Therapeutics Exam 4 (Scott - Geriatric and Men's Health) Flashcards
(131 cards)
1
Q
Testosterone will decrease with _______
A
age
2
Q
Testosterone peaks around what age?
A
Early 20s
3
Q
6 Roles of Testosterone Surge/Puberty?
A
bone/muscle growth facial/body hair growth penis growth testicular growth spermatogenesis increase libido
4
Q
what is hypogonadism
A
incomplete/delayed sexual maturity
5
Q
what are some men’s health issues during puberty/young adulthood
A
delayed sexual maturity (hypogonadism)
testicular cancer
alopecia
6
Q
Types of testicular cancer?
A
Seminoma and Non-Seminoma
7
Q
Testicular cancer:
Good or bad prognosis?
A
good! even if at very far stages
8
Q
stages for testicular cancer vs stages for prostate
A
testicular: only stages I, II, and III
prostate: stages 1 - 4
9
Q
Treatment for testicular cancer?
A
Orchiectomy
Radiation
Chemo (Cisplatin, Etoposide, bleomycin)
10
Q
T or F:
Alopecia definition: Hair loss starting at the back or front of the head only
A
false!! hair loss at ANY part of the body and for any reason!!
11
Q
Types of alopecia?
A
androgenic alopecia alopecia areata alopecia universalis traction alopecia drug-induced alopecia
12
Q
how/why does androgenic alopecia happen
A
DHT causes hari follicles to shrink and thin = balding
13
Q
what is alopecia areata
A
autoimmune
small round patches
14
Q
what is alopecia universalis
A
complete hair loss on scalp/body
15
Q
what is traction alopecia
A
hair loss because of constant tension on hair by braids or buns
16
Q
what drugs can cause alopecia
A
anabolic steroids
cancer chemotherapy
17
Q
treatment options for alopecia
A
finasteride
minoxidil
(wigs and hair transplant)
18
Q
Finasteride for Alopecia:
Works by inhibiting _________ and inhibiting the conversion of ______
A
inhibits Type II 5 alpha reductase
inhibits conversion of testosterone to DHT
19
Q
Finasteride for Alopecia:
handling note about this drug?
A
women of child bearing age should avoid this because if too much exposure can affect a baby
20
Q
Finasteride for Alopecia:
typical side effects?
A
decreased libido
erectile dysfunction
decrease volume of ejaculate
21
Q
Minoxidil for Alopecia:
MOA?
can be used for what other disease?
A
MOA: enlarges miniature hair folicles
can be used in HTN
22
Q
Directions for using minoxidil
A
apply to scalp twice daily every day
apply to dry scalp and hair
23
Q
how long to you see results with minoxidil
A
4 months
24
Q
Risk factors for hypogonadism/hormonal deficiency
A
aging
chronic illnesses (diabetes, AIDS, RA, CKD)
long term use of corticosteroids
obesity
25
how to be diagnosed with hypogonadism
low testosterone levels WITH symptoms!! (must have both for diagnosis!!)
26
For Diagnosing hypogonadism:
| INITIAL blood test should be done what time of day and should measure what?
test in AM
| check TOTAL testosterone
27
For Diagnosing hypogonadism:
| A total testosterone level of _______ is positive for low testosterone
< 300 ng/dL
28
For Diagnosing hypogonadism:
after initial test you need a test to CONFIRM the diagnosis:
can check via ______ or ____ testosterone tests
total or free
29
For Diagnosing hypogonadism:
Testosterone binds to ______ therefore a ______ test should be done if you think the patient has suspected altered ____ concentrations
binds to SHBG; FREE testosterone test;
if altered SHBG
30
For Diagnosing hypogonadism:
| a free testosterone level of ______ confirms low testosterone
< 5 ng/dL
31
what does SHBG stand for
sex hormone binding globulin
32
Testosterone Replacement Products:
IM Injection -- inject how often?
possible side effect?
weekly or every other week
mood swings
33
Testosterone Replacement Products:
| which one is most similar to physiologic testosterone levels?
the patch
34
Testosterone Replacement Products:
| which ones are important to wash hands after use?
gel and solution.....
35
Contraindications to testosterone products?
