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Therapeutics > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

When should testosterone levels be measured?

A

in the morning

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2
Q

Technical term for incomplete/ delayed puberty?

A

hypogonadism

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3
Q

what defines hypogonadism?

A

delayed puberty; lack of testicular growth at 14 years old

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4
Q

treatment for hypogonadism?

A

IM testosterone esters 50mg monthly; used short-term

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5
Q

What age group is testicular cancer most common in?

A

young men; 15-35 years

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6
Q

testicular cancer treatment

A

surgery, radiation, chemotherapy

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7
Q

what is the cause of alopecia?

A

androgenic alopecia; conversion of testosterone to DHT

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8
Q

what is alopecia areata?

A

an autoimmune disorder; small round patches of hair lost

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9
Q

what is alopecia universalis?

A

autoimmune disorder; complete hair loss on scalp and body

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10
Q

traction alopecia

A

caused by tension on hair due to buns, braids, etc

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11
Q

What is first-line treatment for alopecia?

A

finasteride 1mg po once daily

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12
Q

What is the MOA of finasteride

A

it is a type II 5-alpha reductase inhibitor; inhibits conversion of testosterone to DHT; stops progression of hair loss

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13
Q

Counseling points for finasteride for alopecia

A
  • must be used continuously to maintain efficacy
  • SE include decreased libido, ED, and decreased ejaculate volume.
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14
Q

What is the MOA for Minoxidil?

A
  • a very potent vasodilator
  • enlarges miniaturized hair follicles by increasing blood supply to the hair follicle
  • stimulates hair follicle to the growth phase
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15
Q

Minoxidil strength and counseling

A
  • 5% foam/solution
  • apply to scalp twice daily every day
  • apply to dry scalp and hair
  • may take up to 4 months to see benefit
  • must be used continuously to see results/ maintain benefit
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16
Q

Hypogonadism definition

A

hormonal deficiency in testosterone

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17
Q

How to diagnose hypogonadism

A

low testosterone levels WITH symptoms

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18
Q

What tests/ results are required to confirm low testosterone levels?

A
  • total testosterone level of <300ng/dL
  • a free testosterone level of <5ng/dL
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19
Q

When should testosterone replacement be used?

A

Only when hypogonadism is diagnosed; Low T and symptoms

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20
Q

What dosage form of testosterone therapy is most similar to physiologic testosterone levels?

A

patch; 1-2 patches applied nightly

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21
Q

What is Jatenzo?

A

Testosterone undecanoate capsules; 158-396mg BID with food

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22
Q

What are contraindications to Testosterone hormone therapy?

A
  • prostate cancer
  • breast cancer
  • hematocrit >50% (caused by low O2)
  • PSA greater than 4 ng/dl or PSA >3ng/mL in men at high cancer risk
  • recent or poorly controlled CVD
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23
Q

Testosterone black box warnings

A
  • risk of exposure to children via gel formulation
  • cardiac risk
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24
Q

What dosage form of testosterone has the highest cardiac risk?

A

Injection> patches and gels

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25
Q

What is a goal testosterone level?

A

400 to 700ng/dL

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26
Q

What should be monitored within 3-6 months of initiating testosterone therapy?

A
  • testosterone levels
  • hematocrit levels
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27
Q

erectile dysfunction definition

A

a consistent inability to obtain or sustain an erection sufficient for intercourse in at least 50% of attempts

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28
Q

What are some potential causes of ED?

A
  • DM
  • HTN
  • coronary artery disease
  • neurological diseases (MD, Parkinson’s, stroke)
  • low testosterone levels
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29
Q

what drugs are responsible for drug-induced ED?

A
  • Antidepressants (SSRIs)
  • some antihypertensive agents
  • estrogens/ anti-androgens
  • 5- alpha reductase inhibitors (finasteride)
  • cancer chemotherapy
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30
Q

What is the physiology of an erection?

