Exam 5 Flashcards
(102 cards)
1
Q
When should testosterone levels be measured?
A
in the morning
2
Q
Technical term for incomplete/ delayed puberty?
A
hypogonadism
3
Q
what defines hypogonadism?
A
delayed puberty; lack of testicular growth at 14 years old
4
Q
treatment for hypogonadism?
A
IM testosterone esters 50mg monthly; used short-term
5
Q
What age group is testicular cancer most common in?
A
young men; 15-35 years
6
Q
testicular cancer treatment
A
surgery, radiation, chemotherapy
7
Q
what is the cause of alopecia?
A
androgenic alopecia; conversion of testosterone to DHT
8
Q
what is alopecia areata?
A
an autoimmune disorder; small round patches of hair lost
9
Q
what is alopecia universalis?
A
autoimmune disorder; complete hair loss on scalp and body
10
Q
traction alopecia
A
caused by tension on hair due to buns, braids, etc
11
Q
What is first-line treatment for alopecia?
A
finasteride 1mg po once daily
12
Q
What is the MOA of finasteride
A
it is a type II 5-alpha reductase inhibitor; inhibits conversion of testosterone to DHT; stops progression of hair loss
13
Q
Counseling points for finasteride for alopecia
A
- must be used continuously to maintain efficacy
- SE include decreased libido, ED, and decreased ejaculate volume.
14
Q
What is the MOA for Minoxidil?
A
- a very potent vasodilator
- enlarges miniaturized hair follicles by increasing blood supply to the hair follicle
- stimulates hair follicle to the growth phase
15
Q
Minoxidil strength and counseling
A
- 5% foam/solution
- apply to scalp twice daily every day
- apply to dry scalp and hair
- may take up to 4 months to see benefit
- must be used continuously to see results/ maintain benefit
16
Q
Hypogonadism definition
A
hormonal deficiency in testosterone
17
Q
How to diagnose hypogonadism
A
low testosterone levels WITH symptoms
18
Q
What tests/ results are required to confirm low testosterone levels?
A
- total testosterone level of <300ng/dL
- a free testosterone level of <5ng/dL
19
Q
When should testosterone replacement be used?
A
Only when hypogonadism is diagnosed; Low T and symptoms
20
Q
What dosage form of testosterone therapy is most similar to physiologic testosterone levels?
A
patch; 1-2 patches applied nightly
21
Q
What is Jatenzo?
A
Testosterone undecanoate capsules; 158-396mg BID with food
22
Q
What are contraindications to Testosterone hormone therapy?
A
- prostate cancer
- breast cancer
- hematocrit >50% (caused by low O2)
- PSA greater than 4 ng/dl or PSA >3ng/mL in men at high cancer risk
- recent or poorly controlled CVD
23
Q
Testosterone black box warnings
A
- risk of exposure to children via gel formulation
- cardiac risk
24
Q
What dosage form of testosterone has the highest cardiac risk?
A
Injection> patches and gels
25
What is a goal testosterone level?
400 to 700ng/dL
26
What should be monitored within 3-6 months of initiating testosterone therapy?
- testosterone levels
- hematocrit levels
27
erectile dysfunction definition
a consistent inability to obtain or sustain an erection sufficient for intercourse in at least 50% of attempts
28
What are some potential causes of ED?
- DM
- HTN
- coronary artery disease
- neurological diseases (MD, Parkinson's, stroke)
- low testosterone levels
29
what drugs are responsible for drug-induced ED?
- Antidepressants (SSRIs)
- some antihypertensive agents
- estrogens/ anti-androgens
- 5- alpha reductase inhibitors (finasteride)
- cancer chemotherapy
30
What is the physiology of an erection?
- after sexual stimulation, ACh is released, which causes the release of nitrous oxide in the penis
- GTP is converted to cGMP
- Ca++ is released and produces smooth muscle relaxation in the penis
31
first-line treatment of ED
- non-pharmacologic; treat any known causes
- change meds if drug-induced
32
First-line pharmacologic treatment of ED
- Oral PDE-5 inhibitors
(if contraindicated, use vacuum erection device)
33
PDE-5 inhibitor MOA
- promotion of smooth muscle relation in the penis by inhibition of phosphodiesterase 5
- inhibits breakdown of cyclic AMP
- sexual stimulation is required; more for maintaining an erection than obtaining an erection
34
What to do is PDE-5 inhibitor does not work?
