Women's Heath & Male Health

bladder overactivity- yes

urethral underactivity- sometimes

How does urgency incontinence present:

bladder overactivity-

urethral underactivity-

bladder overactivity- no

urethral underactivity- yes

How does leaking during PA (coughing, sneezing, lifting) present:

bladder overactivity-

urethral underactivity-

bladder overactivity- no or just barely

urethral underactivity- yes

How does the ability to reach the toilet in time following urgency to void present:

bladder overactivity-

urethral underactivity-

bladder overactivity- usually

urethral underactivity- seldom

How does Nocturia present:

bladder overactivity-

urethral underactivity-

Diuretics

Alpha-receptor antagonists/agonists

Calcium channel blockers

Narcotics

Sedative hypnotics

Antipsychotics

Anticholinergics

TCAs

Alcohol

ACEi

What are some medications that can impact urinary function?

Lifestyle changes- Fluids, caffeine, smoking cessation, weight loss

Pelvic floor rehabilitation

Toilet scheduling

Devices

Adjunctive use of absorbency products

What are the nonpharm treatment options for urinary incontinence (1st line over pharm!!)?

Estrogens (topical vaginal therapy that improves urethral tone)

What is the 1st line tx for Stress urgency incontinence?

· limit contractions of the detrusor muscle by targeting M3 receptors

What is the MOA of antimuscarinics?

Beta-3 agonist that relaxes the detrusor muscle

What is the MOA for Mirabegron?

Antimuscarinics or Mirabegron

What medications can be used to treat Urge urinary incontinence or Overactive bladder?

dry mouth, dry eyes/blurry vision, urinary retention, constipation, tachycardia

What are the peripheral anticholinergic side effects associated with antimuscarinics?

sedation, dizziness, cognitive impairment

What are the central anticholinergic side effects?

oxybutynin

What antimuscarinic used to treat OAB/UUI can cause dry mouth or cognitive impairment?

tolterodine

What antimuscarinic is better tolerated?

darifenacin

What antimuscarinic can cause Low cognitive impairment, high rate constipation?

solifenacin

What antimuscarinic has modest M3 activity over M2 and M1--- but has a higher rate for dry mouth?

increased BP, must be renally adjusted

What are the AEs associated with mirabegron?

mirabegron

What medication is used to treat OAB w/ sx of UUI, urgency, and urinary frequency that can be used as a monotherapy or with Solifenacin (antimuscarinic)?

Symptomatic Control

o NSAIDs (Naproxen/Ibuprofen)

Continuous Dosing of Contraceptives

o Progestins- oral POP, MPA IM, LNG IUD

o CHCs

What is the 1st line therapy for endometriosis?

clomiphene citrate

What is the 1st line medication used to induce ovulation?

N/V, breast tenderness, BV, flushing, thrombus formation, multiple births

What are the ADEs associated with Clomiphene Citrate?

Selective estrogen receptor modulator

(SERM)

What class of drug is Clomiphene Citrate?

efficacy (midluteal serum progesterone 8-10 to confirm ovulation)

What should be monitored when on Clomiphene Citrate to induce ovulation?

PCOS

What is the leading cause of anovulatory infertility?

combined oral contraceptives

What is the tx for a PCOS pt with:

menstrual irregularities

hirsutism and/or acne

progestogens

What is the tx for a PCOS pt with:

menstrual irregularities

insulin sensitizers

infertility- metformin only

What is the tx for a PCOS pt with:

menstrual irregularities

infertility

WL

antiandrogens (spironolactone, finasteride)

What is the tx for a PCOS pt with:

hirsutism and/or acne

clomid or letrozole

What is the tx for a PCOS pt with:

infertility

testosterone

What is the mainstay of therapy for transgender men?

estrogen

What is the backbone of transgender therapy for women?

increased risk of VTE and mortality

When should ethinyl estradiol NOT be used?

17-Beta estradiol

What is the MC used bioidentical form of estrogen used for transgender women therapy?

Spironolactone or Cyproterone Acetate-

What are the two antiandrogenic agents used to inhibit the production of testosterone?

Alpha adrenergic agonists= Decongestants

Anticholinergics- Antihistamines, tricyclic antidepressants, antispasmodics, phenothiazines

Diuretics

Testosterone

What aggravative medications should be AVOIDED in a pt with BPH?

alpha-1 adrenergic antagonists

2nd gen= "-ZOSIN"

Terazosin, Doxazosin, Alfuzosin

3rd gen= "-OSIN"

tamsulosin, silodosin

What medication used for BPH has this MOA:

relax prostatic SM in the prostate and bladder neck --> enhancing urinary outflow from the bladder

nonselective

What is the alpha 1 selectivity of 2nd gen alpha 1 adrenergic antagonists:

prazosin, terazosin, doxazosin, alfuzosin

selective

What is the alpha 1 selectivity of 2nd gen alpha 1 adrenergic antagonists:

tamsulosin, silodosin

first-dose syncope, orthostatic hypotension, dizziness, headache, fatigue, nasal congestion, abnormal ejaculation

What are the ADEs associated with alpha 1 adrenergic antagonists?

Strong CYP3A4 inhibitors and inducers

Phosphodiesterase inhibitors

What are the D-D interactions with alpha- 1 adrenergic antagonists?

floppy iris syndrome

What can occur due to blockage of alpha 1- adrenergic receptors in iris dilator muscles?

5 alpha reductase inhibitors

"-STERIDE"

Finasteride and Dutasteride

What class of medications has this MOA:

interferes with testosterone's stimulatory effect on prostate gland enlargement --> reducing prostate size, improving voiding symptoms, and slows disease progression

6mo

What is the onset of 5 alpha reductase inhibitors used to treat BPH?

Impotence, ↓ libido, ejaculation disorders, breast enlargement and tenderness

What are some key ADEs associated with 5 alpha reductase inhibitors (-STERIDE)?

pregnancy!

What are 5-alpha reductase inhibitors (-STERIDE) contraindicated in?

relax prostatic SM in the prostate, urethra, bladder neck, and pelvic BVs

What is the MOA of PDE inhibitors?

headache, flushing, gastroesophageal reflux, sinusitis, visual disturbances, and back pain

What are the key ADEs associated with Tadalafil (Cialis)?

nitrates

What are the D-D interactions with Tadalafil?

Selectively inhibits phosphodiesterase type 5 (PDE5) and increases cyclic guanosine monophosphate levels

What is the MOA associated with Tadalafil?

relax bladder detrouser muscle -> improve the urine storage capacity of the bladder

What is the MOA of action associated with anticholinergics?

· α1-adrenergic antagonist + anticholinergic agent/mirabegron/PDEi

What is the combination tx for BPH with irritative symptoms?

· α1-adrenergic antagonist + 5α-reductase inhibitor

What is the BPH combination therapy with severe symptoms and enlarged prostate?

α-adrenergic + PDEi

What is the combination tx for BPH with erectile dysfunction?

· α1-adrenergic antagonist + anticholinergic or mirabegron

What is the combination tx for BPH with overactive bladder?

PDE-5

What is the 1st line therapy for erectile dysfunction?

up to 36hrs

What is the duration of action for Tadalafil (PDE-5) used for ED?

food does NOT affect absorption, take 30 min prior

What is the administration of Tadalafil for ED?

nitrates or severe hypotension

What are the contraindications for use of Tadalafil for ED?

VED or Alprostadil

What is the 2nd line tx for ED?

all testosterone preparations are class III controlled substances (moderate to low risk for physical and psychological dependence)

What is the DEA regulation for testosterone?