Term
| ? is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse |
|
Definition
|
|
Term
| erictile dysfunction is sometimes referred to as ? although the NIHCDC says that it shouldn't; patients with erictile dysfunction may also develop ? which is an ejactulatory disorder but is not considered ED |
|
Definition
|
|
Term
| ED becomes incresingly frequent as men ?; few man report erection problems before the age of ?, but the percentage of men experiencing ED increases to 26% in men aged ? to ? years and 40% in men aged ? to ? years |
|
Definition
| age; 40; 50 to 59; 60 to 69 |
|
|
Term
| ? and ? nerves innervate the pens |
|
Definition
| sympathetic; parasympathetic |
|
|
Term
| in the flaccid state, ? adrenergic receptors mediate tonic contraction of the arterial and corporal smooth muscles; this maintains ? penile arterial resistance and a balance between blood flow into and out of the corpora |
|
Definition
|
|
Term
| A ? in sympathetic tone and an ? in parasympathetic activity occurs, causing a net ? in blood flow into the erictile tissue |
|
Definition
| decrease; increase; increase |
|
|
Term
| ED can be classified as ?, ? or a mixture of these |
|
Definition
|
|
Term
| ? dysfunction includes abnormalities in the three systems responsible for a normal erection or may be medication induced |
|
Definition
|
|
Term
| many of the risk factors for ED are the same as risk factors for ? disease |
|
Definition
|
|
Term
| in many patients, ? is the first indication of the endothelial dysfunction associated with cardiovascular disease |
|
Definition
|
|
Term
| the presence of ED risk factors leads to the assumption that the patient has ? dysfunction |
|
Definition
|
|
Term
| most commonly, medical conditions that impair ? flow into or out of the erictile tissue or affect the innervation will be stronly associated with ED |
|
Definition
|
|
Term
| patients with ? have exceptionally high rates of ED as a result of vascular disease and neuropathy |
|
Definition
|
|
Term
| a relationship has been found between low ? levels and an increased incidence of metabolic syndrome and type 2 diabetes |
|
Definition
|
|
Term
| ? dysfunction occurs if a patient does not respond to physchological arousal |
|
Definition
|
|
Term
| common causes of psychogenic ED are ? anxiety, ? relationships, lack of sexual ?, and overt psychiatric disorders such as depression and schizophrenia |
|
Definition
| performance, strained, arousability, depression, schizophrenia |
|
|
Term
| many patients may initially have ? dysfunction, but develop a ? component as they try to compe with their inability to achieve an erection |
|
Definition
|
|
Term
| normal penile erections are complex events that require the full function of the ?, ? and ? systems and anything that affects the function of these systems may lead to ED |
|
Definition
| vascular, neurologic, hormonal |
|
|
Term
| ED is not a life-threatening conditions, but left untreated it can be associated with ?, loss of ?, poor self image, and ? discord |
|
Definition
| depression, self - esteem, marital |
|
|
Term
| the primary goalf of therapy for patients with ED is achievement of ? sutiable for ? and improvement in patient quality of ? |
|
Definition
| erections; intercourse; life |
|
|
Term
| The ideal therapy for treatment of ED should have minimal ?, be ? to administer, have a ? onset of action, and few or no drug ? |
|
Definition
| side effects, easy, quick, interactions |
|
|
Term
| In additions to a physical exam, a thorough medical, social, and medication history with emphasis on ? disease must be taken before starting any treatment for ED to assess for ability to safely perform ? activity and assess for possible ? |
|
Definition
| cardiac; sexual; drug interactions |
|
|
Term
| the first thing you want to do in treating a patient with ED is to determine wheter the ED is ? or ? |
|
Definition
|
|
Term
| after determining wheter the patients ED is organic or psychogenic, the initial step in management is to identify associated disease states and lifestyle activities that adversely effect ? function and treat them optimally |
|
Definition
|
|
Term
| Medications suspected to cause or worsen ED should be ? if possible |
|
Definition
|
|
Term
| a wide range of treatment options is now available for men with ED and these include ? devices, ? treatments, ? modifications, ?, and ? |
|
Definition
| medical; pharmacologic, lifestyle, surgery, psychotherapy |
|
|
Term
| when determining the best treatment for an individual with ED, the role of the clinician is to inform the ? and his ? of all available options while understanding his medical history, desires, and goals |
|
Definition
|
|
Term
| usually treatment for ED begins with the least ? option and then treatment progresses to more invasive options if needed |
|
Definition
|
|
Term
| ultimately, the choice of ED treatment should be ?, taking into account patient and partner ?, concomitant ? states, response, ? route, cost tolerability and safety |
|
Definition
| individualized, preferences, disease states, administration |
|
|
Term
| ? should always be addressed in the management of ED |
|
Definition
|
|
Term
| lifestyle modifications associated with the treatment of ED include a healthy ?, ? in regular physical activity, and ? loss. All of which are associated with higher International Indec os Erectile Dysfunction (IIED) scores and an improvement in erectile function |
|
Definition
|
|
Term
| the clinician should recommend ? cessation, reduction in excessive ? intake, and discontinuation of ? drug use in the treatment of ED |
|
Definition
| smoking, alcohol, illicit |
|
|
Term
| pyschotherapy is an appropriate treatment approach for patients with ? or ? erectile dysfunction; if possible the patient's ? should attend these sessions |
|
Definition
| psychogenic; mixed; partner |
|
|
Term
| advantages of psycotherapy in the treatment of ED include ? and ? particitpation, while disadvantages include increased ? and ? commitment |
|
Definition
| noninvasiveness; partner; cost; time |
|
|
Term
| ? induce erections by creating a vacuum around the penis; the ? pressure draws blood into the penis by passively dilating the ? and engorging the ?; the erection is maintained with a constriction band placed at the ? of the penis to reduce ? outflow; these may be used as often as desired, but it is recommended that the constriction band not be left in place longer than ? minutes at a time |
|
Definition
| Vacuum Erection Devices (VEDs); negative; arteries; corpus cavernosa; based; venous; 30 |
|
|
Term
| VEDs have a success rate of greater than ?% in obtaining an erection sufficient for coitus and are considered a ? - line noninvasive therapy |
|
Definition
|
|
Term
| when using a VED, rigidity may be improved by using a ? pump technique in which the vacuum is applies for a couple of minutes, removed, then reapplied for other few minutes. Higer efficacy rates can also be achieved by combining VEDs with other therapies. |
|
Definition
|
|
Term
| the onset of action for VEDs is slow at around ? minutes, which limits ?; adverse effects of VEDs include the presence of a ?, ? , ? penis with a ? life feel as wells as ? ejaculations or inability to ? are also adverse effects |
|
Definition
| 30; spontaneity; cold, lifeless, discolored, hinge; painful, ejaculate |
|
|
Term
| VEDs are contrainidicated in patients with ? disease and should be used with caution in patients on oral ? or who have bleeding disorders due to the increased possibility of ? which is where the penis does not return to its flacid state |
|
Definition
| sickle cell; anticoagulant; priapism |
|
|
Term
| Penile ? are semi - rigid malleable or inflatable rods, which are inserted ? sugically into the corpus cavernosa to allow erections; the maleable rods are ? at all times, but may be bent into position by the patient when desired |
