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When does incidence of ED increase in men over 50-50 yo and goes to 40% 60-69%
Med conditions associated with ED HTN, Arterosclerosis, hyperlipedimia, DM, Psych d/o
Meds that cause erectile dysfunction anticholinergic agents, Dopamine, agonists, estrogents, antianderogens, CNS depressants, agents decrease penile blood floow (anti HTN drugs)
In general, how do we approach ED tx identify and reverse underlying cause
Nonparhm tx to ED lifestyle modifications (lipids), psychotherapy, vacuume erection device, surgical tx (penile prosthesis)
What is the main drug of choice for ED Phosphodiesterase inhibitors
MOA of PDE5 inhibits the breakdown of cGMP which prolongs smooth muscle relaxation (vasodilation)
3 examples of PDE5 sildenafil, vardenafil, tadalafil (all substrate of CYP systems)
Which PDE5i works the fastest? sildenafil (30-60m)
Which drug is a weak CYP inhibitor sidenifil
Which is the longer acting PDEi and when do we use it Tadalafil (Cialis) works up to 36 hours
Dosing for tadlafil 10mg prior to sex or 2.5mg qday for pts who take the other >2/week
AE’s PDEi HA, facial flushing, dyspepsia, nasal congestion dizzy, abnl vision
What is a prolonged erection and priapism >4hrs, >6hrs
What are some serious but rare SE’s priapism, and anterior ischemia of the optic neropathy
With sildenafil-assicaited deaths, what did most pts die from? MI, or CA, CV
What is CI with using PDEs nitrate use, and high CV risk
What drugs are CI with PDEs nitrates, alpha blockers, CYP inhibitors
What is the OTHER drug that is used for ED alprostadil: stimulates adenyl cyclase: ↑production of cAMP→vasodialation
Two types of dosing caverjet: intracavernosa: 5-10mins before, Muse (intraurethral)
AE’s of alprostadil local pain, syncope, dizzy, priapism, fibrotic rxn in injection site (caverjet)
Algorithym for ED organic: PDEi→intracavernosal alprostadil→intraurethral alprostadil→penile prosthesis
Three mechanisms for BPH excess testosterone, excessive a-adrenergic tone, bladder detrusor muscle instability
Drugs that ↑ bBPH testosterone, anticholinergics, symptahomimetics
What are examples of antihistamines 1st generation antihistamines, phenothiazines, TCAs: ↓ detrusor contractility
Examples of sympathomimetics and their action pseudoephedrine, oxymetazoline, phenylephdrine: excess a-adrenergic tone of prostate and bladder neck
AUA sx score for mild, mod, sever mild <7 Mod 8-19 severe: >20
Mild typical s/s for BPH peak urin flow rate <10ml/s, postvoid residual>25-50, ↑ BUN and SCr
Mod s/s for BPH same as mild + obstructive voiding sxs and irritative voiding (signs of detrusor instability)
Severe sigsn of BPH all above + more complications of BPH
Tx goals for BPH ↓ sxs, ↓ dz progression, prevent complications
BPH compliications post-renal/chronic renal failure, infx, hematuria, bladder stones
Tx for mild, mod, sev mild: watchful waiting mod: pharm tx severe: surgery
Three catagories for BPH tx a1 and a1a blockers: relax smooth muscle and may ↓ prostate size, 5-areductase inhibitor: ↓ conversion of testosterone to DHT, Herbals
How long does a1 and a1a onset usually take 2-4wekks
What is 1st line for moderate dz a1 a1A blockers
What is the MC a1 and a1A drug a1: terazosin a1A: tamsulosin
Which drug is most likely to cause abnl ejaculation silodosin: a1A blocker
What is finasteride, used when 5a-reductase inhibitor , when prostate >50g
Name two herbals can be used for BPH, which one more effective Beta-sitosterol pygeum, saw palmetto, 1st better
Onset of action for 5a-reductase inhibitors 6m may cause ↓ libido
What may ↑ tx effective ness combination drugs (dutasteride/tamsuloxin: jalyn)
Three mechanisms for urinariy incontinence Detrusor muscle control, internal and external urethral sphincter
What controls the detrusor muscle both parasympathetics and B-adrenergic
What contraols the internal urethral sphincter alph-adrenergic
What controls the external urethral sphincter somatic or voluntary control
Is incontinence a nl part of aging no, age predisposes, but doesn’t cause
4 types of incontinence urge, stress, overflow, functional
What is not caused by bladder or urethra-specific factors for incontinence functional
Causes/rf’s for UI (diappers) delirium, infx, atrophic urethritis/vaginitis, pharm, psych, excessive uring output, restricted mobilitys, stool imbaction
What drugs can cause urinary retention CCBs, narcotics, antipsychotics, anticholinergics, a-receptor antagonist(men)
What are diruetics to avoid for UI alcohol and caffeine
What are s/s of urge (bladder overactivity) loss of mod-lg vols of urine w/ intense need to void
Three drug classes for urge incontinence anticholinergics, TCAs, topical estrogen (only w/ urethritis or vaginitis)
What is 1st line for urge incontinence anticholinergics
What are anticholinergics used oxybutynin, tolterodine
s/s of stress (uretheral underactivity) loss of sm vols of urine, from ↑ abd pressure
classes for stress UI 5-HT/NE reuptake inhibitar: smooth muscle control: a-adrenergic agonists, topical estrogen, imipramine
1st line for strees UI duloxetine, (alternative is a-adrenergics: pseudophedrine) imipramine 2nd line
What are s/s for overflow/urethral overactivity, bladder underactivity weak stream, dribbline ↑ frequency and incomplete voiding
Tx for above Cholinomimetics: bethanechol: short term use only
What are CI for bethanechol heart dz or asthma
s/s for functional UI and tx impaired mobility, cognitive impairment: scheduled bathroom breaks
Created by: becker15