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PHARM II, QUIZ 2 > Erectile Dysfunciton, Prostate, Testosterone > Flashcards

Erectile Dysfunciton, Prostate, Testosterone Flashcards

1
Q

ED Treatment, risk factors

A
  • HTN
  • Hyperlipidemia
  • Diabetes
  • Smoking
  • Alcohol
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2
Q

ED Treatment, 1st Line

A

PDE5-I (Phosphodiesterase-5 Inhibitors)

Viagra (Sildenafil)
Levitra (Vardenafil)
Cialis (Tadalafil)

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3
Q

ED Treatment, 2nd Line

A

Alprostadil (Synthetic PGE-1)

suppository, intracavernosal injection

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4
Q

PDE5-Inhibitors

A

Phosphodiesterase-5 Inhibitors

  • Acts like Nitric Oxide
    • Increase smooth muscle relaxation & blood flow
  • Doesn’t work for 30-40% of patients (try 6-8 doses)
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5
Q

PDE5 - I ADRs

A
  • Hypotension/Dizziness except not w Cialis/Tadalafil!
  • Headache
  • Flushing
  • Nasal congestion
  • Dyspepsia
  • Visual disturbances not w Cialis/Tadalafil
  • Priapsism & Back Pain - *ONLY w Cialis / Tadalafil *
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6
Q

PDE5-I Interactions

A

Nitrates, CI, need 24-48 hr separation

HTN meds - need to lower dose,
*esp alpha blockers (doxazosin, prazosin, terazosin)

Levitra / Vardenafil CI w Antiarrythmics, LONG Q-T

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7
Q

Viagra (Sildenafil)

A

Phosphodiesterase-5 Inhibitor

Administration -> 1 HOUR PRIOR, NO FATTY FOO

Peak effect -> 30 to 60min
Duration of effect -> 4hr

Daily dose -> 25-100mg, MAX 1

LEAST EXPENSIVE - $10 for 30 pills, 20mg each

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8
Q

Levitra (Vardenafil)

A

Phosphodiesterase-5 Inhibitor

Administration -> 1 HOUR PRIOR, NO FATTY FOO

Peak effect -> 70 to 90min
Duration of effect -> 4hr

Daily dose -> 5-20mg, MAX 1

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9
Q

Cialis (Tadalafil)

how is this one different?

A

Phosphodiesterase-5 Inhibitor

Administration -> prior OR daily dose - FAT FOO OK

Peak effect -> 2hr
Duration of effect -> 24 -36hr

Daily dose -> 5-20mg MAX I

  • No visual disturbances or Hypotension*
  • More prone to Priapsism and Back Pain**

Also indicated for BPH

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10
Q

Which PDE5-I is also indicated for BPH

A

Cialis (Tadalafil)

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11
Q

Which PDE5-I has the fastest peak effect?

A

Viagra / Sildenafil

30-60 min

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12
Q

Which PDE5-I lasts the longest?

A

Cialis (Tadalafil)

24-36 hrs

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13
Q

Which PDE5-I is the least expensive?

A

Genergic Viagra (Sildenafil)

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14
Q

Which PDE5-I can be taken with fatty foods without decreasing efficacy?

A

Cialis (Tadalafil)

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15
Q

Which PDE5-I doesn’t cause Hypotenstion?

A

Cialis (Tadalafil)

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16
Q

Which PDE5-I doesn’t cause visual disturbances?

A

Cialis (Tadalafil)

17
Q

Which PDE5-I is most likely to cause priapsism?