|
Definition
| prostheses; surgically; rigid |
|
|
Term
| becauses penile prostheses are the most ? treatment available, thay are only considered in patients who do not respond to ? or ? deviced, or those who have signivicant ? from other therapies |
|
Definition
| invasive; medications; external; adverse effects |
|
|
Term
| the primary risks associated with penile prostheses are th possibility of ? upon insertion, the rods may interfere with ?, are difficult to ?, and have a higher likelihood of erosion as most need replaced every 10 to 15 years |
|
Definition
| infection; urination; conceal; erosion |
|
|
Term
| ? (Viagra), ? (Cialis), and ? (Levitra) are phosphodiesterase 5 inhibitors |
|
Definition
| sildenafil, tadalafil, vardenafil |
|
|
Term
| Viagra, Cialis, and Levitra act by selectively inhibiting PDE type ?, which is an enzyme that breaks down ?. By inhibiting this breakdown, smooth muscle ? is induced, leading to an erection |
|
Definition
|
|
Term
| PDE inhibitors are only effective in the presence of ? stimulation to drive the ? system, making them facilitators of an erection, not initiators. |
|
Definition
|
|
Term
| Effectiveness of the three available PDE inhibitors are essentially ?, but differences exist in ? as well as incidence of ? and ? |
|
Definition
| comparable; duration of action; side effects; drug interactions |
|
|
Term
| the PDE inhibitors are considered ? line therapies due to high efficacy rates, convenience of dosing, and minimal severe adverse effects |
|
Definition
|
|
Term
| the most dramatic difference between the PDE inhibitors is ? extended duration of action earning it the nickname "the weekender drug" |
|
Definition
|
|
Term
| while sildnafil and vardenafil have half lives of ? to ? hours, tadalafil's half life is approximately ? hours |
|
Definition
|
|
Term
| the exteded half life of tadalafil allows for more ? sexual activity over a couple of days, but may ? the duration of adverse effects and likelihood of ? |
|
Definition
| spontaneous, increase, drug interactions |
|
|
Term
| ? has been approved for use as a ? medication at a lower dose of ? mg than the as needed dose |
|
Definition
| tadalafil; daily; 2.5 - 5 mg |
|
|
Term
| the most common side effects experienced with PDE inhibitors include what 7 side effects |
|
Definition
| headache, facial flushing, nasal congestion, dyspepsia, myalgia, back pain and rarely priapism |
|
|
Term
| vardenafil and sildenafil have been associated with difficulty distinguishing ? from ?, ? tones in vision, or difficulty seeing in dim light due to cross - reactivity with PDE ? in the retina |
|
Definition
| blue from green, bluish, 6 |
|
|
Term
| concern exists about the safety of ? sexual activity and using PDE inhibitors in patients with ? disease |
|
Definition
|
|
Term
| numerous adverse CV events were reported after the release of ? |
|
Definition
|
|
Term
| PDE inhibitors can lead to significant ? and patients taking organic ? are the most at risk, as these drugs potentiate a drop in bp |
|
Definition
|
|
Term
| PDE inhibitors are absolutely contraindicated in patients taking any form of ?, whether scheduled or sublingual for acute situations |
|
Definition
|
|
Term
| when givin PDE inhibitors, caution should also be taken in patients taking ? blockers due to an increased risk of hypotension |
|
Definition
|
|
Term
| the labeling of ? contains a precautionary statement about the possibility of QT prolongation with the use of the drug |
|
Definition
|
|
Term
| patients taking PDE inhibitors need to be aware that there is a need for ? to achieve an erection and that a single trial is not adequate; it is estimated that ? to ? attempts with a medication and specific dose may be needed before successful intercourse results |
|
Definition
| sexual stimulation; 6 to 8 |
|
|
Term
| alprostadil is a ? analog that induces an erection by stimulating ? which leads to an increase in smooth muscle ?, rapid ? inflow, and ? penile rigidity |
|
Definition
| prostaglandin E1, adenylyl cyclase; relaxation; arterial, increased |
|
|
Term
| alprostadil is available as an intracavernosal ? (Caverject or Edex) or a transurethral ? (MUSE), but the ? form is more effective |
|
Definition
| injection; suppository; injectable |
|
|
Term
| both forms of alprostadil are considered more ? than oral medications and VEDs and are considered ? line therapies |
|
Definition
|
|
Term
| alprostadil is the only FDA approved ? for ED |
|
Definition
|
|
Term
| intracavernosal injections are effective in up to ?% of patients, but side effects, lack of ?, and fear of ? limit their widespread us as first line therapy and therefore this therapy is most appropriate for patients in long term, stable relationships |
|
Definition
| 90%; spontaneity; needles |
|
|
Term
| intracavernosal injections should be used cautiously in patients with ? disease, those on ?, or those who have ? disorders, due to increased risk of priapism and bleeding |
|
Definition
| sickle cell; anticoagulants; bleeding |
|
|
Term
| ? and ? are non - FDA approved agents used for intracavernosal injection |
|
Definition
| Papaverine and phentolamine |
|
|
Term
| papaverine is a ? PDE inhibitor that induces erection by ? smooth muscle and ? blood flow |
|
Definition
| nonselective; relaxing; increasing |
|
|
Term
| phentolamine is a competitive ? adrenergic receptor antagonist that ? arterial inflow by opposing arterial constriction |
|
Definition
|
|
Term
| both papaverine and phentolamine are rarely used alone but are commonly used in combination with ? to increase effectivenss and reduce adverse effects because you will be using ? doses of each of the medications |
|
Definition
|
|
Term
| ? is an indole alkaloid produced in the bark of yohimbe trees |
|
Definition
|
|
Term
| yohimbine selectively inhibits ? adrenergic receptors in the brain that are associated with libido and penile erection |
|
Definition
|
|
Term
| ? is not a recommended treatment for any form of Ed because there are only limited data supporting its efficacy |
|
Definition
|
|
Term
| ? are important for general sexual function and libido, but ? supplementation is only effective in patients with documented low serum levels in the treatment of ED |
|
Definition
|
|
Term
| in patients with ?, testosterone replacement is the initial treatment of choice in patients with ED as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood |
|
Definition
|
|
Term
| testosterone replacement may not result in improvements of ED in all patients, and the initial trial should be for ? months. At that time, re-evaluation and additoin of another ED therapy is warranted |
|
Definition
|
|
Term
| ? esters of testosterone offer the most inexpensive replacement option. Testosterone ? and ? have the longest duration of action and are therefore the preferred agents |
|
Definition
| injectable; cypionate, enanthate |
|
|
Term
| testosterone injections are deep ? injections and have to be administered every ? to ? weeks |
|
Definition
|
|
Term
| testosterone patches and gells are administered ? |
|
Definition
|
|
Term
| the most common side effects of topical testosterone are ? reactions caused by the absoption enhancers |
|
Definition
|
|
Term
| although oral testosterone products are available, testosterone has ? oral bioavailability and undergoes extensive ? metabolism |
|
Definition
|
|
Term
| alkylated derivatives of testosterone such as ? and ? have been formulated to compensate for the poor bioavailability and strong first pass metabolism of oral testosterone, but this modification makes them considerably more ? and this effect makes oral replacement undesirable and this route of administration should not be used |
