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Discussion Starter · #1 ·
69 year old patient with prostatic carcinoma has been started on flutamide monotherapy. Recently his blood testosterone level started to increase. You decided to add another drug to minimize the level of peripheral testosterone.
Which of the following drugs you will be starting?

  • a- Anastrazole
  • b- Ketokanazole
  • c- Spironolactone
  • d- Finastride
  • e- Nafaralin
  • f- Metyrapone
  • g- Mifepristone
 

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69 year old patient with prostatic carcinoma has been started on flutamide monotherapy. Recently his blood testosterone level started to increase. You decided to add another drug to minimize the level of peripheral testosterone.
Which of the following drugs you will be starting?

  • a- Anastrazole
  • b- Ketokanazole
  • c- Spironolactone
  • d- Finastride
  • e- Nafaralin
  • f- Metyrapone
  • g- Mifepristone
finasetride told me answer
 

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Discussion Starter · #6 ·
The Correct Answer

When you give flutamide (which is an androgen receptor blocker) you will after some time inhibit the negative feedback that Testosterone has on the pituitary ----> Increased LH ----->Leydig cell stimulation ----> Increased gonadal Testosterone secretion.
To offset this effect you can give a GnRH analog (continuously not pulsatile) to block the pituitary release of LH.
Examples of GnRH analogs are: Nafaralin, Gosereline, Leuprolide, Histrelin, and Buserelin.
The correct answer is E :D
 

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When you give flutamide (which is an androgen receptor blocker) you will after some time inhibit the negative feedback that Testosterone has on the pituitary ----> Increased LH ----->Leydig cell stimulation ----> Increased gonadal Testosterone secretion.

The correct answer is E :D
I agree that this is theoretically correct, but I think that clinically the use of flutamide + GnRH analog is as effective as GnRH analog alone. And the combination is only used at the beginning of the treatment course (of GnRH analog) to control the initial agonist effect of the later, not the reverse.
 

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Discussion Starter · #9 ·
I agree that this is theoretically correct, but I think that clinically the use of flutamide + GnRH analog is as effective as GnRH analog alone. And the combination is only used at the beginning of the treatment course (of GnRH analog) to control the initial agonist effect of the later, not the reverse.
This is exactly how they'll twist you out in Step 1. They'll bring questions that are theoretically feasible but not necessarily applicable in practice.
 
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