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Pharm II > Lecture 8 (GU)-Exam 4 > Flashcards

Lecture 8 (GU)-Exam 4 Flashcards

1
Q

UTI lower urinary tract infections:
* Involve?
* Infection may be what?
* Symptoms confined to where?

A

Lower urinary tract infections
* Involve only the bladder
* Infections may be simple or complicated
* Symptoms confined to the bladder

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2
Q

Upper urinary tract infections
* Involves what?
* Infections may be what?
* Bladder symptoms plus

A
  • Involves bladder and kidneys
  • Infections may be simple or complicated
  • Bladder symptoms plus: fever, chills, fatigue, or any other systemic illness presentation; flank pain, CVA tenderness, pelvic pain, nausea, vomiting (systemic sx)
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3
Q

UTI categorization: Uncomplicated
* Uncomplicated: Urinary tract infection in patients with what? MC in who?

A
  • Urinary tract infection in patients with no structural or functional urinary tract abnormalities
  • MC in premenopausal women
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4
Q

UTI categorization: Complicated
* Urinary tract infection in patients with what?

A

Urinary tract infection in patients with a urinary tract abnormality that predisposes them to infection
* Congenital abnormality or distortion of urinary tract
* Stones
* Obstruction
* Catheter
* BPH
* Neurologic disorders

Often associated with upper and lower urinary tract symptoms

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5
Q

UTI: complicated and / or catheter related
* What are the MC organisms? (3)
* All patients need? (3)

A

MC organisms:
* Enterobacteriaceae
* Pseudomonas aeruginosa
* Enterococcus sp.

All patients need urinalysis, gram-stain, urine culture

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6
Q

UTI: complicated and / or catheter related
* What is the First-line empiric therapy for patients without systemic illness or at high-risk of multi-drug resistant organisms?
* What is the First-line empiric therapy for patients with systemic illness or high-risk of MDR organisms?
* Exact duration dependent on what?

A

First-line empiric therapy for patients without systemic illness or at high-risk of multi-drug resistant organisms:
* Ciprofloxacin or levofloxacin PO

First-line empiric therapy for patients with systemic illness or high-risk of MDR organisms
* Ertapenem, piperacillin-tazobactam, cefepime

Exact duration dependent on patient response and additional symptoms

*

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7
Q

UTI – adult men
* Always considered what?
* What are the sxs?
* Uncommon in who?
* MCC?

A
  • Always considered a complicated infection
  • Dysuria, frequency, urgency +/- suprapubic pain
  • Uncommon in men < 60 years of age
  • MCC = instrumentation of urinary tract (e.g, catheterization, renal stones)
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8
Q

UTI – adult men
* All patients need what?
* If sexually active rule out what?
* If recurrent infection, rule out what?
* What combo of sxs is acute bacterial prostatitis?

A
  • All patients UA and culture
  • If sexually active rule out gonococcal and chlamydia infections (NAAT)
  • If recurrent infection, rule out prostatitis
  • Cystitis + bladder outlet obstruction = acute bacterial prostatitis
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9
Q

Recommended cystitis regimens - men
* What is first line txt? (4)
* What is the duration?

A

  • 7 days
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10
Q

Recommended cystitis regimens - men
* What does not penetrate prostate?
* Recurrent UTIs; evaluated for what?

A
  • Nitrofurantoin, beta-lactams, fosfomycin do not penetrate prostate
  • Recurrent UTIs; evaluated for benign prostate hypertrophy, other obstruction, prostatitis
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11
Q

Pyelonephritis
* What are the causes? (2)
* MC in who?
* What are the sxs?

A
  • Bacteria ascend to the kidneys via the ureters OR
  • Secondary to blood stream infection
  • MC women 18 to 40 years
  • Cystitis symptoms plus signs and symptoms of systemic illness including fever, costovertebral angle tenderness, nausea and vomiting, sepsis
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12
Q

Pyelonephritis
* Elderly may have what?
* CBC with what?
* UA shows what?
* Patients may have what?

A
  • Elderly may have hypotension or mental status changes
  • CBC with leukocytosis and left shift
  • UA shows pyuria, bacteriuria, and possible hematuria
  • Patients may have hydronephrosis secondary to obstruction.
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13
Q

Pyelonephritis
* What are the MC Organisms?

A
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14
Q

Pyelonephritis
* Txt based on what?
* Most patients require?
* Patients should respond to what?

