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Reproductive Block > Pharm - Male > Flashcards

Pharm - Male Flashcards

1
Q

Short acting selective alpha 1 blockers

A

Prazosin, Alfuzosin

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2
Q

Long acting selective alpha 1 blockers

A

Terazosin, Doxazosin

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3
Q

alpha 1 alpha pertially selective blockers

A

Tamsulosin, Silodosin

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4
Q

PDE-5 Inhibitors (for BPH)

A

Tadalafil

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5
Q

5 alpha reductase inhibitors

A

Finasteride, Dutasteride

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6
Q

Type of alpha receptor in prostate

A

alpha-1a

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7
Q

Type of alpha receptor in the bladder detrusor muscle

A

alpha-1d

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8
Q

Prazosin PKPD

A

demethylation; conjugation; fecal elimination (2-4hr half life)

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9
Q

Alfuzosin PKPD

A

3A4; fecal/renal elimination; (10hr half life)

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10
Q

Terazosin PKPD

A

Hepatic-fecal/renal elimination; 12hr half life

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11
Q

Doxazosin PKPD

A

3A4>2D6; fecal elimination; 5-22hrs

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12
Q

Tamsulosin PKPD

A

3A4/2D6; renal/fecal elimination; 5-15hrs half life; bioavailability decreased by food

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13
Q

Silodosin PKPD

A

3A4; glucuronide conjugaiton; fecal/urine elimination; 13hr half life

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14
Q

Prazosin Dosing requirements

A

needs dosing every 12hrs with dose titration; making it a less attractive drug to use due to that and short half life.

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15
Q

Alpha 1 blocker SE

A

GI (xerostemia), CNS (dizziness, somnolence), retrograde ejaculation, floppy iris syndrome

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16
Q

Tadalafil MOA

A

PDE5 inhibtor which causes smooth muscle relaxation

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17
Q

Tadalafil PKPD

A

3A4; fecal elimination

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18
Q

Tadalafil AE

A

non-arteritic ischemic optic neuropathy; retinal artery occlusion; hearing loss

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19
Q

Tadalafil contraindications

A

concurrent organic nitrates - profound hypotension exacerbated by alcohol consumption

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20
Q

Finasteride: Dutasteride

A

F - type 2 5 alpha reductase enzyme; D - type 1&2; competitive long binding time, slow reversal; extensive 3A4 metabolism; pregnancy category X

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21
Q

Finasteride: Dutasteride AE

A

well tolerated; ejaculatory dysfunction, decreased libido, gynecomastia; decreases PSA levels (can be issue if using to monitor prostate cancer)

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22
Q

Beta sitosterols

A

herbal therapy used OTC for BPH - shows improved urinary symptoms and flow but no reduction in prostate size

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23
Q

Saw Palmetto

A

herbal therapy used OTC for BPH; no proven benefit.

