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Pharmacology (Dale Turley) > Mens Health pt.1 > Flashcards

Mens Health pt.1 Flashcards

(80 cards)

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1
Q

Erectile dysfunction facts 
?

A

Rapidly growing interest in class of drugs

Men living longer and gender gap narrowing

56% men reported some degree of ED -

ED rises sharply with age

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2
Q

What NT is key in cascade of erections?

A

nitric oxide

you need nitric oxide sysnthesis and parasympathetic innervation to get an erection ( smooth muscle relaxation to allow blood flow into the cavernousum)

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3
Q

there is no relationship between ED and?

A

testosterone

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4
Q

Six causes of ED?

A

Vasculogenic (Leriche) - most common and this is the one we treat

Psychogenic - mental, guilty

Hormonal

Drugs

Other (mechanical, surgery, combination)

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5
Q

What is the most common cause of ED?

A

Vasculogenic most common

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6
Q

ED risk factors and non-pharmacological causes?

A

alcohol

tobacco

hypercholesterolemia

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7
Q

Phosphodiesterase type 5 (PDE5) Inhibitors examples?

A

Sildenafil (Viagra)

Tadalafil (Cialis)

Verdenafil (Levitra)

** these rely SMOOTH muscle and allow blood to flow into the v=cavernousum ( they were originally used for HTN)**

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8
Q

Oral phosphodiesterase type 5 (PDE5) inhibitors discovery ?

A

Discovered while searching for a new antihypertensive agent

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9
Q

Phosphodiesterase type 5 (PDE5)
 MOA?

A

Main catalyst responsible for conversion of cGMP (cyclic guanosine monophosphate) to GMP

cGMP - relaxes smooth muscle , these meds increase cGMP

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10
Q

End result of Phosphodiesterase type 5 (PDE5)
 MOA?

A

End result is relaxing smooth muscle of the penile arteries and corpus cavernosum resulting in an erection

No drug effect without some type of sexual stimulation ( for it to work)

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11
Q

PDE5s there is no effect w/o?

A

some type of sexual stimulation

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12
Q

PDE5s require?

A

Requires intact parasympathetic nervous system and adequate release of nitric oxide

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13
Q

All three PDE5s are all absorbed ______?

A

orally

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14
Q

___________ inhibited in presence of food

A

sildenafil (Viagra)

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15
Q

sildenafil Viagra and vardenafil (Levitra) onset action ________ and duration_____.

A

30-120 min

4 hours

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16
Q

tadalafil (Cialis) onset _____ and duration effect _____

A

16 min

36 hours

**cialis is the weekended lol but viagra is only 4 hours **

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17
Q

Phosphodiesterase type 5 (PDE5)
 is metabolized by the ?

A

liver CYP 450

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18
Q

Phosphodiesterase type 5 
(PDE5) Inhibitors
: sildenafil and vardenafil ?

A

4 to 5 hours

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19
Q

Phosphodiesterase type 5 
(PDE5) Inhibitors
: tadalafil ?

A

17.5 hours

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20
Q

Tadalafil (Cialis) dosing?

A

5 mg

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21
Q

PDE5s has generally fewer side effects such as?

A

Priapism

(painful erection lasting longer than 6 hours), prolonged erection lasting greater

**typically well tolerated medications **

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22
Q

Caution with PDE5s when used with ?

A

nitrates

** ( if they on these meds then do not give then Nitro cause it can plummet the BP )**

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23
Q

Nitrates lead to ___________ that progresses to cardiac arrest?

A

hypotension

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24
Q

Nitrates facts?

A

Antihypertensive

Drop in BP

Additive effect with other drugs

Cause orthostatic hypotension when used with alpha blockers and more so when most blood is going to the penis and not the head)