A
  • after sexual stimulation, ACh is released, which causes the release of nitrous oxide in the penis
  • GTP is converted to cGMP
  • Ca++ is released and produces smooth muscle relaxation in the penis
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31
Q

first-line treatment of ED

A
  • non-pharmacologic; treat any known causes
  • change meds if drug-induced
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32
Q

First-line pharmacologic treatment of ED

A
  • Oral PDE-5 inhibitors
    (if contraindicated, use vacuum erection device)
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33
Q

PDE-5 inhibitor MOA

A
  • promotion of smooth muscle relation in the penis by inhibition of phosphodiesterase 5
  • inhibits breakdown of cyclic AMP
  • sexual stimulation is required; more for maintaining an erection than obtaining an erection
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34
Q

What to do is PDE-5 inhibitor does not work?

A
  • increase dose; adjust dose to produce an erection that lasts no longer than 1 hour
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35
Q

Drug interactions with PDE-5 inhibitors

A

CYP3A4 inhibitors
- cimetidine, ketoconazole, erythromycin, ritonavir, grapefruit juice, others
- affects metabolism; prolongs the effect of the drugs

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36
Q

Other counseling notes for PDE-5 inhibitors

A
  • food delays the absorption of sildenafil and vardenafil (Levitra) by one hour
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37
Q

potential side effects of PDE-5 inhibitors

A
  • headache
    -flushing
  • dyspepsia
  • nasal congestion
  • light sensitivity
  • NAION (sudden vision loss)
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38
Q

Major contraindication with PDE-5 inhibitors

A
  • transdermal nitrates (nitroglycerin)
  • causes a massive drop in blood pressure (hypotension) and may cause syncope
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39
Q

alpha blockers + PDE-5 inhibitors

A
  • start patients on a lower dose of the PDE-5 inhibitor
  • may cause dizziness
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40
Q

When to report an erection to your doctor?

A
  • when it lasts longer than 4 hours
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41
Q

Patient education about PDE-5 inhibitors

A
  • take 1-2 hours prior to intercourse
  • do not take with food (delays absorption)
  • report erections that last longer than 4 hours
  • report visual and hearing complaints
  • report palpitations or dizziness
  • avoid with nitrates
42
Q

PDE-5 inhibitors for pulmonary hypertension

A
  • routine dose
  • sildenafil 20mg PO TID
  • tadalafil 40mg PO once daily
43
Q

vacuum erection device

A
  • very effective
  • use for patients with contraindications to PDE-5 inhibitors
  • avoid in sickle cell patients
44
Q

Alprostadil pellets MOA and counseling

A
  • increased cAMP production and produces smooth muscle relaxation
  • less effective than injection, but more acceptable to patients
  • onset is 5-10 minutes
  • may cause pain, burning
  • can be used with PDE-5 inhibitors
45
Q

Alprostadil injections MOA and counseling

A
  • increased cAMP production and produces smooth muscle relaxation
  • drug of choice if patient fails PDE-5 inhibitors
  • used for neurogenic ED
  • onset within 5 minutes
  • overall most effective; no sexual stimulation required
  • max of 1/day or 3/week
  • may cause local irritation, pain, burning
  • titrate to dose producing an erection that lasts one hour
  • usual range= 10-20mcg; max of 60mcg
46
Q

penile prostheses counseling

A
  • only used when drug therapy and other therapies fail
  • semi-rigid insert with a pump
  • replace every 5-10 years.
47
Q

OTC recommendations

A

OTC therapies are not recommended; many seized at border contain sildenafil

48
Q

what is priapism

A
  • condition in which a penis remains erect for hours in the absence of stimulation
  • classified into painful (ischemic) and non-painful (non-ischemic)
49
Q

drugs that could cause priapism

A
  • ED drugs
  • antidepressants
  • antipsychotics
  • anticoagulants
  • cocaine
  • others
50
Q

treatment of priapism

A

ischemic:
- phenylephrine injection
- blood aspiration
- saline irrigation
non-ischemic:
- cold packs and compression

51
Q

What is peyronie’s disease and how is it treated?

