Erectile Dysfunciton, Prostate, Testosterone Flashcards Preview

PHARM II, QUIZ 2 > Erectile Dysfunciton, Prostate, Testosterone > Flashcards

Flashcards in Erectile Dysfunciton, Prostate, Testosterone Deck (38):
1

ED Treatment, risk factors

- HTN
- Hyperlipidemia
- Diabetes
- Smoking
- Alcohol

2

ED Treatment, 1st Line

PDE5-I (Phosphodiesterase-5 Inhibitors)

Viagra (Sildenafil)
Levitra (Vardenafil)
Cialis (Tadalafil)

3

ED Treatment, 2nd Line

Alprostadil (Synthetic PGE-1)

(suppository, intracavernosal injection)

4

PDE5-Inhibitors

Phosphodiesterase-5 Inhibitors

- Acts like Nitric Oxide
- Increase smooth muscle relaxation & blood flow

- Doesn't work for 30-40% of patients (try 6-8 doses)

5

PDE5 - I ADRs

- Hypotension/Dizziness **except not w Cialis/Tadalafil!**
- Headache
- Flushing
- Nasal congestion
- Dyspepsia

- Visual disturbances **not w Cialis/Tadalafil**

- Priapsism & Back Pain - *ONLY w Cialis / Tadalafil *

6

PDE5-I Interactions

Nitrates, *CI, need 24-48 hr separation*

HTN meds - need to lower dose,
*esp alpha blockers (doxazosin, prazosin, terazosin)

**Levitra / Vardenafil CI w Antiarrythmics, LONG Q-T**

7

Viagra (Sildenafil)

Phosphodiesterase-5 Inhibitor

Administration -> 1 HOUR PRIOR, NO FATTY FOO

Peak effect -> 30 to 60min
Duration of effect -> 4hr

Daily dose -> 25-100mg, MAX 1

LEAST EXPENSIVE - $10 for 30 pills, 20mg each

8

Levitra (Vardenafil)

Phosphodiesterase-5 Inhibitor

Administration -> 1 HOUR PRIOR, NO FATTY FOO

Peak effect -> 70 to 90min
Duration of effect -> 4hr

Daily dose -> 5-20mg, MAX 1

9

Cialis (Tadalafil)

how is this one different?

Phosphodiesterase-5 Inhibitor

Administration -> prior OR daily dose - FAT FOO OK

Peak effect -> 2hr
Duration of effect -> 24 -36hr

Daily dose -> 5-20mg MAX I


*No visual disturbances or Hypotension*
*More prone to Priapsism and Back Pain**

**Also indicated for BPH**

10

Which PDE5-I is also indicated for BPH

Cialis (Tadalafil)

11

Which PDE5-I has the fastest peak effect?

Viagra / Sildenafil

30-60 min

12

Which PDE5-I lasts the longest?

Cialis (Tadalafil)

24-36 hrs

13

Which PDE5-I is the least expensive?

Genergic Viagra (Sildenafil)

14

Which PDE5-I can be taken with fatty foods without decreasing efficacy?

Cialis (Tadalafil)

15

Which PDE5-I doesn't cause Hypotenstion?

Cialis (Tadalafil)

16

Which PDE5-I doesn't cause visual disturbances?

Cialis (Tadalafil)

17

Which PDE5-I is most likely to cause priapsism?

Cialis (Tadalafil) - 24-36 hr effect

18

HTN drug of choice in sexually active men w ED

ARB (valsartan, losartan, all the sartan's)

**unless CI due to aortic stenosis, renal artery stenosis etc
**or if compelling indication for another drug

19

Absolute Indication for Intervention w BPH

- Renal complications (due to BPH)

- Bladder stones
- Urinary Retention
- Chronic UTIs

20

BPH treatment, classes

Selective and Nonselective Alpha-Antagonists (Zosins)

5-Alpha Reductase Inhibitors (Fina/Dutasteride)

**Combo Alpha Ant + 5 Alpha** Recommended


PDE5-Inhibitors (Cialis)

21

Nonselective Alpha Antagonists

ZOSINS

Terazosin
Doxazosin
Prazosin

MOA: blocks NE effects on vascular smooth muscle. Relaxes urethra sphincter, prostate tissue to ^ urine flow

**Nonselectives, work on vascular, CNS receptors as well >>> ADRs
Ortho Hypotension, Dizziness, Syncope

22

Selective Alpha Antagonists

ZOSINS

Tamsulosin (Flomax)
Alfuzosin --- * ^ with 3A4's *
Silodosin --- * ^ with 3A4's *

Selective for prostate receptors. No effect on BP
Good for combo to HTN meds

**Effective within days - week**

23

Tamsulosin (Flomax)

Selective Alpha Agonist

- Take any time, on empty stomach
- Ok w renal, caution for pts w liver failure

ADRs
- Tired, weak
- ED

24

Alfuzosin

* ^ with 3A4's *

Selective Alpha Agonist

- Take after small meal
- Ok w renal
** CI in mod-sev liver failure **

ADRs
-Tired, weak, dizzy
- Headache
- ED

* ^ with 3A4's *
(Fluconzal, Diltiazem

25

Silodosin

* ^ with 3A4's *

Selective Alpha Agonist

- More potent
- CI in pts w CrCl <30
- CI in liver failure

ADRs
- Tired, weak, dizzy
- ED


* ^ with 3A4's *

26

5-Alpha Reductase Inhibitors

Finasteride > specific for Type II (prostate)
Dutasteride > nonspecific, Type I & II

- Converts testosterone to dihydrotestosterone
- 6 months to take effect

27

5 Alpha Reductase Inhibitors
(Finasteride, Dutasteride)

ADRs

- Impotence
- Decreased Libido
- Decreased semen quantity at ejaculation

- Nausea
- Abdominal Pain
- Asthenia (weakness)

**Pregn Category X** Women avoid contact w pill !!!

28

Combo therapy treatment for BPH

Jalyn
Alpha Antagonist + 5 Alpha Reductase Inhibitor

- Rapid relief w Alpha Antagonist
- Sustained relief w 5 Alpha Reductase
- Discontinue 6-9 months after symptom relief

29

Testosterone HRT CI

Breast or Prostate Cancer

Prostate nodule / PSA ^ 3

HCT ^ 50%

Sleep apnea, untreated

Heart Failure

Those desiring fertility ?

30

Testosterone HRT ADRs

Increased HCT

Acne

Mood swings

Sleep apnea

Infertility

Worsening BPH

Gynecomastia

31

Testosterone WARNINGS

Clot risk (stroke, AMI)

Abuse, Dependency

32

Testosterone, IM administration

Aveed

Depotestosterone

every 10 weeks

**Warning for POME (pulmonary oil micro embolism)

33

Transdermal Testosterone

Androgel
Fortesta
Testim
Axiron (axillary)
Androderm

34

Transdermal Testosterone WARNING

Secondary exposure to testosterone via contact

- Apply only to site directed
- Cover area with t shirt
- Wash hands

35

Prostate Cancer Tx

"Androgen Deprivation Therapy"

- LHRH Analogs
(Luteinizing Hormone Releasing Hormone)

-LHRH Antagonists

- Anti-Androgens

36

LHRH Analogs

Goserelin
Triptorelin
Histrelin
Leuprolide

37

LHRH Antagonists

Firmagon

38

Anti-Androgens

Bicalutamide
Flutamide
Nilutamide
Enzalutamide

*Ketoconazole*