Repro p. 594-598 Flashcards
Male Pt in his 60s complains of nocturia and difficulty starting and stopping urine stream. His urine test also shows wbc casts. what further tests should be done?
digital rectal exam
PSA
BPH is hyperplasia or hypertrophy?
hyperplasia not hypertrophy
Which lobes are involved in BPH?
periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit
Pt with hx of MI presents with dysuria and found to have
smooth, elastic, firm nodular enlargement of the periurethral area. What medication is C/I in this pt for his BPH? why?
tadalafil –> MI pt might use nitroglycerin –> sever hypotention
Pt with HTN and BPH can benefit from which tx?
α1-antagonists —> -zosin
Diff. btw prostatitis and BPH?
prostatitis has low back pain, prostate feels warm, tender, and enlarged. (hypertrophy)
Location of prostate ca?
posterior lobe, peripheral zone
definite dx of prostate ca?
needle core biopsies
Male Pt is his 70s presents with lower back pain. Looking at the x-ray, physician finds this: (look at x-ray).
Which lab values do u expect to be elevated?
total PSA, with dcr fraction of free PSA
serum ALP and PSA.
Which GnRH analog can tx prostate ca and infertility? How is it administered in each case?
Leuprolide
continuous fashion –> p. ca
pulsatile –> infertility
Name 3 drugs that can be used on men with androgen-dependent prostate cancer?
Ethinyl estradiol, DES, mestranol
A female previously been seen for infertility is now complaing of visual disturbances. Her lab value shows an incr in AFP. Upon ultra sound multiple heartbeats are recognized. Which drug was she taking?
Clomiphene
can cause multiple simultaneous pregnancies and visual disturbances.
Raloxifene is primary used to tx what? what is it C/I?
Tx: Breast ca. pt with osteoprosis
incr risk of thromboembolic
letrozole is a —.
Aromatase inhibitors
Unopposed estrogen replacement therapy increases the risk of? what should be co-administered?
endometrial cancer
Progesterone
Norethindrone MOA?
Bind progesterone receptors, incr growth and vascularization of endometrium, thicken cervical
mucus.
5 Contraindications of Combined contraception?
- smokers > 35 years old ( risk of cardiovascular events),
- cardiovascular disease (including history of venous thromboembolism,
- coronary artery disease, stroke),
- migraine (especially with aura),
- breast cancer
Pregnant pt that was brought to the hospital by her husband. She is in distress since she is having contractions although she is in the 30th week of gestation. In order to gain some time to administer steroids to the mother you need to administer which drug first? Why does the mother need to be given steroids?
- normal pregnancy can range from 38 to 42 weeks. before 37 weeks–> premature
- Terbutalin/Ritodrin - β2-agonists that relax the uterus
- steroids help lung maturation of the baby
Describe Progestin challenge?
Cessation of progestrin use causes withdrawal bleeding. This excludes anatomic defects (eg, Asherman syndrome) and chronic anovulation without estrogen.
What drug is a emergency contraception? vs.
What drug is the most effective emergency contraception.
ulipristal vs.
Copper intrauterine device
Female complain of painful menstruation and pain with
defecation. Upon closer look you find “chocolate cyst” and prescribe her some medicine. On her next follow up appointment you barely recognize her since she had gained wt and was growing beard. Her PCP also wrote u a note saying “stop messing w/ my pt’s HDL and LFT levels”. What drug did u previously prescribe her?
Danazol
A mother brings her 13 year old boy to the PCP and complains that her son is too short for his age. Upon interviewing the son, the physician notices bulky musculature and finds out that he works out and is into competitive wrestling. What should the doc be suspecting that is causing his growth inhibition?
Steroid use: Testosterone, methyltestosterone
Premature closure of epiphyseal plates
Pt with BPH and and baldness can benefit from which drug and what is the MOA?
Finasteride
5α-reductase inhibitor
T or F? Finasteride is used for prostate ca?
F. it is Flutamide
—- and —- inhibits 17,20-desmolase.
Ketoconazole, Spironolactone
α1A,D receptors are found on what organ and therefore —- drug can inhibit this receptors. Vs. α1B receptors are found where?
α1A,D –> prostate
α1B –> on vessels
PDE-5 incr blood flow in what organ and which specific part?
incr cGMP –> incr blood flow in corpus cavernosum of penis
T or F? Viagra can be used for pulmonary hypertension?
T
MOA of Minoxidil?
Direct arteriolar vasodilator
clinical use: alopecia, refractory HTN
Prostate ca spreads to which plexus?
batson’s plexus
