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109 Cards in this Set

  • Front
  • Back
phenoxybenzamine
alpha androgen blocker for BPH- not used anymore due to hypotension and tachycardia
prazosin
alpha androgen blocker for BPH
multiple daily dosing
higher hypotension
terazosin
alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
doxazosin
alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
alfuzosin
alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
more selective, less ejaculatory dysfxn
tamsulosin
alpha androgen blocker for BPH
qd dosing, treats obstructive sxs (reduces muscle tone)
-all have risk of floppy iris syndrome (if having cataract surgery)
silodosin
alpha androgen blocker for BPH
-pending fda approval
finasteride
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
dutasteride
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
tolterodine
anticholinergic for BPH
-treats irritative sxs (like urgency)
leuprolide (BPH)
GNRH agonist, blocks release of LHRH, reduced testosterone
-IM monthly or q3 mo
-NOT used anymore for BPH
nafarelin
GNRH agonist, blocks release of LHRH, reduced testosterone
-SQ daily
-NOT used anymore for BPH
botox
used for BPH
-intraprostatic
-reduces gland size
PDE-5 inhibitors for prostate
reduces IPSS score
desmopressin
for BPH
-decreases urine volume, nocturia (sleep better)
ADE HA, dizzy, low Na
-contra in >65yrs
surgery for BPH
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
ADT
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
hormone therapy
for prostate cancer
-only lasts 2 years before progressing to hormone refractory disease
orchiectomy
remove testicles for pros cancer
-cause decreased libido, sexual impotence, hot flushes
estrogens for prostate cancer
reduce serum androgen levels like orchiectomy
-ADEs: CV, gynecomastia, HTN, edema, thromboembolism, liver tumors, N, V
leuprolide (for cancer)
LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis
-given monthly or yearly
goserelin
LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis
triptorelin
LHRH agonist (induce down regulation, decrease testosterone)
-can cause initial increase in testost, and hypercalcemia
-ADEs hot flushes, osteoporosis
ceterolix
LHRH antagonist for cancer
-same effect as LHRH agonist
-less hot flushes
ganirelix
LHRH antagonist for cancer
-same effect as LHRH agonist
-less hot flushes
cyproterone
steroidal androgen receptor blocker for prostate cancer
-not used anymore due to liver toxicity and GI disturbances
flutamide
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
biclutamide
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
nilutamide
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
aminoglutethamide
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
ketoconazole
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
docetaxel
systemic chemo (for androgen ind disease)
-used with prednisone or extramustine and suramin
bone metastases
strontium-89
bisphosphonates (pamidronate IV or zoledronic acid IV)
EBRT (external beam radiation)
bone pain
corticosteroids, narcotic analgesics, NSAIDs
stage 1 treatment
radical prostatectomy, cryotherapy, radiotherapy, or waiting
stage 2 treatment
prostatectomy, radiotherapy
-hormone therapy following radiation
stage 3 treatment
radiation with hormone therapy
-LHRH agonists equal to orchiectomy equal to diethylstilbestrol (estrogen) equal to nonsteroidal antiandrogens
stage 4 treatment
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
prostatectomy
removal of gland, seminal vesicles, and bladder neck
-if PSA goes up 3 weeks after surgery, need radiotherapy
-ADEs: ED, urinary incontinence
EBRT
radiation
-ADEs: D, rectal irritation, dysuria, urinary freq
brachytherapy
radiation
-voiding difficulties, bowel function abnormalities, rectal bleeding
medications causing ED
anticholinergics, DA agonists, estrogens, antiandrogens, CNS depressants, diuretics, B blockers, sympatholytics
sildenafil
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
vardenafil
-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)
tadalafil
PDE-5 inh
-also causes PDE-11 inhibition, causes skeletal muscle ADEs (pain in back, butt)
-very long 1/2 life
testosterone
-normalizes in 6-8 weeks, some improvement in days
ADEs: Na retention, weight gain, HTN, increased erythropoiesis, increased stimulation of prostate tissue
alprostadil
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
apomorphine
for ED
sublingual, causes N, V, HA, dizzy, sweating
trazodone
for ED
-not effective
yohimbine
for ED
-not effctive
papaverine
for ED
-not used much
-can cause hypotension, priapism, fibrosis
phentolamine
for ED
non selective alpha blocker
-reduces vascular tone
-not recommended
bladder overactivity
-have urgency and frequency
-large leakage and nocturnal incontinence
urethral underactivity
-sometimes urgency, rarely frequency
-caused by exercise, running, sneezing, etc
-have leakage during activity (small amt), less nocturnal incontinence
oxybutinin
anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc
tolterodine
anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc
darifenacin
anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc
solifenacin
anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc
trospium
anticholinergic for urge incontinence
-ADEs dry mouth, blurry vision, decreased urination, etc
