Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
17 Cards in this Set
- Front
- Back
|
When is hormonal therapy used for prostate CA?
|
Stage III or IV prostate cancer
Palliative treatment Poor performance status Rising PSA in absence of CT findings |
|
|
Androgen deprivation therapy: methods?
|
Surgical or medical castration
Anti-androgens Combined Androgen Blockade = GnRH + anti-androgen agent |
|
|
What is the 'gold standard' for surgical androgen deprivation therapy?
|
Bilateral orchiectomy
|
|
|
Surgical ADT: advantages? disadvantages?
|
Immediate decrease in bone pain
Decreased compliance issues Hot flashes Fatigue/mood changes Osteoporosis Decreased muscle mass Erectile dysfunction |
|
|
What is the MOA of estrogen therapy for prostate cancer?
|
Negative feedback on hypothalamus, so decreases in GnRH/LH/testosterone
|
|
|
GnRH: name of analogues? secretion?
|
Goserelin, Leuprolide
Pulsatile |
|
|
GnRH analogues: clinical course
|
Initial surge in LH/FSH and testosterone
Because a continual release, will eventually have down-regulation of receptors in the pituitary |
|
|
What is Flare syndrome?
|
GnRH agonists cause increased LH, which causes increased testosterone, which can result in a prostate cancer flare.
|
|
|
What do you consider when worried about flare syndrome?
|
Location of disease - what would be the consequence of a flare?
|
|
|
How can you prevent the flare syndrome?
|
By using a Combined Androgen Blockade:
GnRH agonist + anti-androgen |
|
|
What 3 drugs are the anti-androgens?
|
Bicalutamide
Flutamide Nilutamide |
|
|
What is the MOA for anti-androgens?
|
Block androgen binding to receptor.
|
|
|
How do anti-androgens affect testosterone levels?
|
Normal to increased testosterone (so fewer side effects, decreased Flare)
|
|
|
Side effects of anti-androgen therapy
|
Short term: hot flashes, loss of libido, ED, gynecomastia, breast pain
Long term: metabolic syndrome |
|
|
Ketoconazole: MOA
|
Inhibits testicular and adrenal steroidogenesis
|
|
|
Ketoconazole: AEs
|
Pruritis
Nail deformities Addison's crisis (can add hydrocortisone) |
|
|
Ketoconazole: drug interactions
|
Metabolized through CYP 450 - discontinue coumadin and any statin therapy
|
