Chapter 21: men's health Flashcards
health concern related specifically to men
erectile dysfunction
benign prostate hyperplasia
male pattern baldness
male androgen deficiency
prostatitis
drugs classes used to treat erectile dysfunction
orl phosphodiesterase inhibitors (PDE5)
injectable prostaglandins
drug classes used to treat BPH
alpha-1 blockers
5-alpha reductase inhibitors
medication class used to treat male pattern baldness
5-alpha reductase inhibitors
drug used to treat male androgen deficiency
exogenous testosterone
drug classes used to treat prostatitis
ABTs
(ampicillin, ciprofloxin)
six main categories of ED
vasculogenic
psychogenic
neurogenic
hormonal
drug use
other (physical anomaly, chronic illness, surgery, etc)
PDE5 inhibitors
mechanism of action
inhibits smooth muscle relaxation in arteries and the corpus cavernosum by inhibiting the conversion of cGMP
discovered while searching for a new antihypertensive agent
examples of PDE5 inhibitors
sildenafil (Viagra)
vardenafil (Levitra)
tadalafil (Cialis)
selectivity of PDE5 medications
sildenafil (Viagra): 10-fold
tadalafil (Cialis): 10,000 fold
vardenafil (Levitra): 15 fold
PDE5 parmacokinetics
well absorbed orally
extensive distribution
CYP450 system metabolism into active metabolite in urine
excreted mostly in feces
which PDE5’s absorption is inhibited by food
sildenafil (Viagra)
Adverse reactions of PDE5 inhibitors
- CV: flushing
- EENT: rhinitis, sinusitis
- GI: dyspepsia, nausea
- GU: priapism and prolonged erections are RARE
- MISC: flu-like symptoms
- NEURO: headache
Which medications interact with PDE5 inhibitors
Nitrates (most serious)
antihypertensives
macrolides, antifungals, diuretics (require dosage adjustments)
PDE5 inhibitor contraindications
nitrate therapy or any patient who sees a drop in BP
sickle cell, myeloma, leukemia
retinitis pigmentosa
elderly or any patient with renal impairment
injectable prostaglandin mechanism of action
vasoactive
relaxes arterial smooth muscle by stimulating an increase on intracellular cyclic necleotides to increase blood flow to the corpus cavernosum causing erection
examples of injectable prostaglandins
alprostadil (Caverject)
papaverine (Regitine)
vasoactive intestinal polypeptides (UIP
administration of injectible prostaglandins
intracavernosum cavity or transurethal
teach how to administer at lowest possible effective dose
incidence of penile pain with injectible prostaglandins
37%
contraindications for injectible prostaglandins
penile deformity
penile implant
patients with conditions that predispose them to priapism
conditions that predispose a patient to priapism
sickle cell, leukemia, multiple myeloma, polycythemia, thrombocythemia
drugs that can worsen BPH symptoms
first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications
drug classes used to treat BPH
alpha blockers
5-alpha reductase inhibitors
alpha blockers mechanism of action
relaxes smooth muscle in the prostate gland to decrease obstruction of urine flow
examples of nonselective alpha blockers
doxazosin (Cardura)
prazosin (Minipress)
terazosin (Hytrin)
examples of selsctive alpha blockers
alfuzosin (Uroxatral)
tamsulosin (Flomax)
effectiveness of alpha blockers to treat BPH
effectiveness within 1 month
effect ceases when medication is stopped
patient education for drugs used to treat BPH
discuss all medications and possible interactions
cannot donate blood while on these medications of for 6 months after
treatment is not a cure, only for symptom relief
pharmacokinetics of alpha blockers
all are well absorbed except Flomax
all are well distributed and metabolized in liver
excreted in both urine and feces
alpha blockers adverse effects
- CV: orthostatic hypotension
- EENT: rhinitis
- ENDO: decreased libido
- GI: distress
- MS: muscle and back pain
- NEURO: headache, dizziness
alpha blockers interactions
caution with any medications that may decrease BP
alpha blockers patient education
first-dose reactions (orthostatic hypotension) are likely
