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PHRM 825 > scott > Flashcards

scott Flashcards

1
Q

mens health issue

A

coronary heart issues, prosatte cancer, LUTS/BPH, alopecia, testicular cancer, ED, hypogonadism

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2
Q

when leydig cells are stimulated…

A

production on testosterone

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3
Q

when sertoli cells are stimulated…

A

spermatogenesis production

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4
Q

hypogonadism

A

incomplete/delayed sexual maturity, 2% of adolescent population

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5
Q

most common cause of hypogonadism

A

constitutional delay of growth and puberty (CDGP)

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6
Q

what can you use to treat hypogonadism

A

testosterone supplementation
IM testosterone esters
-50 mg monthly, increased by 25 mg

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7
Q

prognosis of testicular cancer

A

5 yr survival rate of 95%

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8
Q

tx of testicular cancer

A

surgery, radiation, chemotherapy

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9
Q

androgenic alopecia

A

most comon
gradual onset
heredity plays a factor
crown temples or both

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10
Q

alopecia areata

A

autoimunne disorder
hair loss in patches
responds to mab tx

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11
Q

alopecia universalis

A

complete loss of ALL body hair

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12
Q

traction alopecia

A

happens over time from tension on har from brains, buns, etc.

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13
Q

drug induced alopecia

A

anabolic steroids
cancer chemotherapy

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14
Q

finasteride (propecia)

A

MOA: inhibits type 2 5-a reductase
-inhibits conversion of testosterone to DHT
Dose: 1 mg PO once daily
need to continue
SE: decreased libido, ED, dec volume of ejaculate
Women of child-bearing age SHOULD AVOID HANDLING

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15
Q

minoxidil (rogaine)

A

MOA: enlarging miniaturized hair follicles
may increase blood supply to hair follicle
stimulates hair follicle from telogen (resting phase) to anagen (growth phase)
Topical: 5% foam; 5% extra strength solution
Apply to scalp 2x daily EVERY DAY
may take 4 moths to see results
continuous tx is necessary to maintain benefit
apply to dry scalp and hair bc wt hair can dilute it

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16
Q

hypogonadism

A

hormonal deficiency (andropause)
risk factors:
-aging, chronic illness (diabetes, aids, rheumatoid arthrisis, ckd), long term use of corticoids, obesity

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17
Q

diagnosis of hypogonadism

A

low testosterone levels WITH symptoms
ref range of test.: 300-1100 ng/dl
morning is highest level of test. levels
a total test. level of <300 ng/dl is positive for low test.
free test. level <5 ng/dl confirms low test.

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18
Q

specific signs and sx of low test.

A

incomplete sexual development
reduced libido and sexual activity
decrease spontaneous erections
breast discomfort
**loss of body hair **
very small testes
inability to father children
height loss
reduced muscle bulk and strength
hot flashes

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19
Q

non-specific signs and symptoms of low test.

A

decreased energy
feeling sad
poor concentration
sleep disturbance
mild anemia
increased body fat
diminished physical or work performance

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20
Q

tx of hypogonadism

A

hormonal therapy (only can be used when hypogonadism is diagnosed)

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21
Q

testosterone replacement products

A

C-3 controlled substances
patches
gels
solutions
IM depo
buccal
sq pellets
capsules

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22
Q

IM injection

A

100 mg IM weekly or 200 mg IM every other week
very high concentrations; possible mood swings
MOST ECONOMICAL

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23
Q

Patch

A

1-2 patches applied nightly
MOST SIMILAR TO PYSIOLOGIC TEST. LEVELS
Apply away from pressure areas

