ADVANCED PHARMACOLOGY NSG 533 2026
QUESTIONS AND ANSWERS | GRADED A+ |
GUARANTEED PASS!!
5 alpha reductase inhibitors
- answer-Management of moderate to severe BPH in patients with enlarged
prostate glands.
Management of patients who desire medical therapy but cannot tolerate alpha-1-
adrenergic antagonists and do not have predominately irritant symptoms or
concomitant erectile dysfunction (Symptoms are non-bothersome, so the delay in
onset would not interfere with Qol)
Reduce prostate size (and PSA) and thus outlet obstruction
Reverse / Slow disease progression
Decrease the risk of disease complications
Note: although dutasteride blocks both the Type I and Type II iso-enzymes of 5-
alpha reductase while finasteride only blocks Type II, there is not a clinically
significant difference in outcomes when either is used
Peak effect 6-12 months, effect is only durable as long as drug is continued
(prostate will return to pre-treatment size (or larger) when / if 5ARIs are
stoppedFinasteride & Dutasteride reduces, but does not stop the prostate from
producing PSA
If PSA fails to decline by 50% after 6-12 months or an increase of 0.3 ng/L or
more above the baseline nadir level, patient should be evaluated for prostate
cancer. May also indicate worsening condition or non-compliance with 5 a-
reductase inhibitors
A patient with type 1 diabetes reports taking propranolol for hypertension. What
concern does this information present for the provider?
- answer-A patient with Type 1 DM is insulin dependent for glucose control and at
high risk for hypoglycemic episodes. Propanolol causes prolonged hypoglycemic
episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a
new prescription for levothyroxine. Which statement by the patient indicates a
need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
,c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine."
- answer-D. Calcium may reduce levothyroxine absorption. Further education is
needed if the patient feels she can take half of a prescribed medication.
ADRs
- answer-(androgen insufficiency) decreased libido, impotence & ejaculatory
disorder, breast tenderness & enlargement
Alpha-blockers
- answer-fairly rapid onset (2-4 weeks) with relatively rapid symptom resolution ,
durable effect (years) with AUA symptom index (AUASI) improving 30-45%. No
effect on prostate size (PSA) or disease progression.
Relax smooth muscle in bladder neck, urethra & prostate(Blue dots indicate the
distribution of alpha receptors surrounding the bladder and prostate). It is clear
why these agents would provide rapid relief of symptoms
New second generation (alfuzosin) and third generation (tamsulosin and silodosin)
agents are preferred because of uroselectivity, no need for dose titration and
limited orthostasis
Alpha-blockers
- answer-Older agents also have an indication for hypertension and have more CV
ADRs (e.g. orthostasis, reflex tachycardia, etc).
e.g. terazosin. doxazosin
dose titration should follow the "start low, go slow" paradigm
Most guidelines advocate for the individual management of BPH and hypertension
Note that the ACC / AHA recommends that that for those with the comorbidities of
hypertension and BPH, each of those conditions should be treated independently
based on GDMT. For those with persistent HTN on maximized first line therapies,
alpha-blockers with vascular effects may provide benefit in terms of additional BP
lowering
Alprostadil - PgE1 analog administered by intracavernosal injection & intraurethral
inserts
- answer-Because PGs bypass many steps in the erectile cascade, they are quite
effective at producing an erection, even in cases where PDE5 inhibitors cannot do
so.
, Most invasive and low patient acceptance. Reserved as second or third line
treatment
Before initiating treatment for ED
- answer-a physical examination and thorough medical, social, and medication
histories with emphasis on cardiac disease must be taken to assess for ability to
safely perform sexual activity and to assess for possible drug interactions
Diagnosis should include PE (including a check for signs of hypogonadism),
medication review, Hx, and labs ( HbA1C, PSA, FLP, testosterone)
Beta-blockers role in therapy?
- answer-So .. beta blockers are used for Symptomatic relief of hyperthyroidism
until more definative therapy is instituted and thyroid levels retun to normal or near
normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher doses
(propranolol ONLY)
Small therapeutic effect in magnitude
thyrotoxicosis
BPH
- answer-BPH increases urethral resistance, resulting in compensatory changes in
bladder function. Obstruction-induced changes in detrusor function, including
smooth muscle hypertrophy, compounded by age-related changes in the
functioning of the bladder, lead to urinary frequency, urgency, and nocturia, the
most bothersome BPH-related complaints. Not all patients with LUTS have BPH
and not all men with BPH have LUTS.
BPH combination therapy
- answer-◦ a-blocker and PDE-5Is
For men with moderate symptoms of BPH and erectile dysfunction, treatment with
daily tadalafil (5 mg/day) alone or in combination with tamsulosin (0.4 mg/day)
can be considered
Addition of PDE-5Is to alpha blockers may improve lower urinary tract symptoms
◦PDE-5i and 5a-RIs
Addition of PDE-5i to 5a-RIs can offset erectile dysfunction commonly seen with
5a-RIs
QUESTIONS AND ANSWERS | GRADED A+ |
GUARANTEED PASS!!