A
  • Blood cultures, UA, gram-stain, urine culture – adjust antibiotic regimen based on culture results
  • Most patients require hospital admission and broad-spectrum IV antibiotics
  • Patients should respond to proper therapy in 12 to 24 hours
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15
Q

Pyelonephritis
* If no or limited response in 3 to 4 days investigate further for what?
* Patient can be discharged when?

A
  • If no or limited response in 3 to 4 days; investigate further for resistant organisms, abscess formation, obstruction, etc
  • Patient can be discharged when clinically improving, meets criteria for IV to PO conversion, and oral antibiotic appropriate based on culture and sensitivity report
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16
Q

Pyelonephritis – Empiric inpatient treatment
* What is first line for Low-risk resistant bacteria (MC)?
* What is first line for High-risk resistant bacteria?

A

Low-risk resistant bacteria (MC)
* Ceftriaxone
* Ciprofloxacin
* Levofloxacin

High-risk resistant bacteria
* Ertapenem
* Meropenem
* Piperacillin-tazobactam
* Cefepime

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17
Q

Pyelonephritis-Empiric inpatient treatment
* Uncomplicated: Duration txt?
* Complicated: Duration txt? What are things that classifed?

A
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18
Q

Pyelonephritis – Empiric outpatient treatment
* Low-risk resistant bacteria first line?

A
  • Ciprofloxacin
  • Levofloxacin
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19
Q

Pyelonephritis – Empiric outpatient treatment
* What is the duration for uncomplicated?
* What is the duration for complicated? What classifies complicated?

A
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20
Q

ABP treatment:

A
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21
Q

5-Alpha Reductase Inhibitors
* What is the MOA?

A

Inhibits 5-alpha reductase in prostate
* Decreases the conversion of testosterone to more potent dihydrotestosterone
* Decreases intraprostatic and serum DHT levels by 70 to 90%
* Decreases prostate size
* Decrease prostate specific antibody production by 50%

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22
Q

Alpha-1 blockers
* What is the MOA of selective?

A

Selective (α1a > α1b)
* BPH - alpha1 receptors in prostate (α1a)
* Relax smooth muscle of prostate and bladder neck
* Improve urinary flow and decrease BPH symptoms

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23
Q

Alpha-1 blockers
* What is the MOA of non-selective?

A

Non-selective (α1a = α1b)
* Block alpha-1receptors in prostate and
* Block alpha-1 receptors on vascular smooth muscle (α1b)
* Vasodilation – decrease SVR = decrease afterload = decrease blood pressure

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24
Q

Hypogonadism
* What is low?
* How do you dx it?

A
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25
Q

Hypogonadism:
* What are the sxs?

A
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26
Q

Hypogonadism:
* If testosterone is low obtain what? Why?
* What can be positive?

A

If testosterone is low obtain LH and FSH
* Differentiate between primary and secondary

±prolactin

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27
Q

Testosterone treatment
* Indicated for men with what?
* Testosterone treatment for men with what? (off label use)

A
  • Indicated for men with hypogonadism secondary to a disorder of the testicles, pituitary gland, or brain
  • Testosterone treatment for men with age-related low testosterone due to aging is considered off label use
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28
Q
A
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29
Q

Testosterone treatment
* What are the benefits?

A

Benefits:
* Increased libido
* Decreased erectile dysfunction
* Increased lean muscle
* Decreased total body fat

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30
Q

Testosterone treatment
* No good evidence for what? (2)

A
  • Improvement in mood, cognition, well-being
  • Cardiovascular health
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31
Q

Testosterone treatment:
* What are the different treatment options?(5)

A
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32
Q

Testosterone treatment
* What are the contraindications?

A
  • Breast cancer
  • Polycythemia (hematocrit > 54%)
  • Prostate cancer
  • Prostate-specific antigen > 4ng/mL or presence of nodules / induration on digital rectal examination
  • Desire for pregnancy
  • Severe lower urinary tract symptoms
  • Uncontrolled heart failure
  • Untreated sleep apnea
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33
Q

Testosterone treatment
* What is the monitoring?

A
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34
Q

Drug induced Erectile disfunction

A
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35
Q
A
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36
Q
A
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37
Q
A
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38
Q

For men with testosterone deficiency, defined as what?

A
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39
Q

What is the MOA of sildenafil?

