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Therapeutics - Exam 5 > Lectures 54,55,56 > Flashcards

Lectures 54,55,56 Flashcards

Men's Health -- Scott

1
Q

BPH anatomy

A

enlarged prostate blocks urine flow from the bladder

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2
Q

BPH pathophysiology

A

common growth after age 40 (90% notice decrease of urine flow by 80 yo)
influence by alpha-1 adrenergic receptors and type II 5-alpha reductase in prostate gland

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3
Q

alpha-1 adrenergic receptors

A

stimulation by NE results in smooth muscle contraction with subsequent narrowing urethra

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4
Q

type II 5-alpha reductase

A

converts testosterone to DHT (responsible for prostate enlargement and growth)

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5
Q

obstructive symptoms of BPH

A

decreased force of stream
hesitancy to initiate voiding
strain or push to urinate
terminal dribbling
intermittency

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6
Q

irritative symptoms of BPH

A

nocturia
frequency
urgency
dysuria
incontinence
QOL

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7
Q

noctura

A

2 or more voids per nigh
redistribution of edema

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8
Q

hypogonadism anatomy

A

incomplete/delayed sexual maturity of the testes

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9
Q

hypogonadism pathophysiology

A

either onset of puberty at 9.5 to 14 yos
or delayed puberty with lack of testicular growth at 14 yo (2% of genpop)

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10
Q

hypogonadism etiology

A

constitutional delay of growth and puberty (CDGP)
functional hypogonadism (secondary to another chronic illness)
organic/genetic hypogonadism

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11
Q

hypogonadism risk factors

A

aging
chronic illness (diabetes, AIDS, rheumatoid arthritis, CKD)
long-term use of corticosteroids
obesity (gradual decrease in mean serum testosterone levels over time)

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12
Q

specific symptoms of hypogonadism

A

reduced libido
gynecomastia
loss of body hair
reduced muscle bulk and strength

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13
Q

ED anatomy

A

persistent inability to achieve and maintain penile erection sufficient for satisfactory sexual performance
either psychogenic, reflexogenic, or nocturnal type

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14
Q

psychogenic ED mechanism

A

secondary stimulation to audiovisual or fantasy
released ACH –> release of nitrous oxide from NANC neurons –> stimulation

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15
Q

reflexogenic ED mechanism

A

elevated levels of cGMP –> Ca2+ release –> smooth muscle relaxation –> blood flooding chambers –> prevent the draining of blood –> erection

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16
Q

nocturnal ED mechanism

A

3 to 6 erections per night (20 to 30 minutes)
controlled by sacral nerves associated with REM sleep, suppression of sympathetic nervous system, and full bladder

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17
Q

ED etiology

A

diseases and conditions
physical
drug-induced
unhealthly lifestyle

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18
Q

diseases and conditions causes of ED

A

diabetes
HTN
coronary atery disease
MS/Parkinson’s/Stroke (medical preoptic area of the brain)
low testosterone levels (rarely)

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19
Q

physical causes of ED

A

injury
surgeries (damage of cavernous nervous)
medicines
radiation

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20
Q

drugs that cause ED

A

antidepressants (SSRIs - 70%)
antihypertensive agents
estrogen/anti-androgens
5-alpha-reductase inhibitors
cancer chemotherapy

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21
Q

unhealthy lifestyle causes of ED

A

tobacco smoking (mostly)
excessive EtOH
obesity
inadequate sleep/fatigue
stress

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22
Q

drugs that may cause drug-induced priapism

A

ED drugs (especially alprostadil)
antidepressants (bupropion, trazodone, fluoxetine, sertraline, lithium)
antipsychotics (clozapine, chlorpromazine)
anticoagulants (heparin, warfarin)
cocaine
others (EtOH, prazosin, hydroxyzine)

