NAPLEX - Urology (ED, BPH, Urinary incontinence) McGraw Hill

JC is a 72-year-old African American male with erectile dysfunction (ED) and no contraindication to the use of a phosphodiesterase (PDE-5) inhibitor. Which of the following medications could potentially interact and lead to increased serum concentrations of the PDE-5 inhibitor? A Erythromycin B Aspirin C Ampicillin D Haloperidol E Influenza vaccine

A Erythromycin inhibits the CYP3A4 enzyme system in the liver and impairs the metabolism of PDE-5 inhibitors. The dose of the PDE-5 inhibitor should be reduced. Answer b is incorrect.Aspirin does not interact with PDE-5 inhibitors. Answer c is incorrect. Antibiotics are not known to interact with PDE-5 inhibitors. Answer d is incorrect. The use of antipsychotics may result in ED by causing hyperprolactinemia, but they do not affect the serum concentration of PDE-5 inhibitors. Answer e is incorrect. Vaccines do not interact with PDE-5 inhibitors.

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. Which of the patient's conditions could potentially lead to symptoms similar to incontinence? A Type 2 diabetes B Hypertension C Breast cancer D Gout

A Type 2 diabetes, if uncontrolled, can lead to polyuria which could mimic incontinence. Answer b is incorrect. Hypertension will not result in symptoms that may mimic incontinence. Answer c is incorrect. Breast cancer will not result in symptoms that may mimic incontinence. Answer d is incorrect. Gout will not result in symptoms that may mimic incontinence.

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. The patient was successfully treated with an antimuscarinic; however, developed severe renal impairment (est CrCl <30mL/min). Which of the following medications are still an option(s) for this patient? A Oxybutynin transdermal patch B Tolterodine ER C Solifenacin D Darifenacin E Trospium chloride ER

ABCD Any delivery system of oxybutynin does not need to be renally adjusted in severe renal impairment. Answer b is correct. Although it is cleared renally, the dose can be decreased and be used in patients with severe renal impairment. Answer c is correct. Although it is cleared renally, the dose can be decreased and be used in patients with severe renal impairment. Answer d is correct.Darifenacin does not need to be renally adjusted in severe renal impairment. Answer e is incorrect. The extended release trospium chloride only comes in one dose for patients with CrCl >30 mL/min. It is should not be used in severe impairment due to increased side effects.

MJ is a 68-year-old man with a past medical history significant for diabetes and hypertension. His current medications include metformin, lisinopril, and metoprolol succinate. He complains of erectile dysfunction (ED) for which he seeks treatment. Select the conditions and medications putting MJ at increased risk for development of ED. Select all that apply. A Diabetes B Hypertension C Age D Metformin E Metoprolol succinate

ABCE Individuals with diabetes are more likely to develop ED. ED develops in diabetics because of the vascular and neurologic changes that may occur. Answer b is correct. Individuals with hypertension are more likely to develop ED. ED develops in patients with hypertension because of the vascular changes that may occur. Answer c is correct. The prevalence of ED increases with increasing age. At 40 years of age, up to 5% of men are afflicted with complete to severe dysfunction. This increases to 15% to25% in men over 65. Answer e is correct. β-Blockers are associated with increased risk of ED. Answer d is incorrect.Metformin use is not associated with increased risk of ED.

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. Which of the following are nonpharmacologic options should the patient be educated on? A Weight reduction B Decrease fluid intake C Increase intake of caffeine D Pelvic floor exercises

ABD A decrease in intake of caffeine is a suitable nonpharmacologic option for UI.