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24
Q

Gel

A

5-10 grams applied to covered area daily
shoulders, upper arms, abdomen

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25
Solution
1-4 applications to arm pits daily apply deodorant first
26
buccal tablet
30 mg buccal tab q 12 hours do not chew or swallow
27
SQ pellet
implanted q 3-6 months delayed onset
28
oral capsule (jatenzo)
158-237 mg BID test. undercaonate TAKE WITH FOOD draw serum test 6 hoyrs after am dose
29
contraindications to test.
prostate cancer breast cancer HCT > 30% PSA > 3-4 ng/ml poorly controlled CVD
30
monitoring
pts should be monitored 3-6 months after initiating therapy TEST. LEVELS SHOULD BE MEASURED WITH A GOAL B/W 400-700 ng/dL Hematocrit should be measured
31
androgen misuse and abuse
side effects: gynecomastia weight gain acne decreased testicular size mood alteration hepatotoxicity
32
prostate cancer
most common type of cancer in men 2nd leading cause in cancer deaths in men MOST MEN WITH DX DO NOT DIE FROM IT
33
Risk factors of prostate cancer
increasing age african ancestry family history
34
PSA screening (prostate specific antigen)
most men without prostate cancer have PSA levels under 4 ng/ml of blood
35
BPH pathophysiology
prostate gland contains several types of tissue embedded with alpha-1a adrenergic receptors stimulation by NE results in smooth muscle contraction with subsequent narrowing of urethra
36
type-2-alpha reductase in the prostate gland
converts test. to DHT responsible for prosate enlargment and growth some men apprear to be genetically predisposed to producing large quantities
37
obtructive symptoms of bph
decreased force of stream hesitanvy to initiate voiding strain or push to urinate terminal dribblinh intermittency
38
irritative symptoms
nocturia frequency urgency dysuria incontinence QOL
39
how to diagnose BPH
clinical symptoms AND digital exam measuring flow rate measuring residual volume Bladder scan >25-30 ml AUA symptom score
40
complications of BPH
chronic renal failure overflow urinary incontinence recurrent UTIs ***diminished quality of life***
41
role of a pharmacist in BPH
advise on OTC products encourage evaluation advise use of rx medications screen for potential ADRs from meds
42
levels of bph
Mild <7 Moderate 8-19 Severe > 20
43
mild symptoms of BPH tx
watchful waiting
44
moderate symptoms of BPH tx
ED: a-adrenergic antagonist, phosphodiesterase inhibitor, or both SMALL PROSTATE AND LOW PSA: a-agrenergic antagonist LARGE PROSTATE AND INCREASED PSA: 5 a-reductase inhibitor or 5 a reductase inhibitor+a-adernergic antagonist predominant irritative voiding symptoms: a-adrenergic antagonist + anticholongeric agent
45
severe symptoms of BPH tx
minimally invasive surgery or prostatectomy
46
goals of therapy
control symptoms drecrease aua score by at least 3 pts prevent complications delay need for surgery
47
non-drug therapy for BPH
avoid drugs with strong anti-cholingeric properties bc they decrease contractility of bladder detrusor muscle and results in urinary retention Examples to avoid: antihistamines ESPECIALLY benadryl tricyclic antidepressants cogentin, artane, scopolamine anti-muscarinics (ditropan)
48
non-drug therapy for all patient with BPH
restrict fliud, EtOH, and caffeine intake in PM avoid diuretics and nasal decongestants, if possible use kegel exercises
49
Drug therapy MILD
Saw Palmetto 160 mg PO BID Meh product we dont know too much about it and efficacy is debatable and literature is not consistent
50
BPH therapy MODERATE
Alpha-blockers Hormone therapy PDE inhibitors
51
BPH therapy SEVERE
consider invasive treatement optiosn
52
alpha-1a adrenergic blockade
developed for tx of HTN relaxes smooth muscle tone of prostate gland and bladder neck (IMPROVES URINE FLOW) does not reduce size of prosate gland onset in 1-6 week decreases AUA score by 30-40% EQUAL CLINICAL EFFECTIVENESS
53
alpha-1 adrenergic blockers!!!!
alfuzosin doxazosin silodosin tamsulosin terazosin
54
terazosin (hytrin)
soft gel cap 1 mg HS 10-20 mg HS maintenance dose
55
doxazosin (cardura)
tablets 1 mg HS 4-8 mg HS
56
tamsulosin (flomax)
capsules 0.4 mg HS 0.4-0.8 mg HS do not crush take 0.5 hr pc MORE SLECTIVE IN URINARY TRACT
57
alfuzosin (uroxatrol)
SR tablet 10 mg daily 10 mg daily do not crush MORE SLECTIVE IN URINARY TRACT
58
Silodosin (RAPAFLO)
tablets 4 mg daily 4-8 mg daily take with meal MORE SLECTIVE IN URINARY TRACT
59
Alpha-1 adrenergic blockers side effects
dizziness headache fatigue hypertension retrograde ejaculation (decrease volume) (rapaflo, flomax)
60
Intra-operative floppy iris syndrome
side effect of an alpha-1 adrenergic blocker ESP. SHOWN IN USE WITH FLOMAX can complicate cataract procedure and increase the risk of post-op complications inquire about cataracts when first filling rx for flomax
61
Tadalafil
USE FOR MODERATE BPH 2.5 mg if CrCl is 30-50 ml/min DO NOT use is CrCl <30 ml/min relaxes smooth muscle tone of prostate gland and bladder neck improves urine flow
62
hormonal therapy for BPH
5-ALPHA REDUCTASE INHIBITORS decreases size of prostate gland by 20-50% men with prostate size >40 grams benefit most onset of action may be as long as 6 MONTHS
63
Finasteride
hormonal therapy for Moderate BPH Proscar 5 mg po daily
64
dutasteride (avodart)
hormonal therapy for moderate BPH 0.5 mg po daily
65
Finasteride + tadalafil
BPH + ED
66
Tamsulosin + tolterodine
BPH + OAB
67

PHRM 825 (11 decks)

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