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Fall 2018/P3 Year' > Therapeutics Exam 4 (Scott - Geriatric and Men's Health) > Flashcards

Therapeutics Exam 4 (Scott - Geriatric and Men's Health) Flashcards

1
Q

Testosterone will decrease with _______

A

age

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2
Q

Testosterone peaks around what age?

A

Early 20s

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3
Q

6 Roles of Testosterone Surge/Puberty?

A 
bone/muscle growth
facial/body hair growth
penis growth
testicular growth
spermatogenesis
increase libido
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4
Q

what is hypogonadism

A

incomplete/delayed sexual maturity

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5
Q

what are some men’s health issues during puberty/young adulthood

A

delayed sexual maturity (hypogonadism)
testicular cancer
alopecia

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6
Q

Types of testicular cancer?

A

Seminoma and Non-Seminoma

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7
Q

Testicular cancer:

Good or bad prognosis?

A

good! even if at very far stages

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8
Q

stages for testicular cancer vs stages for prostate

A

testicular: only stages I, II, and III
prostate: stages 1 - 4

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9
Q

Treatment for testicular cancer?

A

Orchiectomy
Radiation
Chemo (Cisplatin, Etoposide, bleomycin)

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10
Q

T or F:

Alopecia definition: Hair loss starting at the back or front of the head only

A

false!! hair loss at ANY part of the body and for any reason!!

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11
Q

Types of alopecia?

A 
androgenic alopecia
alopecia areata
alopecia universalis
traction alopecia
drug-induced alopecia
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12
Q

how/why does androgenic alopecia happen

A

DHT causes hari follicles to shrink and thin = balding

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13
Q

what is alopecia areata

A

autoimmune

small round patches

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14
Q

what is alopecia universalis

A

complete hair loss on scalp/body

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15
Q

what is traction alopecia

A

hair loss because of constant tension on hair by braids or buns

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16
Q

what drugs can cause alopecia

A

anabolic steroids

cancer chemotherapy

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17
Q

treatment options for alopecia

A

finasteride
minoxidil
(wigs and hair transplant)

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18
Q

Finasteride for Alopecia:

Works by inhibiting _________ and inhibiting the conversion of ______

A

inhibits Type II 5 alpha reductase

inhibits conversion of testosterone to DHT

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19
Q

Finasteride for Alopecia:

handling note about this drug?

A

women of child bearing age should avoid this because if too much exposure can affect a baby

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20
Q

Finasteride for Alopecia:

typical side effects?

A

decreased libido
erectile dysfunction
decrease volume of ejaculate

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21
Q

Minoxidil for Alopecia:
MOA?

can be used for what other disease?

A

MOA: enlarges miniature hair folicles

can be used in HTN

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22
Q

Directions for using minoxidil

A

apply to scalp twice daily every day

apply to dry scalp and hair

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23
Q

how long to you see results with minoxidil

A

4 months

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24
Q

Risk factors for hypogonadism/hormonal deficiency

A

aging
chronic illnesses (diabetes, AIDS, RA, CKD)
long term use of corticosteroids
obesity

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25
Q

how to be diagnosed with hypogonadism

A

low testosterone levels WITH symptoms!! (must have both for diagnosis!!)

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26
Q

For Diagnosing hypogonadism:

INITIAL blood test should be done what time of day and should measure what?

A

test in AM

check TOTAL testosterone

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27
Q

For Diagnosing hypogonadism:

A total testosterone level of _______ is positive for low testosterone

A

< 300 ng/dL

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28
Q

For Diagnosing hypogonadism:
after initial test you need a test to CONFIRM the diagnosis:
can check via ______ or ____ testosterone tests

A

total or free

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29
Q

For Diagnosing hypogonadism:
Testosterone binds to ______ therefore a ______ test should be done if you think the patient has suspected altered ____ concentrations

A

binds to SHBG; FREE testosterone test;

if altered SHBG

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30
Q

For Diagnosing hypogonadism:

a free testosterone level of ______ confirms low testosterone

A

< 5 ng/dL

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31
Q

what does SHBG stand for

A

sex hormone binding globulin

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32
Q

Testosterone Replacement Products:
IM Injection – inject how often?
possible side effect?

A

weekly or every other week

mood swings

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33
Q

Testosterone Replacement Products:

which one is most similar to physiologic testosterone levels?

A

the patch

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34
Q

Testosterone Replacement Products:

which ones are important to wash hands after use?

A

gel and solution…..

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35
Q

Contraindications to testosterone products?