A
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40
Q

what is first line for ED?

A

Phosphodiesterase-5 inhibitors

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41
Q

Phosphodiesterase-5 inhibitors – 1st line
* What is the MOA?

A

Prevent the phosphodiesterase type 5 (PDE-5) enzyme from breaking down cyclic guanosine monophosphate (cGMP)
* Results in an increase in the concentration of penile cavernosa cGMP causing prolonged smooth muscle relaxation in the corpus cavernosum vasculature
* Increased erection hardness and duration in men with ED who have sufficient intact vasculature

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42
Q

Phosphodiesterase-5 inhibitors
* What is the CI? (3)

A
  • Nitrate-containing medications which can cause a precipitous drop in blood pressure
  • Men taking nitrates regularly should not use PDE5i medications
  • Men who carry sublingual nitroglycerin for angina should be advised NOT to use this medication within 24 hours of taking a PDE5i, and possibly longer in the case of use of a PDE5i with a long half-life (i.e., tadalafil)

*

43
Q

Phosphodiesterase-5 inhibitors
* Effective in how many people? Lower rates in who?
* 30 to 40 % are non-responders – at least half will benefit from what?

A
  • Effective in 56 to 82% of patients
    * Lower rates in patients with DM and patients status-post prostatectomy
  • 30 to 40 % are non-responders – at least half will benefit from increased education regarding proper use
44
Q

Phosphodiesterase-5 inhibitors – 1st line
* What are the drug interactions?

A

Many other medications also potentially can interact with or influence the metabolism of PDE5i, including anti-depressants, anti-fungals, anti-hypertensives, and HIV/AIDS drugs

45
Q

Phosphodiesterase-5 inhibitors
* What is the education? (7)

A

  • 5-8
46
Q

Phosphodiesterase-5 inhibitors
* What can be tried?
* Long term use does not result in what?

A
  • Switching from one PDE5i to another for ineffectiveness may be tried; limited research
  • Long-term use does not result in tachyphylaxis
47
Q

Phosphodiesterase-5 inhibitors
* Oral PDE5i have what?
* Dose-response is not what?
* What has similar efficacy?

A
  • Oral PDE5i have similar efficacy
  • Dose-response is not linear; very small response difference from lowest to highest dose
  • On demand doing and daily dosing have similar efficacy
48
Q

Phosphodiesterase-5 inhibitors
* What are the SE?

A
49
Q
A
50
Q

Alternative agents- ED
* Alprostadil PDE1iL: What is the MOA? What is the injection?

A
  • Alprostadil PDE1i – increased production of cAMP which works similarly to cGMP
  • Intra-urethral or intracavernosal injection
51
Q

Alternative agents: Alprostadil PDE1i
* Treatment options for who? (3)

A
  • Men for whom PDE5i are contraindicated
  • Men or partners who prefer to avoid oral medication
  • Men or partners who prefer not to use the needles required for ICI medications

30 to 78% efficacy – successful intercourse

52
Q

Alternative agents: Alprostadil PDE1i
* What are the SE?(5)

A
  • Genital pain (6.5 to 34.7%)
  • Minor urethral trauma (1 to 5.1%)
  • Urethral pain or burning (0 to 29%)
  • Dizziness (0 to 7.0%)
  • Prolonged priapism
53
Q

Gynecomastia: Physiologic issues? (age ranges)

A
54
Q

What are conditions associated with gyncomastia?

A
55
Q

This was not a good slide lol, I did not know how to question this

Gynecomastia: treatment
* Verify what?
* Rule out what?
* Discontinue what? Must occur when? What is not reversible? Likely irreversible if regression?
* Observation most successful in who?

A
56
Q

Fill in gynecomastia causes:

A
57
Q

Gynecomastia - treatment
* What are the medication therapy indications?

A

Does not bother them => no txt

58
Q

Gynecomastia - treatment
* What are specific treatments?

A
59
Q

Gynecomastia - treatment (tamoxifen)
* What is the MOA?

A
60
Q

Gynecomastia - treatment (Surgery)
* Alternative to what?
* MC in patients with what?
* Should not be performed until when?
* Increasing testosterone may increase what?

A
61
Q

Serms: Selective
* What type of effects depend on? (2)
* MC (3)

A
  • Variable effects dependent on body tissue
  • Specific tissue effects dependent on specific agent
  • MC tamoxifen, raloxifene, clomiphene
62
Q

Serms
* Antiestrogen effects on what? Important treatment component of what?