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. After determining that a condition or medication was NOT the cause of incontinence, which of the following medication could be recommended? A Oxybutynin transdermal patch (over-the-counter) B Darifenacin C OnabotulinumtoxinA D Mirabegron E Duloxetine

ABD Antimuscarinics are a first-line option for urge urinary incontinence (UUI); moreover, the over-the-counter (OTC) version is only approved for use in women. Answer b is correct. Antimuscarinics are a first-line option for UUI; however, this option may be more expensive since it is currently brand only. Answer c is incorrect.OnabotulinumtoxinA is not currently a first line treatment option for UUI. Answer d is correct.Mirabegron, a β3 agonist, is a first-line option for UUI; however, this option may be more expensive since it is currently brand only. Answer e is incorrect.Duloxetine, although not FDA-approved, has only shown to be useful in stress urinary incontinence. *But not very efficacious*

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. Which the patient's medications could result in effects similar to incontinence? A Metformin B Canagliflozin C Amlodipine D Chlorthalidone E Allopurinol

B .Metformin is not associated with incontinence Answer b is correct.Canagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, exerts in mechanism of action by contributing to a reduction of sugar reabsorption in the proximal tubule which leads to a reduced reabsorption of glucose into the bloodstream and consequently loss of sugar in the urine and subsequent loss of water. Answer d is correct.Chlorthalidone, a thiazide diuretic, exerts in reabsorption of sodium and chloride primarily through inhibition of the Na+/Cl− symporter resulting in a diuretic effect. Answer c is incorrect.Amlodipine is not associated with incontinence. Answer e is incorrect.Allopurinol is not associated with incontinence.

Which of the following is responsible for increased prostate growth? A Prostate-specific antigen (PSA) B Dihydrotestosterone (DHT) C 5-α-reductase inhibitor (5ARI) D Testosterone

B Androgens, specifically dihydrotestosterone, bind to androgen receptors and increase expression of genes that control prostate growth. For this reason, use of 5ARI, which inhibit the conversion of testosterone to DHT, are therapeutic targets to prevent this process Answer a is incorrect. As PSA is produced by the prostate, it may high in patients with an enlarged prostate. However, it does not directly cause an increase in prostate growth. Answer c is incorrect. While 5-α-reductase facilitates the conversion of testosterone to DHT, it is simply the enzyme and is not directly responsible for increasing prostate growth. As stated above, by inhibiting 5-α-reductase, production of DHT is reduced and the latter is what is directly responsible for prostate growth. Answer d is incorrect.Testosterone binds to androgen receptors; however, it freely dissociates as well. DHT is the chief androgen involved in prostate growth and the target of 5ARI therapy.

A 75-year-old woman is experiencing symptoms of increased urinary frequency, urgency, and leakage throughout normal daily activities. She has not tried any medications for these symptoms. Her past medical history is significant for type 2 diabetes, hypertension, gout, and breast cancer. She is currently treated with metformin, canagliflozin, amlodipine, allopurinol, chlorthalidone, and tamoxifen. Her most recent blood pressure was 132/78 mm Hg, heart rate (HR) was 82 bpm, and labs included: Alc 6.9%, Na+ 142 mEq, serum creatinine (SCr) 1.1 mg/dL (est creatinine clearance [CrCl] 55 mL/min), body mass index (BMI) 33 kg/m2. What type of incontinence is this patient experiencing? A Stress urinary incontinence (SUI) B Urge urinary incontinence (UUI) C Overflow incontinence (OI) D Mixed incontinence E Functional incontinence

B SUI occurs during exercise/exertion. Answer b is correct. UUI is correct as the symptoms include increased urinary frequency and urgency. Answer c is incorrect. OI results in symptoms such as incomplete voiding and hesitancy. In women, it is most commonly due to an enlarged ovarian cyst. Answer d is incorrect. The patient is NOT experiencing multiple types of incontinence. Answer e is incorrect. There is no notation of cognitive or functional issues that are resulting in the incontinence.

Which of the following is an advantage of tamsulosin when compared to doxazosin? Select all that apply. A Increased efficacy in reducing lower urinary tract symptom (LUTS) B Decreased orthostatic hypotension C Quicker onset of action in lowering symptoms D Decreased syncope

BCD Tolerability is improved with use of tamsulosin as it specifically targets α1A-receptors in the prostate. Discontinuation rates and cardiovascular side effects are reduced in patients taking tamsulosin versus other second-generation α blockers (doxazosin and terazosin). Answer c is correct. As tamsulosin does not require titration to reach an effective dose, its effects are seen often within the first week of therapy. Answer a is incorrect.Tamsulosin is not more efficacious than other α blockers. Most α blockers, including doxazosin, will lower the American Urological Association (AUA) Symptom Score 4-6 points.