imipramine
TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well
doxepin
TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well
nortriptyline
TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well
desipramine
TCA for urge incontinence
-not used much anymore
-unless patient has neuralgia or depression as well
duloxetine
SNRI for stress incontinence (coughing, sneezing, etc)
-may become 1st line
pseudoephedrine
alpha agonist for stress incontinence (sneezing, etc)
-first line therapy
imipramine
TCA for stress incontinence
-optional therapy
bethanechol
for overflow incontinence
-cholinergic drug
-increases activity and sensitivity of bladder
-ADEs drooling, spit, urination
clonidine
non-hormonal drug therapy for post-menopausual vasomotor sxs
-reduces vascular reactivity
-ADEs hypotension, dry mouth, drowsiness
paroxetine
non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH
fluoxetine
non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH
-inconsistent effect
citalopram
non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH
venlafaxine
non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs dry mouth, insomnia, sedation, C, decrease appetite
-increase serotonin, reduce LH
gabapentin
non-hormonal drug therapy for post-menopausual vasomotor sxs
-ADEs fatigue, dizzy
black cohash
non-hormonal drug therapy for post-menopausual vasomotor sxs
-estrogen receptor modifier
-causes hepatotoxicity
vaginal candidiasis risk factors
-broad spectrum antibiotics
-tight clothing
-impaired immune status
-contraception (IUD, sponge- d/t glycogen in vaginal secretions)
-diabetes (sugar)
vaginal candidiasis tx
-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
trichomonas vaginitis risks
multiple sex partners
trichomonas tx
should treat partner
-metronidazole oral DOC
-same for pregnent women
-ADEs GI
bacterial vaginosis risks
-childbearing age, elevated pH in vagina (increased amine production)
-chemical irritation caused by overgrowth of bacteria
bacterial vaginosis tx
-dont need to treat partners
-metronidazole or clindamycin systemic or cream/gel
-for pregnant women- use systemic over topical
-oral or vaginal lactobacillus
vaginal candidiasis presents as
pseudohyphae, perivaginal itching, redness, dysuria, small satellite lesions, little discharge (if there is it is thick and cottage cheese-like)
trichomonas presents as
flagellated parasite
-50% asymptomatic
-dyuria, lower ab pain, itching
-strawberry spots
-lots of frothy white/green discharge, smells fishy
BV presents as
-clue cells, discharge (gray white/yellow), fishy
human papillomavirus
-soft, moist, clusters
-electrocauterization, laser, cryotherapy
-drugs often fail- podophyllin, podofilox, 5-fluorouracil, trichloroacetic acid, interferon inducers
-prevent with vaccine
pelvic inflammatory disease risks
-hx of PID
-vaginal douching
-IUD user
-multiple sex partners (OC and barrier methods decrease risk)
-can be caused by BV, STDs
pelvic inflammatory disease tx
cefotetan and doxycycline
ceftriaxone and doxycycline (plus/minus flagyl)
-levofloxacin/ofloxacin with or without flagyl
-treat sexual partners
prochlorperazine
phenothiazine used for N/V in pregnancy
chlorpromazine
phenothiazine used for N/V in pregnancy
metoclopramide
promotility agent used for N/V in pregnancy (accelerate gastric emptying)
ondansetron
serotonin antagonist used for N/V in pregnancy
tx constipation in pregnancy
-high fiber foods
-mild bulk laxatives
-avoid strong cathartics or enemas
tx hemorrhoids in pregnancy
-stool softeners, sitz baths, creams
aspirin 60mg/day
pregnancy induced HTN (PIH) prevention
-given weeks 24-28 until labor for high risk
methyldopa
DOC for PIH
labetalol
2nd choice for PIH
-may lower fetal weight
atenolol
2nd choice for PIH
-may lower fetal weight
hydralazine
used for PIH
-not monotherapy
-no ADEs
convulsions in pregnancy
magnesium sulfate IV
-want serum 4-7meg/L
-delays labor
-if toxicity give calcium
-can cause loss of deep tendon reflexes, hypocalcemia
magnesium sulfate for preterm labor
DOC
-tocolytic agent
ADEs: flushing, N, HA, GI, D, resp depression, loss of deep tendon reflex, hypotension
-fetal drowsines, depression, hypocalcemia
terbutaline
tocolytic agent- B2 agonist
-tremors, tachycardia, arrhythmia, chest pain are ADEs
ritodrine
tocolytic agent- B2 agonist
-tremors, tachycardia, arrhythmia, chest pain are ADEs
indomethacin
tocolytic agent- antiprostaglandin
-2nd line therapy
-ADEs: GI irritation, D, increased bleeding at delivery
-fetal pulmonary HTN (fetal ductus arteriosus closure)
nifedipine
tocolytic agent- CCB
-2nd line therapy
-ADEs: vasodilation, hypotension, tachycardia, N, HA
-no fetal effects
sulindac
tocolytic agent- antiprostaglandin
-2nd line therapy
-ADEs: GI irritation, D, increased bleeding at delivery
-fetal pulmonary HTN (fetal ductus arteriosus closure)
betamethasone
antenatal corticosteroids
-to speed fetal lung maturation
-best 7 days prior to delivery, but effective 24 hrs before
-given IM
dinoprostone
prostaglandin E2 to ripen cervix
misoprostil
-to ripen cervix (induce labor)
-not FDA approved, but may be more effective than dinoprstone
oxytocin
dilates cervix, stimulates uterine contractions (for induction of labor)
-given continuous IV infusion
metoclopramide
DA antagonist used to increase prolactin
-stimluate milk production