Mens Pharmacology Quiz Flashcards
Men who use large doses of anabolic steroids are at increased risk for?
A) Anemia
B) Hirsutism
C) Cholestatic jaundice and elevation of aspartate transaminase blood levels
D) Testicular enlargement
C
A 60 year old man is found to have a prostate lump and an elevated PSA blood test. Magnetic resonance imaging suggest several enlarged lymph nodes in the lower abdomen, and an x-ray reveals 2 radiolucent lesions in the bony pelvis. This patient is likely to be treated with which of the following drugs?
A) Methytestosterone
B) Anastrozole
C) Desogestrel
D) Leuprolide
D
Finasteride has efficacy in the prevention of male pattern baldness by virtue of its ability to?
A) Reduce the production of dihydrotestosterone
B) Competitively antagonize androgen receptors
C) Inhibit the synthesis of testosterone
D) Decrease the release of gonadotropins
A
A recent trial (2006) and Cochrane Review (2012) concluded for patients with severe urinary symptoms associated with BPH that Saw Palmetto was as effective as:
A) Finasteride
B) Placebo
C) Tamsulosin
D) All of the above
B - Serenoa repens (thought to be the active component), even when given at double and triple doses, did not improve urinary flow measures or prostate size in men with lower urinary tract symptoms consistent with BPH
Your patient Mr. Howard, after undergoing testing, returns to clinic for help managing his symptoms of BPH.
He has stopped taking OTC cold meds, and cut back on coffee since his visit 2 weeks ago.
Vitals: 5’11” 180 lbs BP: 120/80 HR: 60 T: 98.6 RR: 16
His PSA is 5.1, his creatinine is 1.6, lipids are slightly elevated as per his last visit.
His AUA symptom score is 20. He would like to be treated.
Enter your responses to the following 3 questions. Keep in mind his renal function, and elevated PSA.
1) Choose an oral alpha blocker, state the initial dose, AND describe the dose titration. Use a couple of sentences to summarize the advantages and disadvantages of this approach to therapy.
2) Choose a 5-alpha reductase inhibitor, state the dose. Use a couple of sentences to summarize the advantages and disadvantages of this approach to therapy.
3) Which option would you advise Mr. Howard to use? Explain why?
1) The oral alpha blocker of choice is tamsulosin 0.4 mg daily, and to eventually titrate up to reach a maximum dose of 0.8 mg daily. The advantages of tamsulosin are: no dosing adjustment for renal failure required, fast acting on symptom relief and it is prostate specific so it has limited adverse effects. Disadvantages are: association with dizziness, ED, orthostatic hypotension, and ejaculation issues.
2) The 5ARI of choice is finasteride 5 mg daily. The advantages are: it can reduce prostate size and decrease bleeding associated with prostate enlargement, which can help improve LUTS symptoms and urine flow. Disadvantages are: association with male breast cancer, decreased libido, ED, and pseudo lowering of PSA, so it requires close monitoring.
3) I would advise Mr. Howard to use tamsulosin first because alpha blockers are first line and has the quickest onset of symptom relief, which would be ideal because he is symptomatic. Tamsulosin is also a good choice because it does not have to be dose adjusted for renal function, and that is important because Mr. Howard’s creatinine was elevated.
Which of the following medications is contraindicated with the use of sildenafil? Why is this medication contraindicated?
A) Tamsulosin
B) Amoxicillin
C) Nitroglycerin
D) Lisinopril
C - nitroglycerin is contraindicated with PDE5 inhibitors because it can cause severe hypotension and lead to subsequent syncope/other cardiac events
Which of the following drug classes has been more commonly associated with erectile and other sexual dysfunction as adverse effects?
A) Antihistamines
B) Thyroxines
C) Insulin glargine
D) Leukotriene receptor antagonists
A
Which adverse effect of terazosin would be the most concerning for a patient with BPH?
A) Erectile dysfunction
B) Dizziness
C) Gynecomastia
D) Nausea
B - as most patients are elderly, dizziness is usually the most concerning adverse effect. ED and gynecomastia are unlikely when using alpha-blockers. Nausea is seen with almost every medication.
