GU/Repro Pharm

Question 1

BPH Medications: Alpha blockers (…osin):

Answer 1

Indications: first line treatment for mild/mod BPH
MOA: antagonizes prostatic alpha-1 adrenergic receptors causing relaxation muscles of prostate and bladder neck
Effect: Allows urine to flow more easily
Meds: tamulosin, terazosin

Question 2

BPH Medications: Alpha-reductase inhibitors (…asteride)

Answer 2

MOA: inhibits 5-alpha-reductase which interferes with conversion of testosterone
Impact: slows progression or causes regression of prostatic enlargement, decreases risk of urinary retention
Drugs: finasteride (#1) being used

Question 3

ED drugs: Phosphodiesterase-5 inhibitors (…denafil)

Answer 3

Indications: erectile dysfunction, pulmonary hypertension
MOA: Inhibits PDE5, preventing degradation of cGMP which increases nitric oxide levels in smooth muscle cells to cause/prolong vasodilation
Effect: Prolong erections
Drugs: sildenafil, tadalafil, verdenafil

Question 4

Testosterone replacement: Exogenous testosterone

Answer 4

Indications: hypogonadism, transgender hormone therapy (masculinizing)
MOA: binds to androgen receptors
Effect: produces anabolic and androgenic effects: masculinization
Drugs: transdermal or IM

Question 5

Hormonal Contraceptives: Progesterone only (progestin)

Answer 5

Indications: contraception, metrorrhagia

MOA: exogenous progestin suppresses FSH/LH

Effect: thickens cervical mucus, thins the lining of the endometrium, suppresses but doesn’t totally inhibit ovulation to provide contraceptive effects

Drugs
First generation: Norethindrone, norethindrone acetate, norgestrol
Second generation: Levonorgestrel
Third generation: Norgestimate, Desogestrel
Fourth generation: Drospirenone
Options:
Pill-daily
IM injection-q 3months
Rod-q 3 years
IUD-q 3-7 years

Question 6

Hormonal contraception: Combination Agents

Answer 6

Combination of estrogen and progesterone (ethinyl estradiol (EE) and progestin)
Indications: contraception, dysmenorrhea (endometriosis), regulation of irregular cycles, emergency contraception
MOA: EE binds to estrogen receptors,suppressing FSH/LH + MOA of progestin
Effect: Suppresses ovulation in addition to thinning cervical mucus, endometrial lining to provide contraceptive effects
Options:
Emergency contraception: within 72 hours of unprotected sex, high dose x 2 doses (Plan B)
Pill-daily x 28 days, vs 84 days (last 3-7 days placebo to allow progesterone to drop and withdraw bleed occur
Triphasic (not so well) vs. monophasic(works well)
Vaginal ring q 4 weeks (last week out to allow for withdraw bleed)
Patch apply weekly x 3 weeks, off 1 week

Question 7

GnRH Agonists

Answer 7

Indications: prostate CA, endometriosis, uterine fibroids (severe/symptomatic), suppression of puberty, chemical castration, gender-affirmation
MOA: inhibits gonatropin release
Effect: inhibits ovarian and testicular steroidogenesis to inhibit puberty or stop testosterone or estrogen production
Drug: leuprolide