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24
Q

Alprostadil MOA

A

mimics PGE1 which activated adenylate cyclase to increase intracellular cAMP

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25
Alprostadil drug delivery
either urethral suppository or intra-cavernosal injection - limits systemic effects, rapid onset
26
PDE5 inhibitors PKPD
hepatic metabolism (3A4, 2C), primarily fecal elimination
27
PDE5 inhibitors adverse effects
Most commonly HA; rarely non-arteritic ischemic optic neuropathy, hearing loss, angina, MI, tachycardia
28
PDE5 inhibitors drug interaction
Nitrates (contra), alpha blockers, drugs affecting CYP activity
29
Vardenafil interactions
more than 70 drugs leading to increased risk of QT prolongation
30
Role of hormone replacement in ED
little effect alone; may improve response to PDE5 inhibitors
31
Yohimbine MOA
alpha 2 receptor inhibitor, causing decreased intracellular Ca2+ and increased smooth muscle relaxation; also antagonizes NANC nerves, increasing release of NO
32
Yohimbine effectiveness
little increase over placebo
33
Yohimbine PKPD
rapid absorption, short half life,, crosses BBB (AE of CNS)
34
Yohimbine Interaction
MAOI effect at high levels (interaction with tyramine and caffeine); worsens renal function in those with kidney issues (contraindicated)
35
Serum testicular cancer markers
alpha fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropic (B-HCG)
36
Primary cheomtherapy for testicular cancer
Etoposide/Cisplatin, Bleomycin/Etoposide/Cisplatin, Estoposide/Mesna/Ifosfamide/Cisplatin
37
Second-Line or metastatic for testicular cancer
Vinblastine/Mesna/Ifosfamide/Cisplatin, Paclitaxel/Mesna/Ifosfamide/Cisplatin
38
High dose regimens for testicular cancer
Paclitaxel/Ifosfamide/Mesna followed by Carboplatin/Etoposide then stem cells; Carboplatin/Etoposide then stem cells
39
Mechanism of resistance to cisplatin
decreased influx, increased efflux, sequestration, increased DNA repair, increased tolerance to DNA lesion, defective apoptotic response
40
Bleomycin MOA
binds DNA in presence of iron with ferrous oxide mediated DNA stand breakage
41
Cisplatin MOA
nuclear and mitochondrial DNA damage and redox stress
42
Carboplatin MOA
slower reaction with nuclear DNA, less potent than cisplatin - give bigger dose than Cisplatin
43
Etoposide MOA
stabilizes DNA and topoisomerase II complexes resulting in strand breakage
44
Ifosfamide MOA
metabolically activated alkylating agent producing intra and inter strand DNA cross links
45
Paclitaxel MOA
promotes microtubule assembly and stabilizes their formation by inhibiting depolymerization
46
Vinblastine MOA
binds to low affinity sites on tubulin, resulting in splitting of the microtubules into spiral aggregates or protofilaments; this leads to the disintegration of the microtubule
47
Mesna MOA
forms acrolein-mesna thioether complexes which are inactive and eliminated in the urine without causing hemorrhagic cystitis.
48
Bleomycin Toxicity
late developing skin toxicity
49
Cisplatin toxicity
renally eliminated; active accumulation in renal cells; inhibits breakdown of lipids to generate metabolic energy, ototoxic, neurotoxic
50
Carboplatin toxicity
less nausea, neurotoxicity, ototoxicity and nephrotoxicity than cisplatin
51
Etoposide toxicity
n/v, stomatitis, diarrhea, hepatic toxicity after high dose treatment
52
Ifosfamide toxicity
neurotoxic (coma, seizures, ataxia from release of chloroacetaldehyde)
53
Paclitaxel toxicity
(fligastim protectant) peripheral neuropathy (esp. bad in DM neuropathy)
54
Mesna toxicity
most commonly dysgeusia, soft stools, HA
55
Bleomycin dose limiting toxicity
pulmonary fibrosis, intersitial pneumonitis
56
Cisplatin dose limiting toxicity
renal toxicity (amifostine protectant)
57
Carboplatin dose limiting toxicity
thrombocytopenia
58
Etoposide dose limiting toxicity
leukopenia
59
Ifosfamide dose limiting toxicity
myelosuppression
60
Paclitaxel dose limiting toxicity
bone marrow suppression
61
Vinblastine dose limiting toxicity
neuropathy
62
Cisplatin mechanism of toxicity
CDDP causes redox/ER stress which leds to interruption of inracellular energy production leading to renal epithelial cell death; it also depletes the antioxidant system in the Cochlea causing ototoxicity
63
Bleomycin mechanism of toxicity
stimulate the production of ROS, chemokines, and cytokines; these pro-inflammatory and pro-fibrotic mediators in the initiation and maintenance of fibrosis
64
Androgen receptor blockers
Bicalutamide, Enzalutamide, Flutamide, Nilutamide
65
Targeted Alkylator
Estramustine
66
GnRH Agonists
Goserelin, Histrelin, Leuprolide, Triptorelin
67
GnRH Antagonist
Degarelix
68
17-alpha inhibitor
Abiraterone
69
Immunotherapy for prostate cancer
Sipuleucel-T
70
First line therapy for prostate cancer
medical or surgical castration plus a pure anti-androgen
71
GnRH agonist AE
transient hyperandrogenic state; then hypoadrenergic state leading to edema, HTN, decreased libido, gynecomastia, decreased bone mineral density; teratogens
72
Histrelin AE
seizures, suicidal ideation
73
Leuprolide AE
MI, CHF
74
Degarelix
reversible GnRH antagoinst given subq; causes castrate levels within 3 days
75
Degarelix AE
hot sweats, weight gain, HTN, elevated hepatic enzymes, QT prolongation
76
Estramustine MOA
binds EBP on prostate CA, inhibiting microtubules, promoting dis-assembly and G2/M arrest, producing DNA strand breakage
77
Estramustine AE
GI upset, gynecomastia, mastalgia, impotence, edema, thromboembolism, MI, PE and stroke, elevated LFTs, hyperbilirubinemia
78
Bicalutamide receptor specificity
antagonist and some agonist activity with prostate>central; only one with CYP inhibition 3A4>2C9, 2D6
79
Flutamide receptor specificity
prostate only
80
Flutamide AE
hepatotoxicity, liver failure (BBW), blood dyscrasias
81
Nilutamide AE
respiratory insufficiency (BBW), interstitial pneumonitis, increased time to accomodate transition from light to dark, HF/HTN
82
Enzalutamide AE
CNS issues (dizziness, insomnia, seizures)
83
General Androgen Receptor Blocks AE
GI toxicity, hot flashes, aches and pains; all teratogens (except Nilutamide)
84
Sipuleucel-T MOA
autologous cellular immunotherapy designed to stimulate T-cell immunity against prostatic acid phosphatase (PAP) using patient's APC
85
Sipuleucel-T AE
mild infusion reactions, fevers, chills, dyspnea, n/v, parasthesias, citrate toxicity and fatigue
86
Difference in 17alpha hydroxylase inhibitor (Abiraterone) and Ketoconazole
Ketoconazole causes a hypo-aldosterone and hypo cortisol state in addition to its hypo-androgenic state, while 17alpha inhibitor causes a hyper-mineralocorticoid effect
87
Abiraterone AE
hyper-mineralocorticoid state (decrease effects by giving corticosteroids also), elevated hepatic enzymes, Cat X drugs
88
ER-alpha in the prostate
activation mediates aberrant proliferation, inflammation, and malignancy
89
ER-beta in the prostate
activation mediates a protective, antiproliferative, anti-inflammatory effect; may reduce aromatase expression and local estrogens
90
Chemotherapeutics for prostate cancer
Docetaxel and Carbazitaxel with corticosteoids and anithistamines to preempt edema and injection reactions; Mitoxantrone + prednisone used for palliation of severe pain from hormone refractory disease

Reproductive Block (4 decks)

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