Therapeutics Exam 4

Front 1

phenoxybenzamine

Back 1

alpha androgen blocker for BPH- not used anymore due to hypotension and tachycardia

Front 2

prazosin

Back 2

alpha androgen blocker for BPH
multiple daily dosing
higher hypotension

Front 3

terazosin

Back 3

alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)

Front 4

doxazosin

Back 4

alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)

Front 5

alfuzosin

Back 5

alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
more selective, less ejaculatory dysfxn

Front 6

tamsulosin

Back 6

alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
-all have risk of floppy iris syndrome (if having cataract surgery)

Front 7

silodosin

Back 7

alpha androgen blocker for BPH
-pending fda approval

Front 8

finasteride

Back 8

alpha reductase inhibitor for BPH, reduces gland size
blocks DHT
-takes longer to work (6 months)
-reduces PSA but not free PSA
-ADRs ED, dec libido, gynecomastia

Front 9

dutasteride

Back 9

alpha reductase inhibitor for BPH, reduces gland size
blocks DHT
-takes longer to work (6 months)
-reduces PSA but not free PSA
-ADRs ED, dec libido, gynecomastia

Front 10

tolterodine

Back 10

anticholinergic for BPH
-treats irritative sxs (like urgency)

Front 11

leuprolide (BPH)

Back 11

GNRH agonist, blocks release of LHRH, reduced testosterone
-IM monthly or q3 mo
-NOT used anymore for BPH

Front 12

nafarelin

Back 12

GNRH agonist, blocks release of LHRH, reduced testosterone
-SQ daily
-NOT used anymore for BPH

Front 13

botox

Back 13

used for BPH
-intraprostatic
-reduces gland size

Front 14

PDE-5 inhibitors for prostate

Back 14

reduces IPSS score

Front 15

desmopressin

Back 15

for BPH
-decreases urine volume, nocturia (sleep better)
ADE HA, dizzy, low Na
-contra in >65yrs

Front 16

surgery for BPH

Back 16

for mod to severe BPH sxs
-for large prostates, hematuria, bladder stones, imp renal fxn, UTIs, severe urinary retention
-IRRITATIVE sxs not reduced
-complications: sexual dysfxn, urinary incontinence, retrograde ejaculation
-can also vaporize gland with less ADEs

Front 17

ADT

Back 17

androgen depletion therapy for prostate cancer
-only use if systemic
-slows PSA progression, but does not increase survival
-ADEs osteporosis, insulin resistance, increased fat distribution and lipids, lean muscle wasting, MI risk, periodontal disease

Front 18

hormone therapy

Back 18

for prostate cancer
-only lasts 2 years before progressing to hormone refractory disease

Front 19

orchiectomy

Back 19

remove testicles for pros cancer
-cause decreased libido, sexual impotence, hot flushes

Front 20

estrogens for prostate cancer

Back 20

reduce serum androgen levels like orchiectomy
-ADEs: CV, gynecomastia, HTN, edema, thromboembolism, liver tumors, N, V

Front 21

leuprolide (for cancer)

Back 21

LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis
-given monthly or yearly

Front 22

goserelin

Back 22

LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis

Front 23

triptorelin

Back 23

LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis

Front 24

ceterolix

Back 24

LHRH antagonist for cancer
-same effect as LHRH agonist
-less hot flushes

Front 25

ganirelix

Back 25

LHRH antagonist for cancer
-same effect as LHRH agonist
-less hot flushes

Front 26

cyproterone

Back 26

steroidal androgen receptor blocker for prostate cancer
-not used anymore due to liver toxicity and GI disturbances

Front 27

flutamide

Back 27

nonsteroidal androgen blocker for prostate cancer
-less GI and hepatic toxicity
-induces chemical castration except testosterone hot flush
-ADEs: gynecomastia, D, N, LFT abnorm, breast tenderness
-not as effective as LHRH agonists, used in combo

