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Questions and Answers
What is the primary mechanism of action of PDE-5 inhibitors in treating erectile dysfunction?
What is the primary mechanism of action of PDE-5 inhibitors in treating erectile dysfunction?
Which of the following is a common side effect of PDE-5 inhibitors?
Which of the following is a common side effect of PDE-5 inhibitors?
Which condition serves as a contraindication for the use of PDE-5 inhibitors?
Which condition serves as a contraindication for the use of PDE-5 inhibitors?
What is the primary mechanism of action for alpha-blockers in treating benign prostatic hyperplasia (BPH)?
What is the primary mechanism of action for alpha-blockers in treating benign prostatic hyperplasia (BPH)?
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Which alpha-blocker is reported to have the most significant first-dose syncope risk?
Which alpha-blocker is reported to have the most significant first-dose syncope risk?
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What adverse effect can directly result from using 5-alpha-reductase inhibitors?
What adverse effect can directly result from using 5-alpha-reductase inhibitors?
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Which of the following statements about alpha-blockers and 5-alpha-reductase inhibitors is correct?
Which of the following statements about alpha-blockers and 5-alpha-reductase inhibitors is correct?
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What potential warning should patients using PDE-5 inhibitors be aware of?
What potential warning should patients using PDE-5 inhibitors be aware of?
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What are some common adverse drug reactions (ADRs) associated with DM and vascular disease?
What are some common adverse drug reactions (ADRs) associated with DM and vascular disease?
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Which condition is a contraindication for Letrozole?
Which condition is a contraindication for Letrozole?
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What is the first line treatment for dysmenorrhea?
What is the first line treatment for dysmenorrhea?
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Which of the following is an indication for ovulation induction?
Which of the following is an indication for ovulation induction?
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What are some potential contraindications for the use of combined oral contraceptives (COCs)?
What are some potential contraindications for the use of combined oral contraceptives (COCs)?
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Which of the following is not an adverse drug reaction associated with DMPA?
Which of the following is not an adverse drug reaction associated with DMPA?
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Which of the following is a last-line treatment option for dysmenorrhea?
Which of the following is a last-line treatment option for dysmenorrhea?
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What is a common side effect of NSAIDs in the treatment of dysmenorrhea?
What is a common side effect of NSAIDs in the treatment of dysmenorrhea?
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Which medication is considered a first-line option for treating acute uncomplicated cystitis?
Which medication is considered a first-line option for treating acute uncomplicated cystitis?
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What is a major adverse drug reaction associated with certain GU medications?
What is a major adverse drug reaction associated with certain GU medications?
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In patients with renal impairment, which parameter is recommended for monitoring prior to starting certain medications?
In patients with renal impairment, which parameter is recommended for monitoring prior to starting certain medications?
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Which second-line option is indicated for patients with acute uncomplicated cystitis?
Which second-line option is indicated for patients with acute uncomplicated cystitis?
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What should be monitored when patients are on Mirabegron?
What should be monitored when patients are on Mirabegron?
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Which of the following medications is NOT recommended in pregnancy due to potential adverse effects on male fetuses?
Which of the following medications is NOT recommended in pregnancy due to potential adverse effects on male fetuses?
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What monitoring is advised for medications with narrow therapeutic ranges?
What monitoring is advised for medications with narrow therapeutic ranges?
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Which of the following is a contraindication for using certain GU drugs in patients?
Which of the following is a contraindication for using certain GU drugs in patients?
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What should a patient do if she misses 1 tablet of her hormonal contraceptive?
What should a patient do if she misses 1 tablet of her hormonal contraceptive?
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Which condition is an absolute contraindication for hormonal contraceptives?
Which condition is an absolute contraindication for hormonal contraceptives?
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In Hormone Replacement Therapy (HRT), which combination is appropriate for women with an intact uterus?
In Hormone Replacement Therapy (HRT), which combination is appropriate for women with an intact uterus?
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What is the indication for starting tocolytics during preterm labor?
What is the indication for starting tocolytics during preterm labor?
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What is a potential benefit of Hormone Replacement Therapy in postmenopausal women?
What is a potential benefit of Hormone Replacement Therapy in postmenopausal women?
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What specific condition should a patient have to qualify for unopposed estrogen therapy?
What specific condition should a patient have to qualify for unopposed estrogen therapy?
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How long should additional non-hormonal contraception be used after missed hormonal tablets?
How long should additional non-hormonal contraception be used after missed hormonal tablets?
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Which of the following medications is commonly used as a tocolytic?
Which of the following medications is commonly used as a tocolytic?
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Which medication class primarily addresses overflow incontinence due to poor bladder contractility?
Which medication class primarily addresses overflow incontinence due to poor bladder contractility?
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What is a common adverse drug reaction (ADR) associated with oxybutynin?
What is a common adverse drug reaction (ADR) associated with oxybutynin?
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Which medication should be avoided in patients with severe hepatic impairment?
Which medication should be avoided in patients with severe hepatic impairment?
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What is a contraindication (CI) for tolterodine IR?
What is a contraindication (CI) for tolterodine IR?
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For which condition is topical estrogens indicated as a treatment?
For which condition is topical estrogens indicated as a treatment?
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What potential effect does alcohol have when taken with anticholinergics?
What potential effect does alcohol have when taken with anticholinergics?
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Which of the following drugs requires careful monitoring for QT prolongation when combined with certain antiarrhythmics?
Which of the following drugs requires careful monitoring for QT prolongation when combined with certain antiarrhythmics?
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What is the recommended maximum daily dose of fesoterodine fumarate for patients with severe renal impairment?
What is the recommended maximum daily dose of fesoterodine fumarate for patients with severe renal impairment?
