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Endocrine Module > Pharmacotherapy of ED and BPH > Flashcards

Pharmacotherapy of ED and BPH Flashcards

1
Q

What is first line therapy for ED?

A

PDE 5 Inhibitor

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2
Q

What is second line therapy for ED?

A

Intracavernosal injections of erectogenic drugs OR intraurethral prostaglandin suppository

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3
Q

What is adjunct therapy for ED?

A

TST ONLY for patients with LOW levels

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4
Q

What is the function of PDE5i?

A

Selectively inhibits PDE5, enzyme that inactivates cGMP

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5
Q

If a patient fails 1 PDE5i what is the next step?

A

Try another PDE5i within the class before considering the entire class as treatment failure

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6
Q

Sildenafil Brand Name and Initial Dose?

A

Viagra, 50 mg 30 min-4hrs before intercourse

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7
Q

What is the renal and hepatic dosing for >65 for Viagra?

A

25 mg initially

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8
Q

What can cause delay absorption fo Viagra and Levitra?

A

High Fat Foods delaying absorption by 1 hr

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9
Q

Vardenafil Option 1 Brand Name and Initial Dose?

A

Levitra, 5-10 mg 1hr

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10
Q

What is the renal dosing for >65 for Levitra?

A

5 mg initially
caution in hepatic

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11
Q

Vardenafil Option 2 Brand Name and Initial Dose?

A

Staxyn, 10 mg 1hr

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12
Q

What is the renal dosing for Staxyn?

A

No renal dosing
CI in hepatic

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13
Q

What is the counseling pearl for Staxyn?

A

Take without food/liquid
Dissolve tablet on tongue

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14
Q

Tadalafil Brand Name and Initial Dose?

A

Cilalis,
10 mg 30 min-36 hr OR
2.5 mg daily

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15
Q

What is the renal dosing for Cialis?

A

No renal dosing
CI in hepatic

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16
Q

What PDE5i has cautionary use with alpha blockers?

A

Cialis and Stendra

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17
Q

Avanafil Brand Name and Initial Dose?

A

Stendra, 100 mg 15-30 min

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18
Q

What is the renal dosing for Stendra?

A

AVOID in CrCl ,30 and hepatic

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19
Q

What is CI with Stendra?

A

CYP3A4i, avoid large amounts of ethanol = orthostatic hypotension

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20
Q

What is onset for Viagra and Levitra?

A

30 mins

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21
Q

What is onset for Staxyn?

A

60 mins

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22
Q

What is onset for Cialis?

A

45 mins

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23
Q

What is onset for Stendra?

A

25-40 mins

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24
Q

What is the duration of Cialis?

A

24-36 hrs

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25
Q

What are side effects most common in Vardenafil?

A

HA, Flushing, and Blue Vision

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26
Q

Blue Vision is a side effect seen with which PDE5i?

A

Sildenafil, Vardenafil, and Avanafil

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27
Q

What is a common side effect of Tadalafil?

A

Myalgia and Back Pain

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28
Q

When are PDE5i Contraindicated?

A

In patients taking Nitrates
Isosorbide Mono/Di-nitrate or SL NTG

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29
Q

What is the result of PDE5i + Nitrate?

A

Life threatening HYPOtension

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30
Q

If the patient is already on a nitrate, can you prescribe PDE5i?

A

NO

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31
Q

If the patient is on a PDE5i, can you administer nitrates?

A

Yes IF they have waited the appropriate amount of time

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32
Q

How long do you have to wait for Sildenafil before nitrate admin?

A

24 hrs

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33
Q

How long do you have to wait for Vardenafil before nitrate admin?

A

24 hrs

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34
Q

How long do you have to wait for Tadalafil before nitrate admin?

A

48 hrs

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35
Q

If the patient is already on an alpha-blocker (some interaction) what dose of PDE5i do you start the on?

A

Lowest

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36
Q

What are the advantages of PDE5i?

A

Convenient, low A/E, all equally effective, and discreet use

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37
Q

What drug is a Prostaglandin E1?

A

Alprostadil

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38
Q

What is the MOA and Place in therapy for Alprostadil?

A

Dilates arteries in the corpora cavernosa which thus increases penile blood flow, 2nd line

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39
Q

Can Alprostadil be used with TST?

