Chapter 21: men's health Flashcards Preview

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Flashcards in Chapter 21: men's health Deck (60):
1

 

 

health concern related specifically to men

 

erectile dysfunction

benign prostate hyperplasia

male pattern baldness

male androgen deficiency

prostatitis

2

 

 

drugs classes used to treat erectile dysfunction

 

 

orl phosphodiesterase inhibitors (PDE5)

injectable prostaglandins

3

 

 

drug classes used to treat BPH

 

 

alpha-1 blockers

5-alpha reductase inhibitors

4

 

 

medication class used to treat male pattern baldness

 

 

5-alpha reductase inhibitors

5

 

 

drug used to treat male androgen deficiency

 

 

exogenous testosterone

6

 

 

drug classes used to treat prostatitis

 

 

ABTs

(ampicillin, ciprofloxin)

7

 

 

six main categories of ED

 

vasculogenic 

psychogenic 

neurogenic 

hormonal 

drug use

other (physical anomaly, chronic illness, surgery, etc)

8

 

 

PDE5 inhibitors

mechanism of action

 

 

 

 

inhibits smooth muscle relaxation in arteries and the corpus cavernosum by inhibiting the conversion of cGMP

discovered while searching for a new antihypertensive agent

9

 

 

examples of PDE5 inhibitors

 

 

sildenafil (Viagra)

vardenafil (Levitra)

tadalafil (Cialis)

10

 

 

selectivity of PDE5 medications

 

 

sildenafil (Viagra): 10-fold 

tadalafil (Cialis): 10,000 fold

vardenafil (Levitra): 15 fold

11

 

 

PDE5 parmacokinetics

 

 

well absorbed orally

extensive distribution

CYP450 system metabolism into active metabolite in urine

excreted mostly in feces

A image thumb
12

 

 

which PDE5's absorption is inhibited by food

 

 

sildenafil (Viagra)

13

 

 

Adverse reactions of PDE5 inhibitors

 

  • CV: flushing
  • EENT: rhinitis, sinusitis
  • GI: dyspepsia, nausea
  • GU: priapism and prolonged erections are RARE
  • MISC: flu-like symptoms
  • NEURO: headache

14

 

 

Which medications interact with PDE5 inhibitors

 

Nitrates (most serious)

antihypertensives

macrolides, antifungals, diuretics (require dosage adjustments)

15

 

 

PDE5 inhibitor contraindications

 

nitrate therapy or any patient who sees a drop in BP

sickle cell, myeloma, leukemia

retinitis pigmentosa

elderly or any patient with renal impairment

16

 

 

injectable prostaglandin mechanism of action

 

vasoactive

relaxes arterial smooth muscle by stimulating an increase on intracellular cyclic necleotides to increase blood flow to the corpus cavernosum causing erection

17

 

 

examples of injectable prostaglandins

 

 

alprostadil (Caverject)

papaverine (Regitine)

vasoactive intestinal polypeptides (UIP

18

 

 

administration of injectible prostaglandins

 

 

intracavernosum cavity or transurethal

teach how to administer at lowest possible effective dose

19

 

 

incidence of penile pain with injectible prostaglandins

 

 

37%

20

 

 

contraindications for injectible prostaglandins

 

 

penile deformity

penile implant

patients with conditions that predispose them to priapism

 

21

 

 

conditions that predispose a patient to priapism

 

 

sickle cell, leukemia, multiple myeloma, polycythemia, thrombocythemia

22

 

 

drugs that can worsen BPH symptoms

 

 

first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications

23

 

 

drug classes used to treat BPH

 

 

alpha blockers

5-alpha reductase inhibitors

24

 

 

alpha blockers mechanism of action

 

 

relaxes smooth muscle in the prostate gland to decrease obstruction of urine flow

25

 

 

examples of nonselective alpha blockers

 

 

doxazosin (Cardura)

prazosin (Minipress)

terazosin (Hytrin)

26

 

 

examples of selsctive alpha blockers

 

 

alfuzosin (Uroxatral)

tamsulosin (Flomax)

27

 

 

effectiveness of alpha blockers to treat BPH

 

 

effectiveness within 1 month

effect ceases when medication is stopped

28

 

 

patient education for drugs used to treat BPH

 

discuss all medications and possible interactions

cannot donate blood while on these medications of for 6 months after

treatment is not a cure, only for symptom relief

29

 

 

pharmacokinetics of alpha blockers

 

 

all are well absorbed except Flomax

all are well distributed and metabolized in liver

excreted in both urine and feces

30

 

 

alpha blockers adverse effects

 

  • CV: orthostatic hypotension
  • EENT: rhinitis
  • ENDO: decreased libido
  • GI: distress
  • MS: muscle and back pain
  • NEURO: headache, dizziness

