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33 Cards in this Set

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Doxazosin, terazosin and alfuzosin
For symptomatic BPH relief.

MOA: Antagonists of alpha-1 adrenergic receptors.
- Relax prostate smooth muscle at bladder neck to allow urination
- Don’t shrink prostate size/don’t correct underlying problem
- Antagonize vascular a1 adrenergic receptors
- Must titrate dose to reduce side effects
- Adverse:
CV: syncope, orthostatic hypotension common
Nasal: congestion
Penis: impairs ejaculation
* Contraindicated in patients with angina or heart failure
What would you predict to be an effect of activating a1 adrenergic receptors?
Vasoconstriction
TAMSULOSIN and silodosin
Uroselective andrenergic antagonists.
- MAO: selective α1A antagonists – α1A is concentrated in prostate & penis
- Less α1B adrenergic affinity (in blood vessels) = Less hypotension, less vascular
- Less α1D affinity = less nasal congestion
- Ejaculation still possible problem
Silodosin - requires dose adjustment (renal or hepatic failure)
An elderly man with BPH needs relief; which best explains why tamulosin wouldn’t promote dizziness or syncope?
Doesn’t block a1b vascular receptors.
FINASTERIDE and dutasteride
MAO: Competitive enzyme inhibitors of 5α-reductase reduce dihydrotesterone (DHT) production
- DHT major androgen promoting prostate hyperplasia – for BPH treatment only
- Prototypical: finasteride, dutasteride
- Finasteride – selective inhibitor 5α-reductase II
- Dutasteride –non-selective inhibitor 5α-reductase used more severe BPH
- Adverse
Decrease serum PSA ; can mask cancer detection
Impotence/libido decreases in some patients
Rare– slight increase risk male breast cancer
Aminoglutethimide and Ketoconazole for Prostate Cancer:
FLUTAMIDE; androgen receptor antagonists:
Leuprolide and Goserelin
GnRH agonists:
- For prostate cancer
- Decreases LH/FSH release from pituitary
- Continuous administration decreases sex steroid production via negative feedback –takes weeks to shut down
- Given with androgen receptor antagonist
- Adverse: Impotence, hot flushes & bone loss can occur
- Patients often need biphosphate therapy to guard against osteoporosis.
Degarelix
GnRH antagonist:
- For prostate cancer
- Competitive antagonist at pituitary GnRH receptor
- Rapidly reduces gonadotropin & testosterone levels
- These patients often need biphosphate therapy to guard against osteoporosis
Blood flow in flaccid vs. erect penis:
Nitric oxide and cGMP mechanism of penile erection:
Steps to an erection:
Steps to detumescence:
Testosterone deficiency can cause?
1. Loss of libido
2. Fatigue
3. Erectile dysfunction

* When testing testosterone levels, evaluate morning and free testosterone.
Requirements for an erection:
Requirements for an erection:
Erectile dysfunction can be classified in what 3 ways?
1. Organic
- Problems with blood flow
- Medications
- Nerve damage
- Surgery
- Systemic diseases
- Lifestyle factors
2. Psychogenic
- Lack of interest
- Performance anxiety
- Stress
3. Mixed
Sildenafil, tadalafil (Viagra, Cialis); PDE5 inhibitors to treat impotence:
Direct vasodilators for impotence:
Treatment for premature ejaculation:
Fibrocystic and benign epithelial/proliferative changes:
- Most common disorder of the breast
- Most common cause of breast masses in women ages 25-50 years
- Clinical: lumpy breasts (bilateral usually) with midcycle tenderness
- Calcifications and densities on mammograms
- Pathogenesis: may related to increased activity or increased sensitivity to estrogen
- Nonproliferative versus proliferative
Characteristics of non-proliferative fibrocystic change in breast tissue:
Characteristics of non-proliferative fibrocystic change in breast tissue:
Characteristics of proliferative breast disease without atypia:
Sclerosing adenosis; a type of proliferative breast disease without atypia:
Characteristics of proliferative disease of the breast with atypia:
Characteristics of an intraductal papilloma:
Characteristics of fibroadenoma:
Over 95% of breast carcinomas are what type?
Adenocarcinomas
Characteristics of DCIS Comedocarcinoma type:
Characteristics of lobular carcinoma in situ:
Molecular classifications of breast cancers:
Characteristics of invasive lobular carcinoma: