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Pharmacology (Dale Turley) > Mens Health pt.1 > Flashcards

Mens Health pt.1 Flashcards

1
Q

Erectile dysfunction facts 
?

A

Rapidly growing interest in class of drugs

Men living longer and gender gap narrowing

56% men reported some degree of ED -

ED rises sharply with age

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2
Q

What NT is key in cascade of erections?

A

nitric oxide

you need nitric oxide sysnthesis and parasympathetic innervation to get an erection ( smooth muscle relaxation to allow blood flow into the cavernousum)

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3
Q

there is no relationship between ED and?

A

testosterone

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4
Q

Six causes of ED?

A

Vasculogenic (Leriche) - most common and this is the one we treat

Psychogenic - mental, guilty

Hormonal

Drugs

Other (mechanical, surgery, combination)

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5
Q

What is the most common cause of ED?

A

Vasculogenic most common

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6
Q

ED risk factors and non-pharmacological causes?

A

alcohol

tobacco

hypercholesterolemia

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7
Q

Phosphodiesterase type 5 (PDE5) Inhibitors examples?

A

Sildenafil (Viagra)

Tadalafil (Cialis)

Verdenafil (Levitra)

** these rely SMOOTH muscle and allow blood to flow into the v=cavernousum ( they were originally used for HTN)**

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8
Q

Oral phosphodiesterase type 5 (PDE5) inhibitors discovery ?

A

Discovered while searching for a new antihypertensive agent

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9
Q

Phosphodiesterase type 5 (PDE5)
 MOA?

A

Main catalyst responsible for conversion of cGMP (cyclic guanosine monophosphate) to GMP

cGMP - relaxes smooth muscle , these meds increase cGMP

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10
Q

End result of Phosphodiesterase type 5 (PDE5)
 MOA?

A

End result is relaxing smooth muscle of the penile arteries and corpus cavernosum resulting in an erection

No drug effect without some type of sexual stimulation ( for it to work)

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11
Q

PDE5s there is no effect w/o?

A

some type of sexual stimulation

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12
Q

PDE5s require?

A

Requires intact parasympathetic nervous system and adequate release of nitric oxide

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13
Q

All three PDE5s are all absorbed ______?

A

orally

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14
Q

___________ inhibited in presence of food

A

sildenafil (Viagra)

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15
Q

sildenafil Viagra and vardenafil (Levitra) onset action ________ and duration_____.

A

30-120 min

4 hours

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16
Q

tadalafil (Cialis) onset _____ and duration effect _____

A

16 min

36 hours

**cialis is the weekended lol but viagra is only 4 hours **

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17
Q

Phosphodiesterase type 5 (PDE5)
 is metabolized by the ?

A

liver CYP 450

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18
Q

Phosphodiesterase type 5 
(PDE5) Inhibitors
: sildenafil and vardenafil ?

A

4 to 5 hours

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19
Q

Phosphodiesterase type 5 
(PDE5) Inhibitors
: tadalafil ?

A

17.5 hours

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20
Q

Tadalafil (Cialis) dosing?

A

5 mg

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21
Q

PDE5s has generally fewer side effects such as?

A

Priapism

(painful erection lasting longer than 6 hours), prolonged erection lasting greater

**typically well tolerated medications **

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22
Q

Caution with PDE5s when used with ?

A

nitrates

** ( if they on these meds then do not give then Nitro cause it can plummet the BP )**

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23
Q

Nitrates lead to ___________ that progresses to cardiac arrest?

A

hypotension

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24
Q

Nitrates facts?

A

Antihypertensive

Drop in BP

Additive effect with other drugs

Cause orthostatic hypotension when used with alpha blockers and more so when most blood is going to the penis and not the head)

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25
Q

Tx for ED: injectable prostaglandins?

A

Alprostadil (Caverject)

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26
Q

_______ ______ are injected directly into the side of the penis and produces an erection

A

injectable prostaglandins

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27
Q

injectable prostaglandins dilates the ________ of the penis and allows blood to flow to engorge the penis

A

arteries

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28
Q

How long does it take to get a erection after a injectable prostaglandins? How long does it last?

