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Special Pops Exam 1 > ED > Flashcards

ED Flashcards

1
Q

Failure of the testes to produce testosterone

A

Primary hypogonadism

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2
Q

What is elevated in hypogonadism?

A
  1. LH
  2. FSH
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3
Q

Failure in the hypothalamus or pituitary to produce FSH or LH

A

Secondary hypogonadism

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4
Q

What are 8 symptoms needed for male hormone replacement?

A
  1. Low or absent sex drive
  2. Fatigue
  3. Loss of body hair
  4. Muscle loss
  5. Erectile dysfunction
  6. Osteoporosis
  7. Infertility
  8. Low serum testosterone levels
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5
Q

How is methyltestosterone taken?

A

Orally

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6
Q

Why is methyltestosterone not commonly used anymore?

A

Higher risk of hepatotoxicity and large pass effect

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7
Q

How is Fluoxymesterone taken?

A

Orally

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8
Q

Why is fluoxymesterone avoided?

A

High risk of hepatotoxicity

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9
Q

How is testosterone undecanonate taken?

A

Orally

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10
Q

True or false: testosterone undecanonate has a high risk of hepatotoxicity

A

False

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11
Q

How is Striant taken?

A

Buccally

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12
Q

How is testosterone cypionate taken?

A

IM

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13
Q

How is testosterone enanthate taken?

A

IM

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14
Q

What is a good counseling point for testosterone transdermal patch?

A

Avoid swimming, showering, or washing administration sites for 3 hours after administration

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15
Q

What is a good counseling point for estrogen gel?

A
  1. Cover application to avoid transfer to people
  2. Avoid swimming, showering, or washing administration sites for 2 hours after administration
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16
Q

What is a good counseling point for the testosterone transdermal spray?

A
  1. Cover application to avoid transfer to people
  2. Avoid swimming, showering, or washing administration sites for 2 hours after administration
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17
Q

Where should the testosterone transdermal solution be applied?

A

In the armpit

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18
Q

What should you apply before administering the testosterone solution?

A

Deodorant

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19
Q

What testosterone product must be administered by a healthcare professional?

A

Testosterone subcutaneous implant pellet

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20
Q

What testosterone product has a higher incidence of intranasal adverse effects?

A

Testosterone nasal gel

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21
Q

What testosterone product must be enrolled in the REMS program? Why?

A

Testosterone undecanoate injection; risk of administration and respiratory reactions

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22
Q

How often should patients be monitored when taking hormone replacement?

A

Every 3-4 months

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23
Q

What are 3 labs that are done when patients are taking hormone replacement?

A
  1. Serum lipids
  2. Hematocrit
  3. Prostate-specific antigen (PSA)
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24
Q

When should you discontinue therapy regarding hematocrit?

A

If HCT exceeds 55% at any time

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25
Q

What can testosterone worsen?

A

Urinary symptoms in patients with BPH

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26
Q

What are contraindications with testosterone replacement?

A
  1. Untreated prostate cancer
  2. Men who have breast cancer
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27
Q

When should hormone replacement be implemented?

A

In symptomatic patients once primary hypogonadism is confirmed

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28
Q

How is erectile dysfunction defined?

A

As a persistent failure, 3 month duration, to achieve a penile erection to allow for satisfactory sexual intercourse

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29
Q

What 3 things does organic ED arise from?

A
  1. Vascular
  2. Neurologic
  3. Hormonal etiology
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30
Q

When patients do not respond to psychogenic stimuli and have no organic causes

A

Psychogenic ED

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31
Q

What age does ED generally effect men?

A

Males aged 40 or older

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32
Q

What are 4 types of medications that may cause ED?

A
  1. Antidepressants
  2. Antihypertensives
  3. Antipsychotics
  4. BPH medications
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33
Q

What are 3 other substances that may contribute to ED?

A
  1. Alcohol
  2. Nicotine
  3. Anticholinergics
34
Q

What labs may need to be assessed for ED?

A
  1. Free or total serum testosterone
  2. PSA for BPH
35
Q

What must be done before men can be treated for ED?

A

A stress test

36
Q

What should you avoid when taking PDE-5 inhibitors?

A

Alcohol due to the risk of increased orthostatic hypotension and drowsiness

37
Q

What are the 4 PDE-5 inhibitors?

A
  1. Sildenafil
  2. Vardenafil
  3. Tadalafil
  4. Avanafil
38
Q

What PDE-5 inhibitors need to be taken on an empty stomach?

A
  1. Sildenafil
  2. Vardenafil
39
Q

What is the onset of action for tadalafil?

A

2 hours

40
Q

What is the onset of action for most of the PDE-5 inhibitors?

A

1 hour

41
Q

What 4 things would be indicative of a dose reduction of the PDE-5 inhibitors?

A
  1. Patient is >65
  2. Using an alpha-1 blocker
  3. Mod/strong CYP3A4 inhibitor
  4. Severe renal or liver disease
42
Q

What is the reduced dose of the PDE-5 inhibitors considered as?

