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Men's Health Module > Men’s Health Pharmacology > Flashcards

Men’s Health Pharmacology Flashcards

1
Q

Two hormones that control libido

A

testosterone and dopamine

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2
Q

sympathetic and parasympathetic innervation of penis

A 
parasympathetic = erection
sympathetic = ejaculation
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3
Q

ACh and nitric oxide role in penis

A

involved in erection; parasympathetic release of ACh is involved in NO release which leads to vasodilation

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4
Q

______ can prevent degradation of cGMP and sustain vasodilation.

A

PDE-5 inhibitors

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5
Q

Detumescence

A

phase after ejaculation when penis return to flaccid state

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6
Q

What hormone has inhibitory effect on ejaculation?

A

serotonin

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7
Q

How to treat premature ejaculation?

A

SSRI’s

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8
Q

Drugs causing erectile dysfunction

A
  • Statins
  • Diuretics and anti-HTN
  • Antidepressants, antianxiety drugs, antepileptics, and antipsychotics
  • Antihistamines
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9
Q

How do anti-hypertensives lead to sexual dysfunction?

A

interfere with erections and ejaculation by reducing blood flow

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10
Q

Anti-HTN most likely to cause sexual dysfunction? better alternative?

A

alpha and beta blockers

try CCBs (diltiazem)

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11
Q

How do anti-psychotics and anti-depressants lead to sexual dysfunction?

A

block actions of ACh, serotonin, and norepinephrine which decrease arousal and/or testosterone levels

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12
Q

Antidepressant with highest risk of ED?

A

TCAs

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13
Q

How do antihistamines lead to sexual dysfunction?

A

competitive antagonist on DHT receptor; exaggerates effects of estrogen

galactorrhea in women and gynecomastia in men

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14
Q

First line therapy for all types of ED

A

phosphodiesterase-5 inhibitor (Sildenafil, vardenafil, tadalafil)

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15
Q

What is chemical pathway from sexual arousal to penile erection?

A

arousal -> NO -> cGMP -> decreased Ca2+ -> smooth muscle relaxation -> erection

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16
Q

Physiologic mechanism of penile erection is release of nitric oxide in __________ during sexual stimulation.

A

corpus cavernosum

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17
Q

MOA of PDE-5 inhibitors

A

inhibit degradation of cGMP in corpus cavernosum; increases vasodilation

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18
Q

Other uses of PDE5 inhibitors

A

esophageal spasms and pulmonary HTN

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19
Q

ADRs of PDE-5 inhibitors

A

HA, flushing, dyspepsia, abnormal vision, hypotension

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20
Q

Drug interactions with PDE-5 inhibitors

A

Nitrates or nitric oxide
Alpha blockers
Alcohol
CYP450 inhibitors

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21
Q

What is Alprostadil and how does it work?

A

alternative treatment of ED that is self-injected into penis

prostaglandin E1 analog that stimulates adenyl cyclase and induces erection

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22
Q

two dosage forms of Alprostadil

A

injection

intraurethral pellet

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23
Q

Alprostadil ADRs

A

priapism, pain, urethral bleeding

24
Q

Detrusor has ____ receptors which lead to relaxation; trigone and sphincter have ____ receptors which lead to contraction.

A

beta 2

alpha 1

25
Q

Part of nervous system that facilitates bladder filling and retention

A

sympathetic

26
Q

Sphincter has alpha 1 receptors that lead to _______.

A

contraction

27
Q

micturation is…

A

urination

28
Q

Neurologic process of urination

A

Parasympathetic postganglionic axons in pelvic nerve innervate muscarinic receptors (M3) of bladder smooth muscle and sphincter resulting in contraction of detrusor muscle and relaxation of sphincter

Sympathetic postganglionic neurons release NE, which activates beta3 receptors to relax bladder smooth muscle and beta1 receptors to contract urethral smooth muscle

Somatic axons in pudendal nerve also release ACh, which produces contraction of external sphincter striated muscle; this is your voluntary control over urination

29
Q

What does IPSS score used to assess?

A

BPH

30
Q

Pharm treatment of BPH

A

1st line = alpha-adrenergic antagonists: Tamsulosin (Flomax)

5 alpha-reductase inhibitors: Finasteride (Propecia), Dutasteride

31
Q

MOA of alpha blockers in treating BPH

A

relax vascular smooth muscle in prostate and bladder neck

32
Q

MOA of 5 alpha-reductase inhibitors in treating BPH

A

antiandrogenic; inhibits conversion of testosterone to more potent DHT to decrease prostate size

33
Q

Side effects of adrenergic antagonists (alpha blockers) like Flomax

A
  • orthostatic hypotension
  • vertigo
  • palpations
  • sexual dysfunction (priapism)
  • floppy iris syndrome
34
Q

DIs of alpha blockers

A

any anti-HTN or other vasodilators

35
Q

What does DHT do to prostate?

A

enlarges

36
Q

Specific indications of adding on 5-alpha-reductase

A

BPH due to very large prostate (> 40g) and if moderate to severe symptoms

37
Q

Along with BPH finasteride (Propecia) can treat ________.

A

hair loss

38
Q

Side effects of 5 alpha-reductase inhibitors

A 
sexual dysfunction (impotence, libido) gynecomastia
prostate cancer
  • due to androgen decrease
39
Q

5 alpha-reductase inhibitors DIs

A

none

40
Q

Effects of DHT in men

A

facial and body hair
acne
scalp hair loss
prostate growth

41
Q

Effects of testosterone in men

A

muscle mass
skeletal growth
spermatogenesis
sexual function

42
Q

Effects of estradiol in men

A

bone formation

breast tissue

43
Q

Lifestyle modifications to reduce urinary incontinence

A

weight loss, dietary changes, pelvic floor muscle exercises, and med changes

44
Q

Pharm treatment of urinary incontinence

A

1st line = alpha blocker

then may add anti-muscarinic (oxybutunin)

45
Q

Indications for testosterone replacement

A

hypogonadism

46
Q

Formulations of testosterone replacement

A

oral

**topical gels: IM injections, transdermal patches, buccal tablet

47
Q

Contraindications of testosterone replacement

A 
known prostate or breast cancer
severe lower urinary tract symptoms
enlarged prostate
PSA > 4
elevated hematocrit (>50%)
uncontrolled CHF
untreated sleep apnea
48
Q

When and what to monitored with testosterone replacement therapy?

A

testosterone
hematocrit
PSA

q3months for 1st year, then annually

49
Q

ADRs of testosterone replacement therapy

A

Acne, gynecomastia, enlargement of prostate, worsening of sleep apnea, erythrocytosis, suppression of spermatogenesis

50
Q

first line for male pattern (androgenic) baldness treatment

A

Minoxidil (Rogaine)

51
Q

ADRs of minoxidil

A

Hair color or texture changes (darker, more coarse)

Slight cardiovascular risk

52
Q

DIs of minoxidil

A

hypotension risk with any anti-hypertensives

53
Q

DIs of testosterone replacement

A

anticoags, diabetic drugs, steroids, ACTH

54
Q

What patients may not respond to Viagra?

A

patients with DM-related neurovascular disease

55
Q

Cimetidine MOA and effects

A

competitive antagonist of DHT receptor - so that means that not as much DHT is being produced and thus more testosterone is being converted into estradiol

Men's Health Module (10 decks)

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