Pharmacology Flashcards: Alpha Blockers, PDE-5 Inhibitors, Prostate Therapies, Contraception & Hormone Therapy

Flashcards cover selective and nonselective alpha blockers, PDE-5 inhibitors, 5-alpha reductase inhibitors, contraception methods, hormone therapy (estrogen/progestin), emergency contraception, and hormonal contraceptives' routes, MOA, uses, contraindications, and common brand names.

Which selective alpha blocker can be used for adults AND peds?

Tamsulosin (Flomax)

Which selective alpha blockers are C/I in patients with moderate and severe hepatic impairment?

Alfuzosin (Uroxatral) and Silodosin (Rapaflo)

Which selective alpha blocker must be taken after the same meal each day?

Alfuzosin (Uroxatral)

Are selective or nonselective alpha 1-blockers indicated for BPH AND HTN?

Nonselective: Terazosin (Hytrin) and doxazosin (Cardura)

Which alpha 1-blockers must be titrated slowly the first few days to avoid orthostatic hypotension or syncope?

Nonselective: Terazosin (Hytrin) and doxazosin (Cardura)

When should you take your 1 mg dose of nonselective alpha 1-blockers?

At bedtime

What drug class should a pt avoid if taking an alpha 1-blocker to avoid orthostatic hypotension or syncope?

PDE-5 inhibitors

What warnings and precautions are there for alpha 1-blockers?

Floppy iris syndrome, priapism, angina, and orthostatic hypotension/syncope

Which drug interactions are C/I in silodosin?

CYP3A4 inhibitors (KEGR)

Which 5 alpha reductase inhibitor can be taken with tamsulosin to form Jalyn?

Dutasteride (Avodart)

Which 5 alpha reductase inhibitor blocks only type 2 5 alpha reductase inhibitors?

Finasteride (Proscar)

Which 5 alpha reductase inhibitor blocks only type 1 AND 2 5 alpha reductase inhibitors?

Dutasteride (Avodart)

Which drug class is indicated for pts with symptomatic BPH AND enlarged prostate?

5 alpha reductase inhibitors

Before a pt is put on finasteride, what should you make sure the pt is not taking?

Propecia for hair loss

What is C/I in 5 alpha reductase inhibitors?

Women of child-bearing potential, pregnancy, and children

What significant drug interactions may increase levels of 5 alpha reductase inhibitors?

CYP3A4 inhibitors

What is the only PDE-5 inhibitor that can treat BPH?

Tadalafil

What increased risk is there when taking a PDE-5 inhibitor and alpha blocker in combo?

Hypotension and orthostasis

When should there be possible dose reductions when using PDE-5 inhibitors?

Elderly 65 yr or older, concurrent use of alpha-blocker, concurrent use of CYP3A4 inhibitor, or severe renal or liver dx

Which PDE-5 inhibitor has the longest half-life?

Tadalafil (Cialis), the weekend pill

Which PDE-5 inhibitor has the fastest onset and can be taken closest to sexual activity?

Avanafil (Stendra) - Acute

When taking PDE-5 inhibitors, what drug cannot be used concomitantly? Why?

Nitrates or riociguat – can significantly lower BP

PDE-5 inhibitors should be used with caution with what other medications?

Alpha-blockers and HTN medications

What does alcohol do when taking with PDE-5 inhibitor?

Increases risk of orthostasis and can contribute to ED

What PDE-5 inhibitors can have a delayed onset if taken with high fat or large meal?

Sildenafil (Viagra) and Vardenifil (Levitra)

What drug class is used as an alternative to PDE-5 inhibitors?

Alprostadil, a prostaglandin E1

What is the formulation of alprostadil?

Intracavernous injection or urethral pellets

Can male condoms be used with a female condom?

No

What is C/I in use of female condoms?

Patients with history of toxic shock syndrome

Which contraception barrier method requires a prescription and must be fitted for correct size (3 sizes available)?

Cervical cap

What contraception barrier method is C/I if a patient is allergic to latex or rubber?

Male condom or diaphragm w/ spermicide

What OTC contraceptive contains only progestin and should be take same time every day?

Opill

When should a patient use a non-hormonal method of contraception for the next 48 hours if a patient is on opill?

3 hours late of taking Opill OR vomiting/diarrhea occurs within 4 hours of taking opill

If a patient is on opill, when should a patient take a pregnancy test?

Missed two periods, missed a single period and missed doses of opill, or suspect they may be pregnant

What is the MOA of estrogen?

Binds to intracellular estrogen receptors (ER alpha and ER beta) → receptor-complex binds DNA → regulates transcription of estrogen-responsive genes

How is estrogen metabolized?

Primarily hepatic via CYP3A4

Which type of estrogen can be given PO, IM, vaginal, topical, or transdermal?

Estradiol

What are the therapeutic uses of estrogen?

HRT, contraception, menopausal symptom management, osteoporosis prevention, and certain cancer therapies

What is the MOA of progestin?

Binds to intracellular progesterone receptors PR-A and PR-B → receptor hormone complex binds DNA → regulates transcription of progesterone responsive genes

What are the therapeutic uses of progestin?

Contraception (alone or in combination with estrogen), prevention of endometrial hyperplasia in HRT, treatment of abnormal uterine bleeding, endometriosis, dysmenorrhea, luteal phase support in infertility

If a patient is allergic to polyurethane, what barrier method of contraception must be avoided?

