Pharm GU

Drugs to help Benign Prostatic Hyperplasia

-Nonselective Alpha 1 Adrenergic Antagonist -Selective Alpha 1 Adrenergic Antagonists -5alpha Reductase Inhibitors

Meds for Erectile Dysfunction

-PDE5 Inhibitors: considered first line therapy -increase cGMP levels; which leads to arterial vasodilation (which increases blood flow) Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Avanafil (Stendra) Adverse Effects: do not take with Nitrates (vasodilate); taken with caution with Alpha blockers; Priapism (erection last more than 4 hours) *can also use for BPH and Pulmonary Hypertension

Treatment Principles for BPH

-selective alpha 1 antagonists: recommended as first line agents for men without HTN -nonselective alpha 1 antagonists: recommended for men with HTN -5a Reductase Inhibitor: recommended to be used in combination with above agents

Sexual dysfunction in males is the inability to experience sexual desire, erection or ejaculation. Many drugs can cause sexual dysfunction. According to your textbook, which of the following drugs may lead to sexual dysfunction? Select all that apply

1. Certain antidepressant medications such as tricyclic and SSRI's. 2.Certain antihypertensive medications such as beta blockers and ACE Inhibitors 3. Certain recreational drugs such as alcohol, cannabis and opiates

Which of the following are true statements regarding the treatment of Benign Prostate Hyperplasia (BPH)? Select all that apply

1. PDE-5 Inhibitors such as tadalafil (Cialis) may be used in the treatment of BPH. 2. Alpha 1 Blockers may lead to a decrease in blood pressure. Patient should be advised to take this group of medications at bedtime. 3. Alpha 1 Adrenergic Blockers, such as Terazosin (Hytrin), are commonly used to treat BPH

Which of the following statements are accurate regarding Phosphodiesterase (PDE) Inhibitors. Select all that apply

1. The PDE Inhibitors interact with grapefruit juice. The patient should be instructed to avoid grapefruit juice when taking this medication. 2. The patient must be instructed that the duration of action of Viagra is approximately 4 hours, whereas the duration of action of Cialis is 24 to 36 hours. 3. PDE Inhibitors such as Viagra and Cialis should not be taken at the same time as Nitroglycerin and other nitrate medications.

If a woman does not have uterus what hormone therapy do they receive?

Estrogen

if a woman has a uterus what Hormone therapy do they receive?

Estrogen and Progestin

Hormone Therapy (HT) is discouraged in the long term treatment of menopausal symptoms because the hormones have been shown to lead to osteoporosis and bone fractures.

FALSE

Phosphodiesterase (PDE) Inhibitors are commonly used to treat erectile dysfunction because they are administered once monthly by intramuscular injection. They allow spontaneity of one's sexual activities

FALSE

Should Hormone Replacement Therapy be prescribed for long time use?

NO. should only be used for the treatment of menopausal symptoms at the lowest dose possible for the shortest duration possible

Erectile dysfunction in males occurs when not enough blood flows to the penis during sexual stimulation.

TRUE

In the treatment of menopausal symptoms, the FDA states that hormone therapy (HT) should be used at the lowest dose possible, for the shortest duration possible, usually less than 5 years.

TRUE

The male patient with an enlarged prostate should be instructed to avoid medications that can cause urinary retention such as decongestant medications.

TRUE

Complimentary and Alternative Medicine (CAM)

Valerian: to help insomnia St Johns Wort: to help with mild depression Black Cohosh: to help with hot flashes Soy: help with hot flashes Melatonin: help with insomnia Red Clover: help with hot flashes

Which one of the following statements is accurate related to hormone therapy for the post-menopausal woman?

Women with an intact uterus will be prescribed an estrogen-progesterone combination product, whereas estrogen (without progesterone) will be prescribed to women who have had a hysterctomy.

Gabapentin (Neurontin)

anti seizure agent

Clonidine (Catapres)

antihypertensive agent

Nonselective Alpha 1 Adrenergic Antagonist

block alpha adrenergic receptors, including arterioles -blocks prostate contraction; vasodilate arteries -commonly used to treat HTN; adverse effects: orthostatic hypotension and headaches *recommended for men with HTN Terazosin (Hytrin) Doxazosin (Cardura) Alfuzosin (Uroxatral)

Risks of Hormone Replacement Therapy

increase risk of: thromboembolic disease, CAD, CVD, endometrial cancer, breast cancer, ovarian cancer, dementia

SSRI and SNRI

reduce depression

5a Reductase Inhibitors

reduces the size of the prostate gland (may take 6-12 months to see improvement) -enzyme that is responsible for converting testosterone to dihydrotestosterone (responsible for the proliferation of the prostate cells) Finasteride (Proscar) Dutasteride (Avodart)

Benefits of Hormone Replacement Therapy

relief of hot flashes, decrease in urogenital atrophy, prevention of osteoporosis, improved quality of life, prevention of colorectal cancer

Selective Alpha 1 Adrenergic Antagonist

selective for just Alpha1 receptors on prostate gland; have little effect on blood vessels or pressure *recommended as first line agents for men without HTN Tamsulosin (Flomax) Silodosin (Rapaflo)