early side effects will likely disapear with continued use
5-alpha reductase inhibitors mechanism of action
supress testosterone formation in the prostate gland
5-alpha reductase inhibitors affect on PSA levels
increases and therefore abnormal values used for cancer screening in these patients should be adjusted
examples of 5-alpha reductase inhibitors
dutasteride (Avodart)
finasteride (Proscar)
what is also treated by finasteride besides BPH
male pattern baldness (Propecia)
lower dosage than for BPH
5-alpha reductase inhibitor pregnancy category
X for producing genital abnormalities in male offspring
adverse reactions of 5-alpha reductase inhibitors
- CV: postural hypotension
- EENT: rhinitis
- ENDO: impotence, decreased libido, gynecomastia (2%)
- GU: finasterides causes a decrease in PSA even in the presence of cancer
- MS: weakness
- NEURO: dizziness, somnolence
- PUL: dyspnea
5-alpha reductase inhibitor interactions
MANY
including: cimetidine, cipro, diltiazem, ketoconozole, ritonavir, verapimil, st. john’s wort
contraindications for 5-alpha reductase inhibitors
serious skin reactions
pediatric patients
should not be handled by women pregnant or trying to become pregnant
how long does it take to see results from 5-alpha reductase inhibitor therapy
3-6 months
symptoms of hypogonadism
depressed mood, diminished energy, decreased muscle strength and bulk, increased fat mass, impaired cognition, anemia, diminished bone density, fatigue, increased insulin resistance, multiple impaired sexual functions
exogenous testosterone pharmacokinetics
complete absorption with IM administration
99% protein bound to globulin
first pass metabolism in liver to active metabolite
excreted in urine
clinical uses of exogenous testosterone
androgen replacement therapy in treatment of delayed male puberty
maly hypogonadism
replacement therapy in cases of deficient endogenous hormone
adverse effects of testosterone replacement
- CV: edema, flushing, HTN, vasodilation
- DERM: acne, alopecia, dry skin, erythema, hirsutism
- ENDO: breast tenderness, gynecomastia
- GI: n/v, distress
- GU: impotence, testicular atrophy, bladder issues
- HEME: leucopenia, suppression of clotting
- MS: weakness
- NEURO: aggression, amnesia, headache, parathesia, nervousness
- OTHER: pain at injection site
conscientious considerations for testosternoen replacement therapy
require careful monitoring for side effects
change therapy if no visible response in 3-4 months
labs to monitor when patient is on testosterone replacement therapy
lipids, PSA, HCT, and DRE
if oral form, LFTs as well
testosterone contraindications
breast cancer
prostate cancer
pregnancy
testosterone interactions
oral anticoagulants can cause hypoprothrombinemic response
patient education for testosterone therapy
age and physical condition may limit results
women of chid-bearing age should not handle
must not use if they have BPH an abnormal lipid profile
need to screen for prostate and breast cancer
drugs used to treat male pattern baldness
finasteride (Propecia)
minoxidil (Rogaine)
minoxidil mechanism of action
appears to have a direct effect on hair follicles by stimulating resting hair follicles into active growth
no drug interactions because it is topical
when are medications for male pattern bladness less effective
temporal or frontal hair loss
new hair growth with use of medications for male pattern baldness
results are not seen for 2-6 months of daily use and new hair will be lost within 4-6 months of discontinuing treatment
patient education for drugs for male pattern baldness
finasteride should not be handled by children or pregnant females
do not donate blood while on this or for six months after
male specific infections of the GU tract
prostatitis
epididymitis
orchitis
STDs
epididymitis and orchitis in males 14-35
typically due to an STD
epididymitis and orchitis in males younger than 14 or older than 35
typically due to e.coli
medications used to treat male UTIs
ceftriaxone (Rocephin)
doxycycline (Vibramycin)
azithromycin (Zithromax)
