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Reproductive > Sweatman BPH Drugs > Flashcards

Sweatman BPH Drugs Flashcards

1
Q

three drug classes used in BPH treatment

A

Alpha antagonist
PDE5 inhibitors
5 alpha reductase inhibitors

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2
Q

dynamic bladder-outles obstruction due to

A

signalling via Alpha 1a,b,d receptors

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3
Q

static bladder-outlet obstruction

A

5 alpha reductase-testosterone-enlargment of the prostate (hyperplasia)

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4
Q

bladder muscle is under what control

A

Muscarcinic (Acetylcholine) M3 selective and M2 non-selective

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5
Q

only alpha families that matter

A

alpha 1a

alpha 1d

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6
Q

detrussor muscle is under what receptor control

A

alpha-1d

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7
Q

Lower GI tract”–>Trigone, prostatic urethra, prostate gland penile urethra of bladder is under what receptor control

A

alpha 1a

blockade causes relaxation of all these entities and allows for easier urination

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8
Q

alpha blocker with great variation from patient to patient

A

prazosin

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9
Q

dose titration necessary

A

prazosin

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10
Q

all alpha blockers end in

A
  • Zosin
  • losin
  • dozin
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11
Q

advantage of selective alpha 1a agents

A

no need for dose titration, less CV effects

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12
Q

disadvantages of alpha 1a agents

A
  • retrograde ejactulation (tamsulosin, silodosin)

- blockade of dopa receptors in CNS

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13
Q

superior Alpha antagonist at the momen

A

Alfuzosin–> no CNS or ejaculatory effects

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14
Q

alpha 1 blockers in eye surgery

A

floppy iris syndrome

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15
Q

events in erection

A

(PNS S2-S4) via the cavernous nerve-ACH-NOS-NO-SOLUBLE GC–>cGMP–>active PKG–>efflux of calcium (dec intraceullualr concentration)–> vasodilation

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16
Q

MOA for PDE5i

A

inhibits PDE5 which allows cGMP to linger—>prolongs natural vasodilatory action of the endogenous molecule

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17
Q

name the PDE5i

A

tadalafil (cialis)

18
Q

ADE’s for tadalafil

A

Nasopahrygitis, URTI, NON-arteric ischemic optic neuropathy, retinal artery occluson, hearling loss

19
Q

contraindicated in tadalafil usage

A

nitrate-profoudn hypotension

worse with ETOH consumption

20
Q

which androgen activate gene expression more efficiently

A

DHT»testosterone–> binds with higher affinity

21
Q

distribution of type I/II 5 alpha reductase

A

type I: non genital skin, liver, bone

2–> urogenital tissue and genital skin in men and women

22
Q

MOA for 5 alpha reductase inhibitors

A

reduce DHT driven proliferation of the prostate-providing relief for urinary evacuation

23
Q

inhibits type I and 2

A

dutasteride

24
Q

inhibits type 2 only

A

finasteride

25
Q

pregnancy category for 5 alpha reductase inhibitors

A

category X

26
Q

side effects of 5 alpah reductase inhibtors

A

ejaculatory dysfuntion, dec libido, gynecomastia

27
Q

effect on PSA for 5 alpha reductase inhibitors

A

reduces PSA levels-therfore problem if PSA being monitored for Prostate CA

28
Q

beta sitosterols

A

relieve symptoms, improved flow, without shrinking the prostate

29
Q

Saw palmeto and BPH

A

no benefit on symptoms and does not reduce PSA levels

30
Q

Erectile Dysfunction drug that mimics PGE1

A

alprostadil

31
Q

MOA for alprostadil

A

activates adenylate cyclase–> makes cAMP from ATP–>PKA–>calcium efflux, vasodilation

32
Q

delivery for alprostadil and systemic effects

A 
urethral suppository
direct injection into corpus cavernosum
*these routes show very litle systematization
no drug dugr interxns
*Cv events rare
33
Q

adverse effects of oral ED tablets

A

CV issues angina and MI (and worsening of pre-exisiting CV issues)
Sudden loss of hearing and Optic Neuropathy (vision loss)
headache

34
Q

why is tadalafil used for both BPH and ED

A

long duration of action

35
Q

Drug Drug interaction with oral ED pills

A

YES

–all hepatically metabolised by 3A4

36
Q

absolute contraindications for ED pills

A

Nitrates

37
Q

potential contraindictions for ED pills

A

alpha blockers

drugs acting on cyps

38
Q

ED pill with QT prolonging propensity

A

Vardenafil

interaction with > 70 drugs

39
Q

testosterone therapy (HRT) and its effect on ED

A

may improve sensitivty to PDE5i’s–>High levels of T not necessary to maintain erection,

40
Q

this drug inihibits Alpha 2-AR’s by NE, as well as antagonized NANC (presynaptic inhibition)–>increases release of NO

A

Yohimbe

41
Q

Yohimbe contrainidacted in

A

renal failure/dysfunction

Reproductive (9 decks)

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