Male Disorders Pharm-Fitzpatrick

Question 1

Finasteride and dutasteride are these types of drugs

Answer 1

Steroid 5alpha reductase inhibitors

Question 2

Sildenafil, vardenafil, and tadalafil are these types of drugs

Answer 2

PDE5 inhibitors for ED

Question 3

List a1 antagonists for symptomatic relief of lower urinary tract syndromes

Answer 3

Terazosin
Doxazosin
Tamsulosin
Silodosin
Alfuzosin

Drug class to relax muscle tone
DYNAMIC REMEDY
Rapid relief of symptoms - days

Question 4

List the dominant alpha1 receptor subtype for the following:

Prostate: __
Detrusor: __
Spinal cord: __
Blood vessels: __

Answer 4

Prostate=alpha1A
Detrusor=alpha1D > alpha1A
SC=alpha1D
Blood vessels=alpha1B > or equal to alpha1A

Question 5

Alpha1 antagonists compete with ___. This mechanism reduces spasm, promotes muscle relaxation and improves urine flow

Answer 5

NE

Question 6

List alpha1 antagonists that are non-specific for a1 subtypes`

Answer 6

Terazosin
Doxazosin
Alfuzosin

Question 7

List the a1 antagonists that are subtype specific and which subtypes are dominant

Answer 7

Tamsulosin
Silodosin

a1A=a1D > a1B

Question 8

These a1 antagonists have no uroselectivity, adverse effects include postural hypotension and need to titrate the 1st doe, and fatigue. Drug interactions with PDE-5 inhibitors

Answer 8

Terazosin and doxazosin

Question 9

This uroselective a1 antagonist has adverse effects such as QT prolongation and interacts with CYP450

Answer 9

Alfuzosin

Question 10

These uroselective a1 antagonists target a1A and a1D equally, adverse effects such as reduced ejaculation, intraoperative floppy iris syndrome, and has interactions with CYP450

Answer 10

Tamsulosin and silodosin

Question 11

These 5a reductase inhibitors slow BPH progression

Answer 11

Finasteride and dutasteride

Drug class that prevents enlargementand shrinks prostate

Structural remedy

Delayed action –> shrinkage and symptom relief ~ 3-6 months

Question 12

Finasteride and dutasteride slow BPH progression by inhibiting what enzyme?

Answer 12

SAR II

Question 13

What are direct effects of SAR II inhibition for tx of BPH?

Answer 13

• T accumulation

- DHT depletion

Question 14

What are indirect effects of SAR II inhibition for tx of BPH?

Answer 14

AR receptor less occupied –> no gene transcription

Question 15

This steroid 5a reductase inhibitor is a specific inhibitor of SAR II:

Answer 15

Finasteride

Question 16

This steroid 5a reductase inhibitor has dual inhibitor function on SAR I and SAR II

Answer 16

Dutasteride

Question 17

What are some adverse events associated with 5a reductase inhibitors for tx of BPH?

Answer 17

ED
Gynecomastia
Depressed libido
Ejaculation disturbances

Question 18

This PDE-5 inhibitor is now approved by the FDA for use in BPH

Answer 18

Tadalafil

Question 19

Describe the pathway from GTP to smooth muscle relaxation and ultimately a boner:

Answer 19

GTP –> NO (from NANC neurons) interacts with guanylate cyclase –> cGMP –> smooth muscle relaxation –> boner

Question 20

Sildenfail, vardenafil, and tadalafil inhibit this enzyme that converts cGMP –> GMP

Answer 20

PDE-5

Question 21

This PDE-5 inhibitor has a span of efficacy of about 36 hrs and a half life of 18 hrs

Answer 21

Tadalafil

Question 22

PDE-5 inhibitors are cleared by this hepatic enzyme

Answer 22

CYP3A4

Question 23

In addition to PDE-5, sildenafil and vardenafil act on this PDE receptor subtype

Answer 23

PDE-6 on the retina –> adverse effect of blue vision disturbance

Question 24

What are some side effects of Tadalafil

Answer 24

Back pain
Myalgia
Limb pain

NSAIDS okay

Can be used for BPH

Question 25

What are contraindications with PDE-5 inhibitor usage?

Answer 25

Organic nitrates --> may induce extreme hypotension

Question 26

When you use Vardenafil and an a1 receptor antagonist, what should you consider?

Answer 26

Pt should be hemodynamically stable prior to initiating therapy. INITIATE vardenafil AT THE LOWEST RECOMMENDED DOSE

Question 27

When tadalafil is used for tx of BPH, concurrent ___ are not recommended.

Answer 27

Alpha1 blockers

Question 28

Alpha blockers should be initated at the lowest recommended dose in pts currently taking __

Answer 28

Sildenafil

Question 29

This injectable drug stimulates PDE-1 for ED

Answer 29

Caverject Papaverine and phentolamine

Question 30

Doxazosin, terazosin, alfuzosin, tamsulosin, and silodosin are these types of drugs:

Answer 30

Alpha1 adrenergic antagonists