31

 

 

alpha blockers interactions

 

 

caution with any medications that may decrease BP

32

 

 

alpha blockers patient education

 

first-dose reactions (orthostatic hypotension) are likely

early side effects will likely disapear with continued use

33

 

 

5-alpha reductase inhibitors mechanism of action

 

 

supress testosterone formation in the prostate gland

 

34

 

 

5-alpha reductase inhibitors affect on PSA levels

 

 

increases and therefore abnormal values used for cancer screening in these patients should be adjusted

35

 

 

examples of 5-alpha reductase inhibitors

 

 

dutasteride (Avodart)

finasteride (Proscar)

36

 

 

what is also treated by finasteride besides BPH

 

 

male pattern baldness (Propecia)

lower dosage than for BPH

37

 

 

5-alpha reductase inhibitor pregnancy category

 

 

X for producing genital abnormalities in male offspring

38

 

 

adverse reactions of 5-alpha reductase inhibitors

 

 

  • CV: postural hypotension
  • EENT: rhinitis
  • ENDO: impotence, decreased libido, gynecomastia (2%)
  • GU: finasterides causes a decrease in PSA even in the presence of cancer
  • MS: weakness
  • NEURO: dizziness, somnolence
  • PUL: dyspnea

39

 

 

5-alpha reductase inhibitor interactions

 

 

MANY

including: cimetidine, cipro, diltiazem, ketoconozole, ritonavir, verapimil, st. john's wort

40

 

 

contraindications for 5-alpha reductase inhibitors

 

 

serious skin reactions

pediatric patients

should not be handled by women pregnant or trying to become pregnant

41

 

 

how long does it take to see results from 5-alpha reductase inhibitor therapy

 

 

3-6 months

42

 

 

symptoms of hypogonadism

 

 

depressed mood, diminished energy, decreased muscle strength and bulk, increased fat mass, impaired cognition, anemia, diminished bone density, fatigue, increased insulin resistance, multiple impaired sexual functions

 

43

 

 

exogenous testosterone pharmacokinetics

 

complete absorption with IM administration

99% protein bound to globulin

first pass metabolism in liver to active metabolite

excreted in urine

44

 

 

clinical uses of exogenous testosterone

 

 

androgen replacement therapy in treatment of delayed male puberty

maly hypogonadism

replacement therapy in cases of deficient endogenous hormone

45

 

 

adverse effects of testosterone replacement

 

  • CV: edema, flushing, HTN, vasodilation
  • DERM: acne, alopecia, dry skin, erythema, hirsutism
  • ENDO: breast tenderness, gynecomastia
  • GI: n/v, distress
  • GU: impotence, testicular atrophy, bladder issues
  • HEME: leucopenia, suppression of clotting
  • MS: weakness
  • NEURO: aggression, amnesia, headache, parathesia, nervousness
  • OTHER: pain at injection site

46

 

 

conscientious considerations for testosternoen replacement therapy

 

require careful monitoring for side effects

change therapy if no visible response in 3-4 months

 

47

 

 

labs to monitor when patient is on testosterone replacement therapy

 

 

lipids, PSA, HCT, and DRE

if oral form, LFTs as well

48

 

 

testosterone contraindications

 

 

breast cancer

prostate cancer

pregnancy

49

 

 

testosterone interactions

 

 

oral anticoagulants can cause hypoprothrombinemic response

50

 

 

patient education for testosterone therapy

 

 

age and physical condition may limit results

women of chid-bearing age should not handle

must not use if they have BPH an abnormal lipid profile

need to screen for prostate and breast cancer

51

 

 

drugs used to treat male pattern baldness

 

 

 

 

finasteride (Propecia)

minoxidil (Rogaine)

52

 

 

minoxidil mechanism of action

 

 

appears to have a direct effect on hair follicles by stimulating resting hair follicles into active growth

no drug interactions because it is topical

53

 

 

when are medications for male pattern bladness less effective

 

 

temporal or frontal hair loss

54

 

 

new hair growth with use of medications for male pattern baldness

 

 

results are not seen for 2-6 months of daily use and new hair will be lost within 4-6 months of discontinuing treatment

55

 

 

patient education for drugs for male pattern baldness

 

finasteride should not be handled by children or pregnant females

do not donate blood while on this or for six months after

56

 

 

male specific infections of the GU tract

 

 

prostatitis

epididymitis

orchitis

STDs

57

 

 

epididymitis and orchitis in males 14-35

 

 

typically due to an STD

58

 

 

epididymitis and orchitis in males younger than 14 or older than 35

 

 

typically due to e.coli

59

 

 

medications used to treat male UTIs

 

 

ceftriaxone (Rocephin)

doxycycline (Vibramycin)

azithromycin (Zithromax)

60