```
prostate cancer
breast cancer
hematocrit > 50%
Baseline PSA greater than 4 ng/mL
Recent or poorly controlled CVD
```
36
Black box warnings for Testosterone products:
| Testosterone gel?
concerns with secondary exposure to children!!
| put gel in area that people wont touch and wash hands after use!!!
37
Black box warnings for Testosterone products:
| there is some cardiac risk with them -- which one is worse than others?
injection is worst!
38
Testosterone Replacement Products:
| For solution - put deodorant how in relation to it?
apply deodorant first!!
39
why are hematocrit levels/monitoring important with testosterone products
testosterone will increase RBCs
40
Goal testosterone levels with testosterone therapy?
400 - 700 ng/dL
41
For testosterone therapy monitoring:
| if hematocrit is > ____% then therapy should be stopped -- reinitiate when it drops to a safe level
54
42
ADEs of supraphysiologic doses of testrogens?
```
gynecomastia
decreased testicular size
weight gain
acne
mood alteration
hepatoxicity
```
43
what race is at higher risk of prostate cancer
african american
44
Prostate Cancer Facts:
| Most common cell type: _________
adenocarcinoma
45
Prostate Cancer Facts:
| Use ______ to rate tumor grade
gleason score
46
the prostate surrounds the _______
proximal uretha
47
prostate cancer growth is common after age ______
40
48
The prostate has hella _________ receptors
alpha adrenergic
49
_________ converts testosterone to DHT
type II 5 alpha reductase
50
_____________ is responsible for prostate enlargement and growth
Type II 5 alpha reductase
51
BPH Pathophys:
| Stimulation by ____ results in smooth muscle _____ with subsequent _____ of the urethra
by NE (norepinephrine)
muscle contractions
subsequent narrowing
52
BPH: Obstructive Symptoms?
aka symptoms that come from when there is so much pressure on the urethra it is blocked
- Decrease forced of stream
- Hesitancy to initiate voiding
- strain or push to urinate
- terminal dribbling
- intermittency (start and stop and start)
53
BPH: Irritative Symptoms?
```
Nocturia
Increased frequency
Urgency
Dysuria
Urge incontinence
decrease on QOL
```
54
Diagnosis of BPH done by?
clinical symptoms AND digital exam
measure flow rate/ measuring residual volume and AUA symptom score
55
Complications of BPH?
chronic renal failure
overflow urinary incontinence
recurrent UTIs
diminished quality of lide
56
AUA scores help guide treatment of ______
BPH (score is based on symptoms!)
57
Treating BPH is based on _____
severity AKA AUA score
58
AUA Scores and BPH thus treatment:
Mild: AUA < _______
Moderate: AUA ___ - ___
Severe: AUA > ____
< 7
8 - 19
20
59
For BPH Patients:
| Avoid drugs with strong _______ properties
anti-cholinergic drugs
60
what are drugs that are examples of anti-cholinergic drugs
antihistamines
TCAs
Scopolamine (Cogentin - benztropine; Artane)
Anti - muscarinics (Ditropan)
61
Non-Pharm therapy options for BPH?
restrict fluid, EtOH, and caffeine intake in PM
Avoid diuretics and nasal decongestants (bc alpha agonists)
use kegel exercises
62
Drug Therapy for mild BPH?
saw palmetto?
| relatively safe and may be anti-androgenic.....
63
Drug therapy for moderate BPH?
alpha blockers
hormone therapy
PDE inhibitors
64
MOA of alpha blockers for BPH?
alpha adrenergic blocker = relaxes smooth muscle tone and prostate gland and bladder neck ----- improves urine flow
65
Alpha adrenergic blockers:
| T or F: will NOT reduce the size of the prostate gland
true!!
66
Alpha adrenergic blockers:
| which one is the most effective?
not one specifically!
| they are equally clinical effectiveness
67
what drugs are alpha adrenergic blockers
```
terazosin
doxazosin
tamsulosin
alfuzosin
silodosin
```
68
which alpha adrenergic blockers need/should be taken at night and WHY
terazosin
doxasozin
why - because of first dose effect/orthostatic!