A

1/2 the normal dose

43
Q

What PDE-5 inhibitor has the lowest risk of hypotension?

A

Tadalafil

44
Q

What PDE-5 Inhibitors has a risk of visual light sensitivity and blurred vision?

A
  1. Sildenafil
  2. Vardenafil
  3. Avanafil
45
Q

If priapism occurs what should be given first?

A

Pseudoephedrine

46
Q

If the first line intervention didn’t work for priapism, what should be given?

A

Phenylephrine

47
Q

When can testosterone replacement be used for patients with ED?

A

When they have low levels of testosterone

48
Q

What is the MOA of alprostadil?

A

Stimulates adenylyl cyclase leading to an increase in cAMP an eventual smooth muscle relaxation of the arterial blood vessels

49
Q

What patients would alprostidil be more effective in?

A

Patients with diabetes and postradical prostatectomy

50
Q

What drug has the highest risk of priapism?

A

Alprostadil

51
Q

Which alprostadil formulation has the better efficacy?

A

Intracavernosal

52
Q

What is first line therapy for ED, unless contraindicated?

A

PDE-5 inhibitors

53
Q

What is second line treatment for ED?

A
  1. Use a different PDE-5 inhibitor
  2. Alprostadil intraurethral suppositories
  3. Intracavernous injection
54
Q

When do BPH symptoms generally appear in males?

A

50 years or older

55
Q

What enzyme converts testosterone and androstenedione to DHT?

A

Type II 5-alpha reductase

56
Q

What are 7 medications that can worsen BPH?

A
  1. Anticholinergics
  2. Antihistamine
  3. Caffeine
  4. Decongestants
  5. SNRIs and TCAs
  6. Testosterone products
  7. Diuretics
57
Q

What are two factors that are involved in LUTS?

A
  1. Static factors
  2. Dynamic factors
58
Q

What is the PSA value that is indicative of an enlarged prostate?

A

> 1.4 mcg/L

59
Q

What are 4 labs that are done to diagnose BPH?

A
  1. PSA
  2. Serum creatinine
  3. BUN
  4. Urinalysis
60
Q

What are the 4 2nd generation alpha-antagonists?

A
  1. Prazosin
  2. Doxazosin (Cardura & Cardura XL)
  3. Terazosin
61
Q

What are the 3rd generation alpha-antagonists?

A
  1. Alfusozin
  2. Tamsulosin
  3. Silodosin
62
Q

What are 3 side effects of the 2nd generation alpha-antagonists

A
  1. Hypotension
  2. Dizziness
  3. Syncope
63
Q

When should the 2nd generation alpha-antagonists be taken?

A

At night before bed to avoid hypotension

64
Q

What 2 3rd generation alpha-antagonists should be taken after meals?

A
  1. Alfuzosin
  2. Tamsulosin
65
Q

When do the alpha antagonists reduce urinary symptoms?

A

2-6 weeks

66
Q

True or false: the alpha antagonists do not reduce prostate size

A

True

67
Q

What are 4 common adverse effects of the alpha antagonists?

A
  1. Hypotension (2nd gen. Mostly)
  2. Floppy iris syndrome
  3. Rhinitis
  4. Abnormal ejaculation
68
Q

What are the 2 5alpha-reductase inhibitors?

A
  1. Finasteride
  2. Dutasteride
69
Q

True or false: the 5 alpha-reductase inhibitors have a faster onset than the alpha 1 antagonists

A

False

70
Q

Which 5 alpha-reductase inhibitor has the larger decrease in DHT?

A

Dutasteride

71
Q

What are 4 ADRs of the 5 alpha reductase inhibitors?

A
  1. Erectile dysfunction
  2. Decreased libido
  3. Gynecomastia
  4. Ejaculatory dysfunction
72
Q

How long does it take to see a 50% decrease in PSA levels with the 5 alpha-reductase inhibitors?

A

6-12 months

73
Q

What is important to know with the 5 alpha-reductase inhibitors?

A

Pregnancy category X

74
Q

When should 2.5 mg dose of Tadalafil be used?

A

If CrCl is 30-50

75
Q

What are 2 lifestyle modifications used for BPH?

A
  1. Avoiding alpha agonist
  2. Limiting hydration before bed
76
Q

What are 3 non pharmacologic treatments that can be utilized if pharmacotherapy has failed?

A
  1. TURPS
  2. TUIPS
  3. Prostatectomy
77
Q

What is the most effective treatment for patients with LUTS?

A

The combination of an alpha antagonist and 5 alpha-reductase inhibitors

78
Q

What may be another treatment option for patients with LUTS?

A

Beta-3 agonists combined with an alpha blocker

79
Q

What PDE-5 inhibitor has a side effect of muscle weakness?

A

Tadalafil

80
Q

When can you not use silodosin?

A

CrCl is <30

81
Q

When should you decrease the dose for sildosin?

A

CrCl is 30-50

Special Pops Exam 1 (5 decks)

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