|
Definition
| methyltestosterone and fluoxymesterone; hepatotoxic |
|
|
Term
| before initiating testosterone, the patient should undergo evaluation for ? and ? cancer |
|
Definition
|
|
Term
| anemia is a reduction in the concentration of ? that results in a reduced ? carrying capacity of the blood |
|
Definition
|
|
Term
| initially, patients with anemia may be ? but eventually the lack of ? to the tissues could result in fatigue, lethargy, shortness of breath, headache, edema, and tachycardia |
|
Definition
|
|
Term
| common causes of anemia include ? loss, ? production of red blood cells, increased ? of RBCs, or some combination of these factors |
|
Definition
| blood; decreased; destruction |
|
|
Term
| determination of the ? of the anemia is essential for successful management; appropriate treatment of anemia will result in an increase in ? with a corresponding increase in ? carrying capacity and reduction in symptoms |
|
Definition
| underlying cause; hemoglobin; oxygen |
|
|
Term
| anemia is generally more common in ?, particularly during their ? years (ages 17-49) |
|
Definition
|
|
Term
| in patients over 65 years of age, anemia is significantly more common in what particular race |
|
Definition
|
|
Term
| anemia is especially more common in ? patients receiving chemotherapy and patients with chronic ? disease |
|
Definition
|
|
Term
| severe anemia is defined as HgB levels of ? g/dL or less |
|
Definition
|
|
Term
| the indidence of anemia in cancer patients varies based on ? type and level of ? of the chemotherapy regimen; severe anemia occurs about 75% of the time in patients who receive ? chemotherapy while severe anemia occurs less than 10% of the time in patients who receive common ? chemotherapy |
|
Definition
| tumore; myelosuppression; lymphoma; breast cancer |
|
|
Term
| chemotherapy induced anemia is most common in patients with ?, ? tumors, and ? tumors |
|
Definition
|
|
Term
| ? deficiencies such as iron, vitamin B12, and folic acid are common causes of decreased ? production but can be often easily treated |
|
Definition
|
|
Term
| patients with cancer as well as chronic kidney disease (CKD) are at risk for developing a ? anemia |
|
Definition
|
|
Term
| patients with chronic immune related diseases such as ? and ? can develop anemia as a complication of their disease |
|
Definition
| rheumatoid arthritis and systemic lupus erythematosus |
|
|
Term
| anemia related to chronic inflammatory conditions is typically termed ? |
|
Definition
| anemia of chronic disease |
|
|
Term
| ? is a process which starts with a pluripotent stem cell in the bone marrow that differentiates into and erythroid colony forming unit |
|
Definition
|
|
Term
| deficiencies in nutrients such as folic acid and vitamin B12 may hinder the process of ? maturation |
|
Definition
|
|
Term
| folic acid and vitamin B12 are required for the formation of ?; when these nutrients are decreased, DNA synthesis is ? and consequently ? maturation is also inhibited |
|
Definition
| DNA; inhibited; erythrocyte |
|
|
Term
| poor ? can be a contributor to deficiencies in folic acid and vitamin B12 |
|
Definition
|
|
Term
| patients with a condition called ? anemia are unable to absorb vitamin B12 via their GI tract due to a lack in a glycoprotein called ? |
|
Definition
| pernicious; intrinsic factor |
|
|
Term
| intrinsic factor binds to ? and facilitates its absorption in the ilieum; ? anemia results in vitamin B12 deficiency despite adequate dietary vitamin B 12 intake |
|
Definition
|
|
Term
| ? is essential in the formation of hemoglobin; lack of iron leas to a decrease in ? sythesis and ultimately ? |
|
Definition
|
|
Term
| ? anemia typicaly occurs because of either inadequate absorption of rion or excess ? loss |
|
Definition
|
|
Term
| inadequate absorption of iron may occur in patients who have congenital or acquired intestinal diseases, such as ? disease, ? disease, or ? |
|
Definition
| inflammatory bowel, celiac, bowel resection |
|
|
Term
| ? and diets poor in iron may also contribute to iron deficincy states and possible iron - deficiency anemia |
|
Definition
|
|
Term
| ? may cause destruction of highly proliferating stem cells, thereby decreasing the production of mature ? |
|
Definition
| chemotherapy; erythrocytes |
|
|
Term
| cancer can cause anemia via ?, prleacing normal bone marrow with ? cells, and releasing ? that lead to decreased EPO (erythropoietin) production |
|
Definition
| hemorrhage; malignant; cytokines |
|
|
Term
| patients with chronic kidney disease suffere from a decrease in ? production because it is produced mainly in the kidneys |
|
Definition
|
|
Term
| in patients with anemia of chornic disease, there is a blunted production and response to ? |
|
Definition
|
|
Term
| anemia of chornic disease also affects iron ?, causing iron sequestration into storage sites and ? the amount available to the rest of the body |
|
Definition
|
|
Term
| the goal of anemia therapy is to increase the ? level, which will improve red cell ? carrying capacity, alleviate ?, and prevent ? from anemia |
|
Definition
| hemoglobing; oxygen; symptoms; complications |
|
|
Term
| normal HbG values for males are ? to ? g/dL and for females normal HgB levels are ? to ? g/dL |
|
Definition
|
|
Term
| continuation of a patient's anemia therapy should be assessed primarily by ? of clinical signs and symptoms; patients who experience a resolution may not require ? therapy to maintain their Hgb levels with normal limits; ultimately, prevention of complications owing to anemia such as ? and ? can be avoid if Hgb levels are greater than ? g/dL |
|
Definition
| resolution; aggressive; hypoxia; cardiovascular sequalae; 7 |
|
|
Term
| the ? of anemia must determined and used to guide therapy |
|
Definition
|
|
Term
| the most important nonpharmacologic treatment of anemia is the ? of RBCs |
|
Definition
|
|
Term
| Negative aspects associated with transfusion of RBCs include, ?, ?, ? compications, and high ? of the procedure |
|
Definition
| infections, ummunosuppression, microciurculatory, cost |
|
|
Term
| usually only patients requiring ? corrections such as those with ? symptoms receive blood transfusions |
|
Definition
|
|
Term
| usually, symptomatic patients who present with Hgb concentration of ? to ? g/dL are candidates for transfusion |
|
Definition
|
|
Term
| other than transfusion, nonpharmacologic therapy plays a ? role in the management of anemia |
|
Definition
|
|
Term
| in the United States, nutrient poor diets are ? the sole cause of anemia in a patient; therefore, ingesting a diet rich in ?, ? or ? should be encouraged but it is rarely the sole modality of treatment |
|
Definition
| rarely; vitamin B12, iron, folic acid |
|
|
Term
| the initial treatment for iron deficiency anemia (IDA) is ? iron therapy with a goal of ? mg of elemental iron daily for those who are able to tolerate this route of administration |
|
Definition
|
|
Term
| iron supplementation resolves anemia by replacing ? stores in the body that are necessary for ? production and maturation; if treated properly, a response should be seen in ? to ? days, and Hgb values should rise by about ? g/dL per; patients should be reassessed if Hgb does not increase by ? g/Dl in 3 weeks |
|
Definition
|
|
Term
| dosing for iron should be divided equally into ? or ? doses daily; an empty stomach is preferred for maximal ? with the medication being taken ? hours before or ? hours after a meal |
|
Definition
|
|
Term
| after absorption, iron binds to ? in the plasma and is transported to the ? (for myoglobin) ? (for storage), or ? (for red cell production) |
|
Definition
| transferrin; muscle; liver; bone marrow |
|
|
Term
| iron is not actively ? from the body |
|
Definition
|
|
Term
