8 decks)

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