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;
20 Cards in this Set
- Front
- Back
|
For which question are Sildenafil, Tadalafil, and Vardenafil the most likely the answer?
|
Best initial therapies for erectile dysfunction.
Sildenafil has also been approved for the treatment of pulmonary hypertension. |
|
|
How do Sildenafil, Tadalafil, and Vardenafil work?
|
These medications are phosphodiesterase inhibitors. They decrease vascular tone and increase flow into the penis by increasing local concentrations of NO.
|
|
|
What are the most common adverse effects of Sildenafil, Tadalafil, and Vardenafil?
|
Phosphodiesterase inhibitors can cause hypotension, headache, and facial flushing. They should not be used in combination with nitrates for patients who have coronary artery disease. Grapefruit juice can increase the levels of these medications because of its effect on inhibiting cytochrome P450
|
|
|
A 72 yo male comes to the office because of a delay in his ability to urinate. He has a decreased urinary stream, increased urinary frequency, and hesitancy. There is no burning pain when he urinates. Urinalysis is normal.
What is the best initial therapy for this patient? |
Best therapy for benign prostatic hypertrophy (BPH) is a combination of 5alpha-reductase inhibitors, such as finasteride, and peripheral alpha blockers, such as doxazosin, terazosin, prazosin, or tamsulosin.
|
|
|
A 72 yo male comes to the office because of a delay in his ability to urinate. He has a decreased urinary stream, increased urinary frequency, and hesitancy. There is no burning pain when he urinates. Urinalysis is normal.
How does the best initial therapy work? |
Finasteride blocks the production of dihydrotestosterone, which stimulates growth of the prostate.
Peripheral alpha blockers relax the internal urinary sphincter, opening the bladder neck, prostate capsule, and prostatic urethra. Prazosin, terazosin, doxazosin, and tamsulosin increase the volume in the urinary stream. |
|
|
A 72 yo male comes to the office because of a delay in his ability to urinate. He has a decreased urinary stream, increased urinary frequency, and hesitancy. There is no burning pain when he urinates. Urinalysis is normal.
What are the most common adverse effects of the best initial therapy? |
Peripheral alpha blockers can cause dizziness and orthostatic hypotension. Tamsulosin has the same therapeutic benefit with less incidence of hypotension.
|
|
|
A 72 yo male comes to the office because of a delay in his ability to urinate. He has a decreased urinary stream, increased urinary frequency, and hesitancy. There is no burning pain when he urinates. Urinalysis is normal.
What procedure would you try if the first therapy does not work? |
If medical therapy fails, the treatment of BPH is a transurethral resection of the prostate (TURP).
|
|
|
When are finasteride and dutasteride the most likely answers?
|
Finasteride and dutasteride are the best therapies for benign prostatic hypertrophy. They decrease the volume of the prostate and increase the volume of urinary flow. Finasteride is also approved to treat male-pattern hair loss.
|
|
|
How do finasteride and dutasteride work?
|
These medications inhibit 5alpha-reductase, which converts testosterone to dihydro-testosterone. DHT is the hormone responsible for the growth of the prostate as well as male-pattern hair loss.
|
|
|
What are the most common adverse effects of finasteride and dutasteride?
|
Finasteride and dutasteride have a very small effect of decreasing libido, decreasing the volume of ejaculate, and causing mild increase in the incidence of erectile dysfunction.
|
|
|
When is ezetimibe the most likely answer?
|
Ezetimibe is used to treat hyperlipidemia. It is added to an HMG-CoA reductase inhibitor if the LDL is not sufficiently controlled. The major advantage of ezetimibe is its limited adverse effects and tolerability.
|
|
|
What is ezetimibe's mechanism of action?
|
Ezetimibe inhibits absorption of cholesterol at the brush border. It blocks the sterol transporter.
|
|
|
What are the most common adverse effects of ezetimibe?
|
Ezetimibe causes diarrhea and abdominal pain because of its ability to block fat absorption.
|
|
|
A 54 yo female comes to the office for evaluation of the sudden over whelming urge to urinate and pain in her bladder. This happens frequently and results in incontinence. She has failed behavior modification for this problem.
What is the best initial therapy? |
The best therapies for overactive bladder incontinence is tolterodine, oxybutynin, trospium, darifenacin, or solifenacin. None of these medications has any clear therapeutic benefit over the others.
|
|
|
A 54 yo female comes to the office for evaluation of the sudden over whelming urge to urinate and pain in her bladder. This happens frequently and results in incontinence. She has failed behavior modification for this problem.
What is the mechanism of action of the best initial therapy? |
Tolterodine, Oxybutynin, Trospium, Darifenacin, and Solifenacin are muscarinic receptor antagonists and have a significant anticholinergic effect.
|
|
|
A 54 yo female comes to the office for evaluation of the sudden over whelming urge to urinate and pain in her bladder. This happens frequently and results in incontinence. She has failed behavior modification for this problem.
What are the most common adverse effects of therapy? |
Tolterodine, Oxybutynin, Trospium, Darifenacin, and Solifenacin are associated with dry mouth, dry eyes, and constipation secondary to their anticholinergic effects.
|
|
|
When is varenicline the answer and how does it work?
|
Varenicline is a therapy for smoking cessation. It is an adjunct therapy to behavioral modifications, nicotine replacement, and bupropion. It is most useful in people who have signs of nicotine withdrawal. It has greater efficacy than nicotine replacement therapies, such as patches and gum, and bupropion.
Varenicline is a nicotinic acetylcholine receptor partial agonist. It blocks nicotine from binding. |
|
|
What is bupropion?
|
Bupropion is an antidepressant that can also be used to help with smoking cessation.
|
|
|
How does bupropion work?
|
Bupropion inhibits the reuptake of norepinephrine and dopamine. It is an aromatic aminoketone that has amphetamine-like qualities.
|
|
|
What are bupropion's most common adverse effects?
|
Bupropion can cause hypertension, insomnia, and seizures but does not have adverse sexual effects as do the SSRIs. It is contraindicated for those with eating disorders because it can suppress appetite. It is also contraindicated for those with a seizure disorder and those using MAO inhibitors.
|