| some studies suggest that iron aborption may be increased by adding ? to the drug regimen but this can increase the risk of ? side effects; patients who cannot tolerate iron on an empty stomach may take it with food, but iron absorption is ? when it is taken with food |
|
Definition
| vitamin C (ascorbic acid); GI; reduced |
|
|
Term
| side effects associated with oral iron therapy are mostly ? related and drug interactions may occur predominantly owing to iron - drug ?, resulting in decreased absorption of the interactig drug (exaples include ?, ?, and ?); to avoid this interaction, doses of iron and interacting drug should be separated by ? to ? hours |
|
Definition
| GI; binding; fluoroquinolones, tetracyclines, phenytoin; 2 to 4 |
|
|
Term
| ? iron therapy is appropriate in cases where patients are unable to tolerate or have not responded well to oral iron therapy |
|
Definition
|
|
Term
| parenteral iron therapy is currently available in ? different forms; ? was the first parenteral iron formulation to be approved, followed by ? and then ?; the last two are only approved by the FDA to treat anemia associated with ? in patients receiving ? but they are effective in treating IDA as well |
|
Definition
| 3; iron dextran; ferric glucontate; iron sucrose; CKD; EPO |
|
|
Term
| a test dose of iron dextran must be administered to patients who are abou to receive their first dose of iron dextran because of the risk of ? |
|
Definition
|
|
Term
| anemia from ? or ? deficiency is treated effectively by replacing the missing nutriet |
|
Definition
|
|
Term
| vitamin B12 and folic acid are both essential for ? production and maturation |
|
Definition
|
|
Term
| vitamin B12, or ?, administered both ? and ? is equally effective in treating anemia from vitamin B12 deficiency; however, use of ? cyanocobalamin is the most common meth of vitamin B12 replacement because it is completely absorbed when given this way whereas ? vitamin B12 is poorly absorbed via the GI tract |
|
Definition
| cyanocobalamin; parenterally; orally; parenteral; oral |
|
|
Term
| if parenteral cyanocobalamin is used initially, ? vitamin B12 can be used as maintenance therapy; typically the response to therapy is ? with Hgb levels increasing after a ? of therapy |
|
Definition
|
|
Term
| drug interactions between cyanocobalamin have been observed with ? and ? that decrease the oral absorption of vitamin B12 |
|
Definition
| omeprazole; ascorbic acid |
|
|
Term
| when treating folic acid deficiency, an initial daily dose of ? mg per day is typically effective however patients with malabsorption sydromes may require large doses up to ? mg per day |
|
Definition
|
|
Term
| just like with vitamin B12 replacement therapy, response to folic acid repalcement therapy is typically observed within ? of initiating therapy; Hgb will start to rise after ? weeks of therapy and may take from ? to ? months to resolve the deficiency completely |
|
Definition
|
|
Term
| folic acid has been reported to decrease ? levels by inducing its metabolism |
|
Definition
|
|
Term
| ? is a term given to those with underlying conditions that contribute to or cause anemia in a patient; these chronic diseases can include, ?, ? and other ? disorders |
|
Definition
| anemia of chronic disease; cancer; CKD; inflammatory |
|
|
Term
| in patients with anemia owing to cancer and CKD, therapy with ? or ? can increase Hgb, ? transfusion requirements, and improve quality of life, but this therapy has ? risks and monitoring requirements |
|
Definition
| epoetin; darbepoetin; decrease; safety |
|
|
Term
| epoetin and darbopoetin are ? |
|
Definition
| erythropoietin stimulating agents (ESA) |
|
|
Term
| darbopoetin differs from epoetin in thet it is ? and exhibits a ? half life in the body allowing for a ? dosing interval |
|
Definition
| glycosylated; longer; longer |
|
|
Term
| a number of clinical trials and recent meta analysis suggest that epoetin and darbepoetin may be ? to cancer patients due to the possibility of increased ? events, increased ? progression, or a combination of the two |
|
Definition
| detrimenta; thrombotic; tumor |
|
|
Term
| ESAs should only be used to prevent a ?, and should not be initiated unless the hemoglobin is less than or equal to ? g/dL; use of ESAs should not hava a ? intent |
|
Definition
| transfusion; 10; curative |
|
|
Term
| cancer patients may also have ? deficiency secondary to EPO use or to cancer; therefore, it is imperative that these patients have iron studies does to assess adequate iron stores needed to drive hematopoiesis |
|
Definition
|
|
Term
| patietns with CKD progress through ? stages of disease based on ? |
|
Definition
|
|
Term
| anemia is a common development in patients with CKD, and anemia evaluation and treatment should be initiated in patients with stage ? CKD which is when the GFR is less than ? mg/dl |
|
Definition
|
|
Term
| CKD anemia is typically a ?, ? anemia that is due to ? deficiency therfore therapy with ? and ? is effective in treating CKD anemia |
|
Definition
| normocytic; normochromic; EPO; epoetin; darbepoetin |
|
|
Term
| the epoetin and darbepoetin doses required for CKD anemia typically are ? than the doses need for anemia from cancer/chemotherapy and ? adiministration is the preferred route of administration |
|
Definition
|
|
Term
| in the treatment of patients with anemia due to CKD, epoetin doses should be increased by ?% if patients do not have an adequate response after 2 to 4 weeks of therapy and decreased by ?% if the absolute increase in Hgb is greater than 3 g/dL |
|
Definition
|
|
Term
| although ? deficiency is the primary cause of CKD anemia, ? deficiency is often present as well and it is essential to assess and monitor the CKD patient's iron status |
|
Definition
|
|
Term
| if ? stores are not properly maintained in patients with anemia caused by CKD, epoetin and darbepoetin will not be effective; iron therapy is generally given via ? administration as opposed to ? administration as this route is typically not effective especially in patients undergoing ? |
|
Definition
|
|
Term
| when treating patients who have anemia associated with chronic diseases other than cancer or CKD such as ? and ? the most important principle is to treat the ? disease |
|
Definition
| rheumatoid arthritis; systemic lupus erythematosus; underlying |
|
|
Term
| a ? g/dL titration is desirable in patients with IDA; reevalutae patients with an increase of less than ? g/dL in 3 weeks |
|
Definition
|
|
Term
| in patients with folic acid deficiency, ? may be normal and ? may be high |
|
Definition
| methylmalonic acid; homocysteine |
|
|
Term
| in patients with vitamin B 12 deficiency, methylmalonic acid and homocysteine levels may be ? |
|
Definition
|
|
Term
| do not exceed more than ? g/dL ever 2 weeks when using ESAs to increase Hgb |
|
Definition
|
|
Term
| when using ESAs, do not exceed Hgb of greater than ? g/dL in cancer patients because of an increased risk of death and adverse effects |
|
Definition
|
|
Term
| ? is defined as the complaint of involuntary leakage of urine |
|
Definition
|
|
Term
| urinary incontinence is often associated with other bothersome ? urinary tract symptoms such as ?, increased ? frequency, and ? |
|
Definition
| lower; urgency; daytime; nocturia |
|
|
Term
| the peak prevalence of urinary incontinence in females is around the age of ? which is approximately 50 years of age |
|
Definition
|
|
Term
| UI can result from abnormalities ? to and ? to the urinary tract |
|
Definition
|
|
Term
| within the urinary tract, abnormalities may occur in the ?, the ?, or a combination of both structures |
|
Definition
|
|
Term
| accurate diagnosis and ? of UI type is critical to the selection of appropriate drug therapy |
|
Definition
|
|
Term
