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PHRM 825 Therapeutics > Exam 5 - Lec 49-51 Men's Health > Flashcards

Exam 5 - Lec 49-51 Men's Health Flashcards

1
Q

most common cause of hypogonadism

A

constitutional delay of growth and puberty (CDGP)

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2
Q

incomplete/delayed sexual maturity usually requires __________ supplementation

A

testosterone

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3
Q

IM testosterone esters for hypogonadism start at ___ mg month, increased by 25 mg (max 100 mg)

A

50

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4
Q

which cancer is the most common cancer in young men aged 15-35 years?

A

testicular cancer

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5
Q

5 year survival rate for testicular cancer

A

95%

(80% cure rate even if stage III)

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6
Q

what surgical procedure can treat testicular cancer?

A

orchiectomy (removal of one or both testicles)

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7
Q

what is the name of the major type of alopecia?

A

androgenic alopecia (male pattern baldness)

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8
Q

what is alopecia areata?

A

autoimmune alopecia; small round patches appear

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9
Q

what is alopecia universalis?

A

complete hair loss on scalp and body

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10
Q

what is traction alopecia?

A

constant tension on hair

(ppl with man buns are more at risk)

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11
Q

what is drug-induced alopecia?

A

alopecia caused by anabolic steroids or chemotherapy

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12
Q

finasteride (Propecia) mech of action?

A

inhibits type II 5-alpha reductase

(inhibits conversion of testosterone to DHT)

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13
Q

dose of finasteride (Propecia) for alopecia

A

1 mg PO once daily

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14
Q

minoxidil (Rogaine) mech of action?

A

enlarging miniaturized hair follicles

(inc blood supply, stimulates hair follice from telogen (resting phase) to anagen (growth phase))

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15
Q

what % of minoxidil is used for alopecia and how often per day should it be used?

A

5%; twice daily every day

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16
Q

hormonal deficiency (andropause) risk factors (4)

A

-aging
-chronic illness (diabetes, AIDS, rheumatoid arthitis, CKD)
-long term use of corticosteroids
-obesity

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17
Q

diagnosis of hypogonadism requires what two things?

A

low testosterone levels WITH symptoms

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18
Q

a total testosterone level of < ___ ng/gL is positive for low testosterone; confirm with 2nd test and free testosterone level < ___ ng/dL confirms low testosterone

A

300 ng/dL

5 ng/dL

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19
Q

which dosage form for testosterone therapy is most similar to physiologic testosterone levels?

a. IM injection
b. patch
c. gel
d. solution
e. buccal tablet
f. SQ pellet
g. oral capsule

A

b. patch

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20
Q

subQ pellets for testosterone therapy have a delayed onset of how many months?

A

3-4 months

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21
Q

testosterone undecanoate capsules brand name?

A

Jatenzo

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22
Q

dose for Jatenzo for THT

A

158 to 396 mg BID with food

(measure serum testosterone level 6 hrs after AM dose)

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23
Q

contraindications to THT (5)

A

-prostate cancer
-breast cancer
-hematocrit > 50%
-baseline PSA (prostate specific antigen) > 4 ng/mL, or PSA > 3 ng/mL in men at high risk of prostate cancer
-recent or poorly controlled CVD

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24
Q

black box warning for testosterone gel formulation

A

concerns with secondary exposure to children

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25
Q

patients should be monitored ___ - ____ months after initiating THT

A

3-6 months

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26
Q

goal testosterone levels after THT therapy?

A

400-700 ng/dL

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26
Q

goal testosterone levels after THT therapy?

A

400-700 ng/dL

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26
Q

goal testosterone levels after THT therapy?

A

400-700 ng/dL

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27
Q

if hematocrit is > ___ %, testosterone therapy should be stopped

A

54%

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28
Q

diseases and conditions that can cause ED (5)

A

-diabetes mellitus
-hypertension
-CAD
-MS - Parkinsons - stroke
-low testosterone levels

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29
Q

what class of drugs are most noted for drug-induced sexual dysfunction?

A

antidepressants

(SSRIS - up to 70%)

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30
Q

three subtypes of erections

A

-psychogenic (happens in brain)
-reflexogenic (something stimulates it)
-nocturnal (bedtime, morning wood)

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31
Q

erections are initiated by

a. sympathetic NS
b. parasympathetic NS

A

b. parasympathetic NS

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32
Q

in erections, ___ is released which causes release of ___ from the NANC neurons in the penis. NO activates guanylate cyclase, which converts ___ to ___, which results in ___ release and produces smooth muscle relaxation

A

ACh
NO (nitrous oxide)
GTP
cGMP
Ca+

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33
Q

nocturnal erections are controlled by which nerves?

A

sacral nerves

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34
Q

how many nocturnal erections occur per night?

A

3-6 /night

35
Q

first line oral treatment for ED

A

PDE-5 inhibitors

(promotes sm. muscle relaxation by inhib of PDE-5)

36
Q

true or false: PDE-5 inhibitors increase the refractory period between erections

A

false

(decreases refractory period)

37
Q

4 PDE-5 inhibitors

A

sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra)
avanafil (Stendra)

38
Q

drug interactions with PDE-5 inhibitors: CYP3A4 inhibitors (5)

A

cimetidine
ketoconazole
erythromycin
ritonavir
grapefruit juice
etc.

39
Q

true or false: food delays absorption of PDE-5 inhibitors

A

true

(fatty meal can delay absorption of Viagra and Levitra by 1 additional hour)

40
Q

most common side effect of PDE-5 inhibitors

A

headache

41
Q

NAION (non-arteritic ischemic optic neuropathy) is a possible side effect of PDE-5 inhibitors. What does it mean?