- increase dose; adjust dose to produce an erection that lasts no longer than 1 hour
35
Drug interactions with PDE-5 inhibitors
CYP3A4 inhibitors
- cimetidine, ketoconazole, erythromycin, ritonavir, grapefruit juice, others
- affects metabolism; prolongs the effect of the drugs
36
Other counseling notes for PDE-5 inhibitors
- food delays the absorption of sildenafil and vardenafil (Levitra) by one hour
37
potential side effects of PDE-5 inhibitors
- headache
-flushing
- dyspepsia
- nasal congestion
- light sensitivity
- NAION (sudden vision loss)
38
Major contraindication with PDE-5 inhibitors
- transdermal nitrates (nitroglycerin)
- causes a massive drop in blood pressure (hypotension) and may cause syncope
39
alpha blockers + PDE-5 inhibitors
- start patients on a lower dose of the PDE-5 inhibitor
- may cause dizziness
40
When to report an erection to your doctor?
- when it lasts longer than 4 hours
41
Patient education about PDE-5 inhibitors
- take 1-2 hours prior to intercourse
- do not take with food (delays absorption)
- report erections that last longer than 4 hours
- report visual and hearing complaints
- report palpitations or dizziness
- avoid with nitrates
42
PDE-5 inhibitors for pulmonary hypertension
- routine dose
- sildenafil 20mg PO TID
- tadalafil 40mg PO once daily
43
vacuum erection device
- very effective
- use for patients with contraindications to PDE-5 inhibitors
- avoid in sickle cell patients
44
Alprostadil pellets MOA and counseling
- increased cAMP production and produces smooth muscle relaxation
- less effective than injection, but more acceptable to patients
- onset is 5-10 minutes
- may cause pain, burning
- can be used with PDE-5 inhibitors
45
Alprostadil injections MOA and counseling
- increased cAMP production and produces smooth muscle relaxation
- drug of choice if patient fails PDE-5 inhibitors
- used for neurogenic ED
- onset within 5 minutes
- overall most effective; no sexual stimulation required
- max of 1/day or 3/week
- may cause local irritation, pain, burning
- titrate to dose producing an erection that lasts one hour
- usual range= 10-20mcg; max of 60mcg
46
penile prostheses counseling
- only used when drug therapy and other therapies fail
- semi-rigid insert with a pump
- replace every 5-10 years.
47
OTC recommendations
OTC therapies are not recommended; many seized at border contain sildenafil
48
what is priapism
- condition in which a penis remains erect for hours in the absence of stimulation
- classified into painful (ischemic) and non-painful (non-ischemic)
49
drugs that could cause priapism
- ED drugs
- antidepressants
- antipsychotics
- anticoagulants
- cocaine
- others
50
treatment of priapism
ischemic:
- phenylephrine injection
- blood aspiration
- saline irrigation
non-ischemic:
- cold packs and compression
51
What is peyronie's disease and how is it treated?
- erections bent at least 30 degrees; may also be painful
- treatment: Xiaflex injection (collagenase closridium histolyticum)
- treatment is in urologist office
52
prostate cancer risk factors
- increasing age
- african ancestry
- family history
53
What is PSA screening and what is a normal value?
- Prostate specific antigen
- most men without prostate cancer have PSA levels under 4ng/mL of blood.
- men with levels between 4-10 have a 25% chance of having prostate cancer
- men with levels above 10 have a 50% chance of having prostate cancer
54
pathophysiology of BPH
- growth in the prostate gland
- type II 5-alpha reductase converts testosterone to DHT.
- responsible for prostate enlargement and growth.
55
Irritative symptoms of BPH
- nocturia
- redistribution of edema
56
complications of BPH
- chronic renal failure
- overflow urinary incontinence
- recurrent UTIs
- diminished QOL
57
What is the AUA and resulting categories
- score of symptoms
- <7=mild
- 8-19= moderate
- >20= severe
58
goals of BPH therapy
- control symptoms
- decrease AUA score
59
treatment for mild symptoms
watchful waiting
60
moderate symptoms with erectile dysfunction
- a adrenergic antagonist, PDE-5 inhibitor, or both
61
moderate symptoms with small prostate and low PSA
a adrenergic antagonist
62
moderate symptoms with large prostate and increased PSA
- 5 a reductase inhibitor
- or 5 a reductase inhibitor and a adrenergic antagonist
63
moderate symptoms with predominant irritative voiding symptoms
- a adrenergic antagonist and anticholinergic agent
64
severe symptoms with complications
surgery
65
What drugs to avoid in BPH
- drugs with strong anti-cholinergic properties
- first gen antihistamines
- tricyclic antidepressants
cogentin, artane, scopolamine
- antimuscarinics
66
When to use detrol LA
- when the patient has BPH and incontinence
- avoid in patients with a high post-void residual and max urine flow rate less than 5
67
drug therapy for mild bph otc
saw palmetto; safe but may not be verry effective
68
alpha-1a adrenergic blocker MOA
- relaxes smooth muscle tone of prostate gland and bladder neck to improve urine flow
69
Alpha-1a adrenergic blocker counseling
- does not reduce size of prostate gland
- onset in 1-6 weeks
- take tamsulosin 1/2 hour after same meal each day to increase effectiveness
70
A-1a adrenergic blockers
alfuzosin, doxazosin, silodosin, tamsulosin, terazosin
71
A-1a adrenergic blockers side effects
- dizziness, fatigue, HA, orthostatic hypotension, decreased volume of ejaculation
72
PDE-5 inhibitors for treatment of BPH
- indicated if pt also has ED
- effectiveness similar to alpha antagonists
- tadalafil 5mg daily
- relaxes smooth muscle of prostate gland and bladder neck to improve urine flow
73
5-a reductase inhibitors for treatment of BPH
- indicated if the patient has a prostate larger than 40g
- decreases prostate size
- use in conjunction with alpha antagonist
- onset of action may take up to 6 months
- finasteride 5mg po daily
- dutasteride 0.5mg po daily
74
combination therapy options
- finasteride and tamsulosin: for patients with enlarged prostate glands
- finasteride and tadalafil: for patients with BPH and ED
- tamsulosin and tolterodine: for patients with BPH and OAB
75
how many extra calories in prenatal diet?