A

Antiestrogen effects on the breast decrease symptoms of gynecomastia
* Important treatment component of estrogen and progestin receptor positive breast cancers

63
Q
A
63
Q

Serms
* Estrogenic effects on what?
* What does tamoxifen increase the risk of?

A

Estrogenic effects on bone decrease risk of osteoporosis
* Tamoxifen increases risk of endometrial cancer

64
Q
A
65
Q

Serms
* What are the MC SE?(4)
* What are the CI?(3)

A

MC adverse effects:
* Hot flashes
* Nausea/vomiting
* Increased risk of DVT/PE
* Abnormal vaginal bleeding (tamoxifen)

CI: history of DVT/PE, pregnancy, warfarin therapy (antagonism)

66
Q

Premature ejaculation
* What is the goal?
* What is first line?
* Start with what dose?

A

*

67
Q

Premature ejaculation
* What is second line?
* What is often used as an adjunct to medications?

A
68
Q

Balanitis
* What are the sxs?
* What is the MCC organism?

A

Pain, tenderness, pruritis of the glans penis
* May have curd-like or purulent discharge
* MCC – Candida albicans

69
Q

Balanitis:
* What are the most common causes?

A
  • Uncircumcised
  • Patients with diabetes mellitus
  • Sexual partners with recurrent vaginal candidiasis
70
Q

Balanitis: Supportive
* What is the treatment?

A

Treatment
* Local hygiene – primary if uncircumcised
* Twice daily cleaning with saline solution
* Should include foreskin retraction
* Use soaps with caution

71
Q

Balanitis:
* What is the Empiric Candida treatment?

A
  • 1% clotrimazole or 2% miconazole cream
    * 7 to 14 days
  • Hydrocortisone 1% cream if unresponsive to antifungal cream (last line)
72
Q

What are the CDC’s 5 P’s

A

*

73
Q

STI guidelines
* What are the reportable sexually transmitted infections (STIs)? (6)

A
  • Chlamydia
  • Gonorrhoeae
  • Acute HBV
  • Acute HCV
  • HIV
  • Syphilis

*

74
Q

CDC STI guidelines:
* Which STIs need to be notified to partner?(7)

A
  • Chlamydia
  • Gonorrhoeae
  • Acute HBV
  • Acute HCV
  • HIV
  • Syphilis
  • Trichomonas
75
Q

STI guidelines
* Expedited partner therapy (EPT) has been used for what?
* MC what?
* What is an example?
* In the United States, what is legal?

A

Expedited partner therapy (EPT) has been used for the treatment of some STIs
* MC chlamydial and gonorrheal infections
* For example; Planned Parenthood will treat one partner without testing
* In the United States, EPT is legal in most states

76
Q

CDC STI guidelines
* Patients with non-viral STIs and their sex partners should what?
* Patients diagnosed and treated for what should be retested? When do they get retested?
* What is treated at the department of health?

A
77
Q

Gonorrhoeae:
* What is the morphology?
* Symptoms (3)
* Locations (4)
* What is the dose?

A

  • 1000mg IM x 1 dose if ≥ 150kg or for conjunctivitis
    #conconmittant treatment for C. trachomatis recommended
78
Q

Chlamydia trachomatis (serovars D-K):
* What is the morphology?
* Symptoms (3)
* Locations (3)
* What is the dose? Preg?

A
  • Morph: Intracellular gram neg organism
  • Sxs: Insidous onset, mucoid discharge, often asymptomatic
  • Locations: Urogenital, rectal, nasopharynx
  • Dose: Doxycycline 100mg PO BID x 7 days+

+Azithromycin 1gm x 1 dose if pregnant

79
Q

C. trachomatis serovar L1-L3 (Lymphogranuloma venereum)
* What is the morphology?
* Symptoms (3)
* Locations (2)
* What is the dose?

A
80
Q

Genital Herpes simplex

A
81
Q

What is primary and secondary stage syphilis?

A

*

82
Q

Syphilis (treponema pallidum)
* What is early latent?
* Late latent?
* Neurosyphillis?

A
83
Q

Syphilis treatment

A

*

84
Q

Chancroid:
* What is the organism?
* What are the sxs?
* How is it different than chance of syphilis?

A
85
Q

Chancroid:
* What is the first line treatment?