A 
prostate cancer
breast cancer
hematocrit > 50%
Baseline PSA greater than 4 ng/mL
Recent or poorly controlled CVD
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36
Q

Black box warnings for Testosterone products:

Testosterone gel?

A

concerns with secondary exposure to children!!

put gel in area that people wont touch and wash hands after use!!!

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37
Q

Black box warnings for Testosterone products:

there is some cardiac risk with them – which one is worse than others?

A

injection is worst!

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38
Q

Testosterone Replacement Products:

For solution - put deodorant how in relation to it?

A

apply deodorant first!!

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39
Q

why are hematocrit levels/monitoring important with testosterone products

A

testosterone will increase RBCs

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40
Q

Goal testosterone levels with testosterone therapy?

A

400 - 700 ng/dL

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41
Q

For testosterone therapy monitoring:

if hematocrit is > ____% then therapy should be stopped – reinitiate when it drops to a safe level

A

54

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42
Q

ADEs of supraphysiologic doses of testrogens?

A 
gynecomastia
decreased testicular size
weight gain
acne 
mood alteration
hepatoxicity
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43
Q

what race is at higher risk of prostate cancer

A

african american

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44
Q

Prostate Cancer Facts:

Most common cell type: _________

A

adenocarcinoma

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45
Q

Prostate Cancer Facts:

Use ______ to rate tumor grade

A

gleason score

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46
Q

the prostate surrounds the _______

A

proximal uretha

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47
Q

prostate cancer growth is common after age ______

A

40

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48
Q

The prostate has hella _________ receptors

A

alpha adrenergic

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49
Q

_________ converts testosterone to DHT

A

type II 5 alpha reductase

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50
Q

_____________ is responsible for prostate enlargement and growth

A

Type II 5 alpha reductase

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51
Q

BPH Pathophys:

Stimulation by ____ results in smooth muscle _____ with subsequent _____ of the urethra

A

by NE (norepinephrine)
muscle contractions
subsequent narrowing

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52
Q

BPH: Obstructive Symptoms?

A

aka symptoms that come from when there is so much pressure on the urethra it is blocked

  • Decrease forced of stream
  • Hesitancy to initiate voiding
  • strain or push to urinate
  • terminal dribbling
  • intermittency (start and stop and start)
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53
Q

BPH: Irritative Symptoms?

A 
Nocturia
Increased frequency
Urgency
Dysuria
Urge incontinence
decrease on QOL
54
Q

Diagnosis of BPH done by?

A

clinical symptoms AND digital exam

measure flow rate/ measuring residual volume and AUA symptom score

55
Q

Complications of BPH?

A

chronic renal failure
overflow urinary incontinence
recurrent UTIs
diminished quality of lide

56
Q

AUA scores help guide treatment of ______

A

BPH (score is based on symptoms!)

57
Q

Treating BPH is based on _____

A

severity AKA AUA score

58
Q

AUA Scores and BPH thus treatment:
Mild: AUA < _______
Moderate: AUA ___ - ___
Severe: AUA > ____

A

< 7
8 - 19
20

59
Q

For BPH Patients:

Avoid drugs with strong _______ properties

A

anti-cholinergic drugs

60
Q

what are drugs that are examples of anti-cholinergic drugs

A

antihistamines
TCAs
Scopolamine (Cogentin - benztropine; Artane)
Anti - muscarinics (Ditropan)

61
Q

Non-Pharm therapy options for BPH?

A

restrict fluid, EtOH, and caffeine intake in PM
Avoid diuretics and nasal decongestants (bc alpha agonists)
use kegel exercises

62
Q

Drug Therapy for mild BPH?

A

saw palmetto?

relatively safe and may be anti-androgenic…..

63
Q

Drug therapy for moderate BPH?

A

alpha blockers
hormone therapy
PDE inhibitors

64
Q

MOA of alpha blockers for BPH?

A

alpha adrenergic blocker = relaxes smooth muscle tone and prostate gland and bladder neck —– improves urine flow

65
Q

Alpha adrenergic blockers:

T or F: will NOT reduce the size of the prostate gland

A

true!!

66
Q

Alpha adrenergic blockers:

which one is the most effective?

A

not one specifically!

they are equally clinical effectiveness

67
Q

what drugs are alpha adrenergic blockers

A 
terazosin
doxazosin
tamsulosin
alfuzosin
silodosin
68
Q

which alpha adrenergic blockers need/should be taken at night and WHY

A

terazosin
doxasozin

why - because of first dose effect/orthostatic!
(the others are more selective for receptors in the urinary tract)

69
Q

Tamsulosin:

directions for taking?

