Repro p. 594-598

Question 1

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?

Answer 1

digital rectal exam

PSA

Question 2

BPH is hyperplasia or hypertrophy?

Answer 2

hyperplasia not hypertrophy

Question 3

Which lobes are involved in BPH?

Answer 3

periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit

Question 4

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?

Answer 4

tadalafil –> MI pt might use nitroglycerin –> sever hypotention

Question 5

Pt with HTN and BPH can benefit from which tx?

Answer 5

α1-antagonists —> -zosin

Question 6

Diff. btw prostatitis and BPH?

Answer 6

prostatitis has low back pain, prostate feels warm, tender, and enlarged. (hypertrophy)

Question 7

Location of prostate ca?

Answer 7

posterior lobe, peripheral zone

Question 8

definite dx of prostate ca?

Answer 8

needle core biopsies

Question 9

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?

Answer 9

total PSA, with dcr fraction of free PSA

serum ALP and PSA.

Question 10

Which GnRH analog can tx prostate ca and infertility? How is it administered in each case?

Answer 10

Leuprolide
continuous fashion –> p. ca
pulsatile –> infertility

Question 11

Name 3 drugs that can be used on men with androgen-dependent prostate cancer?

Answer 11

Ethinyl estradiol, DES, mestranol

Question 12

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?

Answer 12

Clomiphene

can cause multiple simultaneous pregnancies and visual disturbances.

Question 13

Raloxifene is primary used to tx what? what is it C/I?

Answer 13

Tx: Breast ca. pt with osteoprosis

incr risk of thromboembolic

Question 14

letrozole is a —.

Answer 14

Aromatase inhibitors

Question 15

Unopposed estrogen replacement therapy increases the risk of? what should be co-administered?

Answer 15

endometrial cancer

Progesterone

Question 16

Norethindrone MOA?

Answer 16

Bind progesterone receptors, incr growth and  vascularization of endometrium, thicken cervical
mucus.

Question 17

5 Contraindications of Combined contraception?

Answer 17

• 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

Question 18

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?

Answer 18

• 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

Question 19

Describe Progestin challenge?

Answer 19

Cessation of progestrin use causes withdrawal bleeding. This excludes anatomic defects (eg, Asherman syndrome) and chronic anovulation without estrogen.

Question 20

What drug is a emergency contraception? vs.

What drug is the most effective emergency contraception.

Answer 20

ulipristal vs.

Copper intrauterine device

Question 21

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?

Answer 21

Danazol

Question 22

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?

Answer 22

Steroid use: Testosterone, methyltestosterone

Premature closure of epiphyseal plates

Question 23

Pt with BPH and and baldness can benefit from which drug and what is the MOA?

Answer 23

Finasteride

5α-reductase inhibitor

Question 24

T or F? Finasteride is used for prostate ca?

Answer 24

F. it is Flutamide

Question 25

—- and —- inhibits 17,20-desmolase.

Answer 25

Ketoconazole, Spironolactone

Question 26

α1A,D receptors are found on what organ and therefore —- drug can inhibit this receptors. Vs. α1B receptors are found where?

Answer 26

α1A,D –> prostate

α1B –> on vessels

Question 27

PDE-5 Žincr blood flow in what organ and which specific part?

Answer 27

incr cGMP –> incr blood flow in corpus cavernosum of penis

Question 28

T or F? Viagra can be used for pulmonary hypertension?

Answer 28

T

Question 29

MOA of Minoxidil?

Answer 29

Direct arteriolar vasodilator

clinical use: alopecia, refractory HTN

Question 30

Prostate ca spreads to which plexus?

Answer 30

batson’s plexus