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Pharmacology > Chapter 21: men's health > Flashcards

Chapter 21: men's health Flashcards

1
Q

health concern related specifically to men

A

erectile dysfunction

benign prostate hyperplasia

male pattern baldness

male androgen deficiency

prostatitis

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2
Q

drugs classes used to treat erectile dysfunction

A

orl phosphodiesterase inhibitors (PDE5)

injectable prostaglandins

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3
Q

drug classes used to treat BPH

A

alpha-1 blockers

5-alpha reductase inhibitors

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4
Q

medication class used to treat male pattern baldness

A

5-alpha reductase inhibitors

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5
Q

drug used to treat male androgen deficiency

A

exogenous testosterone

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6
Q

drug classes used to treat prostatitis

A

ABTs

(ampicillin, ciprofloxin)

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7
Q

six main categories of ED

A

vasculogenic

psychogenic

neurogenic

hormonal

drug use

other (physical anomaly, chronic illness, surgery, etc)

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8
Q

PDE5 inhibitors

mechanism of action

A

inhibits smooth muscle relaxation in arteries and the corpus cavernosum by inhibiting the conversion of cGMP

discovered while searching for a new antihypertensive agent

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9
Q

examples of PDE5 inhibitors

A

sildenafil (Viagra)

vardenafil (Levitra)

tadalafil (Cialis)

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10
Q

selectivity of PDE5 medications

A

sildenafil (Viagra): 10-fold

tadalafil (Cialis): 10,000 fold

vardenafil (Levitra): 15 fold

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11
Q

PDE5 parmacokinetics

A

well absorbed orally

extensive distribution

CYP450 system metabolism into active metabolite in urine

excreted mostly in feces

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12
Q

which PDE5’s absorption is inhibited by food

A

sildenafil (Viagra)

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13
Q

Adverse reactions of PDE5 inhibitors

A
  • CV: flushing
  • EENT: rhinitis, sinusitis
  • GI: dyspepsia, nausea
  • GU: priapism and prolonged erections are RARE
  • MISC: flu-like symptoms
  • NEURO: headache
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14
Q

Which medications interact with PDE5 inhibitors

A

Nitrates (most serious)

antihypertensives

macrolides, antifungals, diuretics (require dosage adjustments)

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15
Q

PDE5 inhibitor contraindications

A

nitrate therapy or any patient who sees a drop in BP

sickle cell, myeloma, leukemia

retinitis pigmentosa

elderly or any patient with renal impairment

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16
Q

injectable prostaglandin mechanism of action

A

vasoactive

relaxes arterial smooth muscle by stimulating an increase on intracellular cyclic necleotides to increase blood flow to the corpus cavernosum causing erection

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17
Q

examples of injectable prostaglandins

A

alprostadil (Caverject)

papaverine (Regitine)

vasoactive intestinal polypeptides (UIP

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18
Q

administration of injectible prostaglandins

A

intracavernosum cavity or transurethal

teach how to administer at lowest possible effective dose

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19
Q

incidence of penile pain with injectible prostaglandins

A

37%

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20
Q

contraindications for injectible prostaglandins

A

penile deformity

penile implant

patients with conditions that predispose them to priapism

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21
Q

conditions that predispose a patient to priapism

A

sickle cell, leukemia, multiple myeloma, polycythemia, thrombocythemia

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22
Q

drugs that can worsen BPH symptoms

A

first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications

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23
Q

drug classes used to treat BPH

A

alpha blockers

5-alpha reductase inhibitors

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24
Q

alpha blockers mechanism of action

A

relaxes smooth muscle in the prostate gland to decrease obstruction of urine flow

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25
Q

examples of nonselective alpha blockers

A

doxazosin (Cardura)

prazosin (Minipress)

terazosin (Hytrin)

26
Q

examples of selsctive alpha blockers

A

alfuzosin (Uroxatral)

tamsulosin (Flomax)

27
Q

effectiveness of alpha blockers to treat BPH

A

effectiveness within 1 month

effect ceases when medication is stopped

28
Q

patient education for drugs used to treat BPH

A

discuss all medications and possible interactions

cannot donate blood while on these medications of for 6 months after

treatment is not a cure, only for symptom relief

29
Q

pharmacokinetics of alpha blockers

A

all are well absorbed except Flomax

all are well distributed and metabolized in liver

excreted in both urine and feces

30
Q

alpha blockers adverse effects

A
  • CV: orthostatic hypotension
  • EENT: rhinitis
  • ENDO: decreased libido
  • GI: distress
  • MS: muscle and back pain
  • NEURO: headache, dizziness
31
Q

alpha blockers interactions

A

caution with any medications that may decrease BP

32
Q

alpha blockers patient education

A

first-dose reactions (orthostatic hypotension) are likely

early side effects will likely disapear with continued use

33
Q

5-alpha reductase inhibitors mechanism of action

A

supress testosterone formation in the prostate gland

34
Q

5-alpha reductase inhibitors affect on PSA levels

A

increases and therefore abnormal values used for cancer screening in these patients should be adjusted