5 alpha reductase inhibitors
- answer-Management of moderate to severe BPH in patients with enlarged
prostate glands.
Management of patients who desire medical therapy but cannot tolerate alpha-1-
adrenergic antagonists and do not have predominately irritant symptoms or
concomitant erectile dysfunction (Symptoms are non-bothersome, so the delay in
onset would not interfere with Qol)
Reduce prostate size (and PSA) and thus outlet obstruction
Reverse / Slow disease progression
Decrease the risk of disease complications
Note: although dutasteride blocks both the Type I and Type II iso-enzymes of 5-
alpha reductase while finasteride only blocks Type II, there is not a clinically
significant difference in outcomes when either is used
Peak effect 6-12 months, effect is only durable as long as drug is continued
(prostate will return to pre-treatment size (or larger) when / if 5ARIs are
stoppedFinasteride & Dutasteride reduces, but does not stop the prostate from
producing PSA
If PSA fails to decline by 50% after 6-12 months or an increase of 0.3 ng/L or
more above the baseline nadir level, patient should be evaluated for prostate
cancer. May also indicate worsening condition or non-compliance with 5 a-
reductase inhibitors
A patient with type 1 diabetes reports taking propranolol for hypertension. What
concern does this information present for the provider?
- answer-A patient with Type 1 DM is insulin dependent for glucose control and at
high risk for hypoglycemic episodes. Propanolol causes prolonged hypoglycemic
episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a
new prescription for levothyroxine. Which statement by the patient indicates a
need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
,c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of
levothyroxine."
- answer-D. Calcium may reduce levothyroxine absorption. Further education is
needed if the patient feels she can take half of a prescribed medication.
ADRs
- answer-(androgen insufficiency) decreased libido, impotence & ejaculatory
disorder, breast tenderness & enlargement
Alpha-blockers
- answer-fairly rapid onset (2-4 weeks) with relatively rapid symptom resolution ,
durable effect (years) with AUA symptom index (AUASI) improving 30-45%. No
effect on prostate size (PSA) or disease progression.
Relax smooth muscle in bladder neck, urethra & prostate(Blue dots indicate the
distribution of alpha receptors surrounding the bladder and prostate). It is clear
why these agents would provide rapid relief of symptoms
New second generation (alfuzosin) and third generation (tamsulosin and silodosin)
agents are preferred because of uroselectivity, no need for dose titration and
limited orthostasis
Alpha-blockers
- answer-Older agents also have an indication for hypertension and have more CV
ADRs (e.g. orthostasis, reflex tachycardia, etc).
e.g. terazosin. doxazosin
dose titration should follow the "start low, go slow" paradigm
Most guidelines advocate for the individual management of BPH and hypertension
Note that the ACC / AHA recommends that that for those with the comorbidities of
hypertension and BPH, each of those conditions should be treated independently
based on GDMT. For those with persistent HTN on maximized first line therapies,
alpha-blockers with vascular effects may provide benefit in terms of additional BP
lowering
Alprostadil - PgE1 analog administered by intracavernosal injection & intraurethral
inserts
- answer-Because PGs bypass many steps in the erectile cascade, they are quite
effective at producing an erection, even in cases where PDE5 inhibitors cannot do
so.
, Most invasive and low patient acceptance. Reserved as second or third line
treatment
Before initiating treatment for ED
- answer-a physical examination and thorough medical, social, and medication
histories with emphasis on cardiac disease must be taken to assess for ability to
safely perform sexual activity and to assess for possible drug interactions
Diagnosis should include PE (including a check for signs of hypogonadism),
medication review, Hx, and labs ( HbA1C, PSA, FLP, testosterone)
Beta-blockers role in therapy?
- answer-So .. beta blockers are used for Symptomatic relief of hyperthyroidism
until more definative therapy is instituted and thyroid levels retun to normal or near
normal..
Reduction of peripheral manifestations
Tachycardia, sweating, severe tremor, nervousness
Inhibition of peripheral conversion of thyroid hormones at higher doses
(propranolol ONLY)
Small therapeutic effect in magnitude
thyrotoxicosis
BPH
- answer-BPH increases urethral resistance, resulting in compensatory changes in
bladder function. Obstruction-induced changes in detrusor function, including
smooth muscle hypertrophy, compounded by age-related changes in the
functioning of the bladder, lead to urinary frequency, urgency, and nocturia, the
most bothersome BPH-related complaints. Not all patients with LUTS have BPH
and not all men with BPH have LUTS.
BPH combination therapy
- answer-◦ a-blocker and PDE-5Is
For men with moderate symptoms of BPH and erectile dysfunction, treatment with
daily tadalafil (5 mg/day) alone or in combination with tamsulosin (0.4 mg/day)
can be considered
Addition of PDE-5Is to alpha blockers may improve lower urinary tract symptoms
◦PDE-5i and 5a-RIs
Addition of PDE-5i to 5a-RIs can offset erectile dysfunction commonly seen with
5a-RIs