A
  • Azithromycin 1 gram PO x 1
  • Ceftriaxone 500 mg IM x 1
86
Q

Condyloma acuminata
* What is it?

A

Condylomata acuminata (CA), also known as anogenital warts, are manifestations of anogenital human papillomavirus (HPV) infection. CA manifest as variably sized and shaped soft papules or plaques on anogenital skin.

87
Q

Condyloma acuminata
* What is KEY?
* What strains cause of genital warts?
* What strains is associated with cervical and anal cancer?

A
  • No cure; prevention is KEY
  • HPV 6, 11 = > 90% of genital warts
  • HPV 16, 18 associated with cervical and anal cancer

*

88
Q

Condyloma acuminata
* What is the prevention?
* What does it protect against?

A
  • Prevention: Gardasil-9 vaccine
  • Protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
89
Q

Gardasil-9 vaccine
* Recommended for who?
* What is the dosing series?

A

*

90
Q

HPV treatments – patient applied
* What are some of the treatments?
* Preg?
* What are the SE?

A
91
Q

HPV treatments – provider applied
* What are the different treatments?

A
92
Q

HPV treatment: What is the DOC for pregnancy?

A

Trichloroacetic acid (TCA) = DOC for pregnancy

*

93
Q

5-Alpha Reductase Inhibitors
* What are the examples?
* What is the MOA?

A

Dutasteride and finasteride
* Inhibit 5-alpha reductase which converts testosterone to dihydrotestosterone
* Decreases intra prostate DHT by 80 to 90%
* Dihydrotestosterone increases prostate size

94
Q

5-Alpha Reductase Inhibitors
* Decreases what?
* May cause what?

A
  • Decreases PSA levels
  • May cause false-negative PSA
95
Q

Prostate CA
* Second most common what?
* What is the MC type of cancer?
* Secreening is what?
* Treatment varies based on what?

A
  • Second most common cancer in men worldwide
  • Adenocarcinoma of lung is the MC type
  • Screening is generally controversial – know general information
  • Treatment varies based on many factors
96
Q

Screening for Prostate Cancer
* What are the recommendations?

A

Digital Rectal Examination (DRE)
* Most authorities agree on using DRE as part of periodic health screening for men over age 50
* Role in screening for prostate cancer is not clear (not currently recommended by the USPSTF)
* Done in conjunction with PSA testing as part of the periodic health examination in men > 50 who are at average risk and in > 40 who are at higher risk (black; family history of prostate cancer)

97
Q

Screening for Prostate Cancer: Prostate-Specific Antigen(PSA)
* What is it?
* What is it produced by?
* Screening can detect what?

A
  • Glycoprotein that is specific to prostate but not to prostate cancer
  • Produced by all types of prostate tissue whether healthy, hyperplastic, or malignant
  • Screening can detect tumors at a more favorable stage
98
Q

Screening for Prostate Cancer: Prostate-Specific Antigen(PSA)
* No data indicating that PSA screening decreases what?
* Some authorities do not what?
* USPSTF Grade what?

A
  • No data indicating that PSA screening decreases mortality from prostate cancer
  • Some authorities do not recommend use of PSA for routine screening
  • USPSTF Grade C (selectively recommend) for men 55-69 years
99
Q

Screening for Prostate Cancer: PSA
* What is normal?
* What is considered borderline?
* What is considered high?
* Higher PSA level the more likely presence of what?

A
  • Results under 4 ng/ml are usually considered normal
  • Results between 4 and 10 ng/ml are considered borderline
  • Results over 10 ng/ml are considered high
  • Higher PSA level the more likely presence of prostate cancer
100
Q

Prostate-Specific Antigen (PSA)
* However, men with prostate cancer can have what?
* A negative PSA and a negative DRE makes what?
* Age-specific ranges may be useful when?

A
  • However, men with prostate cancer can have a negative or borderline PSA level
  • A negative PSA and a negative DRE make the presence of cancer unlikely
  • Age-specific ranges may be useful as older men have higher PSA levels than younger men, even in the absence of cancer
101
Q

Testicular germ cell tumors
* curable or non-curable?
* What is the survival rate?
* What is recommended prior to therapy?

A
  • Most curable solid neoplasm
  • 95% overall 5-year survival
  • Sperm banking recommended prior to therapy
102
Q
A

*

Pharm II (14 decks)

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