thera II test III guy junk

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thera II test III guy junk
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  1. mild classificatino of BPH
    • <7 AUA score
    • asymptomatic
    • peak urinary flow rate <10mL/s
    • postvoid residual urine volume >25-50ml
  2. moderated classification of BPH
    • 8-19 AUA score
    • obstructive voiding symptoms
    • irritative voiding symptoms
  3. severe classification of BPH
    • > 20 AUA score
    • one or more complication of BPH
  4. 4  drug groups that exacerbate BPH
    • alpha adrenergic agonist
    • testosterone replacement therapy
    • anticholinergic agents
    • diuretics
  5. anticholinergic agents that exacerbate BPH
    • antihistamines
    • phenothiazines
    • TCA's
    • Parkinson's meds
  6. alpha adrenergic agents that exacerbate BPH
    • pseudoephedrine
    • ephedrine
    • phenylephrine
  7. 5 behavior modifications for BPH
    • restricting fluids close to bedtime
    • minimize caffeine
    • minimize alcohol
    • frequent emptying of bladder while awake
    • avoiding exacerbating meds
  8. which BPH pts would benefit from behavior modifications
    mild asymptomatic w/o complications
  9. pharmacologic therapy for BPH
    • alpha1 adrenergic receptors
    • 5a reductase inhibitors
    • combination therapy
  10. what group would benefit from pharmacologic therapy for BPH
    moderate to severe symptoms or bothersome symptoms
  11. effects of alpha adrenergic antagonists
    • improve AUA score by 30-40% in 2-6 weeks
    • increase urinary flow rate by 2-3mL
    • reduce postvoid residual volume
  12. 2nd gen alpha adrenergic antagonist
    • prazosin
    • alfuzosin
    • terazosin
    • doxazosin
  13. 3rd gen alpha adrenergic antagonist
    tamsulosin
  14. advantages of 3rd gen alpha 1 antagonist
    • selective for prostate receptors
    • do not cause hypotension
    • no titration in necessary
  15. disadvantage of 2nd gen alpha 1 adrenergic antagonists
    • peripheral vascular as well
    • first dose syncope
    • orthostatic hypotension
    • dizziness
    • titrate over several weeks
  16. 2 2nd gen a1 antags to take at bedtime
    • terazosin
    • doxazosin
  17. 2 2nd gen a1 antag that come in extended release
    • doxazosin
    • alfuzosin
  18. 2nd gen a1 antag that is uroselective
    alfuzosin
  19. condition associated with doxazosin and tamsulosin
    floppy iris syndrome
  20. effects of 5a reductase inhibitor for BPH
    • reduce prostate size by 25%
    • increae peak urinary flow by 1.6-2mL/s
    • improve voiding in 1/3 of pts
    • slow disease progressoin
  21. drug to inhibit type II 5a reductase
    finasteride
  22. drug to inhibit type I & II 5a reductase
    dutasteride
  23. 3 irritating symptoms of BPH
    • urinary frequency
    • urinary urgency
    • nocturia
  24. 4 obstructive symptoms of BPH
    • decreased force of stream
    • hesitancy
    • straining
    • intermittency
  25. 80% of cases of ED are caused by what
    • organic
    •   vascular
    •   neurologic
    •   hormonal
  26. 3 causes of ED
    • organic
    • psychogenic
    • drug induced
  27. management approach for a pt who is at a high risk of cardiovascular even and has ED
    phosphodiesterase inhibitro is CI and sexual intercourse should be deferred
  28. what is responsible for 10-25% of ED cases
    drug induced
  29. 6 drug groups that can play a part in ED
    • anticholinergic
    • suppressors of libido
    • CNS depressants
    • reduced blood flow
    • inhibitors of prolactin
    • other
  30. anticholinergics which can cause ED
    • antihistamines
    • TCA
    • phenothiazines
  31. 3 libido suppressing drugs that can cause ED
    • estrogen
    • digoxin
    • spironolactone
  32. 4 CNS depressants that attribute to ED
    • narcotics
