Urology Drugs

Question 1

What 5 classes of drugs can contribute to BPH symptoms?

Answer 1

Antihistamines (BENADRYL!), decongestants, diuretics, opiates, and tricyclics

Question 2

What are the 3 categories of drugs used to treat BPH?

Answer 2

Alpha blockers
5-alpha reductase inhibitors
Phosphodiesterase-5 inhibitors

Question 3

What is the MOA of 5-alpha reductase inhibitors?

Answer 3

Interfere with testosterone stimulation by blocking formation of DHT, allow prostate to shrink

Question 4

What is the MOA of phosphodiesterase-5 inhibitors?

Answer 4

Allow smooth muscle relaxation

Question 5

What drugs do you use in patients with BPH and ED?

Answer 5

Alpha blocker, phosphodiesterase 5 inhibitors, or both

Question 6

What drugs do you use in patients with enlarged prostate?

Answer 6

5-alpha reductase inhibitors

or 5-alpha reductase inhibitor and an alpha blocker

Question 7

What drugs do you use in someone with a small prostate?

Answer 7

Alpha blockers

Question 8

What drugs do you use in patients with predominant irritative voiding symptoms?

Answer 8

Alpha blocker and anticholinergic agents

Question 9

Drug class: Terazosin

Answer 9

Alpha blocker

Question 10

Drug class: Doxazosin

Answer 10

Alpha blocker

Question 11

Drug class: Alfuzosin

Answer 11

Alpha blocker

Question 12

Drug class: Tamsulosin

Answer 12

Alpha blocker

Question 13

Drug class: Silodosin

Answer 13

Alpha blocker

Question 14

Which alpha blockers are second generation?

Answer 14

DTA

Doxazosin, terazosin, alfuzosin

Question 15

Which alpha blcokers are third generation?

Answer 15

TSA

Tamsulosin, Silodosin, Alfuzosin

Question 16

Which drugs do you have to take with a meal?

Answer 16

Alpha blockers, specifically third generation:

Tamsulosin, Silodosin, Alfuzosin

Question 17

True or false: Titration is necessary for alpha blockers

Answer 17

True, except for Alfuzosin

Question 18

Which drugs should be taken at bedtime?

Answer 18

Alpha blockers, so you can sleep through the side effects

Question 19

How long does it take to see symptom improvement with alpha blockers?

Answer 19

Within one week

4-6 point improvement in IPSS

Question 20

Which drugs are associated with floppy iris syndrome?

Answer 20

Alpha blockers:

Tamsulosin, Terazosin, Doxasozin

Question 21

What size should a prostate be for a pt to be put in a 5-alpha reductase inhibitor?

Answer 21

40 mL

Question 22

Drug class: Finasteride

Answer 22

5-alpha reductase inhibitor

Question 23

Drug class: Dutasteride

Answer 23

5-alpha reductase inhibitor

Question 24

How long do 5-alpha reductase take to work?

Answer 24

May take months

Less effective than alpha blockers

Question 25

What are side effects associated with 5-alpha reductase inhibitors?

Answer 25

Related to libido, decreased ejaculation function/ED

Question 26

Which drugs should not be handled by women of child bearing age?

Answer 26

5-alpha reductase inhibitors (Finasteride, dutasteride)

Question 27

Which drugs could interfere with PSA levels?

Answer 27

5-alpha reductase inhibitors (decrease PSA by 50%)

Question 28

How do phosphodiesterase-5 inhibitors improve BPH?

Answer 28

Reduce LUTS related to BPH

Question 29

Drug class: Tadalafil

Answer 29

Phosphodiesterase-5 inhibitor

Question 30

Drug class: Sildenafil

Answer 30

Phosphodiesterase-5 inhibitor

Question 31

When is combination therapy appropriate for BPH?

Answer 31

When patient has LUTS and an enlarged prostate (use dutasteride + tamsulosin)

Question 32

What drugs are used to treat incontinence?

Answer 32

Antimuscarinic agents, Botulinum Toxin Type A injection, Beta-3 agonist

Question 33

Drug class: Oxybutynin

Answer 33

Antimuscarinic

Question 34

Drug class: Tolterodine

Answer 34

Antimuscarinic

Question 35

Drug class: Solifenacin

Answer 35

Antimuscarinic

Question 36

Drug class: Darifenacin

Answer 36

Antimuscarinic

Question 37

Drug class: Trospium

Answer 37

Antimuscarinic

Question 38

Drug class: Festoterodine

Answer 38

Antimuscariic

Question 39

Which formulations should be used for incontinence?

Answer 39

Long acting! Less side effects | But not more effective than short acting!

Question 40

What should you do if a patient is experiencing side effects from their incontinence medications?

Answer 40

Reduce dose, change formulation to extended release, or change dosage form

Question 41

Drug class: Onabotulinumtoxin A

Answer 41

Botulinum Toxin injection for urinary incontinence

Question 42

Dosing for Onabotulinumtoxin A

Answer 42

100 units IM over 20 injections 1 cm apart | Repeat every 3 to 9 months

Question 43

Drug class: Myrbetriq

Answer 43

Beta 3 Agonist

Question 44

How does Myrbetriq work?

Answer 44

Acts at the beta 3 receptors in the bladder to mediate smooth muscle relaxation Improves urine storage by increasing bladder capacity

Question 45

What do you have to worry about with beta 3 agonists?

Answer 45

Increased blood pressure

Question 46

Dosing of Myrbetriq?

Answer 46

25 mg once daily, increased to 50 mg after 8 weeks

Question 47

When should a BPH patient receive an anticholinergic drug?

Answer 47

When patient still has symptoms of urgency and frequency after treatment with alpha blocker or 5-alpha reductase inhibitors Men with 8+ voids per day, 3+ episodes of urgency, or have post-void residual urine monitored