PHARM_BPH

Question 1

name the short acting selective alpha-1 blocker

Answer 1

alfuzosin

Question 2

name the two 5-alpha-reductase inhibitors

Answer 2

finasteride

dutasteride

Question 3

which alpha-1 receptor predominates in smooth muscle of prostate & penile urethra?

Answer 3

alpha1-a

Question 4

which alpha-1 receptor predominates in the bladder detrusor muscle?

Answer 4

alpha-1d

Question 5

which alpha blocker is considered the superior alpha blocker because it has improvement in LUTS & has no AE on dizziness, asthenia, & ejaculatory dysfunction?

Answer 5

alfuzosin

Question 6

what is the advantage of selective alpha-1a blockers?

Answer 6

dont have to titrate dose (diminsed effects on CV function)

Question 7

what are the disadvantages of alpha-1a blockers?

Answer 7

abnormal retrograe ejaculation

block of dopamine & other regulatory CNS transmitters

Question 8

what is floppy iris syndrome?

Answer 8

occasional AE during cataract surgery in pts taking any of the alpha-1 blockers

Question 9

how does tadalafil work?

Answer 9

inhibits PDE5 which would normally degrade cGMP–>smooth-muscle relaxation

Question 10

how is tadalafil metabolized?

Answer 10

CYP3A4 in liver

Question 11

how is tadalafil eliminated?

Answer 11

fecal elimination

Question 12

what are the AEs of tadalafil?

Answer 12

headache, Nausea, indigestion, nasopharyngitis, URIs

Question 13

what are the must know contraindications for taking tadalafil?

Answer 13

organic nitrates

Question 14

what happens if you take nitrates and tadalafil at the same time?

Answer 14

profound hypotension

exacerbated by alcohol consumption

Question 15

what are the beta-sitosterols used for?

Answer 15

improved urinary symptoms of BPH but DO NOT significantly reduce size of prostate

Question 16

does saw palmetto work for BPH?

Answer 16

NO

Question 17

how does alprostadil work?

Answer 17

mimic of PGE1 which stimulates adenylate cyclase to increase cAMP–>PKA–>decrease intracellular Ca2+–>smooth muscle relaxation–>erection

Question 18

how is alprostadil administered?

Answer 18

locally via urethral suppository or intra-cavernosal injection

Question 19

how are all of the PDE inhibitors administered?

Answer 19

oral

Question 20

which PDE5 inhibitor has a long half life and thus makes it useful for therapy in BPH?

Answer 20

tadalafil

Question 21

how are all of the PDE5 inhibitors metabolized?

Answer 21

hepatic metabolism CYP3A4

Question 22

what are some of the common AEs of PDE5 inhibitors?

Answer 22

headache
CV issues
sudden loss of hearing
loss of sight

Question 23

replacing what hormone may improve response of hypogonadal men to PDE5 inhibitors such as sildenafil?

Answer 23

testosterone

Question 24

which drug used to treat erectile dysfunction crosses the BBB easily potentially producing anxiety, antidiuresis, dizziness, flushing, headache and hypertension?

Answer 24

yohimbine

Question 25

which drug used to treat erectile dysfunction has MAOI action at supra-clinial doses?

Answer 25

yohimbine (tyraminen & caffeine interactions posible)

Question 26

which drug used to treat erectile dysfunction can worsen renal function?

Answer 26

yohimbine

Question 27

what are some of the common adverse effects of the PDE5 inhibitors?

Answer 27

non-arteritic ischemic optic neuropathy

sudden hearing loss