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Men's Health Module > Men’s Health Pharmacology > Flashcards

Men’s Health Pharmacology Flashcards

(55 cards)

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1
Q

Two hormones that control libido

A

testosterone and dopamine

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2
Q

sympathetic and parasympathetic innervation of penis

A 
parasympathetic = erection
sympathetic = ejaculation
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3
Q

ACh and nitric oxide role in penis

A

involved in erection; parasympathetic release of ACh is involved in NO release which leads to vasodilation

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4
Q

______ can prevent degradation of cGMP and sustain vasodilation.

A

PDE-5 inhibitors

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5
Q

Detumescence

A

phase after ejaculation when penis return to flaccid state

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6
Q

What hormone has inhibitory effect on ejaculation?

A

serotonin

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7
Q

How to treat premature ejaculation?

A

SSRI’s

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8
Q

Drugs causing erectile dysfunction

A
  • Statins
  • Diuretics and anti-HTN
  • Antidepressants, antianxiety drugs, antepileptics, and antipsychotics
  • Antihistamines
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9
Q

How do anti-hypertensives lead to sexual dysfunction?

A

interfere with erections and ejaculation by reducing blood flow

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10
Q

Anti-HTN most likely to cause sexual dysfunction? better alternative?

A

alpha and beta blockers

try CCBs (diltiazem)

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11
Q

How do anti-psychotics and anti-depressants lead to sexual dysfunction?

A

block actions of ACh, serotonin, and norepinephrine which decrease arousal and/or testosterone levels

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12
Q

Antidepressant with highest risk of ED?

A

TCAs

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13
Q

How do antihistamines lead to sexual dysfunction?

A

competitive antagonist on DHT receptor; exaggerates effects of estrogen

galactorrhea in women and gynecomastia in men

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14
Q

First line therapy for all types of ED

A

phosphodiesterase-5 inhibitor (Sildenafil, vardenafil, tadalafil)

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15
Q

What is chemical pathway from sexual arousal to penile erection?

A

arousal -> NO -> cGMP -> decreased Ca2+ -> smooth muscle relaxation -> erection

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16
Q

Physiologic mechanism of penile erection is release of nitric oxide in __________ during sexual stimulation.

A

corpus cavernosum

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17
Q

MOA of PDE-5 inhibitors

A

inhibit degradation of cGMP in corpus cavernosum; increases vasodilation

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18
Q

Other uses of PDE5 inhibitors

A

esophageal spasms and pulmonary HTN

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19
Q

ADRs of PDE-5 inhibitors

A

HA, flushing, dyspepsia, abnormal vision, hypotension

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20
Q

Drug interactions with PDE-5 inhibitors

A

Nitrates or nitric oxide
Alpha blockers
Alcohol
CYP450 inhibitors

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21
Q

What is Alprostadil and how does it work?

A

alternative treatment of ED that is self-injected into penis

prostaglandin E1 analog that stimulates adenyl cyclase and induces erection

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22
Q

two dosage forms of Alprostadil

A

injection

intraurethral pellet

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23
Q

Alprostadil ADRs

Study These Flashcards
A

priapism, pain, urethral bleeding

24
Q

Detrusor has ____ receptors which lead to relaxation; trigone and sphincter have ____ receptors which lead to contraction.

Study These Flashcards
A

beta 2

alpha 1

25
Part of nervous system that facilitates bladder filling and retention
sympathetic
26
Sphincter has alpha 1 receptors that lead to _______.
contraction
27
micturation is...
urination
28
Neurologic process of urination
Parasympathetic postganglionic axons in pelvic nerve innervate muscarinic receptors (M3) of bladder smooth muscle and sphincter resulting in contraction of detrusor muscle and relaxation of sphincter Sympathetic postganglionic neurons release NE, which activates beta3 receptors to relax bladder smooth muscle and beta1 receptors to contract urethral smooth muscle Somatic axons in pudendal nerve also release ACh, which produces contraction of external sphincter striated muscle; this is your voluntary control over urination
29
What does IPSS score used to assess?
BPH
30
Pharm treatment of BPH
1st line = alpha-adrenergic antagonists: Tamsulosin (Flomax) 5 alpha-reductase inhibitors: Finasteride (Propecia), Dutasteride
31
MOA of alpha blockers in treating BPH
relax vascular smooth muscle in prostate and bladder neck
32
MOA of 5 alpha-reductase inhibitors in treating BPH
antiandrogenic; inhibits conversion of testosterone to more potent DHT to decrease prostate size
33
Side effects of adrenergic antagonists (alpha blockers) like Flomax
- orthostatic hypotension - vertigo - palpations - sexual dysfunction (priapism) - floppy iris syndrome
34
DIs of alpha blockers
any anti-HTN or other vasodilators
35
What does DHT do to prostate?
enlarges
36
Specific indications of adding on 5-alpha-reductase
BPH due to very large prostate (> 40g) and if moderate to severe symptoms
37
Along with BPH finasteride (Propecia) can treat ________.
hair loss
38
Side effects of 5 alpha-reductase inhibitors
``` sexual dysfunction (impotence, libido) gynecomastia prostate cancer ``` * due to androgen decrease
39
5 alpha-reductase inhibitors DIs
none
40
Effects of DHT in men
facial and body hair acne scalp hair loss prostate growth
41
Effects of testosterone in men
muscle mass skeletal growth spermatogenesis sexual function
42
Effects of estradiol in men
bone formation | breast tissue
43
Lifestyle modifications to reduce urinary incontinence
weight loss, dietary changes, pelvic floor muscle exercises, and med changes
44
Pharm treatment of urinary incontinence
1st line = alpha blocker | then may add anti-muscarinic (oxybutunin)
45
Indications for testosterone replacement
hypogonadism
46
Formulations of testosterone replacement
oral **topical gels: IM injections, transdermal patches, buccal tablet
47
Contraindications of testosterone replacement
``` known prostate or breast cancer severe lower urinary tract symptoms enlarged prostate PSA > 4 elevated hematocrit (>50%) uncontrolled CHF untreated sleep apnea ```
48
When and what to monitored with testosterone replacement therapy?
testosterone hematocrit PSA q3months for 1st year, then annually
49
ADRs of testosterone replacement therapy
Acne, gynecomastia, enlargement of prostate, worsening of sleep apnea, erythrocytosis, suppression of spermatogenesis
50
first line for male pattern (androgenic) baldness treatment
Minoxidil (Rogaine)
51
ADRs of minoxidil
Hair color or texture changes (darker, more coarse) | Slight cardiovascular risk
52
DIs of minoxidil
hypotension risk with any anti-hypertensives
53
DIs of testosterone replacement
anticoags, diabetic drugs, steroids, ACTH
54
What patients may not respond to Viagra?
patients with DM-related neurovascular disease
55
Cimetidine MOA and effects
competitive antagonist of DHT receptor - so that means that not as much DHT is being produced and thus more testosterone is being converted into estradiol

Men's Health Module (10 decks)

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