A

5 to 15 minutes

The erection will last 30 minutes to an hour or up to orgasm.

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29
Q

If using injectable prostaglandins then a patient must?

A

A patient must learn to perform a penile self-injection each time he wishes to engage in sexual activity.

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30
Q

Pharmacokinetics of Injectable Prostaglandins?

A

Rapid absorbed within 10 min

Effects last 1 hour

75% metabolized one-pass lungs

Half-life 5 to 10 minutes

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31
Q

Injectable Prostaglandins
 adverse reactions?

A

Localized pain

Priapism

Contraindicated in Peyronie’s disease and penile implants

First dose under direct supervision for duration less than 1 hour

27 to 30 gauge needle proximal dorsal 1/3

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32
Q

BPH facts?

A

Affects 50% men over 60 and 90% men over 70 years old

Compression urethra caused by prostate enlargement and they get urinary retention and dribbling and hesitancy , decreased caliber, nocrutia,

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33
Q

Drugs Used in the Treatment of Benign Prostatic Hypertrophy?

A

Alpha blockers

5-Alpha reductase inhibitors

**alpha receptors that are expressed at the base of the bladder and the prostate **

34
Q

Alpha blockers MOA?

A

Relax smooth muscle in the prostate gland -
it does not shrink the
prostate

Decrease obstruction of urine flow

35
Q

Alpha blockers are effective within _ month?

A

1

Effect ceases when the medication is stopped

36
Q

Alpha blockers examples?

A

Terazosin (Hytrin)

Doxazosin (Cardura)

Tamsulosin (Flomax)

Alfuzosin (Uroxatrol)

Prazosin (Minipress)

37
Q

Alpha blockers have ____________ effects

A

Anti-hypertensive effects

38
Q

When prescribing A-blocers, look at other medications that may interact with __?

A

BP

39
Q

Alpha-1 meds side effect ?

A

orthostatic hypotension

40
Q

What alpha blockers are more selective at prostate and bladder and Less side effects of hypotension?

A

Newer meds:

tamsulosin (Flomax)

and

alfuzosin (Uroxatrol)

41
Q

Alpha blocker are well absorbed _____?

A

orally

42
Q

Alpha blockers are metabolized by the ?

A

liver

** ( careful with other drugs that are metabolized with the liver and clotting agents like anticoags, and careful in people with liver disease)**

43
Q

Alpha blockers side effects?

A

Hypotension (first dose in clinic or bedtime with discussion about activity)

Headache

Dizziness

Muscle pain

Watch with occasional use of
PDE5 Inhibitors

44
Q

5-Alpha reductase inhibitors MOA?

A

Inhibit the conversion of testosterone to dihydrotestosterone, suppressing prostate growth (decrease in prostate volume 30%)

shrink it

45
Q

5-Alpha reductase inhibitors is effective within?

A

2 to 6 months

Usually the response is sustained after therapy

46
Q

5-Alpha reductase inhibitors

examples?

A

finasteride (Proscar) - most common

dutasteride (Avodart)

47
Q

5-Alpha reductase inhibitors

are well absorbed ______?

A

orally

48
Q

5-Alpha reductase inhibitors

is metabolized by the ?

A

liver to active metabolites

49
Q

Drugs Used in the Treatment of Benign Prostatic Hypertrophy Conscientious considerations?

A

Must consider latest guidelines and literature

Must pay attention to other medications patient is on

May require up to 6months of therapy to show effect. not over night change

50
Q

Drugs Used in the Treatment of Benign Prostatic Hypertrophy: Family patient education
?

A

Discuss all medications, OTC, supplement for possible interactions

saw palmetto, ginseng

51
Q

Drugs Used in the Treatment of Benign Prostatic Hypertrophy FDA cat? and why?

A

FDA Category X

cause

producing genitalia abnormalities in male offspring

52
Q

You cannot donate blood if you are on what agents or for 6 months after?