Female condom

What barrier methods must be avoided in patients with history of toxic shock syndrome?

Female condom, diaphragm with spermicide, cervical cap, and a sponge

A patient with current UTIs should avoid what barrier methods?

Sponge and diaphragm with spermicide

A patient allergic to spermicide should avoid what barrier methods of contraception?

Diaphragm with spermicide, cervical cap, sponge, spermicide alone

Which types of progestin are used for contraception?

Levonorgestrel, desogestrel, drospirenone (Lover’s Doing the Dirty)

What type of progestin is used in hormone therapy in menopause?

Medroxyprogesterone acetate, micronized progesterone

What progestin is used to treat endometriosis or heavy menstrual bleeding?

Dienogest, norethindrone acetate, depot medroxyprogesterone

What progestin is used to treat cancer or appetite stimulation?

Megestrol acetate

When should a patient call 911 if a patient is on hormonal contraceptives?

ACHES = abdominal pain (severe), chest pain, severe headaches, severe eye problems, swelling or sudden leg pain

If a patient has 1 late or missed dose (< 48 hours since last dose) of COC, what should the patient do?

Take missed pill ASAP and next dose on schedule even if it makes 2 pills in one day. No backup concentration is required, and EC is not needed. CONSIDER if missed doses earlier in the same cycle or in week 3 of the previous cycle.

If a patient has 2 missed pills (> 48 hrs since last dose) of COC, what should the patient do?

Take the most recent missed pill ASAP and take next dose on schedule even if that makes 2 pills in 1 day; discard any other missed pills. Backup is REQUIRED for next 7 days. EC is considered in week 1 and week 2.

What oral contraceptive has risk of ectopic pregnancy with increased use and is less effective than COCs?

Progestin-only oral contraceptive

Which POP must be taken within 3 hours of the same each day? If missed > 3 hrs, use backup contraception for 48 hours?

Norethindrone 0.35 mg

What POP is mainly used for endometriosis and abnormal uterine bleeding?

Norethindrone acetate 5 mg

What POP is indicated for contraception, especially for breastfeeding women, estrogen-intolerant patients, or those w/ certain cardiovascular risks?

Norethindrone 0.35

Which POP has more flexibility if a patient missed a pill in a 24 hr window?

Drospirenone

What are the transdermal patches used in non-oral contraceptive options?

Ethinyl estradiol + Norelgestromin (Xulane, Zafemy) and ethinyl estradiol + levonorgestrel (Twirla)

Transdermal patches of non-oral contraceptives have less effectiveness in what special population?

Women who weigh > 198 pounds

What pts should avoid using transdermal patches of non-oral contraceptives?

Pts w/ clotting risk, pts > 35 y/o smokers, pts w/ cerebrovascular dx or past clots, and postpartum pts

How often do patients apply new transdermal patch for contraception?

Weekly for first 3 weeks; take off patch in week 4 and expect menses

If a transdermal patch has been off or partially off for less than 1 day, what should the pt do?

For less than 1 Day, try to reapply it; if the patch does not adhere completely, apply new patch immediately → NO BACKUP CONTRACEPTION IS NEEDED

If a transdermal patch has been off or partially off for more than 1 day/ if not sure how long, what should the pt do?

Apply new patch and start new 4-week cycle. Must use non-hormonal backup contraception for first week of new cycle

Which contraceptive transdermal patch is C/I in what special population? Why?

Women who have BMI 30 kg/m2 ≥ → reduced effectiveness, higher risk of VTE

How often is NuvaRing/EluRyng (etonogestrel and ethinyl estradiol) replaced?

Inserted intravaginally once a month; started on or before day 5 of menses; kept in place for 3 weeks and removed for 1 week

When should a backup contraception method be used if a patient uses a NuvaRing/EluRyng?

If the vaginal ring is expelled more than 3 hrs

Which vaginal ring is used for the entire year and is reusable?

Annovera (Segesterone/ethinyl estradiol)

How is Depo Provera administered?

Administered every 3 months subQ or IM within 5 days of onset of menstrual bleeding

What is a significant adverse effect of Depo Provera?

Can increase risk of bone fractures

What hormonal contraceptive should be considered for pt with acne?

COC w/ lower androgenic activity or no androgen activity (Yaz, Yasmin)

What hormonal contraceptive should be considered for breastfeeding pts?

POPs or nonhormonal

What hormonal contraceptive should be considered for pts with fluid retention/bloating?

Product containing drosperinone

What hormonal contraceptive should be considered for a pt with migraines WITH aura?

Progestin only or nonhormonal (if no aura use any method)

What is the best method used for emergency contraception?

Copper IUD

Name the 3 types of emergency contraception.

Copper IUD, Ella (ulipristal acetate), Levonorgestrel (Plan B One-step)

Which emergency contraception is OTC and must be taken ASAP (within 3 days)?

Levonorgestrel (Plan B)

What emergency contraception must be prescribed and taken ASAP (within 5 days)?

Ella (ulipristal acetate)

Ella can be less effective in what population? What about Plan B?

Ella is less effective in patients that weigh > 195 lbs; Plan B is less effective in patients that weigh over 165 lbs

Name the topical forms of 17 beta-estradiol for hormone therapy

Vaginal cream (Estrace), vaginal ring (Estring), vaginal tablet (Vagifem), and vaginal insert (Imvexxy)

Name brand names for the estradiol transdermal patches for hormone therapy.

Alora, Climara, and Vivelle-Dot