A

sudden vision loss

42
Q

true or false: patients on oral or transdermal nitrates can use PDE-5 inhibitors such as Viagra

A

false

(don’t use; nitrates cause vasodiation, can cause massive drop in bp)

43
Q

true or false: patients on alpha-blockers should start PDE-5 inhibitors at a higher dose

A

false

(start at lower dose)

44
Q

PDE-5 inhibitors for pulmonary hypertension; what dose of Revatio and Adcirca do you use?

A

Revatio (sildenafil) 20 mg po tid
Adcirca (tadalafil) 40 mg po once daily

45
Q

true or false: vacuum erection devices should be avoided in sickle cell patients

A

true

46
Q

alprostadil pellets brand name

A

Muse

47
Q

alprostadil pellets are ___ effective than injection

A

less

48
Q

what should you do first before using alprostadil pellets?

A

urinate first

49
Q

alprostadil injection brand name

A

Caverject

50
Q

alprostadil injection (Caverject) is best for which type of ED?

A

neurogenic

51
Q

true or false: alprostadil injections require sexual stimulaion

A

false

(no sexual stim. required)

52
Q

what are the 3 components of the Trimix injection?

A

papaverine
phentolamine
prostaglandin E1

53
Q

what is priapism?

A

prolonged erection

54
Q

what is Peyronie’s Disease (PD)?

A

having a bent erection (at least 30 degrees); includes penile plaques

55
Q

drug to treat Peyronie’s Disease

A

Xiaflex (collagenase clostridium histolyticum injection)

56
Q

which group is most likely to develop prostate cancer?

a. non-hispanic white
b. non-hispanic black
c. asian & pacific islander
d. american indian and alaska native
e. hispanic/latino

A

b. non-hispanic black

57
Q

most common type of cancer in men

A

prostate cancer (1:7)

58
Q

_____ score rates tumor grade in prostate cancer

A

Gleason

59
Q

PSA screening: most men w/o prostate cancer have PSA levels under ___ ng/mL of blood

A

4 ng/mL

60
Q

PSA level between 4 and 10 have about a 1 in ___ chance of having prostate cancer

A

4

(25%)

61
Q

if PSA is more than ___, the chance of having prostate cancer is over 50%

A

10

62
Q

normal prostate gland is less than ___ grams

A

20

63
Q

true or false: type-II 5 alpha reductase in the prostate gland is responsible for prostate enlargement and growth

A

true

64
Q

nocturia (needing to pee 2+ times per night) is common with which disease?

A

BPH

65
Q

AUA for mild BPH

A

less than or equal to 7

66
Q

AUA for moderate BPH

A

8-19

67
Q

AUA for severe BPH

A

greater than or equal to 20

68
Q

why do we avoid drugs with strong anti-cholinergic properties in BPH?

A

decreases contractility of bladder detrusor muscle; results in urinary retention

(ex. antihistamines like benadryl, TCA’s, cogentin, artane, scopolaimine, anti-muscarinics like ditropan)

69
Q

what is post-void residual?

A

amount of urine left in bladder after peeing

70
Q

saw palmetto is used to treat mild ___?

A

BPH

(160 mg po bid)

71
Q

alpha-1 adrenergic blockers (5)

A

terazosin
doxazosin
tamsulosin
alfuzosin
silodosin

72
Q

what drugs are used to treat moderate BPH?

A

alpha-1a adrenergic blockers/blockade

(relaxes sm. muscle tone of prostate gland AND bladder neck; improves urine flow)

73
Q

true or false: alpha-1a adrenergic blockade reduces the size of the prostate gland

A

false

(does not reduce size; it does dec. AUA by 30-40%; onset is 1-6 weeks)

74
Q

when should tamsulosin be taken for BPH?

A

1/2 hour after same meal each day (enhances AUA)

75
Q

true or false: silodosin can be taken with or without a meal

A

false

(take w/ meal)

76
Q

most common side effect of alpha-1 adrenergic blockers

A

dizziness (orthostatic hypotension)

77
Q

orthostatic hypotension is common in first dose with

a. Uroxatrol and Flomax
b. Cardura and Hytrin
c. Rapaflo and Flomax
d. Cardura and Rapaflo

A

b. Cardura and Hytrin

(doxazosin and terazosin)

78
Q

which is most selective for alpha-1a receptors in urinary tract?

a. terazosin
b. doxazosin
c. tamsulosin
d. alfuzosin
e. silodosin

A

c. tamsulosin

79
Q

what syndrome has been observed during cataract surgery in patients treated with Flomax?

A

intra-operative floppy iris syndrome

80
Q

tadalafil can be used for ED and BPH, 5 mg daily, but 2.5 mg should be used if CrCl is in what range?

A

30-50 mL/min

81
Q

do not use tadalafil if CrCl < ___ mL/min

A

30 mL/min

82
Q

dose for finasteride (Proscar) for BPH

A

5 mg po daily

83
Q

dose for dutasteride (Avodart) for BPH

A

0.5 mg po daily

84
Q

which type of BPH requires minimally invasive/invasive surgical therapies?

a. mild
b. moderate
c. severe

A

c. severe

85
Q

what is transurethral resection of the prostate (TURP)?

A

scraping done to reduce the size of prostate tissue

86
Q

true or false: botox injections can be used for severe BPH

A

true

(used to induce prostatic atrophy in group of patients who were not surgical candidates)

PHRM 825 Therapeutics (25 decks)

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