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Flashcards in Sweatman BPH Drugs Deck (41):
1

three drug classes used in BPH treatment

Alpha antagonist
PDE5 inhibitors
5 alpha reductase inhibitors

2

dynamic bladder-outles obstruction due to

signalling via Alpha 1a,b,d receptors

3

static bladder-outlet obstruction

5 alpha reductase-testosterone-enlargment of the prostate (hyperplasia)

4

bladder muscle is under what control

Muscarcinic (Acetylcholine) M3 selective and M2 non-selective

5

only alpha families that matter

alpha 1a
alpha 1d

6

detrussor muscle is under what receptor control

alpha-1d

7

Lower GI tract"-->Trigone, prostatic urethra, prostate gland penile urethra of bladder is under what receptor control

alpha 1a
blockade causes relaxation of all these entities and allows for easier urination

8

alpha blocker with great variation from patient to patient

prazosin

9

dose titration necessary

prazosin

10

all alpha blockers end in

-Zosin
-losin
-dozin

11

advantage of selective alpha 1a agents

no need for dose titration, less CV effects

12

disadvantages of alpha 1a agents

-retrograde ejactulation (tamsulosin, silodosin)
-blockade of dopa receptors in CNS

13

superior Alpha antagonist at the momen

Alfuzosin--> no CNS or ejaculatory effects

14

alpha 1 blockers in eye surgery

floppy iris syndrome

15

events in erection

(PNS S2-S4) via the cavernous nerve-ACH-NOS-NO-SOLUBLE GC-->cGMP-->active PKG-->efflux of calcium (dec intraceullualr concentration)--> vasodilation

16

MOA for PDE5i

inhibits PDE5 which allows cGMP to linger--->prolongs natural vasodilatory action of the endogenous molecule

17

name the PDE5i

tadalafil (cialis)

18

ADE's for tadalafil

Nasopahrygitis, URTI, NON-arteric ischemic optic neuropathy, retinal artery occluson, hearling loss

19

contraindicated in tadalafil usage

nitrate-profoudn hypotension
worse with ETOH consumption

20

which androgen activate gene expression more efficiently

DHT>>testosterone--> binds with higher affinity

21

distribution of type I/II 5 alpha reductase

type I: non genital skin, liver, bone
2--> urogenital tissue and genital skin in men and women

22

MOA for 5 alpha reductase inhibitors

reduce DHT driven proliferation of the prostate-providing relief for urinary evacuation

23

inhibits type I and 2

dutasteride

24

inhibits type 2 only

finasteride

25

pregnancy category for 5 alpha reductase inhibitors

category X

26

side effects of 5 alpah reductase inhibtors

ejaculatory dysfuntion, dec libido, gynecomastia

27

effect on PSA for 5 alpha reductase inhibitors

reduces PSA levels-therfore problem if PSA being monitored for Prostate CA

28

beta sitosterols

relieve symptoms, improved flow, without shrinking the prostate

29

Saw palmeto and BPH

no benefit on symptoms and does not reduce PSA levels

30

Erectile Dysfunction drug that mimics PGE1

alprostadil

31

MOA for alprostadil

activates adenylate cyclase--> makes cAMP from ATP-->PKA-->calcium efflux, vasodilation

32

delivery for alprostadil and systemic effects

urethral suppository
direct injection into corpus cavernosum
*these routes show very litle systematization
no drug dugr interxns
*Cv events rare

33

adverse effects of oral ED tablets

CV issues angina and MI (and worsening of pre-exisiting CV issues)
Sudden loss of hearing and Optic Neuropathy (vision loss)
headache

34

why is tadalafil used for both BPH and ED

long duration of action

35

Drug Drug interaction with oral ED pills

YES
--all hepatically metabolised by 3A4

36

absolute contraindications for ED pills

Nitrates

37

potential contraindictions for ED pills

alpha blockers
drugs acting on cyps

38

ED pill with QT prolonging propensity

Vardenafil
interaction with > 70 drugs

39

testosterone therapy (HRT) and its effect on ED

may improve sensitivty to PDE5i's-->High levels of T not necessary to maintain erection,

40

this drug inihibits Alpha 2-AR's by NE, as well as antagonized NANC (presynaptic inhibition)-->increases release of NO

Yohimbe

41

Yohimbe contrainidacted in

renal failure/dysfunction