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What is a common ADR of solifenacin?
What is a common ADR of solifenacin?
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In which situation should the dose of tolterodine be reduced?
In which situation should the dose of tolterodine be reduced?
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What type of medication is referred to as a beta-3 adrenergic agonist?
What type of medication is referred to as a beta-3 adrenergic agonist?
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Which condition does sudden urge to urinate indicate?
Which condition does sudden urge to urinate indicate?
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What adverse reaction is associated with oxybutynin IR but less so with ER formulations?
What adverse reaction is associated with oxybutynin IR but less so with ER formulations?
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Which group of medications is typically indicated for treating stress incontinence?
Which group of medications is typically indicated for treating stress incontinence?
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Study Notes
Erectile Dysfunction (ED)
- PDE-5 inhibitors (e.g., sildenafil, tadalafil) work by inhibiting phosphodiesterase type 5, which degrades cyclic guanosine monophosphate (cGMP)
- Increased cGMP levels enhance nitric oxide (NO) effects, promoting vasodilation and penile erection
- Common side effects include headache, flushing, nausea, back pain, hypotension, and priapism.
- Important Warnings: Stop the medication immediately if sudden vision loss (NAION) or sudden decrease or loss of hearing occurs.
- Contraindications: Uncontrolled or moderate/severe cardiovascular conditions (angina, arrhythmias, hypertension, heart failure, valvular disease, cardiomyopathy), recent myocardial infarction, and ophthalmic disorders (glaucoma, macular degeneration, diabetic retinopathy, eye trauma/surgery).
Benign Prostatic Hyperplasia (BPH)
- Alpha-blockers (e.g., tamsulosin): Block alpha-adrenergic receptors, relaxing bladder and prostate smooth muscle, improving urinary flow
- Effective for dynamic symptoms of BPH, working quickly within days to weeks.
- Alpha-1A antagonists (e.g., tamsulosin) are more effective than 5-alpha-reductase inhibitors (5-ARIs) in the short and long term.
- Common Side Effects: First-dose syncope, orthostatic hypotension, dizziness (terazosin > doxazosin >> alfuzosin > tamsulosin)
- 5-alpha-reductase inhibitors (e.g., dutasteride, finasteride): Inhibit the conversion of testosterone to dihydrotestosterone, which contributes to prostate growth.
- Efficacy: Primarily effective for long-term symptom management, reducing prostate volume and slowing its progression.
- Common Side Effects: Dry mouth (worse with immediate-release formulations), constipation, some have other GI issues (nausea, dyspepsia)
Urinary Tract Infections (UTIs)
-
Acute Uncomplicated Cystitis:
- First-line treatment: Nitrofurantoin, trimethoprim-sulfamethoxazole (Bactrim), fosfomycin, trimethoprim.
- Second-line treatment: Amoxicillin-clavulanate (Augmentin), cephalexin, cefpodoxime, cefadroxil.
- Third-line treatment: Reserved for cases of antibiotic resistance.
Drug Monitoring and Toxicity
- General Monitoring Parameters (especially regarding renal function): Baseline serum creatinine, baseline blood urea nitrogen, avoid use if creatinine clearance is below 35 ml/min.
-
Specific Monitoring Parameters:
- Tolterodine IR & ER: Monitor for QT prolongation if taking certain antiarrhythmics.
- Mirabegron: Monitor for increased blood pressure and urinary retention.
- Nitrofurantoin: Monitor baseline serum creatinine and baseline blood urea nitrogen.
- Anticholinergic/antimuscarinic medications: Consider renal and hepatic considerations for appropriate dosing.
Hormonal Contraceptives
- Combined Oral Contraceptives (COCs) commonly used for contraception and dysmenorrhea.
- Contraindications: Blood pressure ≥160/100, pregnancy, undiagnosed vaginal bleeding, known or suspected breast malignancy, hepatic adenomas or carcinomas or active liver disease, active thrombophlebitis, current or previous history of thromboembolic disorder or cerebrovascular disease, carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia, cerebrovascular or coronary artery disease, cholestatic jaundice of pregnancy or jaundice with prior pill use, diabetes mellitus with vascular involvement, headache with focal neurological symptoms, uncontrolled hypertension, thrombogenic rhythm disorder or valvulopathies.
Hormone Replacement Therapy (HRT)
- Indications: Postmenopausal women with no contraindications to menopausal hormone therapy (MHT).
-
Types:
- Unopposed estrogen: For women with a history of hysterectomy.
- Combo estrogen + progestin: For women with an intact uterus to prevent estrogen-associated endometrial hyperplasia.
- Benefits: Can help alleviate menopausal symptoms (e.g., hot flashes, night sweats, vaginal dryness).
- Risks: Increased risk of blood clots, stroke, heart attack, and breast cancer (especially with combined estrogen and progestin).
Labor Suppressants (Tocolytics)
- Preterm Labor: Defined as labor occurring between 20 and 37 weeks of gestation.
- Tocolytics (e.g., nifedipine, magnesium sulfate): Used to prolong pregnancy and delay labor for 48 hours to one week.
- Criteria to initiate tocolytics: Regular uterine contractions and cervical change.
- Magnesium Sulfate: Important to monitor for magnesium toxicity, indicated by loss of deep tendon reflexes, respiratory depression, and cardiac arrhythmias.
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Description
This quiz covers key information about Erectile Dysfunction (ED) and Benign Prostatic Hyperplasia (BPH). It includes mechanisms of action for PDE-5 inhibitors and alpha-blockers, common side effects, warnings, and contraindications for both conditions. Test your knowledge on these important urological issues.
