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63 Cards in this Set
- Front
- Back
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at what age does ED peak
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70 years
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what are some organic causes of ED
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HTN, CAD, PVD, DM, RF, PD, CVA, MS, hypogonadism, thyriod, hyperprolactemia, priapism, peyronies, ETOH, smoking, drugs, history of radiation
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what medications cause ED
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anti HTN, depressents, androgens, NSAIDS, benzo, gemfibrozil, digoxin, cimetidine, reglan
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what percent of ED is caused by psychological factors
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10-20%
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is nocturnal penile tumescence is normal with pysch factors of ED
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yes
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at what percent is inability to maintain an erection a problem
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25%
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what history questions would you ask related to social habits for ED
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etoh
drugs smoker stressors of work, marital, sexual routine depression |
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what physical exam would you focus on for ED
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VS - HTN
distribution of body hair thyroid breasts for gynecomastia or nipple tenderness CV exam inspect penis for infection or deformities examine testes prostate DRE Neurological exam |
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what secondary medical causes would you like to rule out first in ED
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DM
Lipids TSH PSH - BPH depression and OCD |
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what labs will you draw initially for ED
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testosterone level
cmp cbc lipid panel tsh urinalysis if testosterone low - fsh, prolactin, lh |
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what medication class is used for treatment of ED
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PDE-5
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what is the action of PDE-5 medications
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prolong nitric oxide, cause vasodialation, increase intracavernosal gmp
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what are absolute contraindications when prescribing PDE5 medications
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nitrates, alpha adrenergic blockers, drugs that prlong QT
P450 and P3A4 Caution - MI within last 6 months, positive stress test, angina, uncontrolled HTN, hypotension |
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what is the dosage and instructions for cialis
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max dose is 20mg in 24 hours, longer acting, more convienent, take several hours prior to intercourse, or 30 minutes, last 36 hours
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what is the dosage and instructions of viagra and levitra
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max of levitra is 20mg per day, viagra 100mg per day. Take 30 minutes before intercourse, lasts 4 hours
avoid excessive food and ETOH |
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what are SE of PDE5 medications
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flushing, dyspepsia, nasal congestion, change in color perception, priapism
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this is a noncancerous enlargement of the prostate, with obstructive or irritative voiding symptoms
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BPH
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what is the cause of BPH
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high androgens
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at what age does BPH usually present
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50%> 60 years, uncommon under 40 years
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what are risk factors for BPH
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phsyical activity
increased PSA levels age |
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what are s/s of BPH
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weak stream
hestitency post void dribble incomplete emptying of bladder frequency and urgency nocturia urinary retention hematuria exam: firm, smooth, symetrical prostate i |
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what diagnostic tests would you perform with BPH
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urine
AUA symptom index creatnine post void residual pressure flow study cystoscopy - severe symptoms PSA us of prostate needle biopsy with +nodule IVP to rule out UTI |
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based on the AUA index
what is mild moderate and severe levels |
<8 mild
8-18 mod 19-35 severe |
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what are nonpharmacologic treatments
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limit fluids before bed
frequent voiding avoid anticholinergic or sympathomemtics avoid caffiene, alcohol |
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what is the gold standard to relieve symptoms of urinary retention
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TURP
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what is an OTC medication for BPH
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Saw Palmetto 160mg BID
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what medication classes are used for BPH - 2
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alpha blockers
5-alpha reductase inhibitor |
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how does alpha blockers work in BPH
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relax smooth musle of the bladder neck and prostate to increase urine flow
no effect on prostate size |
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which medication reduces DHT formation
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avodart
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how does 5-alpha reductase inhibors work in BPH
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blocks conversion of testosterone, reduce size of prostate.
decreases psa and inflammation advodart 0.5mg daily proscar 5mg daily |
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what side effects occur with alpha blockers
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orthostatics
dizziness syncope take at night increase slowly |
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this is an acute inflammation of the prostate that is usually associated with fever, perineal pain and dysuria
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acute prostatits
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what bacteria is most common in acute prostatitis
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ecoli
pseudomonas kelsiella proteus chlamydia trich gonorrhea |
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what age is most common in acute prostatitis
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30-50 year olds
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what are some risk factors for acute prostatitis
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sexually active
sexual abstinence multiple partners UTI trauma |
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what are s/s of acute prostatits
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sudden onset
fever, chills, malaise enlarged, boggy, tender prostate perineal pain decreased stream frequency, urgency, dysuria nocturia *pain with defication and urination |
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what diagnostic tests are indicated for acute prostatitis
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urine with culture
fractionated urine after prostate message grame stain DO not do PSA |
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what medication is the choice for acute prostatits
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cipro 400mg BID x 4 weeks
doxy 100mg BID for one day, then once daily x 4 weeks NSAIDs Antipyretics Stool softners |
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when do you follow up with acute prostatits
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4-6 weeks after inital treatment
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this is chronic inflammation of the prostate that results in recurrent infection, inflammation, and difficulty with urination
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chronic prostatitis
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which is the most common type of prostatitis
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chronic
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what bacteria is seen in chronic prostatitis
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ecoli
klebsiella proteus staph |
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at what age is most common to see chronic prostatitis
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over 50
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what are s/s of chronic prostatis
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asymptomatic
frequency, urgency, dysuria, dribbling, hesitancy pain with defication and ejaculation perineal, lower abdominal pain, scrotal or penis pain hematuria mild prostate tenderness, enlargement NO fever, malaise, not as sick |
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what diagnostic tests would you order in chronic prostatitis
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fractional urine
urine with culture CT/US if suspect cancer NO psa |
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what are non pharmacological treatments for chronic prostatits
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sitz bath
good hydration avoid coffee, tea, alcohol avoid anticholinergics, sympathomemetics surgical resection if intractible chronic disease |
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what medications to dyou give to treat chronic prostatits
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cipro 400 BID x 4-12 weeks
ofloxacin 300mg BID x 4-12 weeks suppression Bactrim DS one tab 4-12 weeks prostate has poor absorption, why you need long term treatment |
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leading cause of cancer in men
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prostate
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what is the age of diagnosis of prostate cancer
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over 60 avg 72
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what are risk factors of prostate cancer
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family history
increased age AA smoking high fat diet |
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what are clinical findings in prostate cancer
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asymptomatic
lymphadenopathy prostate hard, fixed, nodule urinary retnention anemia LBP or hip pain radiating to testes lymphedema |
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what are some diagnostic tests you would order for prostate cancer
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US
PSA - >10 alk phos bone scan with PSA >20 Ct biopsy |
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what increase in the total PSA would cue you into prostate cancer
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increase of 0.35/year should biopsy even if still WNL, increased risk
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at what age do you start screening for prostate cancer
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50 years annual PSA and DRE
High risk at 45 - family history and AA Very high risk at 40 years if isolated elevation, screen several weeks later to confirm |
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what are other diagnostic tools for PSA screening
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free psa
psa veloscity - show increase in level of psa even in normal range age adjusted psa biposy - to confirm diagnosis |
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what psa level should be biopsied
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10
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what posa level is considered normal
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under 4
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what psa could be biopsied
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4.9 to 9.9
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what psa do you order a bone scan
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over 20
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what are the staging of prostate cancer 1-4
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1 confined to prostate no nodule
2 palpable nodule, confined to prostate 3 local extension 4 regional lymph and distant mets |
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what is the 5 year survival of prostate cancer that is confined to the prostate
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98%
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what is the 5 year survival of prostate cancer that has spread outside of the prostate
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29%
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what is the gleason classification 1-5
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1 best differentiated to 5 least differentiated, you want the cancer to be more differentiated.
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