| in ? urinary incontinence, the urethra and/or urethral spincters cannot generate enough resistance to impede urine flow from the bladder when intra-abdominal pressures are elevated |
|
Definition
|
|
Term
| intra-abdominal pressures are elevated by exertional activities such as ?, ? , ?, ?, and ?. |
|
Definition
| excercise, running, lifting, coughing, sneezing |
|
|
Term
| in stress urinary incontinence, the amount of urine lost is generally ? with each episode and ? and ? are rarely seen |
|
Definition
| small; nocturia; enuresis (bedwetting) |
|
|
Term
| the loss of tophic effects of ? on the uroepithelium at penopause is thought to be important in the urethral underactivity associated with stress urinary incontinence |
|
Definition
|
|
Term
| clearly established risk factors for stress urinary incontinence include ?, childbirth associated with ? delivery, ?, ? impairment, ? and ? age |
|
Definition
| pregnacy, vaginal, menopause, cognitive, obesity, increasing |
|
|
Term
| unless the sphincter mechanism is compromised by ? or ? stress urinary incontinence is exceedingly rare in males; the most common surgeries that would cause this are surgeries associated with the ? |
|
Definition
| surgery; trauma; prostate |
|
|
Term
| in urger urinary incontinence, the ? muscle is overactive and contracts inappropriately during the filling phase |
|
Definition
|
|
Term
| the amount of urine lost in UUI episodes can be as large as the entire contents of the ?; sleep may be interupted by ? and ? with UUI |
|
Definition
| bladder; enuresis; nocturia |
|
|
Term
| risk factors for UUI include ? age, ? disorders, ? outlet obstruction, ? and recurrent ? |
|
Definition
| increasing, neurologic, bladder, hysterectomy, urinary tract infections (UTIs) |
|
|
Term
| in ? urinary incontinence, an important but ? form of UI in both sexes, the bladder is filled to capacity at all times but cannot ?, causing urine to leak out episodically |
|
Definition
| overflow; uncommon; empty |
|
|
Term
| if OUI is caused by bladder ?, the ? muscle has weakened, in some cases enough to lose the ability to ? contract; in this case, the bladder cannot be ? completely and ? volumes of residual urine remain after ? (or urination) |
|
Definition
| underactivity; detrusor; voluntarily; emptied; large; micturition |
|
|
Term
| clinically, overflow urinary incontinence, is most commonly seen in the setting of long term chronic bladder outlet obstruction due to ? or ? prostate enlargement |
|
Definition
|
|
Term
| overflow urinary incontinence may also be a maifestation of ? bladder, frequently being seen in patients with ?, lower ? injuires, ?, or following ? surgery |
|
Definition
| neurogenic; diabetes; spinal cord; multiple sclerosis; pelvic |
|
|
Term
| if the OUI is caused by urethral ?, the resistance of the urethra and/or sphincters cannot be overcome by ? contractility which results in ? bladder emptying |
|
Definition
| overactivity; detrusor; incomplete |
|
|
Term
| functional urinary incontinence is not generally caused by ? urinary tract physiology as it is usually caused by factos ? to the urinary tract |
|
Definition
|
|
Term
| page 912 for predisposing factors for functional urinary incontinence (too many to make a flaschard out of) |
|
Definition
|
|
Term
| frequently, ? or more types of UI may coexist in a given patient, and this is called ? UI |
|
Definition
|
|
Term
| the presence of mixed UI leads to ? and ? difficulties due to the confusing array of presenting signs and symptoms and the opposing effect that a given treatment can have in differenty types of UI (a given drug may ? the signs and symptoms of one type of UI but ? those of other types) |
|
Definition
| diagnostic; therapeutic; reduce; worsen |
|
|
Term
| an interesting type of mixed UI is coexisting bladder ? (UUI) and impaired bladder ? (OUI); this is most common in the elderly, and is called ? |
|
Definition
| overactivity; contractility; detrusor hyperactivity with impaired contractility (DHIC) |
|
|
Term
| many medications can influence the ? urinary tract, including those not for managing genitourinary disorders, and can preceipitate the onset or aggravate existing voiding dysfunction and UI |
|
Definition
|
|
Term
| the clinical presentation of UI depends on the ? pathophysiology |
|
Definition
|
|
Term
| a complete ? and ? are essential to correctly classify the type(s) of UI present; it is important to assess the degree of ? of the patient due to the UI signs and symptoms |
|
Definition
| medical history; physical examination; annoyance |
|
|
Term
| components of the physical exam include an ? exam, ? evaluation, ? exam (in females), ? evaluation (in men), direct observation of the ? opening when patient coughs or strains, as well as a ? exam |
|
Definition
| abdominal; neurologic; pelvic; genital/prostate; urethral; perineal |
|
|
Term
| when treating UI, patient ? goals should be identified; this frequently requires reaching a ? between efficacy and tolerability of drug therapy; these goals are not static and may ? with time |
|
Definition
| specific; compromise; change |
|
|
Term
| at the primary care level, ? treatment of UI constitutes the chief approach to UI management; in patients in whom pharmacologic or surgical management is innappropriate or undesirable or refused, nonsurgical ? treament is the only option |
|
Definition
| nonpharmacologic; nonpharmacologic |
|
|
Term
| nonpharmacologic approaches in the treatment of urinary incontinence include ? modifications, scheduled ? regimens, ? floor muscle rehabilitation, ? devices, and ? interventions |
|
Definition
| lifestyle; voiding; pelvic; anit-incontinence; supportive |
|
|
Term
| ? treatment may be even better than ? treatment in some cases when it comes to treating certain forms of urinary incontinence |
|
Definition
| nonpharmacologic; pharmacologic |
|
|
Term
| nonpharmacologic treatment can allow the use of ? drug doses; the combination of both pharmacologic and nonpharmacologic therapies may have at least and ? effect on UI signs and symptoms |
|
Definition
|
|
Term
| good nonpharmacologic treatment of UI is the combination of ? and ? training |
|
Definition
|
|
Term
| ? is rarely a first line treatment for UI; surgery is generally considered only when the degree of boether or lifestyle compromise is sufficent and other nonoperative therapies are either undesired or have been less effective |
|
Definition
|
|
Term
| bladder ? can be fixed by surgery but bladder ? cannot so surgery is rarely considered as a treatment option for ? urinary incontinence |
|
Definition
| overactivity; underactivity; urge (UUI) |
|
|
Term
| surgery is the most effective in the management of ? urinary incontinence as it is directed at stabilizing the ? and or ? neck; in males, SUI is best treated by implanting an artificial urinary ? |
|
Definition
| stress; urethra; bladder; sphincter |
|
|
Term
| the ?/? drugs are the first line pharmacologic treatment for UUI; they are the most efffective agents in suppressing premature ? contractions, enhancing bladder ?, and relieving symptoms |
|
Definition
| anticholinergic/antispasmodic; detrusor; storage |
|
|
Term
| the major problem with existing anticholinergic agents used in the treatment of UUI is their lack of selectivity to bladder ? receptors, thus leading to ? limiting side effects outside of the urinary tract |
|
Definition
|
|
Term
| side effect related to the use of anticholingergic drugs are ? nervous system related (dry mouth, constipation, blurred vision, etc.) |
|
Definition
|
|
Term
| ? is the most problematic of the anticholinergic side effects and is frequently ? limiting |
|
Definition
|
|
Term
| which is better and more tolerable: tolterodine IR or oxybutynin IR |
|
Definition
|
|
Term
| oral ? formulations shold probably be preferred over ? and/or ? ones |