A

Yes

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40
Q

Alprostadil Option 1 Brand and Initial Dose?

A

Caverject, Edex
2.5 mcg intraCAVERNOSALLY 5-10 min

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41
Q

When do you AVOID Alprostadil?

A

Sickle cell anemia, coagulopathy, venous incompetence, and Peyronie’s disease

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42
Q

Alprostadil Option 2 Brand and Initial Dose?

A

MUSE
125-250 mcg intraURETHRALLY 5-10 min

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43
Q

What are the AEs of Intracavernosal Caverject/Edex?

A

Penile Pain
Hematoma
Fibrotic nodules

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44
Q

What are the AEs of Intraurethral MUSE?

A

Urethral pain/burning
Partner experiences burning
Testicular pain

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45
Q

What are the general AEs of Alprostadil (no matter which route)?

A

Dizzy, HA, decreased BP

46
Q

Which route of Alprostadil is more effective?

A

Intracavernosal 70-90%
65% of intraurethral

47
Q

What are the advantages of PGE1?

A

Local application
Minimal systemic effects
Rarity of DDI

48
Q

What is the MOA of Testosterone?

A

Improved libido, sexual function, and mood
Enhances release of NO

49
Q

What is the indication of TST?

A

Primary Hypogonadism

50
Q

What are the pearls of oral TST?

A

Less effective than IM and transdermal TST

51
Q

For TST Buccal Mucoadhesive what is the counseling?

A

Remove before toothbrushing

52
Q

What is the most common form of TST?

A

IM Injection

53
Q

For renal and hepatic impairment what is the dosing for IM TST?

A

AVOID/CI

54
Q

Supraphysiologic serum concentrations caused by IM TST can lead to what?

A

Mood Swings

55
Q

Aveed IM TST has what?

A

REMs program

56
Q

Why does Aveed need a REMS program?

A

May cause POME: pulmonary oil micro embolism reaction

57
Q

What is a counseling point for TST Transdermal and Gel?

A

Avoid swimming showering, or washing for 2 hrs after application

58
Q

What is Virilization of Children and what form of TST is the concern?

A

Children exposed to TST GEL causing unintended AEs

59
Q

How is the Subcutaneous Pellets TST administered?

A

Implant by healthcare professional, onset 3-4 months

60
Q

What are the disadvantages to the pellet TST?

A

If there are complications the pellets must be removed surgically

61
Q

What is TST Nasap Spray and the dosing?

A

Natesto, prime first dose with 10 units, consider alternative therapy is TST <300

62
Q

What are the Cardiovascular AEs of TST?

A

Increased risk of MI, Stroke, and clots
Do NOT use with 3-6 month history of CVD

63
Q

What are the Genitourinary AEs of TST?

A

May cause BPH or worsen it

64
Q

What are the Malignancy AEs of TST?

A

TST dependent tumors (prostate)

65
Q

When do you obtain TST levels usually?

A

8am

66
Q

When do you check free TST for Oral?

A

6 hrs after morning dose, 7 days after initiation

67
Q

When do you check free TST for IM Cypionate/Enanthate?

A

Midpoint

68
Q

When do you check free TST for IM Undecanoate?

A

Right before 4th dose

69
Q

When do you check free TST Gel?

A

After 2 wks

70
Q

When do you check free TST Patch?

A

3-12 hrs after application

71
Q

When do you check free TST SQ Implant?

A

At end of dosing interval

72
Q

When do you check free TST Buccal?

A

Before a dose 4-12 weeks in

73
Q

When do you check free TST Nasal?

A

1 month

74
Q

What are other labs to assess with TST therapy?

A
  1. Hematocrit: increase
  2. Hemoglobin: increase
  3. Lipids: Increase total and LDL
  4. LFT: aggravate liver disease (oral TST)
  5. PSA and DRE
75
Q

What schedule are testosterone products?

A

Schedule III

76
Q

What is Priapism?

A

Prolonged penile erection >4hrs, soft glands

77
Q

What do you give Rx for in hospital for Priapism?

A

Intracavernos phenylephrine

78
Q

Is BPH a progressive disease?

A

Not always

79
Q

What is the first line treatment option for Mild BPH?

A

Watchful Waiting

80
Q

What are the therapy options for Moderate BPH?

