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Pharm 2 Exam 2 > Men's Medication > Flashcards

Men's Medication Flashcards

1
Q

ED comorbidities

A

cardiovascular disease and HTN, diabetes, lower urinary tract symptoms, prostate cancer, and depression

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2
Q

Which meds are known to cause ED? KNOW THIS LIST WELL!

A

Alpha-adrenergic blockers - Tamsulosin
CNS depressants - Benzodiazepines, Narcotics, Antipsychotics
Diuretics - Loop and potassium sparing
Antihypertensives - Beta-blockers, Clonidine
Antihistamines
Antidepressants - Selective serotonin reuptake inhibitors (SSRIs)

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3
Q

An erection is an adequate response to which part of the nervous system?

A

Primarily parasympathetic response

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4
Q

What are the 2 requirements for a successful erection?

A

intact parasympathetic nerve system and the release of adequate nitric oxide

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5
Q

Possible causes leading to ED

A

Vasculogenic (arterial or cavernosal)
Psychogenic
Hormonal
Neurogenic
Drug use
Other: anatomic anomaly, mechanical abnormalities, surgical complications, and the natural result of chronic disease and old age

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6
Q

What is the problem w/ prescribing PDE5 inhibitors?

A

PDE5 inhibitors are expensive - insurance does not cover or limit amount

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7
Q

What is a rare but serious SE of using PDE5 inhibitors?

A

Priapism (related to use of alprostadil)

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8
Q

Tx for priapism

A

Can be treated with corpora aspiration, followed by intracavernosal injection with alpha-adrenergic agonists such as phenylephrine (Neo-Synephrine).

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9
Q

When is alprostadil used to tx ED?

A

When patients do not respond to PDE5 inhibitors due to cord injury because it is not dependent on nitric oxide to create an erection.

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10
Q

When are PDE5 inhibitors CONTRAINDICATED?

A

Those on nitrates should not take PDE5 inhibitors.

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11
Q

When should pts seek medical tx for a prolonged erection?

A

Priapism longer than 4 hours

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12
Q

Pts using transurethral alprostadil should not have sexual intercourse with which population?

A

Pregnant women

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13
Q

Drugs used to tx ED

A

Oral Phosphodiesterase Type 5 Inhibitors
Injectable Prostaglandin

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14
Q

Oral Phosphodiesterase Type 5 Inhibitors medications

A

Sildenafil
Vardenafil
Tadalafil

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15
Q

Oral Phosphodiesterase Type 5 Inhibitors MOA

A

PDE5 is the main catalyst responsible for the conversion of cGMP to guanosine monophosphate which causes dilation of smooth muscle - PDE5 inhibitors block cGMP from degrading into GMP therefore keeping the erection up

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16
Q

Oral PDE5 inhibitors are only effective when?

A

There is sexual stimulation because these drugs do not cause penile erections, only the ability of the penis to respond to sexual stimulation.

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16
Q

Oral PDE5 inhibitors are only effective when?

A

There is sexual stimulation because these drugs do not cause penile erections, only the ability of the penis to respond to sexual stimulation.

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17
Q

Uses for PDE5 inhibitors

A

Treatment of erectile dysfunction
Tadalafil - BPH
Sildenafil and tadalafil - pulmonary HTN

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18
Q

Sildenafil and vardenafil onset of action and duration

A

With sildenafil (Viagra) and vardenafil (Levitra), the onset of action is 30-120 minutes, and the duration of effect is approximately 4 hours

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19
Q

Tadalafil onset of action and duration

A

Tadalafil (Cialis) has an onset of action of 15 minutes and a duration of effect of 36 hours

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20
Q

Oral Phosphodiesterase Type 5 Inhibitors SE

A

Flushing, visual disturbance, epistaxis, Dyspepsia, Headache, priapism

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21
Q

PDE5 Inhibitors interaction w/ nitrates

A

Hypotension, cardiac arrest, death

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22
Q

PDE5 inhibitors interaction w/ antihypertensives

A

additive drops in BP occur

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23
Q

PDE5 inhibitor contraindications

A

Those who are concurrently taking organic nitrate therapy (nitroglycerine, isosorbide mononitrate, or isosorbide dinitrate)
Pts w/ sickle cell disease, myeloma, and leukemia
Elderly and renal impairment