Front 28

biclutamide

Back 28

nonsteroidal androgen blocker for prostate cancer
-less GI and hepatic toxicity
-induces chemical castration except testosterone hot flush
-ADEs: gynecomastia, D, N, LFT abnorm, breast tenderness
-not as effective as LHRH agonists, used in combo

Front 29

nilutamide

Back 29

nonsteroidal androgen blocker for prostate cancer
-less GI and hepatic toxicity
-induces chemical castration except testosterone hot flush
-ADEs: gynecomastia, D, N, LFT abnorm, breast tenderness
-imp dark adaption, EtOH intolerance, interstitial pneumonitis
-not as effective as LHRH agonists, used in combo

Front 30

aminoglutethamide

Back 30

inhibits adrenal steroidogenesis by blocking P450 3A4 (blocks testosterone made by adrenal glands)
-give with corticosteroid to prevent adrenal insufficiency
-ADE skin rash, lethargy, N, V, impotence

Front 31

ketoconazole

Back 31

inhibits adrenal steroidogenesis by blocking P450 3A4 (blocks testosterone made by adrenal glands)
-give with corticosteroid to prevent adrenal insufficiency
-ADE impotence, pruritis, nail changes

Front 32

docetaxel

Back 32

systemic chemo (for androgen ind disease)
-used with prednisone or extramustine and suramin

Front 33

bone metastases

Back 33

strontium-89
bisphosphonates (pamidronate IV or zoledronic acid IV)
EBRT (external beam radiation)

Front 34

bone pain

Back 34

corticosteroids, narcotic analgesics, NSAIDs

Front 35

stage 1 treatment

Back 35

radical prostatectomy, cryotherapy, radiotherapy, or waiting

Front 36

stage 2 treatment

Back 36

prostatectomy, radiotherapy
-hormone therapy following radiation

Front 37

stage 3 treatment

Back 37

radiation with hormone therapy
-LHRH agonists equal to orchiectomy equal to diethylstilbestrol (estrogen) equal to nonsteroidal antiandrogens

Front 38

stage 4 treatment

Back 38

surgical or chemical castration
-LHRH agonists, antagonists, nonsteroidal antiandrogens, adrenal antagonists
-leuprolide equal to diethylstilbestrol but has better ADR profile (less DVT, N, V, gynecomastia)
-goserelin equal to orchiectomy
-biclutamide not as good as castration + diethylstilbestrol

Front 39

prostatectomy

Back 39

removal of gland, seminal vesicles, and bladder neck
-if PSA goes up 3 weeks after surgery, need radiotherapy
-ADEs: ED, urinary incontinence

Front 40

EBRT

Back 40

radiation
-ADEs: D, rectal irritation, dysuria, urinary freq

Front 41

brachytherapy

Back 41

radiation
-voiding difficulties, bowel function abnormalities, rectal bleeding

Front 42

medications causing ED

Back 42

anticholinergics, DA agonists, estrogens, antiandrogens, CNS depressants, diuretics, B blockers, sympatholytics

Front 43

sildenafil

Back 43

PDE-5 inhibitor
-also inhibits PDE-6, cuases blue color vision changes
-warning with alpha blockers (other two are contra)
-contra with nitrates
-other two have warnings for hepatic or renal imp- viagra does not

Front 44

vardenafil

Back 44

-warnings if hypotension, strong 3A4 inhibitors, priaprism, bleeding disorder, peptic ulcer, deformity of penis
-all can cause hearing loss (not permanent)
-all cuase vision loss (can be permanent- have to stop)

Front 45

tadalafil

Back 45

PDE-5 inh
-also causes PDE-11 inhibition, causes skeletal muscle ADEs (pain in back, butt)
-very long 1/2 life

Front 46

testosterone

Back 46

-normalizes in 6-8 weeks, some improvement in days
ADEs: Na retention, weight gain, HTN, increased erythropoiesis, increased stimulation of prostate tissue

Front 47

alprostadil

Back 47

for ED
prostaglandin E1
-increases cAMP, increased blood flow to penis
-injection into cavernosum or intraurethral as pellet
-ADEs: fibrosis, pain, priapism, pain, burning, itching to partner
-loss of efficacy over time

