Men's Health

Question 1

The production of nitrous oxide occurs in what nervous system?

Answer 1

Parasympathetic

Question 2

What is the first line treatment for ED?

Answer 2

PDE5

Question 3

What is the mechanism of NO?

Answer 3

Nitrous oxide diffuses across the membrane of smooth muscle = increase GTP –> cGMP will cause cascade –> decrease intracellular calcium = relaxation = vasodilation = blood flows IN = erection

Question 4

Why is PDE 5 Enzyme a target for ED?

Answer 4

Because it degrades cGMP
Inhibit clearance = increase cGMP = decreases Ca2+

Question 5

Where is PDE 5 found?

Answer 5

Penis

Question 6

PDE 5 Inhibitors can cause what?

Answer 6

Drop in BP due to relaxation of vascular smooth muscle

Question 7

What are the adverse effects of PDE4 Inhibitors?

Answer 7

HA, Flushing, Dyspepsia, Nasal Congestion, and others

Question 8

Which PDE 5 has the highest incidence of HA and Flushing?

Answer 8

Vardenafil

Question 9

What is another A/E of Silfenafil?

Answer 9

Visual: BLUE hue, blurred vision, light sensitvity

Question 10

What is another A/E of Vardenafil?

Answer 10

Prolonged QT Interval

Question 11

What is another A/E of Tadalafil?

Answer 11

Back pain, myalgia, pain in limbs

Question 12

Sildenafil has the most effect in what tissue target?

Answer 12

Rods/Cones in Eyes

Question 13

Vardenafil has the most effect in what tissue target?

Answer 13

Vascular/Cardiac

Question 14

Tadalafil has the most effect in what tissue target?

Answer 14

Skeletal Muscle

Question 15

Avanafil has the most effect in what tissue target?

Answer 15

Vascular/Cardiac

Question 16

Nitrates and PDE 5 Inhibitors used together causes what?

Answer 16

Significant and Serious drop in BP

Question 17

What is Priapism and is it an A/E of PDE 5?

Answer 17

Sustained erection >4hrs and YES

Question 18

What is Non-Arteritis Anterior Ischemic Optic Neuropathy and is it an A/E of PDE 5?

Answer 18

Temporary or permeant blindness
YES

Question 19

In what scenario would a PDE 5 inhibitor NOT work?

Answer 19

If there was a decrease in the ability to produce NO

Question 20

What is Alprostadil and its MOA?

Answer 20

PGE1, increase cAMP = decrease Ca2+

Question 21

Is Alprostadil independent or dependent on NO?

Answer 21

INDEPENDENT

Question 22

What is Phentoalmine?

Answer 22

Alpha Adrenergic Antagonist

Question 23

What is Papaverine?

Answer 23

Nonspecific PDE Inhibitor

Question 24

Are Phentoalmine and Papaverine independent or dependent on NO?

Answer 24

INDEPENDENT

Question 25

What are the A/Es of Alprastodil, Phentoalmine, and Papaverine?

Answer 25

1. Priaprism 2. Pain of Injection 3. Fibrosis w/Long term use 4. Non-Penile Vasodilation

Question 26

Where is testosterone produced?

Answer 26

Leydig Cells = men Corpus Luteum and Adrenal Cortex = women

Question 27

When is the time of highest diurnal release of testosterone?

Answer 27

At waking

Question 28

What has a 5x affinity for androgen receptors compared to testosterone?

Answer 28

Dihydrotestosterone DHT

Question 29

What are the Androgen effects?

Answer 29

1. Sexual differentiation and maturation 2. Increases muscle mass 3. Bone growth 4. Erythropoiesis 5. Sexual drive 6. Male pattern baldness 7. Prostatic hyperplasia

Question 30

What are the side effects of androgen replacement therapy?

Answer 30

1. Priapism 2. Prostatic Hyperplasia 3. Prostate Cancer 4. Gynecomastia

Question 31

When would you want to block androgens?

Answer 31

BPH or Prostate Cancer

Question 32

What are anti-androgens for BPH?

Answer 32

Finasteride and Dutasteride

Question 33

What is the MOA and A/E of finasteride and dutasteride?

Answer 33

5-a-reductase inhibition Decreased libido, impotence, and gynecomastia

Question 34

What alpha-1 blockers are used for BPH and their MOA?

Answer 34

Tamsulosin, Silodosin, and Alfuzosin Cause relaxation of smooth muscle and improve urine flow

Question 35

What are A/Es of alpha-1 blockers?

Answer 35

1. Cardiovascular (less of a problem for alfuzosin) 2. Orthostatic Hypotension 3. Tachycardia 4. Congestion

Question 36

What are Androgen Receptor Antagonists used as 2nd line option for prostate cancer?

Answer 36

Flutamide and Bicalutamide