35
Q

examples of 5-alpha reductase inhibitors

A

dutasteride (Avodart)

finasteride (Proscar)

36
Q

what is also treated by finasteride besides BPH

A

male pattern baldness (Propecia)

lower dosage than for BPH

37
Q

5-alpha reductase inhibitor pregnancy category

A

X for producing genital abnormalities in male offspring

38
Q

adverse reactions of 5-alpha reductase inhibitors

A
  • CV: postural hypotension
  • EENT: rhinitis
  • ENDO: impotence, decreased libido, gynecomastia (2%)
  • GU: finasterides causes a decrease in PSA even in the presence of cancer
  • MS: weakness
  • NEURO: dizziness, somnolence
  • PUL: dyspnea
39
Q

5-alpha reductase inhibitor interactions

A

MANY

including: cimetidine, cipro, diltiazem, ketoconozole, ritonavir, verapimil, st. john’s wort

40
Q

contraindications for 5-alpha reductase inhibitors

A

serious skin reactions

pediatric patients

should not be handled by women pregnant or trying to become pregnant

41
Q

how long does it take to see results from 5-alpha reductase inhibitor therapy

A

3-6 months

42
Q

symptoms of hypogonadism

A

depressed mood, diminished energy, decreased muscle strength and bulk, increased fat mass, impaired cognition, anemia, diminished bone density, fatigue, increased insulin resistance, multiple impaired sexual functions

43
Q

exogenous testosterone pharmacokinetics

A

complete absorption with IM administration

99% protein bound to globulin

first pass metabolism in liver to active metabolite

excreted in urine

44
Q

clinical uses of exogenous testosterone

A

androgen replacement therapy in treatment of delayed male puberty

maly hypogonadism

replacement therapy in cases of deficient endogenous hormone

45
Q

adverse effects of testosterone replacement

A
  • CV: edema, flushing, HTN, vasodilation
  • DERM: acne, alopecia, dry skin, erythema, hirsutism
  • ENDO: breast tenderness, gynecomastia
  • GI: n/v, distress
  • GU: impotence, testicular atrophy, bladder issues
  • HEME: leucopenia, suppression of clotting
  • MS: weakness
  • NEURO: aggression, amnesia, headache, parathesia, nervousness
  • OTHER: pain at injection site
46
Q

conscientious considerations for testosternoen replacement therapy

A

require careful monitoring for side effects

change therapy if no visible response in 3-4 months

47
Q

labs to monitor when patient is on testosterone replacement therapy

A

lipids, PSA, HCT, and DRE

if oral form, LFTs as well

48
Q

testosterone contraindications

A

breast cancer

prostate cancer

pregnancy

49
Q

testosterone interactions

A

oral anticoagulants can cause hypoprothrombinemic response

50
Q

patient education for testosterone therapy

A

age and physical condition may limit results

women of chid-bearing age should not handle

must not use if they have BPH an abnormal lipid profile

need to screen for prostate and breast cancer

51
Q

drugs used to treat male pattern baldness

A

finasteride (Propecia)

minoxidil (Rogaine)

52
Q

minoxidil mechanism of action

A

appears to have a direct effect on hair follicles by stimulating resting hair follicles into active growth

no drug interactions because it is topical

53
Q

when are medications for male pattern bladness less effective

A

temporal or frontal hair loss

54
Q

new hair growth with use of medications for male pattern baldness

A

results are not seen for 2-6 months of daily use and new hair will be lost within 4-6 months of discontinuing treatment

55
Q

patient education for drugs for male pattern baldness

A

finasteride should not be handled by children or pregnant females

do not donate blood while on this or for six months after

56
Q

male specific infections of the GU tract

A

prostatitis

epididymitis

orchitis

STDs

57
Q

epididymitis and orchitis in males 14-35

A

typically due to an STD

58
Q

epididymitis and orchitis in males younger than 14 or older than 35

A

typically due to e.coli

59
Q

medications used to treat male UTIs

A

ceftriaxone (Rocephin)

doxycycline (Vibramycin)

azithromycin (Zithromax)

60
Q
A

Pharmacology (28 decks)

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