Men's Health (Drugs for Prostate Caner, BPH, and Erectile Dysfunction) Flashcards
(23 cards)
Benign Prostatic Hyperplasia (BPH)
Nonmalignant enlargement of prostate causing an obstruction
Can have difficulties emptying bladder depending on the obstruction size. May need catheters/surgery/megs to decrease swelling
Finasteride (Proscar)
Indications: Mechanical obstruction
Reduces DHT (dihydrotestosterone) levels promoting regression of epithelial tissue, decreasing prostate size
Benefits take 6-12 months
Lifelong tx; PO w/ or w/out food
Adverse Effects of Finasteride (Proscar)
Gynecomastia, decreased ejaculate volume and libido
Finasteride (Proscar) Pregnancy Category
Category X - can be absorbed through the skin so pregnant women should not handle this med.
Men should not donate blood for 6 mod after stopping med (long half life)
Alpha1 Adrenergic Blockers
Indication: Dynamic Obstruction; relaxes smooth muscle in the prostate capsule, prostatic urethra, and bladder neck
PO, dosing varies by med
“Zosin”
Meds: Terazosin (Hytrin), Doxazosin (Cardura), Tamsulosin (Flomax)
Doxazosin (Cadura) Adverse Effect
effects Blood Pressure
Tamsulosin (Flomax)
selective to prostate, abnormal ejaculation
Androgen Receptor Blockers: Eulexin (Flutamide)
Used for Prostate Cancer ONLY
Combo w/ either surgical or chemical castration (GnRH agonist)
PO, TID
Adverse Effect of Eulexin (Flutamide)
Gynecomastia, N/V/D, liver toxicity
–monitor LFT’s
Gonadotropin-Releasing Hormone Agonist - Leuprolide (Lupron)
Indications: Prostate Cancer (alternate to orchiectomy); suppressed testosterone production
Good to take Vitamin D and Ca with this med.
Adverse effects of Leuprolide (Lupron)
Hot flashes, impotence, loss of libido
Increases risk of osteoporosis and related fractures
PDE5 Inhibitors
“The afils” for erectile dysfunction:
Can use in pt’s w/ STABLE CHD
Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra)
Sildenafil (Viagra)
also treats pulmonary artery HTN (Revatio)
Taken right before sex
PRN only, peaks in 1 hr, short half life (4 hrs), wait 24 hrs before taking Nitro; High fatty foods delay reabsorption and reduce peak levels
Tadalafil (Cialis)
The “weekend Warrior” - lasts longer
PRN or once daily, peak level 2 hrs, half life (17.5hrs); duration (36hrs); wait 48 hrs before taking Nitro
Causes of Erectile Dysfunction
Atherosclerosis, neurological, drugs, decreased testosterone, psychological (stamp test)
Erection Patho.
Sexual Arousal -> increases parasympathetic nerve response to penis -> local release of nitric oxide -> Activates Fuanylyl cyclase (an enzyme that makes cGMP (cyclic guanosine monophosphate) -> cGMP promotes relaxation of arteries and trabecular smooth muscle -> increased blood flow = erection -> erection subsides when cGMP is removed by PDE5
PDE5
causes vasodilation
Viagra and Nitro
both cause vasodilation which causing BP to drop causing a hypotensive crisis
Vardenafil (Levitra)
PRN only, peaks in 1 hr, half life (4-5hrs); duration of action is 4hrs; wait 24 hrs before taking Nitro
Similar to viagra except: Prolong QT Syndrome! (can cause cardiac arrhythmia)
Adverse Effects of PDE5 Inhibitors; The “-Afils”
Hypotension, Priapism (painful, long lasting erections), Visual Disturbance
Drug Interactions w/ PDE5 Inhibitors
Nitrates and Alpha-adrenergic antagonists
Injectable Erectile Dysfunction Drugs
Produces erection when directly injected into the coups cavernosum (penis); erection w/in 10 mins; lasts 2-4hrs
Papavarine and Phentolamine
Alprostadil (prostaglandin E1)
- an option for people with heart conditions who cannot take other erection meds
STD’s in elder patients
unprotected sex, no pregnancy worries, swinging singles, more partners