|
Definition
|
|
Term
| list the 6 recommended anticholingergic agens used in the treatment of UUI |
|
Definition
| oxybutynin, tolterodine, trospium chloride, solifenacin, darifenacin, fesoterodine |
|
|
Term
| patient characteristics such as age, comorbidities, concurrent drug therapies, and ability to adhere to the prescribed regimen can also influence ? therapy selection |
|
Definition
|
|
Term
| careful dose ? is necessary to maximize efficacy and tolerability; the selected agents should be titrated to the ? tolerated dose and maintained there for at least ? weeks in order to assure and adequate therapeutic trial; if therapeutic goals are not achieved, a switch to an alternative agent should be made |
|
Definition
|
|
Term
| there is no rationale for use of ? or more anticholinergics concurrently at ? doses |
|
Definition
|
|
Term
| women with UI (UUI plus SUI) or UUI plus atrophic vaginitis and/or urethritis may also benefit from the addition of a locally administerd ? to anticholinergic therapy |
|
Definition
|
|
Term
| it is generally felt that there is no role for ? therapy in SUI males resulting from surgery or trauma; however, there may be a possible role for ? added to nonpharmacologic treatment such as ? rather than PFMR alone |
|
Definition
| pharmacologic; duloxetine; PFMR |
|
|
Term
| ? in contrast to UUI is frequently curable by surgery, therefore these patients may not have to undergo years of drug therapy than may be inclompletely effective in symptom relief |
|
Definition
|
|
Term
| vaginally administerd ? plays only a modest role in managing SUI (urethral ?) unless it is accompanied by local sights of estrogen deficiency such as atopic ? or ? |
|
Definition
| estrogen; underactivity; vaginitis; urethritis |
|
|
Term
| it is thought that estrogens increase the number of as well as increase the sensitivity of ? adrenoreceptors |
|
Definition
|
|
Term
| if estrogens are to be used in SUI management, only ? administered products should be used |
|
Definition
|
|
Term
| there is support for the use of a variety of alpha adrenoreceptos agonists such as ?, ? and ? in the therapy of mild to moderate ? |
|
Definition
| phenylpropanolamine, pseudoephedrine; ephedrine; SUI |
|
|
Term
| ? was removed from the market in late 2000 due to the risk of ischemic ? in women; however it is still available on the ? so clinicians need to monitor and ? its use |
|
Definition
| phenylpropanolamine; stroke; internet; discourage |
|
|
Term
| although still available by prescription, ? is considerably more toxic than other alpha agonists and its use is not recommended |
|
Definition
|
|
Term
| there is really one one alpha agonist that should be used in the management of SUI and this is ? |
|
Definition
|
|
Term
| the major impediment to using alpha agonists is the extensive list of ? |
|
Definition
|
|
Term
| in the past, alpha agonist therapy was generally added to ? therapy in those insufficiently improved with estrogen alone and in whome its use was not ?; with the recent availability of ?, treatment is now available for estrogen non or hyporesponders whether they can or cannot take alpha agonists |
|
Definition
| estrogen; contraindicated; duloxetine |
|
|
Term
| ? is a selective serotonin-norepinephrine reuptake inhibitor similar pharacoloigally to ? |
|
Definition
|
|
Term
| the use of duloxetine for the treatment of SUI is ? label in the united states |
|
Definition
|
|
Term
| duloxetine ? central serotonergic and adrenergic tone which is involved in ascending and descending control of ? smooth muscle and the internaly ? sphincter |
|
Definition
| enhances; urethral; urinary |
|
|
Term
| the use of duloxetine in SUI is complicated by the potential for multiple clinically relevant drug-drug interactions with cyp ? and ? inhibitors, ? reactions if abruptly discontinued, high rates of ? and other side effects, ? contraindicating its uses in patients with any degree of hepatic impairment, and its mild ? effect |
|
Definition
| 1A2, 2D6; withdrawal; nausea; hepatotoxicity; hypertensive |
|
|
Term
| in overflow UI due to atonic bladder, a trial of ? may be reasonable if contraindications do not exist |
|
Definition
|
|
Term
| ? bladder means poor bladder contractility and this is seen in ? urinary incontinence |
|
Definition
|
|
Term
| the cholimomimetic effects of ? are not urospecific and its side effects are bothersome |
|
Definition
|
|
Term
| alpha adrenoreceptor ? such as prazosin, terazoxin, etc. may benefit OUI by ? the bladder outflow tract and hence reducing outflow resistance |
|
Definition
|
|
Term
| if pharmacologic therapy fails in the treatment of OUI, intermittent urethral ? by the patient or caregiver 3 to 4 times per day is recoemmended |
|
Definition
|
|
Term
| two etiologic factors for BPH include advanced patient ? and the stimulatory effect of ? |
|
Definition
|
|
Term
| ? inhibitors (such as ? and ?) directly interfere with one of the major etiologic factors of BPH |
|
Definition
| 5 alpha reductase; finasteride; dutasteride |
|
|
Term
| excessive stimulation of ? adrenergic receptors in smooth much of the prostate and uretrha results in smooth muscle ? |
|
Definition
|
|
Term
| patients with ? muscle instability will develop irritative ? symptoms such as urninary urgency and frequency |
|
Definition
|
|
Term
| detrusor muscle fibers are embedded with ? receptors therefore ? of these receptors may be particularly useful for controlling these symptoms |
|
Definition
|
|
Term
| androgens stimulate ? but not ? tissue hyperplasia therefore androgen antagonism does not induce a complete reduction in the prostate size to normal; this explains one of the limitations of the clinical effect of ? inhibitors |
|
Definition
| epithelial; stromal; 5 alpha reductase |
|
|
Term
| ? tissue is the primary focus of alpha 1 adrenergic receptors in the prostate |
|
Definition
|
|
Term
| of the alpha 1 receptors found in the prostate, 70% of them are of the ? subtype |
|
Definition
|
|
Term
| predictors of BPH disease progresion include an enlarged prostate of at least ? grams or PSA of at leas ? ng/ml |
|
Definition
|
|
Term
| for patients with moderate to severe BPH symptoms, the patient is usually offered ? treatment first. ? are preferred over ? because they have a faster onset of action and improve symptoms independent of prostate ? |
|
Definition
| drug; alpha antagonists; 5 alpha reductase inhibitors; size |
|
|
Term
| ? have a delayed onset of action and are seldom effective in patients with ? size prostate glands (less than 30 g) |
|
Definition
| 5 alpha reductase inhibitors; smaller |
|
|
Term
| for patients with complications of BPH disease, ? is indicated |
|
Definition
|
|
Term
| although it is potentially curative, surgery can result in significant morbidity, including ? dysfunction, ? ejaculation, urinary ?, ?, or ? infections |
|
Definition
| erectile, retrograde, incontinence, bleeding, urinary tract |
|
|
Term
| the gold standard for BPH surgery is a ? |
|
Definition
|
|
Term
| drug treatment is used in patients with severe disease when the patient refuses ? or when the patient is not a surgical candidate because of concomitant diseases |
|
Definition
|
|
Term
| it was found that selected patients with moderate to severe symptoms will benefit from the combination of a ? and ?; specificaly ? plus ? therapy is more effective that either given alone; combination therapy is more ? and produces more ? |
|
Definition
| alpha antagonist; 5 alpha reductase inhibitor; doxazosin; finasteride; expensive; adverse effects |
|
|
Term
| to reduce ? patients should be instructed to stop drinking fluids several ? before going to bed, and then ? before they go to sleep |
|
Definition
|
|
Term
