Androgens and antiandrogens

Question 1

primary goal of testosterone therapy

Answer 1

restoring testosterone level

Question 2

When do you draw testosterone level?

Answer 2

morning, between 8 and 10 am

Question 3

Testosterone therapy effects start

Answer 3

within 3-6 months of starting therapy. bone density takes 24 months to improve

Question 4

adverse effects of testosterone

Answer 4

acne, prostate disorders, sleep apnea, erythrocytosis (rise in hct).

Question 5

testosterone forms

Answer 5

1. Androgen, Testim, Fortesta (gel that comes in 50-100 mg daily).
2. testosterone enanthate or cypionate (IM. 50-100 mg q week or 100-200 mg q2 weeks).
3. SC infection and pellet.

Question 6

education for testosterone topical administration

Answer 6

wash hands before applying, do not touch until med is dry. do not touch area for 5 hours after administered.

Question 7

Testosterone contraindications

Answer 7

prostate cancer, male breast cancer, lower UTI, erythrocytosis (low hgb & hct), sleep apnea, uncontrolled CHF (testosterone causes sodium retention). do not use if hct is >50.

Question 8

Testosterone drug interactions

Answer 8

anticoagulants (increases anticoagulant effects of warfarin), diabetic agents (risk for hypoglycemia), corticosteroids (fluid retention).

Question 9

monitoring while on testosterone.

Answer 9

3. check level 2-3 months after starting tx. once stable, check q 6-12 months.
4. evaluate for prostate cancer at 3 months and one year after starting therapy
5. check Hct (CBC) 3-6 months after starting tx and then annually.

Question 10

5-Alpha Reductase Inhibitors

Answer 10

Finasteride (Proscar, Propecia)

antiandrogen

Question 11

Finasteride (Proscar, Propecia) Indications

Answer 11

treats BPH and male pattern baldness.

at 5mg, it reduces risk for BPH but at higher risk for prostate cancer.

Question 12

Finasteride (Proscar, Propecia) Pharmacodynamics

Answer 12

inhibits enzymes that convert testosterone to DHT (dihydrotestosterone). antiandrogen effects.

Question 13

Finasteride (Proscar, Propecia) Caution/contraindications

Answer 13

prostate evaluation required for anyone on this medication with increase in PSA level

Question 14

GnRH analogues

Answer 14

antiandrogen

Leuprolide (Lupron)

Question 15

Leuprolide (Lupron) Pharmacodynamics

Answer 15

LH releasing hormone agonists. (blocking LH releasing hormone). creates reversible chemical orchiectomy state in males (used in prostate cancer). creates reversible chemical oophorectomy state in females.

Question 16

Leuprolide (Lupron) Indications

Answer 16

advanced prostate and breast cancer, management of endometriosis and uterine fibroids, precocious puberty (to delay onset of puberty), pubertal suppression in transgender teens.

Question 17

Aldosterone antagonist

Answer 17

Spironolactone

Question 18

Spironolactone pharmacodynamics

Answer 18

aldosterone antagonist and inhibitor of 5-alpha reductase. potassium sparing diuretic.

dosing 50-200mg daily.

Question 19

spironolactone indications

Answer 19

PCOS, acne, hirsutism.

Question 20

spironolactone adverse effects

Answer 20

GI upset, gynecomastia

contraindicated in pregnancy. category X