300-400 extra calories per day
76
what to limit in prenatal diet
artificial sweeteners, dairy, eggs, unwashed produce, herbal teas, undercooked meats, caffeine
77
what is the caffeine limit in pregnancy?
200mg/day
78
prenatal supplement reccomendations
- folate 400-600mcg daily
- calcium 1000-1300mg daily
- iron 27-30mg daily
79
when should prenatal supplements be started?
- 3 months prior to conception
- folic acid at least one month prior to conception
80
vaccine reccomendations for pregnancy
- inactivated flu before the end of october
- Tdap between 27-36
- covid-19 vaccination
81
vaccines to avoid in pregnancy
- HPV
- MMR
- live flu
- varicella
- yellow fever
- typhoid fever
82
common teratogens
- warfarin
- lisinopril
- lithium
- methotrexate
- alcohol
- isotretinoin
- statins
83
preferred treatment of diabetes during pregnancy
- insulin
84
preferred treatment of hypertension during pregnancy
- labetalol
- amlodipine
- nifedipine
- hctz
- hydralazine
- methadopa
85
agents to avoid for hypertension during pregnancy
- ACE inhibitors (lisinopril, verapimil, etc)
- ARBS (valsartan, candesartan, etc)
86
treatment of nausea and vomiting during pregnancy:
1st line : non-pharmacologic
2nd line:
- pyridoxine
- doxylamine and pyridoxine
- meclizine, dyphenhydramine
- last line: ondansetron, metoclopramide
87
treatment of heartburn in pregnancy
- antacids (magnesium hydroxide, calcium carbonate)
- sucralfate
- H2 agonists
88
treatment of constipation
- high fiber foods
- increased fluid intake
- regular exercise
89
pharmacologic treatment of constipation
- osmotic laxatives (PEG and Lactulose)
- stool softeners (docusate)
- bulk laxatives (psyllium)
90
treatment of pain in pregnancy
1st line: acetaminophen
avoid NSAIDS after 32 weeks gestation
91
recommended antibiotic treatment for UTIs in pregnancy
- 1st gen cephalosporins (keflex)
- macrobid
- amoxicillin
-ampicillin
92
antibiotics to avoid in pregnancy
- fluoroquinolones: ciprofloxacin and levofloxacin
- tetracyclines: doxycycline and minocycline
- Bactrim DS
93
treatment for gestational diabetes
- monitor blood glucose
- insulin
94
pharmacologic treatment for thromboembolism in pregnancy
- anticoag agents
- avoid warfarin
95
preeclampsia definition
sudden spike in blood pressure plus proteinuria
96
preeclampsia treatment
-aspirin 60-80 mg starting in late first trimester
- hydralazine, labetalol, nifedipine
97
seizure management in pregnancy
- magnesium sulfate 4-6g IV bolus
- may also use phenytoin or benzodiazepines (lorazepam)
98
HELLP syndrome and treatment
- hemolysis
- low platelet count
- elevated liver enzymes
treat with:
- platelets
- corticosteroids
- monitor lab values
99
what is preterm labor?
labor before week 37 gestation
100
medications to treat preterm birth
progesterone
101
premature membrane rupture treatment
- corticosteroids
- antibiotics
- magnesium sulfate
102
preterm labor treatment
- corticosteroids help with lungs
- antibiotics: ampicillin + erythromycin
