QUESTIONS WITH SOLUTIONS GRADED A+
◉ Which alpha blocker is least likely to cause ejaculatory dys?
Answer: Alfuzosin
◉ Benefits and cons of terazosin and doxazosin? Answer: Both are
cheaper, but requires dose titration and BP monitoring
◉ What are the most common s/e of alpha blockers? Answer:
Dizziness, mild asthenia ( fatigue or weakness), abnormal
ejavulation, intra operative floppy iris syndrome,
◉ Most common med to cause floppy iris Syndrome? Answer:
Tamsulosin for up to one year with dc use
◉ Which meds for BPH are 5 alpha reductase inhibitors? Answer:
Finasteride and dustasteride
◉ What is the mechanism of action for 5 alpha reductase inhibitors?
Answer: Reduce tissue size of of prostate overtime ( up to 6 mos) by
reducing levels of DHT
,◉ Side effects of 5 alpha reductase inhibitors? Answer: Decreased
libido, ED, ejaculation dysfunction. Less often breast tenderness or
gynocomastia
◉ Which combination therapy has been shown to be very effective
for BPH? Answer: A combination of both alpha blockers. And 5-
alpha reductase inhibitors
◉ What does removal of prostate tissue do? Answer: It reduces
obstruction of urinary flow..
◉ What are risk factors for prostate cancer? Answer: Age, family
history, black men
◉ Prostate cancer prevalence? Answer: Second most common
cancer in American men and the second most common cause of
cancer death in men
◉ A Gleason score of < or equal to 7 is what? Answer: Pts w/
localized disease and men 70+ W/ well differentiated tumor. These
pts should be under close observation.
◉ A Gleason score of 8+ is what? Answer: Pts w/ a poorly
differentiated tumor, w extracapsular involvement beyond the
,seminal vesicles. And a PSA level >30. Aggressive tumor, with poor
prognostics
◉ What is the treatment for metastatic prostate disease? When
should it be initiated ? Answer: Hormonal treatment
Immediately upon diagnosis of asymptomatic metasteses.
It has been shown to be superior to delaying it until symptoms
develop
◉ What can help pain from bone Mets due to prostate cancer?
Answer: Spot radiation
◉ Zoledronate is used for what? Answer: Prophylaxis or
symptomatically to prevent or treat pain and delay the progression
of bone Mets in Pts w/ prostate cancer.
◉ What is used to assess ED? Answer: International index for
erectile dysfunction screening tool.
◉ What is the most common cause of ED in older men? Answer:
Vascular disease.
◉ What is The Second most common cause of ED in older men?
Answer: Neurologic
, ◉ What should be evaluated first when a pt complains of ED?
Answer: Past medical history:
Sexual hx, onset and duration of ED, sleep associated erections,
decline in libido, medical hx, risk factors, meds review, stressors,
alcohol, substance abuse,
◉ When assessing a pt with ED, what exactly are you looking for?
Answer: Vascular, neurological, and endocrine... (looking for s&s of
these)
◉ What are medications that can exacerbate ED? Answer: Acid
suppressants, anticonvulsants, antihistamines, antihypertensives,
antilipids.
◉ What are the risk factors for ED? Answer: Vascular disease,
neurologic, meds, psychogenic, endocrine
◉ What are first line treatment options for ED? Answer:
Phosphodiesterase inhibitors:
Sildenafil, vardenafil, tadalafil, Avanafil,
◉ Which meds are contraindicated with use of nitrates? Why?
Answer: Phosphodiesterase inhibitors can cause deadly severe
hypotension