Front 48

apomorphine

Back 48

for ED
sublingual, causes N, V, HA, dizzy, sweating

Front 49

trazodone

Back 49

for ED
-not effective

Front 50

yohimbine

Back 50

for ED
-not effctive

Front 51

papaverine

Back 51

for ED
-not used much
-can cause hypotension, priapism, fibrosis

Front 52

phentolamine

Back 52

for ED
non selective alpha blocker
-reduces vascular tone
-not recommended

Front 53

bladder overactivity

Back 53

-have urgency and frequency
-large leakage and nocturnal incontinence

Front 54

urethral underactivity

Back 54

-sometimes urgency, rarely frequency
-caused by exercise, running, sneezing, etc
-have leakage during activity (small amt), less nocturnal incontinence

Front 55

oxybutinin

Back 55

anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc

Front 56

tolterodine

Back 56

anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc

Front 57

darifenacin

Back 57

anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc

Front 58

solifenacin

Back 58

anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc

Front 59

trospium

Back 59

anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc

Front 60

imipramine

Back 60

TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well

Front 61

doxepin

Back 61

TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well

Front 62

nortriptyline

Back 62

TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well

Front 63

desipramine

Back 63

TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well

Front 64

duloxetine

Back 64

SNRI for stress incontinence (coughing, sneezing, etc)
-may become 1st line

Front 65

pseudoephedrine

Back 65

alpha agonist for stress incontinence (sneezing, etc)
-first line therapy

Front 66

imipramine

Back 66

TCA for stress incontinence
-optional therapy

Front 67

bethanechol

Back 67

for overflow incontinence
-cholinergic drug
-increases activity and sensitivity of bladder
-ADEs drooling, spit, urination

Front 68

clonidine

Back 68

non-hormonal drug therapy for post-menopausual vasomotor sxs
-reduces vascular reactivity
-ADEs hypotension, dry mouth, drowsiness

Front 69

paroxetine

Back 69

non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH

Front 70

fluoxetine

Back 70

non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH
-inconsistent effect

Front 71

citalopram

Back 71

non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH

Front 72

venlafaxine

Back 72

non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH

Front 73

gabapentin

Back 73

non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs fatigue, dizzy

Front 74

black cohash

Back 74

non-hormonal drug therapy for post-menopausual vasomotor sxs
-estrogen receptor modifier
-causes hepatotoxicity

Front 75

vaginal candidiasis risk factors

Back 75

-broad spectrum antibiotics
-tight clothing
-impaired immune status
-contraception (IUD, sponge- d/t glycogen in vaginal secretions)
-diabetes (sugar)

Front 76

vaginal candidiasis tx

Back 76

-azole cream/suppository/oral
-nystatin can be used but not first choice (more resistance)
-if pregnant topical preferred
-tea tree oil can cause contact dermatitis, garlic, boric acid, lactobacillus (better for prevention)
-do not need to treat partner

Front 77

trichomonas vaginitis risks

Back 77

multiple sex partners

Front 78

trichomonas tx

Back 78

should treat partner
-metronidazole oral DOC
-same for pregnent women
-ADEs GI

Front 79

bacterial vaginosis risks

Back 79

-childbearing age, elevated pH in vagina (increased amine production)
-chemical irritation caused by overgrowth of bacteria

Front 80

bacterial vaginosis tx

Back 80

-dont need to treat partners
-metronidazole or clindamycin systemic or cream/gel
-for pregnant women- use systemic over topical
-oral or vaginal lactobacillus

Front 81

vaginal candidiasis presents as

Back 81

pseudohyphae, perivaginal itching, redness, dysuria, small satellite lesions, little discharge (if there is it is thick and cottage cheese-like)

Front 82

trichomonas presents as

Back 82

flagellated parasite
-50% asymptomatic
-dyuria, lower ab pain, itching
-strawberry spots
-lots of frothy white/green discharge, smells fishy

