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Pharmacy Drugs > 416 Exam 4 ED, HRT > Flashcards

416 Exam 4 ED, HRT Flashcards

1
Q

MOA of PDE-5 inhibitors

A

Selective inhibition of phosphodiesterase type 5 isoenzymes

-inhibits catabolism of cGMP

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2
Q

PDE-5 inhibitor agents

A

Sildenafil (Viagra)
Vardenafil (Levitra, Staxyn)
Tadalafil (Cialis)
Avanafil (Stendra)

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3
Q

PDE-5 inhibitor DDI

A

Nitrates
Alpha blockers (terazosin, doxazosin)
3A4 inhibitors

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4
Q

PDE-5 inhibitor AE

A
  • HA
  • flushing
  • congestion
  • dyspepsia
  • dizziness
  • hypotension
  • visual effects
  • hearing loss
  • back/limb pain/myalgia
  • priapism
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5
Q

Sildenafil dosing

A

50mg prn

  • onset: 30-60min
  • duration: 4hrs
  • empty stomach
  • PDE-6
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6
Q

Tadalafil Dosing

A

10mg prn OR

  1. 5-5mg QD
    - onset: 30min-6hr
    - duration: 24-36hrs
    - PDE-11
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7
Q

MOA of Alprostadil

A

Stimulates adenyl cyclase which increases cAMP and leads to enhanced blood flow to the corpora cavernosa

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8
Q

Alprostadil dosage forms

A 
Intracevernosal injection (Caverject)
Intraurethral insert (MUSE)
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9
Q

AE of intracavernosal Alprostadil

A
  • cavernosal plaques
  • penile curvature/pain
  • priaprism
  • injection site hematoma
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10
Q

AE of intraurethral Alprostadil

A
  • urethral injury/pain
  • priaprism
  • female vaginal burning/pain
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11
Q

Primary trt for hyperprolactinemia

A

Dopamine agonist (cabergoline > bromocriptine)

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12
Q

Initial trt for ovulatory dysfunction

A

Clomiphene

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13
Q

MOA of clomiphene

A

SERM

  • competes w/ estradiol for estrogen receptors at the hypothalamus
  • blocks estrogen negative feedback at the hypothalamus
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14
Q

AE of clomiphene

A
  • hot flashes
  • mild abdominal or pelvic discomfort
  • vaginal dryness, mood swings
  • less frequent: dizziness, fatigue, breast tenderness, HA
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15
Q

CI with Clomiphene

A
  • uncontrolled thyroid or adrenal dysfunction
  • primary ovarian failure or ovarian cysts
  • abnormal uterine bleeding
  • hepatic disease
  • pregnancy
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16
Q

First line trt for polycystic ovary syndrome (PCOS)

A

Metformin 1500-2000mg/d

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17
Q

Risks of HRT

A
  • endometrial CA
  • CV disease
  • venous thromboembolism
  • breast CA
  • ovarian CA
  • gallbladder disease
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18
Q

Endometrial CA

A

Add progestin for intact uterus

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19
Q

Cardiovascular disease

A

Younger age, closer to MP

20
Q

Venous thromboembolism

A

Lowest dose (transdermal)

21
Q

Breast CA

A

Low dose, short duration (<5yrs)

22
Q

Ovarian CA

A

Short duration use (<5yrs)

23
Q

Gallbladder disease

A

Transdermal

24
Q

Benefits of HRT

A
  • vasomotor symptom relief
  • vaginal symptom relief
  • osteoporosis prevention
25
Q

Estrogens approved for

A

Vasomotor or vaginal menopause symptoms

26
Q

Estrogen AE

A
  • nausea, HA, breast tenderness, uterine bleeding

- may need to taper off when discontinuing

27
Q

ABSOLUTE CI for estrogen therapy

A
  • thromboembolic disease
  • pregnancy
  • active liver disease
  • CAD
  • CVD or TIA
  • undiagnosed vaginal bleeding
  • active breast or endometrial CA
28
Q

Relative CI for estrogen therapy

A
  • HTN
  • hypertriglyceridemia
  • impaired liver function
  • fluid retention
  • hypothyroidism
  • ovarian CA
  • exacerbation of endometriosis
  • exacerbation of asthma, DM, migraine, SLE, epilepsy
  • history of breast CA
29
Q

Oral estrogen products

A

Conjugated equine estrogens (Premarin)
Initial/low dose: 0.3-0.45mg
Usual dose: 0.3-1.25mg

30
Q

Transdermal estrogen product

A

Vivelle, Vivelle Dot (apply twice weekly)
Initial/low dose: 0.025mg/d
Usual dose: 0.025-0.1mg/d

31
Q

Vaginal estrogen product (intravaginally)

A

Femring (replace q3m)

32
Q

Intravaginal estrogens

A

Premarin
Estring (replace q90d)
Vagifem (twice weekly)

33
Q

Progesterone AE

A 
Irritability 
Depression 
HA 
Mood swings
Bloating 
Fluid retention 
Sleep disturbances
34
Q

Progesterone products

A 
Medroxyprogesterone acetate (Provera) 
Micronized progesterone (Prometrium)
35
Q

Oral combination products

A

CEE + MPA (Prempro)

Continuous

36
Q

Transdermal combination product

A

Estradiol + levonorgestrel (Climara Pro)

Continous

37
Q

SERM

A

Ospemifene (Osphena) 60mg QD

38
Q

SERM combination product

A

CEE + Bazedoxifene (Duavee) 45/20mg daily

39
Q

Non-hormonal options for vasomotor symptoms

A

Venlafaxine
Paroxetine (approved)
Gabapentin
Clonidine

40
Q

Male hypogonadism

A
  • reduced libido
  • depression or dysthymia
  • decreased spontaneous erections
  • gynecomastia
  • loss of auxiliary and pubic hair
  • small or shrinking testes
  • infertility
  • hight, BMD, muscle loss
  • hot flashes
  • fatigue, decreased motivation
  • incomplete sexual development
41
Q

TRT CI

A
  • history of breast or prostate CA (unelevated prostate nodule or PSA >4ng/ml)
  • hematocrit >50% (epoetin alfa)
  • untreated severe obstructive sleep apnea
  • severe lower urinary tract symptoms
  • uncontrolled/poorly controlled CHF
42
Q

Testosterone transdermal patch

A

Androderm

43
Q

Testosterone gel

A

Androgel 1%
Testim 1%
5-10g as single dose in the morning and titrate up in 14 day intervals

44
Q

Testosterone transdermal spray

A

Fortesta 4-7 sprays once daily and titrate dose up at 14-35 day intervals

45
Q

Testosterone transdermal solution

A

Axiron

46
Q

Benefits of TRT therapy

A
  • decreased body fat and visceral fat
  • improved libido and sexual function
  • improved mood
  • improvements in cognition and vitality
  • improvement in CV risk factors
  • improvements in T2DM and metabolic syndrome
  • increased bone mineral density
  • increased muscle mass and strength
47
Q

Risks of TRT

A
  • cancers (prostate and breast)
  • erythrocytosis
  • gynecomastia
  • sleep apnea
  • acne, oily skin
  • male pattern baldness
  • liver toxicity
  • dyslipidemia
  • increase in CV outcomes

Pharmacy Drugs (37 decks)

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