Pharm Flashcards
Classes used in tx of BPH?
Alpha-1 blockers
5-alpha reductase inhibitors
Combo: (Jalyn/tamulosin)
Tadalafil (cialis)
Alpha-1 Blockers:
- medications
- MOA
- use
- SE
Meds:
- Terazosin (hytrin)*
- Doxazosin (Cardura)*
- Alfuzosin (Uroxatrol)
- Tamsulosin (flomax)
- Silodosin (Rapaflo)
MOA:
-relax smooth muscle in the bladder neck and the prostatic capsule and prostatic urethra
Use: best drugs for sx management
SE:
- dizziness and orthostatic hypotension (worst with hytrin and cardura)
- can cause severe hypotension if used with phosphodiesterase-5 inhibitors
- problems with ejaculation: can decrease volume of ejaculate by 90%
Combo: 5-alpha reductase inhibitor-alpha-1 blocker
-medication
Meds:
-tamulosin (Jalyn)
5-alpha-reductase inhibitors:
- medications
- use
- MOA
- how long until effects noticed?
- SE
medications:
- Finasteride (Proscar)
- Dutasteride (Avodart)
Use: only agents to provide long term decrease in prostate size and decreased need for prostatic surgery.
MOA:
-inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppress serum DHT…..decreases prostatic size.
-may take up to 1 year before notice reduction in sx
SE:
- decreased libido
- ejaculatory or erectile problems
- decreases PSA by 50%
Cialis:
- drug CI
- dose
- how long until effects noticed?
Drug CI: do not use with nitrates or alpha-1 blockers
Dose: 5mg daily
Takes 2-4weks to note sx improvement when used for BPH.
Erectile Dysfunction
- drug classes
- -drugs in each class
Prostaglandin Injectable
-alprostadil
Phosphodiasterase inhibitors:
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Sildenafil (Viagra)
- Avanafil (Stendra)
Alprostadil (Caverject, Muse)
- MOA
- forms
- onset and duration of action
- CI
- SE
MOA: prostaglandin, vasodilator of cavernosal arteries when injected along penile shaft.
Forms: intracavernosal injections, urethral pellets
Onset: 5-20minutes
Duration: less than 1hr
CI:
- conditions that predispose the pt to priapism
- anatomic or fibrotic conditions of the penis
- urethral stricture, perineal pain
SE:
- syncope
- priapism
- low BP maybe
Phosphodiasterase Inhibitors:
- medications
- MOA
- CI
- Adverse Rxns
Meds:
- Cialis (Tadalafil)
- Levitra (Vardenafil)
- Sildenafil (Viagra)
- Stendra (Avanafil)
MOA:
-enhances the effect of NO by inhibiting PDE-5 so it cant degrade cGMP. (which is responsible for smooth muscle relaxation and inflow of blood to the penis.)
CI:
- men taking nitrates
- caution with alpha-1 blockers for severe hypotension
- hold nitrates for 24hrs after use of PDE-5 or for 48hrs if used Cialis
Adverse reactions:
- severe hypotension
- flushing, HA, dyspepsia
- transient blue vision with viagra
- hearing loss
- priapism
- CYP3A4 inhibitors may increase serum conc of PDE-5
PDE-5 Inhibitors: describe -onset of action -plasma half life -duration of action -effect of food intake -unique side effects ...for each of the following drugs: -avanafil (stendra) -sildenafil (viagra) -Vardenafil (levitra) -Tadalafil (Cialis)
Avanafil:
- onset of action: 15-30min
- plasma half life: 3hr
- duration of action: 6hrs
- effect of food intake: none
- unique side effects: none
Sildenafil:
- onset of action: 30-60min
- plasma half life: 4hrs
- duration of action: up to 12hrs
- effect of food intake: high fat meals decrease efficacy
- unique side effects: vision abnormalities
Vardenafil:
- onset of action: 30-60min
- plasma half life: 4hrs
- duration of action: 10hrs
- effect of food intake: high fat meal decreases efficacy
- unique side effects: vision abnormalities
Tadalafil:
- onset of action: 60-120min
- plasma half life: 17.5hrs
- duration of action: 36hrs
- effect of food intake: not affected
- unique side effects: back pain, myalgias
Testosterone Replacement:
- MC use
- MOA
- Effects
- what are some guidlines prior to starting therapy?
- SE
MC use: primary or secondary hypogonadism
MOA: direct action by binding to androgen receptor. act in tissues that express enzyme 5-alpha reductase
Effects
- increased libido, increased AM erection
- increased body hair
- increased bone density
- increased muscle mas s
- less gynecomastia and larger testes
Guidlines:
- screen for prostate CA in men over 50YO
- screen for erythrocytosis
- make sure sleep apnea is being treated
SE:
- polycythemia
- worsening BPH
- acne
- increase in PSA
- increased risk of prostate CA
- decreased spermatogenesis
- fluid retention
- worsening sleep apnea
- possible of increased risk of cardiovascular events
What is primary/secondary hypogonadism?
Primary: testes fail to produce testosterone
Secondary: pituitary or hypothalamus malfunction.
Testosterone Replacement:
- CI
- routes of admin
- -which formulation is best?
- what is the medication name for the MC gel?
- what is the medication name for the transdermal patch?
- what is the medication name for IM?
CI:
- known breast or prostate CA
- severe lower UTI sx
- HCT greater than 50%
- untreated severe sleep apnea
- PSA greater than 4.0 or greater than 3.0 with risk factors.
Routes:
- oral (hepatic SE and not used in the US)
- buccal tablet
- subQ pellet
- nasal gel
- Parenteral
- Transdermal/topical patch/gel
- **transdermal gel is good first choice
MC gel is androgel.
Transdermal patch: androderm
IM: Delatestry(testosterone enanthate) and testosterone cypionate
Testosterone Replacement:
-what labs need to be monitored?
Labs monitored:
- serum testosterone
- if primary hypogonadism check for normalization of serum LH.
- bone density
- PSA and DRE
- HCT
Urinary Tract Analgesics:
-medication names
Meds:
- Phenazopyridine (Pyridium)
- Pentosan (Elmiron)
Urinary Tract Analgesic: Pyridium
- -use
- -precautions
- -SE
Pyridium:
-use: sx relief of urinary burning, itching, frequency, and urgency associted with UTI or post urologic procedures, will not treat actual infection.
- Precautions:
- -do not use in GFR less than 50
- -dont use more than 2 days
- SE:
- -HA, dizziness, stomach cramps
- -turns skin and sclera yellow
- -turns urine bright orange