| durging the day, patients with BPH should avoid excessive ? and ? intake, as these may cause urinary frequency |
|
Definition
|
|
Term
| patients with BPH should avoid taking OTC mediations that can worsen obstructive voiding symptoms such as ? and ? |
|
Definition
| antihistamines; nasal decongestants |
|
|
Term
| patients with BPH are also encouraged to lose ? because ? is converted to ? in fat tissue and this can cause an alteration in the testosteron: estrogen ratio similar to that which occurs in elderly men which may contribute to the development of BPH |
|
Definition
| weight; testosterone; estrogen |
|
|
Term
| ? reduce the dynamic factor causing BPH symptoms; these drugs cause ? of the bladder neck, prostatic urethra, and prostate smooth muscle |
|
Definition
| alpha antagonists; relaxation |
|
|
Term
| all alpha antagonists are considered ? effective in relieving symptoms assoicated with BPH |
|
Definition
|
|
Term
| the onset of action for alpha antagonists is ? to ? while the onset of action of 5 alpha reductase inhibitors can be up to ? months |
|
Definition
|
|
Term
| an adequate clinical trial of alpha antagonists is considered to be ? to ? weeks |
|
Definition
|
|
Term
| alpha antagonists are ? metabolized and therefore patients with significant ? dysfunction, should take the lowest dose possible; with the exception of ? these drugs do not require dosage modification in patients with renal dysfunction |
|
Definition
| hepatically; hepatic; silodosin |
|
|
Term
| alpha antagonists are recommended as ? line treatment for ? to ? BPH |
|
Definition
|
|
Term
| pharmacologic uroselectivity refers to preferential inhibition of ? and ? receptors which predominate in the prostatic stroma and bladder detrusor muscle respectively |
|
Definition
|
|
Term
| ? has a short plasma half life and requires multiple doses during the day which is inconvenient for the patient and therefore is not used in the treatment of BPH |
|
Definition
|
|
Term
| to minimize first dose syncope from terazosin and doxazosin immediate - release, a slow up titration rom a ? dose of 1 mg/day to a ? dose is essential |
|
Definition
| subtherapeutic; therapeutic |
|
|
Term
| the first dose of IR terazosin and doxazosin should be given at ? so that the patient can seelp through the peak serum concentration of the drug when the adverse effect is most likely to occur |
|
Definition
|
|
Term
| adverse effects associated with alpha antagonists include ?, ? disorders, ?, ? syndrome (most often with tamsulosin treated patients undergoing ? surgery) which is a relaxation of the iris dilator muscle, |
|
Definition
| hypotension, ejaculation; rhinitis; floppy iris; cataracts |
|
|
Term
| in patients who are susceptible to severe hypertension, which alpha antagonists is the drug of choice and what dose |
|
Definition
|
|
Term
| phosphodiesterase inhibitors (such as ?) can cause hypotension as well as the alpha antagonists used in the treatment of BPH so the patient should spread out the administration of these drugs by ? hours to minimize the likelihood of hypotensive events; patients who are taking alpha antagonists should also be causious in taking ? as well as ? |
|
Definition
| viagra etc,; 4; decongestants, antihistamines |
|
|
Term
| tamsulosin is more selective to ? receptors which are found mostly in the prostate and has little effect on ? receptors in the periphery |
|
Definition
|
|
Term
| in patients with ? and ? it is not recommended to use and alpha antagonist alone to treat both disorders |
|
Definition
|
|
Term
| ? reduce the static factor which results in shrinkage of an enlarged prostate; 5 alpha reductase is responible for the coversion of ? into ? which is what stimulates prostate tissue growth |
|
Definition
| 5 alpha reductase inhibitors; testosterone; dihydrotestosterone; |
|
|
Term
| most 5 alpha reductase located in the prostate is subtype ? as opposed to subtype ? |
|
Definition
|
|
Term
| because 5 alpha reductase inhibitors do not produce ? adverse effects, they are preferred for men with moderate to severe BPH who are at risk for developing complications of BPH; patient has an enlarged prostate of at least ? g and a PSA of greater than ? ng/mL |
|
Definition
|
|
Term
| unlike alpha antagonists, ? are used to prevent BPH related complications and disease progression |
|
Definition
| 5 alpha reductase inhibitors |
|
|
Term
| improvement with 5 alpha reductase inhibitors is ? than that seen with alpha antagonists |
|
Definition
|
|
Term
| no dosage adjustments are needed with 5 alpha reductase inhibitors in patients with ? or ? impairment |
|
Definition
|
|
Term
| adverse effects associated with 5 alpha reductase inhibitors include decreased ?, ? dysfunction, ? disorders, as well as ? tenderness |
|
Definition
| libido; erectile; ejaculatory; breast |
|
|
Term
| serum ? levels increaseby 10 to 20% in patients treated with 5 alpha reducatase inhibitors |
|
Definition
|
|
Term
| ? females should not handle 5 alpha reductase inhibitors as it could lead to ? of a male fetus |
|
Definition
|
|
Term
| ? is a selective type II 5 alpha reductase inhibitor while ? is a nonselective type I and type II 5 alpha reductase inhibitor; these two are considered therapeutically ? |
|
Definition
| finasteride; dutasteride; interchangeable |
|
|
Term
| a comnination of a ? and a ? may be considered in symptomatic patients at high risk for BPH complications (patients with an enlarged prostate of at least ? g adna PSA of at least ? ng/mL) |
|
Definition
| alpha antagonist; 5 alpha reductase inhibitor; 30; 1.5 |
|
|
Term
| instead of a 5 alpha reductase inhibitor, you can also ad an ? to an alpha antagonist in the treatment of BPH |
|
Definition
|
|
Term
| if a patient considers his symptoms as still bothersome, consideration should be given to modifying the patient's treatment regimen regardless of the improvement of the patient's ? score |
|
Definition
|
|
Term
| most of the adverse effects associated with alpha antagonists ? as treatment continues and they rarely merit ? of therapy |
|
Definition
|
|
Term
| 5 alpha reductase inhibitors will lower ? levels; if a patient initially responds well to drug therapy and then that same drug therapy fails, this is likely an indication of progressive BPH disease and ? intervention may be indicated |
|
Definition
|
|
Term
| osteoprorosis is most common in post ?, ? women; the most commmon sites for fracture are the ?, ? and ? |
|
Definition
| menopausal; caucasian; hip, wrist, spine |
|
|
Term
| osteoporosis can be defined as ? meaning it has no known cause or ? meaning it is caused by drugs or other diseases |
|
Definition
|
|
Term
| both men and women lose bone as they age but womein have excellerated bone loss surrounding menopause due to loss of ? |
|
Definition
|
|
Term
| the most common cause of drug induced osteoporosis is chronic ? use |
|
Definition
|
|
Term
| osteoporosis is defined as a T score of at least -? standard deviations from the mean; osteopenia is defined as a T score between -? and -? |
|
Definition
| -2.5; between -1 and -2.5 |
|
|
Term
| the primary goal of nonpharmacologic therapy in treating osteoporosis is to prevent ? |
|
Definition
|
|
Term
| dietary ? intake is important for achieving peak bone mass and maintaining bone density; adequate dietary intake of ? is essential for calcium absorption |
|
Definition
|
|
Term
| exercise can be beneficial in preventing ? fractures; ? excercise such as walking, jogging, dancing, and climbing stairs can help build and maintain bone strength; ? exercise and ? strengthening can help improve and maintain strenght, agility, and balance which can reduce ? |
|
Definition
| fragility ;weight - bearing; resistance; muscle |
|
|
Term
| another crucial step in avoiding fragility fractures is the prevention of ? |
|
Definition