    • benzos
    • alcohol
    • anticonvulsants
  33. 3 groups that cause reduced blood flow to corpora and ED
    • diuretics
    • beta blockers
    • central sympatholytics
    •  
  34. 2 central sympatholytics that can attribute to ED
    • methyldopa
    • clonidine
  35. 2 DA antagonist that could contribute to ED
    • metoclopramide
    • phenothiazines
  36. 4 "other" drugs that can attribute to ED
    • finasteride
    • lithium
    • gemfibrozil
    • clofibrate
    • MAO I
  37. AE's of VED
    • discolored penis
    • cool to touch
    • numb
  38. warnings/precautions with VED's
    • CI in sickle cell disease - priapism
    • pts on oral anticoagulants - priapism
  39. 3 PDE-5 inhibitors
    • sildenafil - viagra
    • vardenafil - levitra
    • tadalafil - cialis
  40. PDE-5 I, with no efffect on PDE6 (eyes)
    tadalafil - cialis
  41. PDE-5 I with no effect on PDE-11 (skeletal muscle)
    • sildenafil - viagra
    • vardenafil - levitra
  42. PDE-5I that needs to be taken 2 hrs before meals
    sildenafil - viagra
  43. PDE-5 inhibitor without decreased absorption by fatty meal
    tadalafil - cialis
  44. PDE-5I with longest duration of action
    tadalfil - cialis
  45. PDE-5I showing increased success with daily dosing compared to as needed dosing
    tadalafil - cialis
  46. common adverse events from PDE-5I are caused by what mechanism
    • vasodilation
    •   headache
    •   facial flushing
    •   nasal congesion
    •   hypotension
    •   back and limb pain (tadalafil)-PDE11
    •   dizziness
  47. 2 main vision related AE's from sildenafil and vardenafil
    • loss of blue-green color discrimination
    • nonarteritic anterior ischemic optic neuropaty (NAION) - sudden unilateral painless blindness
  48. some risk factors for NAION
    • glaucoma
    • macular degeneration
    • diabetic retinopathy
    • HTN
    • previous eye surgery or eye trauma
    • > 50 yo
    • smokers
  49. PDE5I showing QT prolongation
    vardenafil - levitra
  50. 3 drug interactions with PDE5I
    • NITRATES
    • a-adrenergic antagonists
    • CYP3A4 inducers and inhibitors
  51. nitrates with tadalafil and (sildenafil & vargenafil)
    • withhold nitrates for 48 hours after
    • withhold nitrated for 24 hours after
  52. 2nd line therapy for ED
    intracavernosal alprostdil
  53. 3rd line therapy for ED
    intraurethral alprostadil
  54. AE of intraurethral aprostadil to be noted
    • female sexual partners will experience side effects as well
    •   burning
    •   itching
    •   pain
  55. primary cause of testosterone deficiency
    testicular failure
  56. secondary cause of testosterone deficiency
    pituitary and/or hypothalamic failure
  57. when is the best time to test testosterone levels
    morning before 10 - regulated by circadian rhythm
  58. normal testosterone levels
    9-30 ng/dL
  59. 3 main general risks of testosterone replacement
    • breast cancer
    • prostate cancer
    • increased hematocrit
  60. 2 special populations to consider with testosterone replacement
    • HIV infect men - short term therapy to promote weight maintenance
    • glucocorticoid-treated men - promotes preservation of lean body mass
  61. 3 other cases to avoid testosterone therapy
    • untreated severe obstructive sleep apnea OSA
    • severe lower urinary tract symptoms LUTS
    • uncontrolled heart failure
  62. 3 options for premature ejaculation
    • SSRI's
    • TCA's
    • topical anesthetics
  63. 3 SSRI's for premature ejaculation
    • fluoxetine - prozac
    • paroxetine - paxil
    • sertraline - zoloft
  64. TCA for premature ejaculation
    clomipramine - anafranil
  65. 3 SSRI's not effective for premature ejaculation
    • nefazadone
    • citalopram - celexa
    • fluvoxamine - luvox

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