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24
How long should nitro be held after an ingestion of PDE5 inhibitor?
Nitroglycerin must be held at least 24 hours following the last dose of sildenafil or vardenafil and 48 hours following tadalafil
25
Injectable Prostaglandins available
Alprostadil intracorneal vs intraurethral
26
Injectable Prostaglandins MOA
Alprostadil is a synthetic form of prostaglandin E1, which acts on the arterial smooth muscle cells, causing them to relax - increases blood flow to the penis
27
Alprostadil works better than PDE5 inhibitors in which pts?
Prostaglandins do not require an intact cord or intact innervations to produce nitric oxide to create an erection
28
Injectable Prostaglandins length of efficacy
Within 10 minutes when injected locally, with an effect that lasts about 1 hour.
29
Injectable Prostaglandins use
Treatment of erectile dysfunction of vascular, psychogenic, or neurogenic etiology
30
Injectable Prostaglandins SE
Penile pain, urethral discomfort, priapism
31
Alprostadil contraindications
Penile deformity (e.g., Peyronie’s disease) Penile implant sickle cell disease or trait, leukemia, multiple myeloma, polycythemia
32
When starting Injectable Prostaglandins what should be done?
The first dose should be done under professional supervision Dose is titrated to desired effect
33
Which drugs worsen the sxs of BPH?
first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications
34
Drugs types to tx BPH
Alpha-1 Blockers 5-Alpha Reductase Inhibitors
35
Medical Therapy of Prostatic Symptoms (MTOPS) Trial outcomes
Results: using finasteride and doxazosin together is more effective than using either drug alone to relieve symptoms and prevent BPH progression
36
Alpha 1 blockers vs 5-alpha reductase inhibitors
5-alpha reductase inhibitors are slow to show effect, requiring up to 6 months to reach maximum benefit
37
Alpha-1 Blockers selective
alfuzosin tamsulosin
38
Alpha-1 Blockers nonselective
doxazosin prazosin terazosin
39
Alpha-1 Blockers MOA
Block alpha-adrenergic stimulation - immediate effect by relaxing prostate muscles
40
Prazosin can treat BPH and?
Nightmares and HTN
41
Doxazosin, prazosin and terazosin tx BPH and?
Hypertension
42
Alpha-1 Blockers SE
Orthostatic hypotension*** Rhinitis Decreased libido, ejaculation failure Headache, dizziness, fatigue
43
When prescribing Alpha 1 blockers, what other meds that the pt is taking should be taken into account?
must consider any medication that may decrease blood pressure
44
Alpha-1 Blockers contraindications
Hypersensitivity to medication Concurrent use with any PDE5 inhibitors
45
Why should the 1st dose of alpha-1 blockers be monitored?
First-dose adverse reactions are a possibility; the first dose should be given in the clinic or at bedtime - can cause hypotension
46
5-Alpha Reductase Inhibitors drugs
dutasteride finasteride
47
5-Alpha Reductase Inhibitors MOA
5-alpha reductase inhibitors competitively and specifically inhibit this type 2 isoenzyme that metabolizes testosterone
48
5-Alpha Reductase Inhibitors uses
Benign prostatic hypertrophy (BPH) Male pattern baldness Polycystic ovary syndrome (PCOS) prostate cancer and hormone replacement therapy for transgender therapy (male to female)
49
5-Alpha Reductase Inhibitors SE
Impotence/ED, decreased libido
50
Contraindications of 5-Alpha Reductase Inhibitors
Hypersensitivity to medication Serious skin reactions to other 5-alpha reductase inhibitors Pediatric patients Pregnancy
51
Interactions with 5-Alpha Reductase Inhibitors
Anything that inhibits (ketoconazole) or induces (St Johns wort) CYP3A4
52
Noteworthy things to remind pts handling of 5-Alpha Reductase Inhibitors
Should not be handled by a pregnant woman or one who may become pregnant
53
Blood donation guidelines for pts on 5-Alpha Reductase Inhibitors
Men who are on these drugs should avoid donating blood for at least 6 months after taking the drug to avoid exposing women to the drug
54
5-Alpha Reductase Inhibitors affect on PSA levels
With the decrease in prostate volume, the use of 5-alpha reductase inhibitors will result in a significant decrease in PSA levels as well
55
Why is 5-Alpha Reductase Inhibitors effect on PSA levels concerning?
This is cause for concern because PSA level is used to screen for prostate cancer
56
Exogenous Testosterone use
Androgen replacement therapy in the treatment of delayed male puberty Male hypogonadism Male osteoporosis
57
Exogenous Testosterone forms
PO, IM, and SC
58
Exogenous Testosterone SE
MI, CVA, DVT/PE Acne, hirsutism, male pattern baldness Breast soreness, gynecomastia Priapism, testicular atrophy, oligozoospermia erythrocytosis, polycythemia Aggressive behavior
59
Exogenous Testosterone can potentiate the effect of which drug?
Warfarin
60
Exogenous Testosterone contraindications
Hypersensitivity to medication or any component of product Breast cancer in men Prostate cancer Pregnancy
61
Exogenous testosterone f/u scheduling
Perform evaluation by history and physical examination every 3-4 months for a year and then annually.
62
Which labs should be monitored in pts on exogenous testosterone?
Testosterone treatment also requires monitoring of lipids, prostate-specific antigen and hematocrit.
63
Which cancers can testosterone stimulate?
Prostate and breast
64
Which Scheduled drug class is testosterone in?
Testosterone is a controlled substance (all forms are schedule III)
65
What should be kept in mind w/ pts w/ BPH and abnormal lipids on testosterone?
Advise men with BPH and abnormal lipid profiles that testosterone treatment may adversely affect these conditions and require close monitoring.
65
What should be kept in mind w/ pts w/ BPH and abnormal lipids on testosterone?
Advise men with BPH and abnormal lipid profiles that testosterone treatment may adversely affect these conditions and require close monitoring.
66
Which meds are used to tx androgenic alopecia?
Finasteride (Propecia) +/- dutasteride (off label) Minoxidil (Rogaine)
67
Minoxidil MOA for hair tx
direct effect on hair follicles by stimulating resting hair follicles into active growth
68
Minoxidil topical interactions
None
69
Finasteride for hair loss SE
Finasteride (Propecia) is given in a much lower dosage for male baldness than for BPH - much less adverse SE
70
What should be screened in pts on Finasteride?
When screening men on finasteride for prostate cancer, the clinician should double the patient’s PSA levels to account for this decrease.
71
If hair loss tx is discontinued, what occurs?
New hair is lost within 4 to 6 months when treatment is discontinued
72
What should be an education point for pts w/ male pattern hair loss?
Male pattern baldness medication is much less effective in frontal and temporal hair loss than in those who have vertex hair loss
73
Tx for epididymitis and orchitis
ceftriaxone (Rocephin), a single 250-mg dose intramuscularly, and doxycycline 100 mg orally, twice daily for 10 days
74
Prostatitis tx
trimethoprim-sulfamethoxazole, twice daily or ciprofloxacin 500 mg twice daily for 4-6 weeks

Pharm 2 Exam 2 (8 decks)

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