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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
What can testosterone worsen?
Urinary symptoms in patients with BPH
26
What are contraindications with testosterone replacement?
1. Untreated prostate cancer 2. Men who have breast cancer
27
When should hormone replacement be implemented?
In symptomatic patients once primary hypogonadism is confirmed
28
How is erectile dysfunction defined?
As a persistent failure, **3 month** duration, to achieve a penile erection to allow for satisfactory sexual intercourse
29
What 3 things does organic ED arise from?
1. Vascular 2. Neurologic 3. Hormonal etiology
30
When patients do not respond to psychogenic stimuli and have no organic causes
Psychogenic ED
31
What age does ED generally effect men?
Males aged 40 or older
32
What are 4 types of medications that may cause ED?
1. Antidepressants 2. Antihypertensives 3. Antipsychotics 4. BPH medications
33
What are 3 other substances that may contribute to ED?
1. Alcohol 2. Nicotine 3. Anticholinergics
34
What labs may need to be assessed for ED?
1. Free or total serum testosterone 2. PSA for BPH
35
What must be done before men can be treated for ED?
A stress test
36
What should you avoid when taking PDE-5 inhibitors?
Alcohol due to the risk of increased orthostatic hypotension and drowsiness
37
What are the 4 PDE-5 inhibitors?
1. Sildenafil 2. Vardenafil 3. Tadalafil 4. Avanafil
38
What PDE-5 inhibitors need to be taken on an empty stomach?
1. Sildenafil 2. Vardenafil
39
What is the onset of action for tadalafil?
2 hours
40
What is the onset of action for most of the PDE-5 inhibitors?
1 hour
41
What 4 things would be indicative of a dose reduction of the PDE-5 inhibitors?
1. Patient is >65 2. Using an alpha-1 blocker 3. Mod/strong CYP3A4 inhibitor 4. Severe renal or liver disease
42
What is the reduced dose of the PDE-5 inhibitors considered as?
1/2 the normal dose
43
What PDE-5 inhibitor has the lowest risk of hypotension?
Tadalafil
44
What PDE-5 Inhibitors has a risk of visual light sensitivity and blurred vision?
1. Sildenafil 2. Vardenafil 3. Avanafil
45
If priapism occurs what should be given first?
Pseudoephedrine
46
If the first line intervention didn’t work for priapism, what should be given?
Phenylephrine
47
When can testosterone replacement be used for patients with ED?
When they have low levels of testosterone
48
What is the MOA of alprostadil?
Stimulates adenylyl cyclase leading to an increase in cAMP an eventual smooth muscle relaxation of the arterial blood vessels
49
What patients would alprostidil be more effective in?
Patients with diabetes and postradical prostatectomy
50
What drug has the highest risk of priapism?
Alprostadil
51
Which alprostadil formulation has the better efficacy?
Intracavernosal
52
What is first line therapy for ED, unless contraindicated?
PDE-5 inhibitors
53
What is second line treatment for ED?
1. Use a different PDE-5 inhibitor 2. Alprostadil intraurethral suppositories 3. Intracavernous injection
54
When do BPH symptoms generally appear in males?
50 years or older
55
What enzyme converts testosterone and androstenedione to DHT?
Type II 5-alpha reductase
56
What are 7 medications that can worsen BPH?
1. Anticholinergics 2. Antihistamine 3. Caffeine 4. Decongestants 5. SNRIs and TCAs 6. Testosterone products 7. Diuretics
57
What are two factors that are involved in LUTS?
1. Static factors 2. Dynamic factors
58
What is the PSA value that is indicative of an enlarged prostate?
>1.4 mcg/L
59
What are 4 labs that are done to diagnose BPH?
1. PSA 2. Serum creatinine 3. BUN 4. Urinalysis
60
What are the 4 2nd generation alpha-antagonists?
1. Prazosin 2. Doxazosin (Cardura & Cardura XL) 3. Terazosin
61
What are the 3rd generation alpha-antagonists?
1. Alfusozin 2. Tamsulosin 3. Silodosin
62
What are 3 side effects of the 2nd generation alpha-antagonists
1. Hypotension 2. Dizziness 3. Syncope
63
When should the 2nd generation alpha-antagonists be taken?
At night before bed to avoid hypotension
64
What 2 3rd generation alpha-antagonists should be taken after meals?
1. Alfuzosin 2. Tamsulosin
65
When do the alpha antagonists reduce urinary symptoms?
2-6 weeks
66
True or false: the alpha antagonists do not reduce prostate size
True
67
What are 4 common adverse effects of the alpha antagonists?
1. Hypotension (2nd gen. Mostly) 2. Floppy iris syndrome 3. Rhinitis 4. Abnormal ejaculation
68
What are the 2 5alpha-reductase inhibitors?
1. Finasteride 2. Dutasteride
69
True or false: the 5 alpha-reductase inhibitors have a faster onset than the alpha 1 antagonists
False
70
Which 5 alpha-reductase inhibitor has the larger decrease in DHT?
Dutasteride
71
What are 4 ADRs of the 5 alpha reductase inhibitors?
1. Erectile dysfunction 2. Decreased libido 3. Gynecomastia 4. Ejaculatory dysfunction
72
How long does it take to see a 50% decrease in PSA levels with the 5 alpha-reductase inhibitors?
6-12 months
73
What is important to know with the 5 alpha-reductase inhibitors?
Pregnancy category X
74
When should 2.5 mg dose of Tadalafil be used?
If CrCl is 30-50
75
What are 2 lifestyle modifications used for BPH?
1. Avoiding alpha agonist 2. Limiting hydration before bed
76
What are 3 non pharmacologic treatments that can be utilized if pharmacotherapy has failed?
1. TURPS 2. TUIPS 3. Prostatectomy
77
What is the most effective treatment for patients with LUTS?
The combination of an alpha antagonist and 5 alpha-reductase inhibitors
78
What may be another treatment option for patients with LUTS?
Beta-3 agonists combined with an alpha blocker
79
What PDE-5 inhibitor has a side effect of muscle weakness?
Tadalafil
80
When can you not use silodosin?
CrCl is <30
81
When should you decrease the dose for sildosin?
CrCl is 30-50

Special Pops Exam 1 (5 decks)

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