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23
Q

priapism

A

prolonged, rigid erection in the absence of appropriate stimulation

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24
Q

non drug therapies of ED

A

vacuum erection devices
penile prosthesis
focused shock wave therapy

25
vacuum erection devices
PRO -- very effective, 60 to 80% CON -- avoid in sickle-cell patients
26
penile prosthesis
irreversible semi-rigid insert pump only use when other treatments fail replace every 5 to 10 years
27
focused shock wave therapy
PRO -- non-invasive, targets vascular function CON -- not FDA approved
28
non drug therapies of BPH
minimally invasive surgeries/prostatectomy avoid drugs with strong anticholinergic properties (Benadryl) botox injections
29
minimally invasive surgeries/prostatectomy
transurethral resection of the prostate (TURP) or transurethral laser enucleation) PRO -- used for severe symptoms and complications CONS -- benefits may be short-lived; risk of acute urinary retention immediately following procedure
30
avoid drugs with strong anticholinergic properties
PROS -- decrease contractility of bladder detrusor muscles, resulting in urinary retention
31
botox injections
induces prostatic atrophy to treat BPH
32
5-alpha-reductase inhibitors
finasteride (5mg QD), dutasteride (0.5mg QD) treats -- alopecia, moderate symptoms of BPH if there is large prostate and increased PSA
33
5-alpha-reductase inhibitors PROS/CONS
PROS -- men with prostate size above 40grams benefit most; decrease PSA by half in 6 months CONS -- women should avoid handling tablets
34
alpha-adrenergic blockers
alfuzosin, doxazosin, and tamsulosin (qhs), silodosin, terozosin treats -- BPH
35
alpha-adrenergic blockers PROS/CONS
PROS -- improves urine flow; equal clinical effectiveness CONS -- does not reduce size of prostate gland; dizziness is main SE but also somnolence, headache, asthenia, blurred vision, and abnormal ejaculation; rapaflo has retrograde ejaculation (decreased volume); intraoperative floppy iris syndrome reported by flomax so inquire about flomax
36
alprostadil
treats -- ED, injection is specifically best for neurogenic ED dosing -- urinate first then insert suppository, roll penis for 10 to 30 seconds, and then take dose (P); max of two per day (P); questionable usage with oral agents (P); titrate to dose that produces an erection lasting 1 hour
37
Alprostadil PROS/CONS
PROS -- more acceptable to many patients than injection (P); onset within 5-10 minutes (P); usable if pt fails to respond to PDE-5 inhibitors (I); no sexual stimulation required (I) CONS -- less effective than transurethral injection (P); local irritation, penile pain, risk of priapism, and cavernosal plaques or area of fibrosis
38
PDE-5 inhibitors
treats -- ED, BPH sildenafil (viagra), tadalafil (cialis) adjust dose to produce an erection that lasts no longer than 1 hour monitoring -- if patient is on oral/transdermal nitrates or alpha-blocker have severe CAD or have an erection longer than 4 hours
39
PDE-5 inhibitor PROS/CONS
PROS -- first line treatment for ED; promotes smooth muscle relaxation; enhances development and maintenance of erection CONS -- sexual stimulation is required; interacts with CYP3A4 inhibitors (grapefruit juice) to prolong effect; food delayed absorption by an hour SE -- headache and non-arteritic ischemic optic neuropathy notable
40
sildenafil (viagra) dosing
25,50,100mg 30 to 60 minutes before intercourse for ED 20 mg TID for pulmonary HTN
41
tadalafil (cialis) dosing
2.5,5,10,20mg 60 minutes before intercourse for ED (2.5 or 5 should only be used in QD dosing) 40mg QD for pulmonary HTN 5mg QD used for moderate BPH
42
testosterone supplements
treats -- hypogonadism, ED (if hypogonadism present) monitoring -- should be monitored 3 to 6 months after initiating therapy (goal of 400 to 700 ng/dL)
43
testosterone supplements PROS
comes in many different formulations (patches, gels, solutions IM depo, buccal, SQ pellets, and capsules) patch = best form in physiologically similar IM injection = most economical enhances sexual interest, frequency of sexual acts, and nocturnal erections
44
testosterone supplements CONS
oral capsule needs to be taken with food OTC products has unknown efficacy/negative impacts black box warning for gel formulation due to secondary exposure
45
alpha-blocker key information
equal clinical effectiveness can cause dizziness**, fatigue, headache, orthostatic hypotension, and retrograde ejaculation (Rapaflo) inquire about cataracts when first filling RX for flomax (intra operative floppy iris syndrome may occur)
46
5-alpha-reductase inhibitor key information
benefits men with prostate size over 40g women should avoid handling tablets due to risk of abnormal development of external genitalia in male fetus combination product with alpha-blocker is more effective than either agent alone
47
PDE-5 inhibitors key information
take on demand vs daily dosing (1-2 hours prior to intercourse) dosing with respect to meals report erections that last over 4 hours report any visual or hearing complaints report palpitations or dizziness avoid nitrates
48
testing for hypogonadism/low-T
serum testosterone levels should be tested in the morning to measure total testosterone levels < 300 ng/dL is positive for low-T, confirmed with 2nd test if free testosterone < 5ng/dL
49
hypogonadism diagnosis
must have low-T and symptoms to be diagnosed
50
types of alopecia in men
androgenic alopecia alopecia areata alopecia universalis traction alopecia drug-induced alopecia
51
androgenic alopecia
most common, 50% of men; gradual onset usually by age 40 hereditary
52
alopecia areata
hair loss in patches responds to monoclonal antibodies autoimmune
53
alopecia universalis
complete loss of all body hair
54
pathophysiology of androgenic
hereditary terminal hair --> hair follicle shrinks --> shortening/thinning due to more DHT being present in the scalp
55
treatment of alopecia
finasteride (propecia) minoxidil (rogaine) topical finasteride and minoxidil hair transplant (non-pharm)
56
finasteride (propecia) mechanism
inhibits type II 5-alpha reductase from converting testosterone to DHT
57
minoxidil (rogaine) mechanism
enlarges miniaturized hair follicles increases blood supply to follicles
58
strategies to talk about men's health disorders
be upfront about the difficulty of the topic ask permission to ask those intimate questions may need to lead with a close-ended question (would you say this describes your current diagnosis accurately?) start with the hard question to ease tension be confident and appear as knowledgable and comfortable to ease concerns do not discredit the patient's feeling (I can understand that this may be embarrassing...)

Therapeutics - Exam 5 (8 decks)

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