(the others are more selective for receptors in the urinary tract)
69
Tamsulosin:
| directions for taking?
swallow whole -- do not crush
| take 1/2 hour after same meal each day
70
Dosing Info:
Silodosin notes?
Alfuzosin notes?
Silodosin: take w/ meal
Alfuzosin: swallow whole; do not crush
71
ADEs of Alpha adrenergic blockers
```
dizziness
fatigue
(headache)
orthostatic hypotension
INTRA-OPERATIVE FLOPPY IRIS SYNDROME!
```
72
explain intra-operative floppy iris syndrome
seen during CATARACT surgery -- happens when patients are treated w/ alpha1blockers
makes surgery more complicated and increases risk of post op complications
(good to ask for first fill- you have cataracts surgery coming up? pts can stop it around time of surgery)
73
what hormonal therapy drugs can be used for BPH
finasteride
| dutasteride
74
BPH and Hormonal Therapy:
| ________ inhibitors will decrease ____ production
```
5 alpha reductase inhibitors
decrease DHT (dihydrotestoterone)
```
75
BPH and Hormonal Therapy:
| Men with a prostate > _____ benefit the most
> 40 grams
76
BPH and Hormonal Therapy:
| Onset of action may be as long as ______
6 months
77
Causes of Erectile Dysfunction?
```
Increasing Age
Diseases (DM, HTN, CAD, MS, Parkinsons)
Physical Injuries
Unhealthy lifestyle (obesity, EtOH, Smoking, Stress)
Fatigue
Drugs
```
78
What drug classes can cause sexual dysfunction?
antidepressants
antihypertensive agents
Estrogens/Anti-Androgens
Cancer Chemo
79
Anatomy and Pathophys of ED:
| Upon sexual stimulation, ______ is released which results in elevated levels of _____
nitrous oxide
| cGMP
80
Anatomy and Pathophys of ED:
cGMP = relaxation of _____ in penis
allows ______ blood to flood chambers
____ get squeezed shut = preventing draining of blood
relaxation of smooth muscles
allows arterial blood
veins get shut
81
____ is important penile health
O2
82
Treatment of ED: Step Wise Treatment
| steps 1 - 5?
```
1 - tx/eliminate known causes
2 - oral PDE-5 inhibitors
3- intraurethral or intracavernous tx
4 - possible combo therapy
5 - penile prosthesis
```
83
T or F: sexual stimulation is required when using PDE-5 inhibitors
true!!
84
what drugs are PDE- 5 inhibitors
sildenafil
vardenafil
tadalafil
avanafil
85
which PDE-5 inhibitor has a long half life
tadalafil (cialis) -- 36 hours
86
best to take PDE-5 inhibitors with or without food
without food!
| food delays absorption and then affect!
87
Drug interactions with PDE-5 inhibitors?
```
Cimetidine
Ketoconazole
erythromycin
ritonavir
grapefruit juice
(prolongs the effect of the drugs)
AND NITRATES
```
88
ADEs of PDE-5 inhibitors
```
headache
flushing
dyspepsia
nasal congestion
lower back/limb pain - tadalafil only
Light sensitivity / blue tinge to vision
NAION (sudden vision loss)
```
89
Dosing of Nitrates in relation to PDE-5 inhibitors?
Viagra/Levitra: 24 hours
| Cialis: 48 hours
90
Precautions with PDE-5 inhibitors?
pts w/ oral or transdermal nitrates
pts on alpha blockers
pts with v severe CAD
prolonged erections
91
take PDE-5 inhibitors when?
1 - 2 hours prior to intercourse
92
the vacuum erection device ---
avoid in what pts?
good for what pts?
avoid in SICKLE CELL pts
| good if pts cant take oral meds...
93
what drug is a transurethral suppository for ED
alprostadil
94
Alprostadil: Transurethral Suppository ---
More acceptable than injection but less effective than injection
onset within _______
ADEs?
onset w/in 5 - 10 minutes
| penile pain or burning
95
Steps for Alprostadil suppository Use?
(alprostadil pellets)
Urinate first
insert suppository
role penis for 10 - 30 seconds
96
max use of alprostadil?