A

Cialis (Tadalafil) - 24-36 hr effect

18
Q

HTN drug of choice in sexually active men w ED

A

ARB (valsartan, losartan, all the sartan’s)

  • *unless CI due to aortic stenosis, renal artery stenosis etc
  • *or if compelling indication for another drug
19
Q

Absolute Indication for Intervention w BPH

A
  • Renal complications (due to BPH)
  • Bladder stones
  • Urinary Retention
  • Chronic UTIs
20
Q

BPH treatment, classes

A

Selective and Nonselective Alpha-Antagonists (Zosins)

5-Alpha Reductase Inhibitors (Fina/Dutasteride)

       **Combo Alpha Ant + 5 Alpha** Recommended

PDE5-Inhibitors (Cialis)

21
Q

Nonselective Alpha Antagonists

ZOSINS

A

Terazosin
Doxazosin
Prazosin

MOA: blocks NE effects on vascular smooth muscle. Relaxes urethra sphincter, prostate tissue to ^ urine flow

**Nonselectives, work on vascular, CNS receptors as well&raquo_space;> ADRs
Ortho Hypotension, Dizziness, Syncope

22
Q

Selective Alpha Antagonists

ZOSINS

A

Tamsulosin (Flomax)
Alfuzosin — * ^ with 3A4’s *
Silodosin — * ^ with 3A4’s *

Selective for prostate receptors. No effect on BP
Good for combo to HTN meds

Effective within days - week

23
Q

Tamsulosin (Flomax)

A

Selective Alpha Agonist

  • Take any time, on empty stomach
  • Ok w renal, caution for pts w liver failure

ADRs

  • Tired, weak
  • ED
24
Q

Alfuzosin

  • ^ with 3A4’s *
A

Selective Alpha Agonist

  • Take after small meal
  • Ok w renal
    • CI in mod-sev liver failure **

ADRs

  • Tired, weak, dizzy
  • Headache
  • ED
  • ^ with 3A4’s *
    (Fluconzal, Diltiazem
25
Q

Silodosin

  • ^ with 3A4’s *
A

Selective Alpha Agonist

  • More potent
  • CI in pts w CrCl <30
  • CI in liver failure

ADRs

  • Tired, weak, dizzy
  • ED
  • ^ with 3A4’s *
26
Q

5-Alpha Reductase Inhibitors

A

Finasteride > specific for Type II (prostate)
Dutasteride > nonspecific, Type I & II

  • Converts testosterone to dihydrotestosterone
  • 6 months to take effect
27
Q

5 Alpha Reductase Inhibitors
(Finasteride, Dutasteride)

ADRs

A
  • Impotence
  • Decreased Libido
  • Decreased semen quantity at ejaculation
  • Nausea
  • Abdominal Pain
  • Asthenia (weakness)

Pregn Category X Women avoid contact w pill !!!

28
Q

Combo therapy treatment for BPH

A

Jalyn
Alpha Antagonist + 5 Alpha Reductase Inhibitor

  • Rapid relief w Alpha Antagonist
  • Sustained relief w 5 Alpha Reductase
  • Discontinue 6-9 months after symptom relief
29
Q

Testosterone HRT CI

A

Breast or Prostate Cancer

Prostate nodule / PSA ^ 3

HCT ^ 50%

Sleep apnea, untreated

Heart Failure

Those desiring fertility ?

30
Q

Testosterone HRT ADRs

A

Increased HCT

Acne

Mood swings

Sleep apnea

Infertility

Worsening BPH

Gynecomastia

31
Q

Testosterone WARNINGS

A

Clot risk (stroke, AMI)

Abuse, Dependency

32
Q

Testosterone, IM administration

A

Aveed

Depotestosterone

every 10 weeks

**Warning for POME (pulmonary oil micro embolism)

33
Q

Transdermal Testosterone

A 
Androgel
Fortesta
Testim
Axiron (axillary)
Androderm
34
Q

Transdermal Testosterone WARNING

A

Secondary exposure to testosterone via contact

  • Apply only to site directed
  • Cover area with t shirt
  • Wash hands
35
Q

Prostate Cancer Tx

A

“Androgen Deprivation Therapy”

  • LHRH Analogs
    (Luteinizing Hormone Releasing Hormone)
  • LHRH Antagonists
  • Anti-Androgens
36
Q

LHRH Analogs

A

Goserelin
Triptorelin
Histrelin
Leuprolide

37
Q

LHRH Antagonists

A

Firmagon

38
Q

Anti-Androgens

A

Bicalutamide
Flutamide
Nilutamide
Enzalutamide

Ketoconazole

PHARM II, QUIZ 2 (3 decks)

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