The Last 5 Lectures Flashcards
(21 cards)
Forms of Testosterone?
Injectable, SL, transdermal [patch, cream, gel], PO. PO form has previously been found to increase risk of liver dz, therefore Miller feels this form is least desirable.
Indications for exogenous testosterone administration
Hypogonadism, loss of muscle mass, bone marrow stimulation, osteoporosis, therapy for transgendered men.
Leuprolide (Lupron)
Synthetic GnRH analog: Anti-androgen and anti-estrogen hormone. Most frequently used to treat advanced prostate CA [palliative tx - not CA tx], precocious puberty, endometriosis. Occasionally part of an IVF regimen.
MOA - interrupts production of testosterone and estrogen at HPA axis.
SFx - Decreased libido, impotence, N/V, hot flashes, osteoporosis.
Finasteride (Proscar)
Antiandrogen. Used to tx BPH. Lower dose used for male pattern baldness. MEN ONLY. Pg or potentially pg women cannot even touch tablets. No blood donation allowed while using.
MOA - Inhibits type II 5-alpha reductase - limits conversion of testosterone to DHT.
SFx - Decreased libido, ED, impotency, depression, gynecomastia.
Alpha-blockers (eg: Tamulosin [Flomax])
Used primarily to tx BPH, but can also be used for HTN.
MOA - relax smooth muscle in prostate and bladder neck relieving urinary sxs.
SFx - hypotension, nasal congestion, weakness.
Sildenafil (Viagra)
Phosphodiesterase 5 Inhibitor. Used to tx erectile dysfunction, pulmonary HTN.
MOA - selective inhibitor of PD5, causing prolonged contraction of smooth muscle fibers in corpus cavernosum of penis, enhancing erection.
SFx - Ha, flushing, dyspepsia, nasal congestion, CYANOPSIA, arrhythmias, close angle galucoma.
CI - pt on NO donors, liver or kidney disease, hypotension
Glucocorticoids indication
Inflammatory or allergic reactions Reactive airway disease Allergies Arthritis AI disease Addison's disease tx (life-saving)
Duration of action for Glucocorticoids
Hydrocortisone: Short acting = 8-12h
Prednisone: Intermediate acting = 18-36h
Dexamethasone/Betamethasone = 24-72+h
Relative strengths of corticosteroids
Hydrocortisone (1) < Prednisone (4) < Dexamethasone (30) < Betamethasone (35).
Note: stronger the anti-inflammatory effect the less the mineralocorticoid effect.
Methotrexate (MTX)
Anti-metabolite, anti-folate immunosuppresant. Used for CA chemotherapy, AI dz [RA, SLE, Crohn’s, psoriasis], off-label for MS.
MOA - suppresses CA cell turnover by destroying folate.
SFx - Nausea, abdominal pn, fever, low WBC counts, increased susceptibility to infx, pulmonary fibrosis. CAT X, obviously.
Note - if pt is taking MTX for RA or psoriasis they may also supplement with folate, but CA PT CANNOT TAKE FOLATE WHILE USING MTX.
Azathioprine (Imuran) MOA
Inhibits purine synthesis, especially in rapidly dividing cells.
Cyclosporine (Sandimmune) MOA
T-cell inhibition: blocks IL-1, -2, -3, -4 and IFN-g
Tacrolimus (Prograf) MOA
T-cell inhibition similar to cyclosporine. 100-fold more powerful than cyclosporine.
DMARDs
Disease-modifying anti-rheumatic drugs. Used to slow auto-immune disease progression.
Ex: Infliximab (Remicade) used for RA and Crohn’s.
Hydroxychloroquine (Plaquenil)
Anti-malarial
Tx for RA, SLE, sjogrens
Tx for Lyme disease
Yearly dilated eye exams are required when on this drug.
Pts with a G6PD deficiency can develop hymolytic anemia
Paclitaxel (Taxol)
Microtubule inhibitor. Anti-CA agent. Similar to colchicine, but colchicine is NEVER used for CA tx.
Benzonatate (Tessalon)
Local anesthetic used as an anti-tussive.
MOA - numbs stretch receptors in the bronchus and decreases cough reflex.
Minimum Alveolar Concentration (MAC)
Volume % concentration of an inhaled anesthetic which will cause 50% of experimental subjects to have paralytic immobility against painful stimulus. Ex: Isofluorane MAC = 1.15.
Malignant Hyperthermia
Rare sfx of anesthetic agents which causes pts’ muscles to contract and raise body temperature.
Antidote: Dantrolene.
Killed MJ?
Propofol (Diprivan), a general anesthetic.
Curare
A chemical Amazonian hunters coated darts in to induce a neuromuscular blockade. Synthesized into tubocurarine.