|
|
Term
| the NOF recommends that all men and women over the age of ? be considered for pharmacologic treatment if they mmet any of the following criteria: history of ? or ? fracture, T score less than or equal to ? at femoral neck or spine, or osteopenia and at least a ?% 10 year probability of hip fracture or at least a ?% 10 year probability of major osteoporosis related fracture as determined by FRAX |
|
Definition
| 50; hip or vertebral; -2.5; 10%; 20% |
|
|
Term
| adequate ? and ? intake are essential for preventing and treating osteoporosis |
|
Definition
|
|
Term
| when calcium supply is insufficient, calcim is taken from bone stores to maintain ? calcium levels; calcium may also correct ? in elderly patients |
|
Definition
| serum; hyperparathyroidism |
|
|
Term
| the highest daily elemental calcium requirements of ? mg are recommended for postmenopausal women and elderly men over the age of 65 |
|
Definition
|
|
Term
| large amounts of calcium taken at once cannot be ?; supplement doses should be limited to ? to ? mg of elemental calcium per dose; calcium intake greater than ? mg/day should be avoided |
|
Definition
| absorbed; 500 to 600 mg; 2500 |
|
|
Term
| calcium ? should be taken with food to maximize absorption; elderly patients or patients taking ? or ? receptor antagonists may have difficult time absorbing calcium due to decreased stomach acid; better absorption may occur in this setting with calcium ? because an acidic environment is not needed for absorption |
|
Definition
| carbonate; PPIs; H2 receptor antagonists; citrate |
|
|
Term
| side effects assoicated with calcium are mainly ? related; calcium salts may reduce the absorption of ? as well as some antibiotics such as ? and ? |
|
Definition
| GI; iron; tetracycline; fluoroquinolones |
|
|
Term
| The NOF recommends a daily vitamin D intake of ? to ? mg for all men and women age 50 and older as it is crucial for ? absorption |
|
Definition
|
|
Term
| to avoid hypercalciuria and hypercalcemia, the maximum recommended dose of vitamin D for most patients is ? IU/day |
|
Definition
|
|
Term
| ? are first line therapy for osteoporosis due to establish efficacy in preventing hip and vertebral fractures; they are also the most commonly prescribed therapy for osteoporosis |
|
Definition
|
|
Term
| bisphosphonates decrease bone ? by binding to the bone matrix and inhibiting ? activity |
|
Definition
|
|
Term
| unlike the other bisphosphonates, ? has not shown to decrease the incidience of hip and nonverterbal fractures altough it has been shown to reduce vertebral fractures similar to the other drugs in this class |
|
Definition
|
|
Term
| it has been proven to be safe to take the bisphosphonates for ? periods of time and bone mineral density continues to improve even after bisphosphonate therapy is ? |
|
Definition
|
|
Term
| the most notable adverse effects associated with bisphosphonates are ? related |
|
Definition
|
|
Term
| adverse events associated with bisphosphonate therapy are commonly due to improper ? |
|
Definition
|
|
Term
| patients in clincal trials who were receivin IV bisphosphonate therapy such as ? experienced a higher rate of ? and an increase in serum ? |
|
Definition
| zoledronic acid; atrial fibrilation; creatinine |
|
|
Term
| oral bisphosphonates are ? absorbed and taking them in the presence of ? or ? can further reduce this absorption; once attached to the bone, bisphosphonates are released very ? and are not recommended in patients with ? insufficiency |
|
Definition
| poorly; food; calcium; slowly; renal |
|
|
Term
| oral bisphosphonates should be taken ? to ? minutes before the first meal after an overnight fast with ? to ? ounces of water; patients should remain ? and refrain from lying down for ? to ? minutes after administration; the tablets should be swallowed ? without chewing or crushing; administration should be with ? only; these drugs should not be taken with other medications |
|
Definition
| 30 to 60; 6 to 8; upright; 30 to 60; whole; water |
|
|
Term
| ? is a selective estrogen receptor modulator that has ? like activity on bones and ? metabolism and estrogen antagonist acitivity in ? and andometrium |
|
Definition
| raloxifene; estrogen; cholesterol; bresast |
|
|
Term
| selective estrogen receptor modulators (SERMs) such as ? reduce bone ? and decrease overall bone turnover |
|
Definition
|
|
Term
| related SERMs ? and ? have ? agonist and antagonist activity at various recepotrs and are limited to the treatment of ? cancer |
|
Definition
| tamoxifen; toremifene; partial; breast |
|
|
Term
| raloxifine has beneficial effects on ? profiles and has ? effects in breast tissue which is very positive as it reduces the likelihood of cancer |
|
Definition
|
|
Term
| adverse effects of raloxifene inclue ?, ? cramps, and increased risk of venous ? |
|
Definition
| hot flushes, leg, thromboembolism |
|
|
Term
| ? either alone or in combination with a ? as hormone replacement therapy has a long history as an effective treatment of osteoporosis |
|
Definition
|
|
Term
| ? is a naturally occurring mammalian hormone that plays a major role in regulation of calicium levels. It inhibits bone ? by binding to ? receptors and is therefore used in the treatment of osteoporosis; compatred to mammalian calcitonin, ? calictonin has high potency and an extended duration of action |
|
Definition
| calcitonin; resorption; osteoclast; salmon |
|
|
Term
| calcitonin salmon is available in ? and ? dosage from as it cannot be administered orally due to inactivation by ? fluids; the ? route is the preferred route of administration |
|
Definition
| injectable; intranasal; gastric; intranasal |
|
|
Term
| ? which is a recombinant human parathyroid hormone, is the first anabolic agent approved by the FDA for the treatment of osteoporosis and is generally reserved for patients with ? to ? osteoporosis; this drug differs from others in that it stimulates ? activity to form new bone when administered ? daily; this drug can actually stimulate ? activity |
|
Definition
| teriparatide; moderate to severe; osteoblast; once; osteoclast |
|
|
Term
| the black box warning for teriparatide says that the product should not be used in patients at increased risk for ?; teriparatide can also cause an ? hypotension |
|
Definition
| osteosarcoma; orthostatic |
|
|
Term
| the AACE does not recommend ? antiresoptive therapy for treating osteoporosis; a possibly good techniquie is squential therapy of ? and ? giving one for a year followd by the other forthe next year |
|
Definition
| combination; teriparatide; alendronate |
|
|
Term
| ? is a human monoclonal antibody that inhibits RANKL and this gives fully ? antiresoptive effects |
|
Definition
|
|
Term
| at this time, ? and ? are FDA approved for the treatment of osteoporosis in men with ? being the first line therapy |
|
Definition
| alendronate; teriparatide; alendronate |
|
|
Term
| glucocorticoids such as (?, ?, ? and ?) increase bone ? and inhibit bone ?; these promote bone resoption through ? calcium absorption from the GI tract and ? renal calcium excretion |
|
Definition
| hydrocortisone, prednisone, methylprednisolone, dexamethasone; resorption; formation; decreased; increased |
|
|
Term
| it is recommended that patients taking glucocorticoids should take ? mg of calcium and ? mg of vitamin D which is more than normal |
|
Definition
|
|
Term
| the ACR recommends ? therapy for all patients who are starting treatment with ? (prednisone ? mg or more daily that will continue for ? months or longer) |
|
Definition
| bisphosphonate; glucocorticoids; 5; 3 |
|
|
Term
| GI diseases can decrease the absorption of ? and ? leading to osteoporosis; patients who receive injectable zoledronic acid may experience ? like symptoms |
|
Definition
|
|