MJ is a 68-year-old man with a past medical history significant for diabetes and hypertension. His current medications include metformin, lisinopril, and metoprolol succinate. He complains of erectile dysfunction (ED) for which he seeks treatment. It is decided that MJ will start treatment with vardenafil. Which of the following counseling points would be appropriate to tell MJ regarding vardenafil use? Select all that apply. A Take this medication immediately prior to sexual intercourse. B Use could lead to postural hypotension and dizziness. C This medication should be taken with a fatty meal. D Common side effects include headache, flushing, dyspepsia, and rhinitis. E Report any changes in vision or hearing to your health care provider.

BDE Phosphodiesterase (PDE-5) inhibitors can decrease in blood pressure, patients should rise slowly after sitting or lying down. Answer d is correct. These are all common side effects of PDE-5 inhibitors. Answer e is correct. PDE-5 inhibitors have been associated with difficulty distinguishing blue and green colors, as well as vision and hearing loss. Answer a is incorrect.Vardenafil should be taken 30 to 60 minutes before anticipated intercourse. Answer c is incorrect. Fatty meals impair absorption of sildenafil and vardenafil for up to 1 hour after consumption.

MJ is a 68-year-old man with a past medical history significant for diabetes and hypertension. His current medications include metformin, lisinopril, and metoprolol succinate. He complains of erectile dysfunction (ED) for which he seeks treatment. MJ should talk to his provider before taking vardenafil with which of the following medications as concomitant use is contraindicated? Select all that apply. A Aspirin B Riociguat C Fluoxetine D Finasteride E Nitrates

BE Concurrent riociguat and phosphodiesterase (PDE-5) inhibitor use is contraindicated due to the potential for severe hypotension. Answer e is correct. Concomitant PDE-5 and nitrates may result in severe hypotension so use is contraindicated. Answer a in incorrect. Administration of PDE-5 inhibitors is not contraindicated with aspirin use. Answer c is incorrect. Administration of PDE-5 inhibitors is not contraindicated with use of fluoxetine. Answer d is incorrect. Administration of PDE-5 inhibitors is not contraindicated with finasteride administration.

An 82-year old patient is taking 2 mg of terazosin for benign prostatic hyperplasia (BPH) comes into the pharmacy complaining of dizziness and generalized muscle weakness and persistent lower urinary tract symptom (LUTS). What would you recommend to his physician? A Add finasteride 5 mg daily to his regimen. B Switch his terazosin to doxazosin 4 mg. C Switch his terazosin to tamsulosin 0.4 mg daily. D Lower the dose of his terazosin to 1 mg. E Add saw palmetto twice daily.

C .Tamsulosin may afford better tolerability for this patient and would be expected to provide symptom relief relatively quickly, often within 1 week of therapy, as it does not require titration. Answer a is incorrect. The patient is complaining of dizziness associated with his α-blocker therapy. Adding finasteride will not ameliorate this and, if a 5-α-reductase inhibitor (5ARI) were added, it may take several months to show benefit in symptom reduction. Answer b is incorrect. Exchanging one long-acting second-generation agent for another would not be ideal and this patient may continue to experience the same side effects. Answer d is incorrect. Lowering his dose of terazosin may improve tolerability; however, he still is experiencing symptoms of BPH. If his dose was lowered, he would likely continue to experience his symptoms. Answer e is incorrect. Based on lack of clinical outcomes, phytotherapy is not recommended by the American Urological Association for treatment of BPH.

Which statement best describes alprostadil? A It should be the first agent tried for the treatment of erectile dysfunction (ED). B It is a nonspecific phosphodiesterase (PDE-5) inhibitor. C It can be administered via a medicated transurethral suppository. D Priapism has not been reported with the use of alprostadil. E It exerts its activity by constricting smooth muscle in the penis.

