GU Exam 3 Brand/Generic

Leuprolide

-Lupron

Leuprolide depot

Lupron Depot

Leurplide intradermal implant

Viadur

Triptorelin depot

Trelstar Depot

Triptorelin

Trelstar LA

Goserelin subcutaneous implant

Zoladex

Leuprolide drug class

Luteinizing hormone-releasing hormone agonist

Degarelix

Firmagon

Ralugolix

Orgovyx

Degarelix and ralugolix drug class

Gonadotropin-Releasing Hormone Antagonists

1st generation antiandrogens

-Flutamide

-Bicalutamide

-Nilutamide

Flutamide

Eulexin

Bicalutamide

Casodex

Nilutamide

Nilandron

2nd generation antiandrogens

-Apalutamide

-Enzalutamide

-Darolutamide

Apalutamide brand name

Erleada

Enzalutamide brand name

Xtandi

Darolutamide

Nubeqa

Abiraterone acetate

Zytiga and Yonsa

Abiraterone acetate MOA

-inhibits synthesis of androgens

-but not technically an antiandrogen

Preventative Medications for Prostate Cancer

-finasteride

-dutasteride

Finasteride brand name

-Proscar

-Propecia

Dutasteride brand name

Avodart

Finasteride and dutasteride drug class

5-alpha reductase inhibitors

Acute Tx for prostatitis

-trimethoprim-sulfamethoxazole

-Ciprofloxacin

-Levofloxacin

-Cephalosporins

-Augmentin and other beta-lactam-beta-lactamase inhibitor combos

trimethoprim-sulfamethoxazole brand name

-Bactrim

-Septra

Ciprofloxacin

-Cipro

Levofloxacin

Levaquin

Augmentin

amoxicillin/potassium clavulanate

Chronic TX for prostatitis

-Trimethoprim

-Fluoroquinolones

Treatments for male pattern baldness

-topical minoxidil

-oral finasteride

-surgical treatment (hair transplantation)

-low-level laser therapy (LLT)

-Platelet-rich plasma (PRP)

-topical DHT blockers (ketoconazole shampoo)

Minoxidil brand name

Rogaine

Minoxidil MOA

vasodilator, prolongs anagen phase

Minoxidil dosage form

foam/solution

Ketoconazole brand name

Nizoral

Ketoconazole MOA

anti-androgen

Treatments for female pattern

-topical minoxidil

-Spironolactone

-low-level laser therapy (LLT)

-topical ketoconazole (shampoo)

-Platelet-Rich Plasma (PRP)

-Nutritional and Complementary Care

-Surgical Tx (Hair Transplantation)

Spironolactone brand name

Aldactone, CaroSpir

Spironolactone MOA/drug class

-Competitive inhibition for aldosterone receptors in distal tubules, leading to increased excretion of fluid and sodium with increased potassium retention

-Potassium-Sparing Diuretic

First-line treatment for Alopecia Areata

intralesional corticosteroids (ILI)

intralesional corticosteroids (ILI) MOA

anti-inflammatory: induces follicle stem cell recovery

Systemic interventions for alopecia areata

-systemic corticosteroids

Targeted Advanced Therapies for alopecia areata

JAK Inhibitors

JAK Inhibitors MOA

blocks signaling critical for hair health follicle destruction

JAK Inhibitors medications

-Baricitinib

-Ritlecitinib

-Deuruxolitinib

FDA-Approved Patient Population for baricitinib

adults and adolescents aged 12 years and older with severe AA

FDA-Approved Patient Population for ritlecitinib

adults and adolescents aged 12 yeras and older with severe AA

FDA-Approved Patient Population for deuruxolitinib

adults with severe AA

Which JAK inhibitors are taken QD?

-Baricitinib

-Ritlecitinib

Which JAK Inhibitor is taken BID?