A
  1. With ED = Alpha-1 Blocker +/- PDE5i
  2. Small prostate and PSA = Alpha-1 blocker
  3. Large prostate and PSA = alpha 1 blocker + Anticholinergic or B3 agonist
81
Q

What are the first gen Alpha 1 Blockers?

A

Phenoxybenzamine

82
Q

What are the second gen Alpha 1 Blockers?

A

Terazosin
Doxazosin
Alfuzosin

83
Q

What are the third gen Alpha 1 Blockers?

A

Tamsulosin
Silodisn

84
Q

Is Prazosin indicated for BPH?

A

NO

85
Q

Which generation is more selective?

A

3rd gen, 2nd are mostly non-selective

86
Q

Terazosin Brand and Starting Dose?

A

Hytrin
1 mg HS QD

87
Q

Doxazosin Brand and Starting Dose?

A

Cardura
1mg HS QS
4 mg QD AM

88
Q

Alfuxosin Brand and Starting Dose?

A

Uroxatral
10 mg QD after meal same time

89
Q

What alpha-1 blockers have slow absorption due to food?

A

Hytrin, Uroxatral, Flomax, and Rapaflo

90
Q

Tamsulosin Brand and Starting Dose?

A

Flomax
0.4 mg QD 30 min after meal same time

91
Q

Silodosin Brand and Starting Dose?

A

Rapaflo
8 mg QD after meal

92
Q

Which alpha-1 blockers are CI’d in severe hepatic disease?

A

Alfuzosin and Sildosin

93
Q

What are the AEs of Alpha-1 Blockers?

A
  1. Orthostatic hypotension/dizzy
  2. Lower volume of ejaculate
  3. Tachycardia
  4. Nasal Congestion
94
Q

What Alpha-1 Blocker are CI’d with ketoconazole, clarithromyxin, and ritonavir?

A

Alfuzosin, Silodosin, and Tamsulosin

95
Q

What Alpha-1 Blocker are cautioned with ketoconazole, clarithromyxin, and ritonavir?

A

Doxazosin

96
Q

Which Alpha-1 Blocker has an increased risk for QT prolongation?

A

Alfuzosin

97
Q

When should tamsulosin be avoided?

A

Sulfa Allergy

98
Q

If using PDE5i with Alpha-1 Blocker what is the admin?

A

Wait one week to stabilize Alpha-1 blocker before starting PDE5i

99
Q

What are the clinical pearls of alpha-1 blockers?

A

Equally effective
Lower AUA by 30-40%
Does NOT alter prostate size

100
Q

If alpha-1 blocker is stopped, what dose do you restart them at?

A

Initial dose

101
Q

What is the MOA of 5-alpha reductase inhibitors?

A

Inhibition of 5-alpha reductase to decrease DHT levels

102
Q

What drugs are classified as 5a-reductase inhibitors?

A

Finasteride and Dutasteride

103
Q

Finasteride Brand and Starting Dose?

A

Proscar and 5mg QD

104
Q

Dutasteride Brand and Starting Dose?

A

Avodart and 0.5 mg QD

105
Q

Can you start a patient on 5a-reductase inhibitors alone?

A

NO, should be prescribed with a-blocker to treat symptoms while 5a-reductase slowly decreases DHT

106
Q

What are the AEs of 5a-reductase inhibitors?

A

ED
Decreased volume of ejaculate
Decreased libido
Gynecomastia

107
Q

What is the CI of 5a-reductase inhibitors?

A

Pregnant women should NOT handle the drug or be exposed to the semen of men who are taking it

108
Q

When should you NOT recommend 5a-reductase inhibitors?

A

Unless Prostate >40 and/or PSA >1.5

109
Q

Alpha-1 Blocker + 5-Alpha Reductase Inhibitor combination is a good option for who?

A

High risk for progression patients:
1. Men over 50 with low urine flow
2. High PSA
3. Large Prostate >30

110
Q

What PDE5i has an FDA indication for BPH and the approved dosing?

A

Tadalafil
2.5 mg QD, may increase to 5mg

111
Q

What product is a B3 Agonist Adjunct Therapy?

A

Mirabegron aka Myrbetriq

112
Q

What is Floppy Iris Syndrome?

A

Happens during cataract surgery causing pupil constriction and the iris becomes floppy

Endocrine Module (16 decks)

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