C A unique delivery system called Muse® places the drug into the urethra where it diffuses across the urethra into the body of the penis. The drug can also be administered by intracavernosal injection. Answer a is incorrect. PDE-5 inhibitors are the first-line choice for the treatment of ED unless there is a contraindication. Alprostadil is used when they are ineffective or cannot be tolerated. Answer b is incorrect.Alprostadil works through its activity as a prostaglandin E1 agonist. It causes vasodilation of the penile arteries by relaxing smooth muscle. Papaverine is a nonspecific PDE-5 inhibitor. Answer d is incorrect. Priapism and prolonged erection can occur with the use of alprostadil. Answer e is incorrect. The mechanism of action does not include vasoconstriction.

Which subtype of muscarinic receptor is the primary target of the antimuscarinic selected in the previous question? A M1 B M2 C M3 D M4 E M5

C Antimuscarinics' therapeutic target is the M3 receptors of the bladder. Answer a is incorrect. A majority of the M1 receptors are located in the central nervous system (CNS). Answer b is incorrect. Although M2 receptors can be found in the bladder, they are not clinically significant in urinary incontinence (UI). Answers d and e are incorrect. M4 and M5 receptors are not clinically significant in UI.

A patient reports that he has been taking his finasteride daily for the past 6 months for benign prostatic hyperplasia (BPH). His last prostate-specific antigen (PSA) was 2.6 ng/mL. Today it is 1.3 ng/mL. This can be best explained by which of the following: A Finasteride stops the prostate from producing PSA. B Finasteride can cause erroneous results in laboratory testing for PSA. C PSA levels are often significantly decreased in patients taking 5ARI. D Finasteride has no effect on the PSA level.

C As finasteride decreases the size of the prostate, there is less prostate volume to produce PSA. PSA levels can be expected to decrease as much as 50% after beginning therapy with either finasteride or dutasteride. Answer a is incorrect. The prostate still produces PSA after patients begin taking 5-α-reductase inhibitor (5ARI) therapy. Answer b is incorrect. The decrease in PSA is not an anomaly associated with erroneous laboratory testing for PSA. Answer d is incorrect.Finasteride has a significant effect on the PSA level.

What is the brand name for mirabegron? A Detrol LA B Ditropan C Myrbetriq D Vesicare E Sanctura XR

C The brand name is Tolterodine. Answer b is incorrect. The brand name is oxybutynin. Answer d is incorrect. The brand name is solifenacin. Answer e is incorrect. The brand name is trospium chloride.

A patient planning on having cataract surgery next week presents with a prescription for tamsulosin. His symptoms are not bothersome but reports urinary hesitancy and straining. You decide to: A Fill the prescription and counsel the patient on risk of sexual side effects. B Call his physician and ophthalmologist and get his order changed to finasteride. C Call his physician and ophthalmologist to determine if treatment with tamsulosin should be deferred until after his cataract surgery. D Fill the prescription and counsel on risk of dizziness and orthostatic hypotension. E Call his physician and get his order changed to terazosin.

C Use of tamsulosin prior to cataract surgery is associated with surgical complications. While these can be treated, it may be prudent to determine if treatment can be deferred until after his procedure. His physician and ophthalmologist should be made aware of his intention to start this medication prior to cataract surgery. Answer a is incorrect. While tamsulosin can cause sexual side effects including ejaculatory disturbances, this is not the best answer. Answer b is incorrect. Candidates for 5-α-reductase inhibitor (5ARI) include those with large prostate volume (typically greater than 40 gm). Without this information, it would be difficult to recommend finasteride for this patient. Answer d is incorrect. As stated above, use of tamsulosin prior to cataract surgery may increase risk for surgical complications that may be prevented by deferring treatment. Answer e is incorrect. Surgical complications have been associated with all α blockers. At this time, informing his physician and discussing this issue with the patient is the best answer.