A
  • erections bent at least 30 degrees; may also be painful
  • treatment: Xiaflex injection (collagenase closridium histolyticum)
  • treatment is in urologist office
52
Q

prostate cancer risk factors

A
  • increasing age
  • african ancestry
  • family history
53
Q

What is PSA screening and what is a normal value?

A
  • Prostate specific antigen
  • most men without prostate cancer have PSA levels under 4ng/mL of blood.
  • men with levels between 4-10 have a 25% chance of having prostate cancer
  • men with levels above 10 have a 50% chance of having prostate cancer
54
Q

pathophysiology of BPH

A
  • growth in the prostate gland
  • type II 5-alpha reductase converts testosterone to DHT.
  • responsible for prostate enlargement and growth.
55
Q

Irritative symptoms of BPH

A
  • nocturia
  • redistribution of edema
56
Q

complications of BPH

A
  • chronic renal failure
  • overflow urinary incontinence
  • recurrent UTIs
  • diminished QOL
57
Q

What is the AUA and resulting categories

A
  • score of symptoms
  • <7=mild
  • 8-19= moderate
  • > 20= severe
58
Q

goals of BPH therapy

A
  • control symptoms
  • decrease AUA score
59
Q

treatment for mild symptoms

A

watchful waiting

60
Q

moderate symptoms with erectile dysfunction

A
  • a adrenergic antagonist, PDE-5 inhibitor, or both
61
Q

moderate symptoms with small prostate and low PSA

A

a adrenergic antagonist

62
Q

moderate symptoms with large prostate and increased PSA

A
  • 5 a reductase inhibitor
  • or 5 a reductase inhibitor and a adrenergic antagonist
63
Q

moderate symptoms with predominant irritative voiding symptoms

A
  • a adrenergic antagonist and anticholinergic agent
64
Q

severe symptoms with complications

A

surgery

65
Q

What drugs to avoid in BPH

A
  • drugs with strong anti-cholinergic properties
  • first gen antihistamines
  • tricyclic antidepressants
    cogentin, artane, scopolamine
  • antimuscarinics
66
Q

When to use detrol LA

A
  • when the patient has BPH and incontinence
  • avoid in patients with a high post-void residual and max urine flow rate less than 5
67
Q

drug therapy for mild bph otc

A

saw palmetto; safe but may not be verry effective

68
Q

alpha-1a adrenergic blocker MOA

A
  • relaxes smooth muscle tone of prostate gland and bladder neck to improve urine flow
69
Q

Alpha-1a adrenergic blocker counseling

A
  • does not reduce size of prostate gland
  • onset in 1-6 weeks
  • take tamsulosin 1/2 hour after same meal each day to increase effectiveness
70
Q

A-1a adrenergic blockers

A

alfuzosin, doxazosin, silodosin, tamsulosin, terazosin

71
Q

A-1a adrenergic blockers side effects

A
  • dizziness, fatigue, HA, orthostatic hypotension, decreased volume of ejaculation
72
Q

PDE-5 inhibitors for treatment of BPH

A
  • indicated if pt also has ED
  • effectiveness similar to alpha antagonists
  • tadalafil 5mg daily
  • relaxes smooth muscle of prostate gland and bladder neck to improve urine flow
73
Q

5-a reductase inhibitors for treatment of BPH

A
  • indicated if the patient has a prostate larger than 40g
  • decreases prostate size
  • use in conjunction with alpha antagonist
  • onset of action may take up to 6 months
  • finasteride 5mg po daily
  • dutasteride 0.5mg po daily
74
Q

combination therapy options

A
  • finasteride and tamsulosin: for patients with enlarged prostate glands
  • finasteride and tadalafil: for patients with BPH and ED
  • tamsulosin and tolterodine: for patients with BPH and OAB
75
Q

how many extra calories in prenatal diet?