2 doses/day
97
Alprostadil Injection:
may be best for ______ ED
onset within ______
best to vary _______
best for neurogenic ED
within 5 minutes
vary the site of injection
98
Alprostadil Injection:
| T or F: You do need sexual stimulation
false!! this does not (PDE5 inhibitors do!!!)
99
Alprostadil Injection:
Max # of injections per day
and
Max # of injections per week?
1 per day
| 3 per week
100
where does the alprostadil injection get injected...
corpora carvernosa
| not the top or underside!!
101
Alprostadil Injection:
Start at a ______ mcg dose
then titrate the dose til you get to an erection that lasts ______
2.5 mcg
want it to last til 1 hour
102
what is priapism
penis remains erect for hours in absence of stimulation or after stimulation has ended
103
possible causes of Priapism
drugs
sickle cell disease
pelvic tumors and infections
leukemias
104
What drug classes/ can cause priapism
ED drugs
Antidepressants (bupropion, trazadone, fluoxetine, sertraline, lithium)
Antipsychotics (clozapine, chlorpromazine)
Anticoagulants (heparin, warfarin)
Cocaine
Misc.... (prazosin, hydroxyzine)
105
T or F: EtOH will cause priapism
true
106
other than Alprostadil Injection, what are some other drugs used for intracavernosal injection?
papaverine
| phentolamine
107
how to treat priaprism
phenylephrine (to cause vasoconstriction)
blood aspiration
saline irrigation
108
T or F: penile prostheses is a good reversible option for current ED
false! not reversible!!
| also $$$$ af
109
Geriatrics:
| what medications increase risk of falls
```
sedatives/hypnotics
neuroleptics
antidepressants
benzos
opioids
loop diuretics
alpha-blockers
```
110
How/why do loop diuretics and alpha blockers increase risk of falls
they both can cause orthostatic hypotension!!
| counsel on about patients getting up and down too fast!
111
For Geriatrics: promote ______ prescribing
conservative
112
For Geriatrics: ideas behind conservative prescribing?
| minimize total number of ______ and ______
total # of meds and non-essential meds (will promote adherence to the essential meds, avoids duplication)
113
For Geriatrics: ideas behind conservative prescribing?
| Minimize use of drugs that have high potential for _____ or have impact on _____ or _____ status
adverse outcomes
| cognitive/functional status
114
For Geriatrics: ideas behind conservative prescribing?
| Optimize dosing based on _____ and ____ function
hepatic; renal
115
For Geriatrics: ideas behind conservative prescribing?
| Adjust doses to achieve _______ targets for chronic diseases
reasonable
116
For Geriatrics: ideas behind conservative prescribing?
| best for gradual reduction for ______ medications
CNS
117
what are some life sustaining treatments
```
ventilators
feeding tubes
dialysis
CPR
hospitalizations
```
118
what is an advanced care directive?
a living will...
| a legal document in which a person specifies what actions should be taken for their health
119
T or F: Palliative care is end of life care like hospice
FALSE (it is for terminally ill patients but not end of life)
120
definition of palliative care?
focusing on symptom control and not disease management (because patient is not responsive to curative treatment)
121
Hospice care = life expectancy is ____ months of less
| and must be certified by who?
6
| certified by a MD
122
what type of incontinence?
urethral blockage
bladder unable to empty properly
overflow
123
what type of incontinence?
relaxed pelvic floor
increased abdominal pressure
stress
124
what type of incontinence?
bladder oversensitivity from infection
neurologic disorder
urge
125
Non-pharm options for urinary incontinence?
```
abosrbent products
physical therapy
catheters
scheduled emptyings
kegels
stable fluid intake
avoid fluids that irritate the bladder (caffeine/carbonated beverages)
```
126
what type of incontinence?
high frequency
large volume
overactive bladder
urge
127
pharm treatment of urge incontienence
anticholinergics/antimuscarinics
128
Anticholinergics for the bladder: decrease contractions of _______
detrusor muscle
129
what type of incontinence?
| small volumes of urine loss with coughing, sneezing, running, or laughing
stress incontnence
130
how to treat overflow incontinence
treat obstruction
alpha adrenergic blockers (BPH)
kegel exercises
131
treatment for neurogenic (atonic) baldder
intermittent catherization
