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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
Q

How long should nitro be held after an ingestion of PDE5 inhibitor?

A

Nitroglycerin must be held at least 24 hours following the last dose of sildenafil or vardenafil and 48 hours following tadalafil

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25
Q

Injectable Prostaglandins available

A

Alprostadil intracorneal vs intraurethral

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26
Q

Injectable Prostaglandins MOA

A

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

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27
Q

Alprostadil works better than PDE5 inhibitors in which pts?

A

Prostaglandins do not require an intact cord or intact innervations to produce nitric oxide to create an erection

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28
Q

Injectable Prostaglandins length of efficacy

A

Within 10 minutes when injected locally, with an effect that lasts about 1 hour.

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29
Q

Injectable Prostaglandins use

A

Treatment of erectile dysfunction of vascular, psychogenic, or neurogenic etiology

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30
Q

Injectable Prostaglandins SE

A

Penile pain, urethral discomfort, priapism

31
Q

Alprostadil contraindications

A

Penile deformity (e.g., Peyronie’s disease)
Penile implant
sickle cell disease or trait, leukemia, multiple myeloma, polycythemia

32
Q

When starting Injectable Prostaglandins what should be done?

A

The first dose should be done under professional supervision
Dose is titrated to desired effect

33
Q

Which drugs worsen the sxs of BPH?

A

first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications

34
Q

Drugs types to tx BPH

A

Alpha-1 Blockers
5-Alpha Reductase Inhibitors

35
Q

Medical Therapy of Prostatic Symptoms (MTOPS) Trial outcomes

A

Results: using finasteride and doxazosin together is more effective than using either drug alone to relieve symptoms and prevent BPH progression

36
Q

Alpha 1 blockers vs 5-alpha reductase inhibitors

A

5-alpha reductase inhibitors are slow to show effect, requiring up to 6 months to reach maximum benefit

37
Q

Alpha-1 Blockers selective

A

alfuzosin
tamsulosin

38
Q

Alpha-1 Blockers nonselective

A

doxazosin
prazosin
terazosin

39
Q

Alpha-1 Blockers MOA

A

Block alpha-adrenergic stimulation - immediate effect by relaxing prostate muscles

40
Q

Prazosin can treat BPH and?

A

Nightmares and HTN

41
Q

Doxazosin, prazosin and terazosin tx BPH and?

A

Hypertension

42
Q

Alpha-1 Blockers SE

A

Orthostatic hypotension***
Rhinitis
Decreased libido, ejaculation failure
Headache, dizziness, fatigue

43
Q

When prescribing Alpha 1 blockers, what other meds that the pt is taking should be taken into account?

A

must consider any medication that may decrease blood pressure

44
Q

Alpha-1 Blockers contraindications

A

Hypersensitivity to medication
Concurrent use with any PDE5 inhibitors

45
Q

Why should the 1st dose of alpha-1 blockers be monitored?

A

First-dose adverse reactions are a possibility; the first dose should be given in the clinic or at bedtime - can cause hypotension

46
Q

5-Alpha Reductase Inhibitors drugs

A

dutasteride
finasteride

47
Q

5-Alpha Reductase Inhibitors MOA

A

5-alpha reductase inhibitors competitively and specifically inhibit this type 2 isoenzyme that metabolizes testosterone

48
Q

5-Alpha Reductase Inhibitors uses

A

Benign prostatic hypertrophy (BPH)
Male pattern baldness
Polycystic ovary syndrome (PCOS)
prostate cancer and hormone replacement therapy for transgender therapy (male to female)

49
Q

5-Alpha Reductase Inhibitors SE

A

Impotence/ED, decreased libido

50
Q

Contraindications of 5-Alpha Reductase Inhibitors

A

Hypersensitivity to medication
Serious skin reactions to other 5-alpha reductase inhibitors
Pediatric patients
Pregnancy

51
Q

Interactions with 5-Alpha Reductase Inhibitors

A

Anything that inhibits (ketoconazole) or induces (St Johns wort) CYP3A4

52
Q

Noteworthy things to remind pts handling of 5-Alpha Reductase Inhibitors

A

Should not be handled by a pregnant woman or one who may become pregnant

53
Q

Blood donation guidelines for pts on 5-Alpha Reductase Inhibitors

A

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
Q

5-Alpha Reductase Inhibitors affect on PSA levels

A

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
Q

Why is 5-Alpha Reductase Inhibitors effect on PSA levels concerning?

A

This is cause for concern because PSA level is used to screen for prostate cancer

56
Q

Exogenous Testosterone use

A

Androgen replacement therapy in the treatment of delayed male puberty
Male hypogonadism
Male osteoporosis

57
Q

Exogenous Testosterone forms

A

PO, IM, and SC

58
Q

Exogenous Testosterone SE

A

MI, CVA, DVT/PE
Acne, hirsutism, male pattern baldness
Breast soreness, gynecomastia
Priapism, testicular atrophy, oligozoospermia
erythrocytosis, polycythemia
Aggressive behavior

59
Q

Exogenous Testosterone can potentiate the effect of which drug?

A

Warfarin

60
Q

Exogenous Testosterone contraindications

A

Hypersensitivity to medication or any component of product
Breast cancer in men
Prostate cancer
Pregnancy

61
Q

Exogenous testosterone f/u scheduling

A

Perform evaluation by history and physical examination every 3-4 months for a year and then annually.

62
Q

Which labs should be monitored in pts on exogenous testosterone?

A

Testosterone treatment also requires monitoring of lipids, prostate-specific antigen and hematocrit.

63
Q

Which cancers can testosterone stimulate?

A

Prostate and breast

64
Q

Which Scheduled drug class is testosterone in?

A

Testosterone is a controlled substance (all forms are schedule III)

65
Q

What should be kept in mind w/ pts w/ BPH and abnormal lipids on testosterone?

A

Advise men with BPH and abnormal lipid profiles that testosterone treatment may adversely affect these conditions and require close monitoring.

65
Q

What should be kept in mind w/ pts w/ BPH and abnormal lipids on testosterone?

A

Advise men with BPH and abnormal lipid profiles that testosterone treatment may adversely affect these conditions and require close monitoring.

66
Q

Which meds are used to tx androgenic alopecia?

A

Finasteride (Propecia) +/- dutasteride (off label)
Minoxidil (Rogaine)

67
Q

Minoxidil MOA for hair tx

A

direct effect on hair follicles by stimulating resting hair follicles into active growth

68
Q

Minoxidil topical interactions

A

None

69
Q

Finasteride for hair loss SE

A

Finasteride (Propecia) is given in a much lower dosage for male baldness than for BPH - much less adverse SE

70
Q

What should be screened in pts on Finasteride?

A

When screening men on finasteride for prostate cancer, the clinician should double the patient’s PSA levels to account for this decrease.

71
Q

If hair loss tx is discontinued, what occurs?

A

New hair is lost within 4 to 6 months when treatment is discontinued

72
Q

What should be an education point for pts w/ male pattern hair loss?

A

Male pattern baldness medication is much less effective in frontal and temporal hair loss than in those who have vertex hair loss

73
Q

Tx for epididymitis and orchitis

A

ceftriaxone (Rocephin), a single 250-mg dose intramuscularly, and doxycycline 100 mg orally, twice daily for 10 days

74
Q

Prostatitis tx

A

trimethoprim-sulfamethoxazole, twice daily or ciprofloxacin 500 mg twice daily for 4-6 weeks

Pharm 2 Exam 2 (8 decks)

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