A

alpha blockers

5 -alpha reductase inhibitors

53
Q

Drugs Used in the Treatment of Benign Prostatic Hypertrophy considerations if pregnant?

A

should not be handled by pregnant women - inhibit development of male genitalia in fetus)

54
Q

Tx of BPH: how long until you see results?

A

3–6 months

55
Q

BPH meds are not a ___ , they are only for ?

A

cure

only for sxs. relief

56
Q

_________ used in male pattern baldness sold as “Propecia”, its only for androgenic male pattern baldness. this will actually grow hair back

A

Finesteride

57
Q

Testosterone Deficiency
 facts?

A

Normal decline in older men

Will not enhance vitality (sample begs to differ) and sexual activity ( yes to this)
That’s not what they say on TV?

Hypogonadism term interchanged

Normal aging

Klinefelters syndrome (androgen deficit)

58
Q

Forms that testosterone is available in?

A

Oral

Injectables - highest
bioavailability

SL

IM

Transdermal

Usually injectable

59
Q

There are black market issues with ?

A

testosterone - steroids

“Low T” clinics - low testosterone clinics

60
Q

Drugs Used to Treat Testosterone Deficiency clinical uses?

A

Androgen replacement therapy in the treatment of delayed male puberty

Male hypogonadism -
genetic abnormality

Replacement therapy in cases of deficiency of endogenous hormone

61
Q

Exogenous testosterone absorption is completely via?

A

IM administration

62
Q

99% of exogenous testosterone is bound to ?

A

hormone globulin

63
Q

Exogenous testosterone

is metabolized by?

A

First pass metabolism in liver to active metabolite

64
Q

Exogenous testosterone

excretion?

A

Excreted 90% in urine (screening PED’s)

65
Q

Exogenous testosterone

adverse effects?

A

CV: HTN

DERM: acne, alopecia

ENDO: breast tenderness, gynecomastia

HEME: leukopenia, suppression of clotting

NEURO: aggression

GI: N/V

GU: impotence, atrophy

MS: weakness

**adverse effects come from overdosing usually **

66
Q

Exogenous testosterone considerations?

A

All forms require careful monitoring for side effects

If no visible response in 3–4 months change therapy

If oral form do LFT every 3–6 months

67
Q

If on testosterone therapy then monitor ?

A

Lipids
PSA
hematocrit
DRE

and if oral then monitor LFT every 3-6 mo

68
Q

Testosterone deficiency meds: patient teaching?

A

Inform patient his age and physical condition may limit results for testosterone

Inform women of child-bearing age not to handle dosage forms

Inform patient must not use if have BPH and abnormal lipid profile - cause it will cause side effects

Inform of need to screen for prostate and breast cancers

69
Q

Propecia effectiveness?

A

Less effective when hair loss is temporal or frontal - more effects if it is male pattern baldness pattern

70
Q

Propecia: New hair is lost after _______ if treatment is discontinued

A

4–6 months

71
Q

Propecia: Results are not seen until after ________ of use

A

2–6 months

72
Q

Propecia: Can not donate blood until after ______ past last use due to teratogenicity issue

A

6 months

73
Q

Propecia causes birth defects in?

A

women

74
Q

Testosterone deficit meds are not approved for use in what population?

A

Pediatric

75
Q

Testosterone deficit meds are contraindicated in?

A

women

76
Q

Testosterone deficit meds: geriatric special population consideration?

A

Discuss precautionary labeling associated with PDE5 use.

Need dosage adjustment in elderly using BPH drugs

77
Q

Terazosin (Hytrin) is a ?

A

reversible selective alpha blocker

78
Q

Doxazosin (Cardura) has a longer ___ than the others?

A

HL

79
Q

Tamsulosin (Flomax) has?

A

lesser effect on BP than the others.

Will not lower BP.

used a lot with kidney stones

80
Q

Alfuzosin (Uroxatrol) can cause?

A

increase QT prolongation

Pharmacology (Dale Turley) (31 decks)

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