adrenal pharm

Question 1

name conditions of xs androgens

Answer 1

prostate cancer
bph
androgenetic alopecia
precocious puberty
hirsituism

Question 2

what are the 5a reductase inhibitors? which ones are used for prostate ca?

Answer 2

finasteride -prostate
dutasteride - prostate

propecia

Question 3

finasteride

Answer 3

inhibits type II 5a-reductase
blocks conversion of T –> DHT

use: prostate cancer

Question 4

propecia

Answer 4

5a-reductase inhibitor

use: hair loss

Question 5

dutasteride

Answer 5

type I/II 5a-reductase inhibitor

use: prostate cancer

Question 6

what are conditions of androgen deficiency

Answer 6

hypogonadism
osteoporosis
muscle wasting in AIDS
HRT in aging men

Question 7

Whats the mech of testosterone?

Answer 7

diffuses across the membrane –> cytosolic receptor –> dimerization/binding to DRE –>alteration of target gene transcription –> growth/differentation/ synthesis of enzymes and functional proteins

Question 8

where testosterone synthesized?

Answer 8

95% synthesized in testes
5% synthesized in adrenal (mostly adrenal for women)

converted to DHT by 5a-reductase
converted to estradiol by aromatase

Question 9

who gets testosterone?

Answer 9

men with subnormal T (<200-300 ng/dL) with sx:

• *low libido
• *decreased morning boners
• *low bone mineral density
• *gynecomastia
• *small testes
• fatigue
• depression
• anemia-reduced muscle strength

Question 10

why is testosterone NOT indicated for impaired spermatogenesis?

Answer 10

T would suppress GnRH and further impair spermatogenesis

Question 11

testosterone formulations

Answer 11

• IM
• transdermal gel
• transdermal patch
• SubQ
• buccal
• nasal
• oral

Question 12

what are advantages of the transdermal formulations?

Answer 12

maintain a stable T level throughout the dosing period

Question 13

adverse effects of testosterone

Answer 13

• decreased spermatogenesis (will return to nl function after discontinuation)
• reversible cholestatic jaundice
• weight gain (edema)
• arterial thrombosis (dec HDL with inc LDL)
• prostate enlargement

Question 14

bicalutamide/flutamide

Answer 14

• androgen receptor antagonist
• use: prostate ca, hirsutism from PCOS
• PO qid
• can have androgen deprivation effects

Question 15

leuprolide

Answer 15

• GnRH analog
• SC or IM
• antagonist when continuous admin –> prostate ca, precocious puberty in boys
• agonist when used pulsatile
• can cause hypogonadism with prolonged treatment

Question 16

spironolactone

Answer 16

androgen receptor antagonist

• inhibits 17aOH-ase + 17,20 desmolase
• use: prostate ca, hirsutism in PCOS
• **causes hyperkalemia and gynocomastia

Question 17

ketoconazole

Answer 17

17a-OH inhibitor –> inhibits testosterone synth

used as antiandrogen in PCOS