BPH and ED Pharm Flashcards

1
Q

how long do SAR inhibitors take to provide relief of sx in BPH

A

3-6 months

*shrinks and prevents enlargement

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2
Q

what are the 3 categories of drugs used for BPH

A

a1 antagonist (-osin)
steriod 5a reductase inhibitor (-steride)
PDE-5 inhibitors (-afil)

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3
Q

name of PGE1 agonist used to tx ED and function

A

alprostadil (caverject) is a penile injection
-increases level of adenylate cyclase –>increased cAMP–> decreases calcium levels–> smooth muscle relaxation –> erection

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4
Q

which PDE-5 inhibitor has the quickest onset ? what is the onset? what is the onset for the other ones?

A

avanafil (15 min if high dose or 30 min if normal dose)

**all others are 60 min

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5
Q

finasteride vs dutasteride

A
MOA: SAR inhibitiors
TX: BPH 
finasteride is specific for SAR 2 
dutasteride affects both SAR 1 and 2
**finasteride causes a 70% decrease in serum  DHT vs 90% in dutasteride  ; both cause 90% DHT decrease in prostate
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6
Q

a prostate that has undergone hyperplasia has excess ____

A

SAR 2

steriod 5alpha reductase

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7
Q

doxazosin MOA, specificity, adverse effects, drug interactions

A
MOA: alpha 1 antagonist 
specificity: alpha 1 >>>>>> alpha 2 
*not uroselective 
side effects: postural hypotension, fatigue, dizziness 
Drug interactions: PDE5 inhibitors
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8
Q

alfuzosin MOA, specificity, adverse effects, drug interactions

A
MOA: alpha 1 antagonist 
specificity: All A1 types 
*IS FUNCTIONALLY UROSELECTIVE 
adverse effects: QT prolongation 
drug interaction:  PDE5 inhibitors , increased CYP34A substrates
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9
Q

how does PDE-5 inhibitors treat ED

A

Nitric oxide leads to increased cGMP which decreases calcium levels and induces smooth muscle relaxation in order to form an erection.

  • cGMP is degraded by PDE-5 into 5’-GMP
  • by inhibiting the level of cGMP degradation you can cause an erection to maintain longer
  • the drug works by competing with cGMP to bind to PDE-5 and using it all up to prevent degradation
  • must have an erection prior to use; does not induce an erection
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10
Q

examples of lower urinary tracts sx (LUTS)

A
interrupted stream 
weak stream
feeling of urgency
dribbling 
feeling of fullness
increased frequency (in middle of night) 
hesitation
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11
Q

what are the 2 categories of drugs used for ED

A
PDE-5 inhibitors (-afil)
PGE1 agonist (-adil)
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12
Q

risk factors for ED

A

obesity, smoking, stress

*SOS

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13
Q

name of the 4 PDE-5 inhibitors used to treat ED

A
  1. tadalafil
  2. sildenafil
  3. vardenafil
  4. avanafil
    * fil a VAST
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14
Q

silodosin MOA, specificity, adverse effects, drug interactions

A

MOA: alpha 1 anatagnost
specificty: alpha 1 A and D > B
*uroselective
side effects: reduced ejaculation and IFIS (inter operative floppy iris syndrome)
drug interaction: PDE5 inhibitors , increased CYP34A substrates

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15
Q

adverse effects of finasteride and dutasteride

A
ejaculation disturbances
ED
depressed libido 
gynecomastia 
*no drug interactions
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16
Q

tamsulosin MOA, specificity, adverse effects, drug interactions

A

MOA: alpha 1 anatagnost
specificty: alpha 1 A and D > B
*uroselective
side effects: reduced ejaculation and IFIS (inter operative floppy iris syndrome)
drug interaction: PDE5 inhibitors , increased CYP34A substrates

17
Q

what causes prostate enlargement

A

aging and DHT

18
Q

contraindications of PDE-5 inhibitors

A

organic nitrates (vasodilators) - causes extreme and dangerous hypotension

19
Q

terazosin MOA, specificity, adverse effects, drug interactions

A
MOA: alpha 1 antagonist 
specificity: alpha 1 >>>>>> alpha 2 
*not uroselective 
side effects: postural hypotension, fatigue, dizziness 
Drug interactions: none
20
Q

adverse effects of aloprastidil ? how to tx it?

A

prolonged erection (priapism) that can develop into a medical emergency (need to evacuate clogged blood)

-symoathomimetic (phenylephrine)

21
Q

which PDE-5 inhibitor is approved to treat BPH and ED

A

tadalafil

22
Q

alpha-1 A vs alpha-1 B vs alpha-1 D function

A

A- prostate smooth muscle contraction
B-vascular constriction
D- spinal cord control of urinary function
D>A detrusor muscle relaxation

*detrusor muscle relaxation allows filling and retention, contraction of muscle occurs during urination

23
Q

which BPH drug provides best mono therapy for prompt relief of symptoms (in days)

A

alpha 1 antagonist group

24
Q

which PDE-5 inhibitor has the longest duration of action and longest half life? what is the duration of it and the other drugs?

A

tadalafil (36 hours) (1/2 life = 18 hours)

**all others are 4 hours (1/2 life 4 hours)

25
Q

when to use combo therapy for BPH with Alpha 1 antagonist and SAR inhibitors

A
  1. severe BPH sx
  2. known large prostate
  3. no response to mono therapy