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25
Tx for ED: injectable prostaglandins?
Alprostadil (Caverject)
26
_______ ______ are injected directly into the side of the penis and produces an erection
injectable prostaglandins
27
injectable prostaglandins dilates the ________ of the penis and allows blood to flow to engorge the penis
arteries
28
How long does it take to get a erection after a injectable prostaglandins? How long does it last?
5 to 15 minutes The erection will last 30 minutes to an hour or up to orgasm.
29
If using injectable prostaglandins then a patient must?
A patient must learn to perform a penile self-injection each time he wishes to engage in sexual activity.
30
Pharmacokinetics of Injectable Prostaglandins?
Rapid absorbed within 10 min Effects last 1 hour 75% metabolized one-pass lungs Half-life 5 to 10 minutes
31
Injectable Prostaglandins
 adverse reactions?
Localized pain Priapism Contraindicated in Peyronie’s disease and penile implants First dose under direct supervision for duration less than 1 hour 27 to 30 gauge needle proximal dorsal 1/3
32
BPH facts?
Affects 50% men over 60 and 90% men over 70 years old Compression urethra caused by prostate enlargement and they get urinary retention and dribbling and hesitancy , decreased caliber, nocrutia,
33
Drugs Used in the Treatment of Benign Prostatic Hypertrophy?
Alpha blockers 5-Alpha reductase inhibitors **alpha receptors that are expressed at the base of the bladder and the prostate **
34
Alpha blockers MOA?
Relax smooth muscle in the prostate gland - it does not shrink the prostate Decrease obstruction of urine flow
35
Alpha blockers are effective within _ month?
1 Effect ceases when the medication is stopped
36
Alpha blockers examples?
Terazosin (Hytrin) Doxazosin (Cardura) Tamsulosin (Flomax) Alfuzosin (Uroxatrol) Prazosin (Minipress)
37
Alpha blockers have ____________ effects
Anti-hypertensive effects
38
When prescribing A-blocers, look at other medications that may interact with __?
BP
39
Alpha-1 meds side effect ?
orthostatic hypotension
40
What alpha blockers are more selective at prostate and bladder and Less side effects of hypotension?
Newer meds: tamsulosin (Flomax) and alfuzosin (Uroxatrol)
41
Alpha blocker are well absorbed _____?
orally
42
Alpha blockers are metabolized by the ?
liver ** ( careful with other drugs that are metabolized with the liver and clotting agents like anticoags, and careful in people with liver disease)**
43
Alpha blockers side effects?
Hypotension (first dose in clinic or bedtime with discussion about activity) Headache Dizziness Muscle pain Watch with occasional use of PDE5 Inhibitors
44
5-Alpha reductase inhibitors MOA?
Inhibit the conversion of testosterone to dihydrotestosterone, suppressing prostate growth (decrease in prostate volume 30%) shrink it
45
5-Alpha reductase inhibitors is effective within?
2 to 6 months Usually the response is sustained after therapy
46
5-Alpha reductase inhibitors | examples?
finasteride (Proscar) - most common dutasteride (Avodart)
47
5-Alpha reductase inhibitors | are well absorbed ______?
orally
48
5-Alpha reductase inhibitors | is metabolized by the ?
liver to active metabolites
49
Drugs Used in the Treatment of Benign Prostatic Hypertrophy Conscientious considerations?
Must consider latest guidelines and literature Must pay attention to other medications patient is on May require up to 6months of therapy to show effect. not over night change
50
Drugs Used in the Treatment of Benign Prostatic Hypertrophy: Family patient education ?
Discuss all medications, OTC, supplement for possible interactions saw palmetto, ginseng
51
Drugs Used in the Treatment of Benign Prostatic Hypertrophy FDA cat? and why?
FDA Category X cause producing genitalia abnormalities in male offspring
52
You cannot donate blood if you are on what agents or for 6 months after?
alpha blockers 5 -alpha reductase inhibitors
53
Drugs Used in the Treatment of Benign Prostatic Hypertrophy considerations if pregnant?
should not be handled by pregnant women - inhibit development of male genitalia in fetus)
54
Tx of BPH: how long until you see results?
3–6 months
55
BPH meds are not a ___ , they are only for ?
cure only for sxs. relief
56
_________ used in male pattern baldness sold as “Propecia”, its only for androgenic male pattern baldness. this will actually grow hair back
Finesteride
57
Testosterone Deficiency
 facts?
Normal decline in older men Will not enhance vitality (sample begs to differ) and sexual activity ( yes to this) That’s not what they say on TV? Hypogonadism term interchanged Normal aging Klinefelters syndrome (androgen deficit)
58
Forms that testosterone is available in?
Oral Injectables - highest bioavailability SL IM Transdermal Usually injectable
59
There are black market issues with ?
testosterone - steroids “Low T” clinics - low testosterone clinics
60
Drugs Used to Treat Testosterone Deficiency clinical uses?
Androgen replacement therapy in the treatment of delayed male puberty Male hypogonadism - genetic abnormality Replacement therapy in cases of deficiency of endogenous hormone
61
Exogenous testosterone absorption is completely via?
IM administration
62
99% of exogenous testosterone is bound to ?
hormone globulin
63
Exogenous testosterone | is metabolized by?
First pass metabolism in liver to active metabolite
64
Exogenous testosterone | excretion?
Excreted 90% in urine (screening PED’s)
65
Exogenous testosterone | adverse effects?
CV: HTN DERM: acne, alopecia ENDO: breast tenderness, gynecomastia HEME: leukopenia, suppression of clotting NEURO: aggression GI: N/V GU: impotence, atrophy MS: weakness **adverse effects come from overdosing usually **
66
Exogenous testosterone considerations?
All forms require careful monitoring for side effects If no visible response in 3–4 months change therapy If oral form do LFT every 3–6 months
67
If on testosterone therapy then monitor ?
Lipids PSA hematocrit DRE and if oral then monitor LFT every 3-6 mo
68
Testosterone deficiency meds: patient teaching?
Inform patient his age and physical condition may limit results for testosterone Inform women of child-bearing age not to handle dosage forms Inform patient must not use if have BPH and abnormal lipid profile - cause it will cause side effects Inform of need to screen for prostate and breast cancers
69
Propecia effectiveness?
Less effective when hair loss is temporal or frontal - more effects if it is male pattern baldness pattern
70
Propecia: New hair is lost after _______ if treatment is discontinued
4–6 months
71
Propecia: Results are not seen until after ________ of use
2–6 months
72
Propecia: Can not donate blood until after ______ past last use due to teratogenicity issue
6 months
73
Propecia causes birth defects in?
women
74
Testosterone deficit meds are not approved for use in what population?
Pediatric
75
Testosterone deficit meds are contraindicated in?
women
76
Testosterone deficit meds: geriatric special population consideration?
Discuss precautionary labeling associated with PDE5 use. Need dosage adjustment in elderly using BPH drugs
77
Terazosin (Hytrin) is a ?
reversible selective alpha blocker
78
Doxazosin (Cardura) has a longer ___ than the others?
HL
79
Tamsulosin (Flomax) has?
lesser effect on BP than the others. Will not lower BP. used a lot with kidney stones
80
Alfuzosin (Uroxatrol) can cause?
increase QT prolongation

Pharmacology (Dale Turley) (31 decks)

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