A

swallow whole – do not crush

take 1/2 hour after same meal each day

70
Q

Dosing Info:
Silodosin notes?

Alfuzosin notes?

A

Silodosin: take w/ meal

Alfuzosin: swallow whole; do not crush

71
Q

ADEs of Alpha adrenergic blockers

A 
dizziness 
fatigue
(headache)
orthostatic hypotension
INTRA-OPERATIVE FLOPPY IRIS SYNDROME!
72
Q

explain intra-operative floppy iris syndrome

A

seen during CATARACT surgery – happens when patients are treated w/ alpha1blockers
makes surgery more complicated and increases risk of post op complications
(good to ask for first fill- you have cataracts surgery coming up? pts can stop it around time of surgery)

73
Q

what hormonal therapy drugs can be used for BPH

A

finasteride

dutasteride

74
Q

BPH and Hormonal Therapy:

________ inhibitors will decrease ____ production

A 
5 alpha reductase inhibitors
decrease DHT (dihydrotestoterone)
75
Q

BPH and Hormonal Therapy:

Men with a prostate > _____ benefit the most

A

> 40 grams

76
Q

BPH and Hormonal Therapy:

Onset of action may be as long as ______

A

6 months

77
Q

Causes of Erectile Dysfunction?

A 
Increasing Age
Diseases (DM, HTN, CAD, MS, Parkinsons)
Physical Injuries
Unhealthy lifestyle (obesity, EtOH, Smoking, Stress)
Fatigue 
Drugs
78
Q

What drug classes can cause sexual dysfunction?

A

antidepressants
antihypertensive agents
Estrogens/Anti-Androgens
Cancer Chemo

79
Q

Anatomy and Pathophys of ED:

Upon sexual stimulation, ______ is released which results in elevated levels of _____

A

nitrous oxide

cGMP

80
Q

Anatomy and Pathophys of ED:
cGMP = relaxation of _____ in penis
allows ______ blood to flood chambers
____ get squeezed shut = preventing draining of blood

A

relaxation of smooth muscles
allows arterial blood
veins get shut

81
Q

____ is important penile health

A

O2

82
Q

Treatment of ED: Step Wise Treatment

steps 1 - 5?

A 
1 - tx/eliminate known causes
2 - oral PDE-5 inhibitors
3- intraurethral or intracavernous tx
4 - possible combo therapy
5 - penile prosthesis
83
Q

T or F: sexual stimulation is required when using PDE-5 inhibitors

A

true!!

84
Q

what drugs are PDE- 5 inhibitors

A

sildenafil
vardenafil
tadalafil
avanafil

85
Q

which PDE-5 inhibitor has a long half life

A

tadalafil (cialis) – 36 hours

86
Q

best to take PDE-5 inhibitors with or without food

A

without food!

food delays absorption and then affect!

87
Q

Drug interactions with PDE-5 inhibitors?

A 
Cimetidine
Ketoconazole
erythromycin
ritonavir
grapefruit juice
(prolongs the effect of the drugs)
AND NITRATES
88
Q

ADEs of PDE-5 inhibitors

A 
headache
flushing
dyspepsia
nasal congestion
lower back/limb pain - tadalafil only
Light sensitivity / blue tinge to vision
NAION (sudden vision loss)
89
Q

Dosing of Nitrates in relation to PDE-5 inhibitors?

A

Viagra/Levitra: 24 hours

Cialis: 48 hours

90
Q

Precautions with PDE-5 inhibitors?

A

pts w/ oral or transdermal nitrates
pts on alpha blockers
pts with v severe CAD
prolonged erections

91
Q

take PDE-5 inhibitors when?

A

1 - 2 hours prior to intercourse

92
Q

the vacuum erection device —
avoid in what pts?
good for what pts?

A

avoid in SICKLE CELL pts

good if pts cant take oral meds…

93
Q

what drug is a transurethral suppository for ED

A

alprostadil

94
Q

Alprostadil: Transurethral Suppository —
More acceptable than injection but less effective than injection
onset within _______
ADEs?

A

onset w/in 5 - 10 minutes

penile pain or burning

95
Q

Steps for Alprostadil suppository Use?

A

(alprostadil pellets)
Urinate first
insert suppository
role penis for 10 - 30 seconds

96
Q

max use of alprostadil?

