E3 Pharm - uro

What antihistamine will cause less erectile dysfunction?

2nd gen antihistamine

What anti-hypertensives will cause less erectile dysfunction?

ACEIs/ARBs, CCBs

What anti-depressive meds will cause less erectile dysfunction?

Buproprion (Wellbutrin)

What phosphodiesterase inhibitor notably causes blurred vision and impaired blue-green discrimination?

Sildenafil

What phosphodiesterase inhibitors will be affected by a fatty meal resulting in a delayed onset?

Sildenafil & Vardenafil

What phosphodiesterase inhibitor will notably cause myalgias?

Tadalafil

What phosphodiesterase inhibitor has the longest duration (24-36 hours), so the patient will be covered for the whole weekend?

Tadalafil

What phosphodiesterase inhibitor will cause QTc prolongation?

Vardenafil

What phosphodiesterase inhibitors have to be renally adjusted?

Sildenafil & Tadalafil

In what patients should phosphodiesterase inhibitor use be avoided?

Healthy patients, sickle cell, leukemia, multiple myeloma

Emergent SE of phosphodiesterase inhibitors

Nonarteritic anterior ischemic optic neuropathy

Contraindication to phosphodiesterase inhibitor use

No nitrates for 24 hours (48 hrs for Tadalafil)

Class of Sildenafil

phosphodiesterase inhibitor

Class of Vardenafil

phosphodiesterase inhibitor

Class of Tadalafil

phosphodiesterase inhibitor

Class of Avanafil

phosphodiesterase inhibitor

Class of Alprostadil

Prostaglandin E1

What form of administration of Alprostadil is preferred?

Intracavernosal injection

When should a patient administer Alprostadil & how long does it last?

Apply 5-10 minutes before intercourse, doesn't last more than 1 hour

Ideal alternative to a phosphodiesterase inhibitor if a patient is on nitrate therapy

Alprostadil

Why is the intraurethral insert of Alprostadil NOT preferred?

Risk of urethral damage/strictures which can lead to post-renal failure

What class of BPH meds has NO effect on prostate size?

Alpha 1 antagonists

Class of Prazosin

2nd gen Alpha 1 antagonist

Class of Terazosin

2nd gen Alpha 1 antagonist

Class of Doxazosin

2nd gen Alpha 1 antagonist

Class of Alfuzosin

2nd gen Alpha 1 antagonist

What 2nd gen Alpha 1 antagonist should be avoided due to increased SEs & shortest duration?

Prazosin

What 2nd gen Alpha 1 antagonist has the lowest incidence of SEs?

Alfuzosin

SEs of 2nd gen Alpha 1 antagonists

1st dose syncope, orthostatic hypotension, dizziness

Class of Tamsulosin (Flomax)

3rd gen Alpha 1 antagonist

Class of Silodosin (Rapaflo)

3rd gen Alpha 1 antagonist

What 3rd gen Alpha 1 antagonist is NOT used due to drug interactions?

Silodosin (Rapaflo)

What Alpha 1 antagonist should you NOT prescribe to someone with a sulfa allergy?

Tamsulosin (Flomax)

Why/When are 3rd gen Alpha 1 antagonists better?

No hypotension, good for patients taking anti-hypertensive meds

What class of BPH meds are preferred in patients with enlarged prostates?

5a-reductase inhibitors

Class of Finasteride

5a-reductase inhibitor

Class of Dutasteride

5a-reductase inhibitor

SEs of 5a-reductase inhibitors

Sexual dysfunctions (decreased libido, erectile dysfunction)

What med is preferred in patients with BPH and Erectile Dysfunction?

Tadalafil

Class of Oxybutynin

Anticholinergic

Class of Tolterodine

Anticholinergic

Class of Trospium

Anticholinergic

Class of Solifenacin

Anticholinergic

Class of Darifenacin

Anticholinergic

Class of Fesoterodine

Anticholinergic

What Anticholinergic has a risk for orthostatic hypotension?

Oxybutynin

What Anticholinergic should be avoided in patients with CrCl < 10 mL/min or severe hepatic impairment?

Tolterodine

What Anticholinergic does NOT cross the BBB so it causes no delirium/dementia symptoms?

Trospium

Contraindicates to Anticholinergics

Urinary retention, decreased GI motility, glaucoma, myasthenia gravis

Botox can be used in refractory _______ urinary incontinence

Urge

How long do the effects of Botox last for urinary incontinence?

4-8 months

What form of administration of estrogen can be used for urethral underactivity?

Transdermal

What alpha receptor agonist can be used to increase the urethral tone?

Duloxetine (Cymbalta)