KR is a 62-year-old Hispanic male with a history of hypertension. He complains of erectile dysfunction (ED) for which he seeks treatment. There is no identifiable organic cause for his ED. Select the statement that correctly describes the approach to treatment in this patient. A Phosphodiesterase (PDE-5) inhibitors would not be the treatment of choice in this patient. B PDE-5 inhibitors are less efficacious in Hispanics. C The use of a PDE-5 inhibitor is not likely to be effective in this patient with hypertension. D A PDE-5 inhibitor would exert its activity by enhancing the vasodilatory effects of cyclic guanosine monophosphate (cGMP). E He should not receive a PDE-5 inhibitor because sexual intercourse would not be advisable because of his cardiac status.

D PDE-5 inhibitors exert their activity by enhancing the vasodilatory effects of cyclic guanosine monophosphate (cGMP). Answer a is incorrect. PDE-5 inhibitors are the treatment of choice in patients with ED that do not have an identifiable cause for their ED. Answer b is incorrect. PDE-5 inhibitors are effective in all ethnic groups. Answer c is incorrect. PDE-5 inhibitors are effective in patients with hypertension that develop ED. Answer e is incorrect. There is no condition present in KR that would make sexual intercourse inadvisable.

A 55-year-old woman is postmenopausal. Along with urinary incontinence (UI), this patient is also suffering from symptoms of vaginal dryness, burning, and itching. Which of the following would be the best pharmacologic option for her? A Oral estrogen B Duloxetine C OnabotulinumtoxinA D Topical estrogen

D Studies have proven that postmenopausal women taking oral estrogen have an increased risk in UI. Answer b is incorrect.Duloxetine is used in stress urinary incontinence (SUI). Answer c is incorrect. Botulinum toxin is used for patients refractory or intolerant to antimuscarinics. Answer d is correct. The symptoms listed above describe vaginal atrophy. Micronized 17-β estradiol (Vagifem) is indicated for vaginal atrophy.

What type of incontinence can be described as having urinary urgency, frequency, and nocturia along with leakage during exercise? A Stress urinary incontinence (SUI) B Urge urinary incontinence/overactive bladder (UUI/OAB) C Overflow incontinence (OI) D Mixed incontinence E Functional Incontinence

D The above symptoms describe both OAB and SUI and therefore are defined as mixed incontinence because it is more than one type of urinary incontinence (UI). *Urgency = urge* Answer a is incorrect. The above symptoms are not SUI alone. Answer b is incorrect. The above symptoms are not UUI alone. Answer c in incorrect. The above symptoms are not OI. Answer e is incorrect. The above symptoms are not caused by functional or cognitive impairments.

Which of the following is the brand name for dutasteride? A Hytrin® B Flomax® C Proscar® D Avodart® E Cardura®

D The generic name for Avodart® is dutasteride. Answer a is incorrect. The generic name for Hytrin® is terazosin. Answer b is incorrect. The generic name for Flomax® is tamsulosin. Answer c is incorrect. The generic name for Proscar® is finasteride. Answer e in incorrect. The generic name for Cardura® is doxazosin.

What pregnancy category is finasteride? A A B B C C D D E X

E 5-α-Reductase inhibitors (5ARIs) are associated with male birth defects. 5ARI, including finasteride and dutasteride, should not be taken or handled by women who are pregnant or women of childbearing age.

MJ is a 68-year-old man with a past medical history significant for diabetes and hypertension. His current medications include metformin, lisinopril, and metoprolol succinate. He complains of erectile dysfunction (ED) for which he seeks treatment. Select the brand name for MJ's new medication, vardenafil. A Relenza® B Viagra® C Enzyte® D Cialis® E Levitra®

E The generic name of Levitra® is vardenafil. Answer a is incorrect. The generic name of Relenza® is zanamivir. Answer b is incorrect. The generic name of Viagra® is sildenafil. Answer c is incorrect. Enzyte® is an over the counter product marketed for the treatment of ED. Answer d is incorrect. The generic name of Cialis® is tadalafil.