A

2 doses/day

97
Q

Alprostadil Injection:
may be best for ______ ED
onset within ______
best to vary _______

A

best for neurogenic ED
within 5 minutes
vary the site of injection

98
Q

Alprostadil Injection:

T or F: You do need sexual stimulation

A

false!! this does not (PDE5 inhibitors do!!!)

99
Q

Alprostadil Injection:
Max # of injections per day
and
Max # of injections per week?

A

1 per day

3 per week

100
Q

where does the alprostadil injection get injected…

A

corpora carvernosa

not the top or underside!!

101
Q

Alprostadil Injection:
Start at a ______ mcg dose
then titrate the dose til you get to an erection that lasts ______

A

2.5 mcg

want it to last til 1 hour

102
Q

what is priapism

A

penis remains erect for hours in absence of stimulation or after stimulation has ended

103
Q

possible causes of Priapism

A

drugs
sickle cell disease
pelvic tumors and infections
leukemias

104
Q

What drug classes/ can cause priapism

A

ED drugs
Antidepressants (bupropion, trazadone, fluoxetine, sertraline, lithium)
Antipsychotics (clozapine, chlorpromazine)
Anticoagulants (heparin, warfarin)
Cocaine
Misc…. (prazosin, hydroxyzine)

105
Q

T or F: EtOH will cause priapism

A

true

106
Q

other than Alprostadil Injection, what are some other drugs used for intracavernosal injection?

A

papaverine

phentolamine

107
Q

how to treat priaprism

A

phenylephrine (to cause vasoconstriction)
blood aspiration
saline irrigation

108
Q

T or F: penile prostheses is a good reversible option for current ED

A

false! not reversible!!

also $$$$ af

109
Q

Geriatrics:

what medications increase risk of falls

A 
sedatives/hypnotics
neuroleptics
antidepressants
benzos
opioids
loop diuretics
alpha-blockers
110
Q

How/why do loop diuretics and alpha blockers increase risk of falls

A

they both can cause orthostatic hypotension!!

counsel on about patients getting up and down too fast!

111
Q

For Geriatrics: promote ______ prescribing

A

conservative

112
Q

For Geriatrics: ideas behind conservative prescribing?

minimize total number of ______ and ______

A

total # of meds and non-essential meds (will promote adherence to the essential meds, avoids duplication)

113
Q

For Geriatrics: ideas behind conservative prescribing?

Minimize use of drugs that have high potential for _____ or have impact on _____ or _____ status

A

adverse outcomes

cognitive/functional status

114
Q

For Geriatrics: ideas behind conservative prescribing?

Optimize dosing based on _____ and ____ function

A

hepatic; renal

115
Q

For Geriatrics: ideas behind conservative prescribing?

Adjust doses to achieve _______ targets for chronic diseases

A

reasonable

116
Q

For Geriatrics: ideas behind conservative prescribing?

best for gradual reduction for ______ medications

A

CNS

117
Q

what are some life sustaining treatments

A 
ventilators
feeding tubes
dialysis
CPR
hospitalizations
118
Q

what is an advanced care directive?

A

a living will…

a legal document in which a person specifies what actions should be taken for their health

119
Q

T or F: Palliative care is end of life care like hospice

A

FALSE (it is for terminally ill patients but not end of life)

120
Q

definition of palliative care?

A

focusing on symptom control and not disease management (because patient is not responsive to curative treatment)

121
Q

Hospice care = life expectancy is ____ months of less

and must be certified by who?

A

6

certified by a MD

122
Q

what type of incontinence?
urethral blockage
bladder unable to empty properly

A

overflow

123
Q

what type of incontinence?
relaxed pelvic floor
increased abdominal pressure

A

stress

124
Q

what type of incontinence?
bladder oversensitivity from infection
neurologic disorder

A

urge

125
Q

Non-pharm options for urinary incontinence?

A 
abosrbent products
physical therapy
catheters
scheduled emptyings
kegels
stable fluid intake
avoid fluids that irritate the bladder (caffeine/carbonated  beverages)
126
Q

what type of incontinence?
high frequency
large volume
overactive bladder

A

urge

127
Q

pharm treatment of urge incontienence

A

anticholinergics/antimuscarinics

128
Q

Anticholinergics for the bladder: decrease contractions of _______

A

detrusor muscle

129
Q

what type of incontinence?

small volumes of urine loss with coughing, sneezing, running, or laughing

A

stress incontnence

130
Q

how to treat overflow incontinence

A

treat obstruction
alpha adrenergic blockers (BPH)
kegel exercises

131
Q

treatment for neurogenic (atonic) baldder

A

intermittent catherization

Fall 2018/P3 Year' (16 decks)

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