Deurruxolitinib

Baricitinib brand name

Olumiant

Ritlecitinib brand name

Litfulo

Deurruxolitinib brand name

Leqselvi

Other Tx options for alopecia areata

-topical steroids & immunotherapy

-oral immunomodulators

Oral immunomodulators for alopecia areata

-Methotrexate

-Cyclosporine

Methotrexate brand name

Trexall, Rheumatrex

Cyclosporine brand name

-Sandimmune (old)

-Neoral (new)

-Gengraf (new)

Medications that pts with BPH should avoid:

-testosterone replacement regimens (for hypogonadism), anabolic steroids: DHEA (dihydroepiandosterone), androstenedione

-alpha-adrenergic agonists (ex: oral or intranasal decongestants), pseudoephedrine, ephedrine, phenylephrine

-diuretics

-drugs with significant anticholinergics AE (antihistamines, phenothiazines, TCA's anticholinergic drugs)

Non-pharm therapy for BPH

-watchful waiting

-annual monitoring (DRE, AUA, PSA)

-Lifestyle changes

-Surgery

What are the 5 criteria for a pt to be referred to a urologist with BPH?

-refractory retention

-UTI

-Hematuria (blood in urine)

-Bladder stones

-Renal Insufficiency

Pharmacologic therapy

-alpha 1-adrenergic receptor antagonists

-5-alpha-reductase inhibitors

-phosphodiesterase inhibitors

-anticholinergic agents

-B3-adrenergic receptor agonist

Alpha 1-adrenergic receptor antagonists first generation

-Phenoxybenzamine

Phenoxybenzamine brand name

Dibenzyline

Alpha 1-adrenergic receptor antagonists second generation

-terazosin

-doxazosin

Doxazosin brand name

Cardura

What is the dosage form for all alpha-1-adrenergic receptor antagonists?

-all are capsules except doxazosin is tablets

terazosin brand name

Hytrin

Alpha 1-adrenergic receptor antagonists third generation

-tamsulosin

-alfuzosin

-silodosin

Tamsulosin brand name

Flomax

Alfuzosin brand name

Uroxatral

Silodosin brand name

Rapaflo

The third generation alpha-1-adrenergic receptor antagonists are ___selective

uroselective

When should you take a 3rd generation alpha-1 adrenergic receptor antagonist?

take 30 minutes after the same meal each day

What is the first line treatment for moderate uncomplicated BPH or for immediate symptom relief not needed and patients are not sx candidates

5alpha-reductase inhibitors

Why are 5 alpha reductase inhibitors not used as first line treatment in mild BPH?

In mild BPH the prostate is not enlarged enough for 5 alpha reductase inhibitors to show effects

What drugs are 5 alpha-reductase inhibitors?

-finasteride

-dutasteride

Finasteride brand name

Proscar

Dutasteride brand name

Avodart

What is the MOA of 5alpha reductase inhibitors?

DHT is predominant androgen in the prostate; important regulator of growth

Dutasteride inhibits which 5 alpha reductase subtypes?

Type I and II

Finasteride inhibits which 5 alpha reductase subtypes?

Type II only

Who should not handle crushed tablets of finasteride?

pregnant women

If someone has ED and BPH which medication is approved for Tx of both diseases?

Tadalafil

tadalafil brand name

Cialis

Tadalafil drug class

PDE5 inhibitor

Anticholinergic agents for BPH

-darifenacin

-fesoterodine

-oxybutynin

-solifenacin

-tolterodine

-trospium

Darifenacin brand name

Enablex

fesoterodine brand name

Toviaz

oxybutynin brand name

Ditropan

solifenacin brand name

Vesicare

tolterodine brand name

Detrol

trospium brand name

Sanctura

Beta-3-adrenergic receptor agonist for BPH

mirabegron

mirabegron brand name

Myrbetriq

Myrbetriq inhibits which CYP enzyme?

2D6

Herbals used for BPH (not really recommended)

-Saw palmetto berry (Serenoa repens)

Saw palmetto brand name

Permixon

Surgical intervention for BPH (gold standard)

TURP (transurethral resection of the prostate)

Which medications can cause ED?

-anticholinergic agents (antihistamines, antiparkinsonian agents, TCAs, phenothiazines)

-Dopamine antagonists (metoclopramide, phenothiazine)

-Estrogens or drugs with Anti-androgenic Effects (LHrH super agonists, digoxin, spironolactone, ketoconazole, cimetidine)

-CNS depressants (barbiturates, narcotics, benzodiazepines, short-term use of large doses of alcohol, anticonvulsants)

-agents that decrease penile blood flow (diuretics, BB, central sympatholytics (methyldopa, clonidine, guanethidine)

-Miscellaneous (methadone, lithium carbonate, gemfibrozil, interferon, clofibrate, MAOIs, opiates)

First line treatment of ED

Non-Pharm:

-psychosexual counseling

-vacuum constriction devices (VED vacuum erection device)