A

300-400 extra calories per day

76
Q

what to limit in prenatal diet

A

artificial sweeteners, dairy, eggs, unwashed produce, herbal teas, undercooked meats, caffeine

77
Q

what is the caffeine limit in pregnancy?

A

200mg/day

78
Q

prenatal supplement reccomendations

A
  • folate 400-600mcg daily
  • calcium 1000-1300mg daily
  • iron 27-30mg daily
79
Q

when should prenatal supplements be started?

A
  • 3 months prior to conception
  • folic acid at least one month prior to conception
80
Q

vaccine reccomendations for pregnancy

A
  • inactivated flu before the end of october
  • Tdap between 27-36
  • covid-19 vaccination
81
Q

vaccines to avoid in pregnancy

A
  • HPV
  • MMR
  • live flu
  • varicella
  • yellow fever
  • typhoid fever
82
Q

common teratogens

A
  • warfarin
  • lisinopril
  • lithium
  • methotrexate
  • alcohol
  • isotretinoin
  • statins
83
Q

preferred treatment of diabetes during pregnancy

A
  • insulin
84
Q

preferred treatment of hypertension during pregnancy

A
  • labetalol
  • amlodipine
  • nifedipine
  • hctz
  • hydralazine
  • methadopa
85
Q

agents to avoid for hypertension during pregnancy

A
  • ACE inhibitors (lisinopril, verapimil, etc)
  • ARBS (valsartan, candesartan, etc)
86
Q

treatment of nausea and vomiting during pregnancy:

A

1st line : non-pharmacologic
2nd line:
- pyridoxine
- doxylamine and pyridoxine
- meclizine, dyphenhydramine
- last line: ondansetron, metoclopramide

87
Q

treatment of heartburn in pregnancy

A
  • antacids (magnesium hydroxide, calcium carbonate)
  • sucralfate
  • H2 agonists
88
Q

treatment of constipation

A
  • high fiber foods
  • increased fluid intake
  • regular exercise
89
Q

pharmacologic treatment of constipation

A
  • osmotic laxatives (PEG and Lactulose)
  • stool softeners (docusate)
  • bulk laxatives (psyllium)
90
Q

treatment of pain in pregnancy

A

1st line: acetaminophen
avoid NSAIDS after 32 weeks gestation

91
Q

recommended antibiotic treatment for UTIs in pregnancy

A
  • 1st gen cephalosporins (keflex)
  • macrobid
  • amoxicillin
    -ampicillin
92
Q

antibiotics to avoid in pregnancy

A
  • fluoroquinolones: ciprofloxacin and levofloxacin
  • tetracyclines: doxycycline and minocycline
  • Bactrim DS
93
Q

treatment for gestational diabetes

A
  • monitor blood glucose
  • insulin
94
Q

pharmacologic treatment for thromboembolism in pregnancy

A
  • anticoag agents
  • avoid warfarin
95
Q

preeclampsia definition

A

sudden spike in blood pressure plus proteinuria

96
Q

preeclampsia treatment

A

-aspirin 60-80 mg starting in late first trimester
- hydralazine, labetalol, nifedipine

97
Q

seizure management in pregnancy

A
  • magnesium sulfate 4-6g IV bolus
  • may also use phenytoin or benzodiazepines (lorazepam)
98
Q

HELLP syndrome and treatment

A
  • hemolysis
  • low platelet count
  • elevated liver enzymes
    treat with:
  • platelets
  • corticosteroids
  • monitor lab values
99
Q

what is preterm labor?

A

labor before week 37 gestation

100
Q

medications to treat preterm birth

A

progesterone

101
Q

premature membrane rupture treatment

A
  • corticosteroids
  • antibiotics
  • magnesium sulfate
102
Q

preterm labor treatment

A
  • corticosteroids help with lungs
  • antibiotics: ampicillin + erythromycin

Therapeutics (7 decks)

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