Question 1

A patient who has BPH is taking alfuzosin (Uroxatral)and finasteride (Proscar).The patient has had two urinary tract infections (UTIs)in the past 2 months.A urinalysis in the clinic is negative for leukocyte esterase but positive for hematuria.The primary care NP should:

A) discontinue finasteride.
B) refer the patient to a urologist.
C) change alfuzosin to tamsulosin.
D) add doxazosin to the drug regimen.

Accepted Answer

Surgery is indicated for patients who are refractory to treatment with medications or who have recurrent UTIs or hematuria.The NP should refer the patient to a urologist.All a-blockers are considered equally efficacious,so changing the drug regimen is not indicated.

Question 2

A man who has cardiovascular disease and takes nitroglycerin for angina pain develops erectile dysfunction.The primary care NP who cares for this patient should recommend:&#10;A) sildenafil (Viagra).&#10;B) testosterone injections.&#10;C) vascular reconstruction surgery.&#10;D) use of a vacuum constriction device.

Accepted Answer

Deaths have been reported in men on concomitant treatment with oral nitrates who are taking sildenafil.Patients with erectile dysfunction should be advised to try nonpharmacologic treatment,such as a vacuum constriction device.Testosterone injections are used for men with documented androgen deficiency.Vascular reconstruction surgery may be used for men with decreased blood flow and should be considered if other treatments are ineffective.

Question 3

A patient who has BPH is taking tamsulosin and dutasteride and asks the primary care NP why he needs to take both medications.The NP should tell him:&#10;A) the combination helps reduce the risk of prostate carcinoma.&#10;B) two-drug therapy is required before corrective prostatectomy surgery.&#10;C) both drugs are given so that smaller doses of each drug may be administered.&#10;D) one gives faster symptom relief, whereas the other shrinks the size of the prostate.

Accepted Answer

A 5a-reductase inhibitor is given to shrink the size of the prostate,but maximum benefit is not achieved until 6 months of therapy.The α-blocker is given to provide more rapid relief.The combination does not decrease the risk of carcinoma.The drug therapy is not a prerequisite to surgery,although it may be used before surgical intervention.The combination therapy does not affect the dose of either drug.

Question 4

A patient who has BPH is taking doxazosin and finasteride.The patient asks the primary care NP whether he has an increased risk of prostate cancer.The NP should tell him:&#10;A) his overall cancer risk is increased.&#10;B) he has an increased risk of a certain type of cancer.&#10;C) his cancer risk is the same as any other man his age.&#10;D) doxazosin will increase his cancer risk, but only slightly.

Accepted Answer

There is an overall reduction in prostate cancer risk for patients taking 5a-reductase inhibitors,such as finasteride,but there is an increased risk of high-grade prostate cancer.His overall cancer risk is less.Doxazosin does not affect cancer risk.

Question 5

The primary care NP is preparing to prescribe sildenafil for a man who has erectile dysfunction.The NP should remember to tell this patient:&#10;A) to avoid oral nitrates while taking this medication.&#10;B) that the drug may cause penile aching.&#10;C) to use a condom if his sexual partner is pregnant.&#10;D) dyspepsia may occur and may warrant discontinuation of the drug.

Accepted Answer

Deaths have been reported in men on concomitant treatment with oral nitrates who are taking sildenafil.Patients taking alprostadil may experience penile ache.Finasteride,not sildenafil,is teratogenic,and a man taking finasteride should use condoms if his partner is pregnant.Dyspepsia is a common but not serious side effect of sildenafil.

Question 6

A patient who has erectile dysfunction wants a medication to use as needed.The primary care NP should recommend:&#10;A) tadalafil (Cialis).&#10;B) sildenafil (Viagra).&#10;C) avanafil (Stendra).&#10;D) vardenafil (Levitra).

Accepted Answer

Avanafil is the newest drug on the market and can be used on an as-needed basis because it has a shorter half-life and shorter onset of action.It may be taken 30 minutes before sexual activity.The other agents have an onset of action of several hours.

Question 7

A man who has benign prostatic hypertrophy (BPH),in whom prostate carcinoma has been ruled out,asks the primary care nurse practitioner (NP)about beginning drug therapy to treat his symptoms.The NP notes that he consistently has blood pressure readings around 145/90 mm Hg.The NP should prescribe:

A) tadalafil (Cialis).
B) doxazosin (Cardura).
C) tamsulosin (Flomax).
D) finasteride (Proscar).

Accepted Answer

Doxazosin is a nonspecific a-blocker,which also lowers blood pressure and should be considered to treat BPH in patients who also have hypertension.Tadalafil is used to treat erectile dysfunction.Tamsulosin is a specific á-blocker and is first-line treatment for patients with BPH who do not have hypertension.Finasteride is a 5a-reductase inhibitor,which is not a first-line medication.

Question 8

A patient tells the primary care NP that he has difficulty getting and maintaining an erection.The NP's initial response should be to:&#10;A) prescribe sildenafil (Viagra).&#10;B) perform a medication history.&#10;C) evaluate his cardiovascular status.&#10;D) order a papaverine injection test to screen for erectile dysfunction.

Accepted Answer

Because the use of multiple medications is associated with a higher prevalence of erectile dysfunction,a medication history should be performed first to see if any medications have sexual side effects.A cardiovascular evaluation may be assessed next.Papaverine injection tests are useful screening tools after a thorough history has been performed.Medications are prescribed only after a diagnosis is determined and other causes have been ruled out.

Deck 33: Male Genitourinary Agents