Front 83

BV presents as

Back 83

-clue cells, discharge (gray white/yellow), fishy

Front 84

human papillomavirus

Back 84

-soft, moist, clusters
-electrocauterization, laser, cryotherapy
-drugs often fail- podophyllin, podofilox, 5-fluorouracil, trichloroacetic acid, interferon inducers
-prevent with vaccine

Front 85

pelvic inflammatory disease risks

Back 85

-hx of PID
-vaginal douching
-IUD user
-multiple sex partners (OC and barrier methods decrease risk)
-can be caused by BV, STDs

Front 86

pelvic inflammatory disease tx

Back 86

cefotetan and doxycycline
ceftriaxone and doxycycline (plus/minus flagyl)
-levofloxacin/ofloxacin with or without flagyl
-treat sexual partners

Front 87

prochlorperazine

Back 87

phenothiazine used for N/V in pregnancy

Front 88

chlorpromazine

Back 88

phenothiazine used for N/V in pregnancy

Front 89

metoclopramide

Back 89

promotility agent used for N/V in pregnancy (accelerate gastric emptying)

Front 90

ondansetron

Back 90

serotonin antagonist used for N/V in pregnancy

Front 91

tx constipation in pregnancy

Back 91

-high fiber foods
-mild bulk laxatives
-avoid strong cathartics or enemas

Front 92

tx hemorrhoids in pregnancy

Back 92

-stool softeners, sitz baths, creams

Front 93

aspirin 60mg/day

Back 93

pregnancy induced HTN (PIH) prevention
-given weeks 24-28 until labor for high risk

Front 94

methyldopa

Back 94

DOC for PIH

Front 95

labetalol

Back 95

2nd choice for PIH
-may lower fetal weight

Front 96

atenolol

Back 96

2nd choice for PIH
-may lower fetal weight

Front 97

hydralazine

Back 97

used for PIH
-not monotherapy
-no ADEs

Front 98

convulsions in pregnancy

Back 98

magnesium sulfate IV
-want serum 4-7meg/L
-delays labor
-if toxicity give calcium
-can cause loss of deep tendon reflexes, hypocalcemia

Front 99

magnesium sulfate for preterm labor

Back 99

DOC
-tocolytic agent
ADEs: flushing, N, HA, GI, D, resp depression, loss of deep tendon reflex, hypotension
-fetal drowsines, depression, hypocalcemia

Front 100

terbutaline

Back 100

tocolytic agent- B2 agonist
-tremors, tachycardia, arrhythmia, chest pain are ADEs

Front 101

ritodrine

Back 101

tocolytic agent- B2 agonist
-tremors, tachycardia, arrhythmia, chest pain are ADEs

Front 102

indomethacin

Back 102

tocolytic agent- antiprostaglandin
-2nd line therapy
-ADEs: GI irritation, D, increased bleeding at delivery
-fetal pulmonary HTN (fetal ductus arteriosus closure)

Front 103

nifedipine

Back 103

tocolytic agent- CCB
-2nd line therapy
-ADEs: vasodilation, hypotension, tachycardia, N, HA
-no fetal effects

Front 104

sulindac

Back 104

tocolytic agent- antiprostaglandin
-2nd line therapy
-ADEs: GI irritation, D, increased bleeding at delivery
-fetal pulmonary HTN (fetal ductus arteriosus closure)

Front 105

betamethasone

Back 105

antenatal corticosteroids
-to speed fetal lung maturation
-best 7 days prior to delivery, but effective 24 hrs before
-given IM

Front 106

dinoprostone

Back 106

prostaglandin E2 to ripen cervix

Front 107

misoprostil

Back 107

-to ripen cervix (induce labor)
-not FDA approved, but may be more effective than dinoprstone

Front 108

oxytocin

Back 108

dilates cervix, stimulates uterine contractions (for induction of labor)
-given continuous IV infusion

Front 109

metoclopramide

Back 109

DA antagonist used to increase prolactin
-stimluate milk production