Exam 5 - Lec 49-51 Men's Health Flashcards
most common cause of hypogonadism
constitutional delay of growth and puberty (CDGP)
incomplete/delayed sexual maturity usually requires __________ supplementation
testosterone
IM testosterone esters for hypogonadism start at ___ mg month, increased by 25 mg (max 100 mg)
50
which cancer is the most common cancer in young men aged 15-35 years?
testicular cancer
5 year survival rate for testicular cancer
95%
(80% cure rate even if stage III)
what surgical procedure can treat testicular cancer?
orchiectomy (removal of one or both testicles)
what is the name of the major type of alopecia?
androgenic alopecia (male pattern baldness)
what is alopecia areata?
autoimmune alopecia; small round patches appear
what is alopecia universalis?
complete hair loss on scalp and body
what is traction alopecia?
constant tension on hair
(ppl with man buns are more at risk)
what is drug-induced alopecia?
alopecia caused by anabolic steroids or chemotherapy
finasteride (Propecia) mech of action?
inhibits type II 5-alpha reductase
(inhibits conversion of testosterone to DHT)
dose of finasteride (Propecia) for alopecia
1 mg PO once daily
minoxidil (Rogaine) mech of action?
enlarging miniaturized hair follicles
(inc blood supply, stimulates hair follice from telogen (resting phase) to anagen (growth phase))
what % of minoxidil is used for alopecia and how often per day should it be used?
5%; twice daily every day
hormonal deficiency (andropause) risk factors (4)
-aging
-chronic illness (diabetes, AIDS, rheumatoid arthitis, CKD)
-long term use of corticosteroids
-obesity
diagnosis of hypogonadism requires what two things?
low testosterone levels WITH symptoms
a total testosterone level of < ___ ng/gL is positive for low testosterone; confirm with 2nd test and free testosterone level < ___ ng/dL confirms low testosterone
300 ng/dL
5 ng/dL
which dosage form for testosterone therapy is most similar to physiologic testosterone levels?
a. IM injection
b. patch
c. gel
d. solution
e. buccal tablet
f. SQ pellet
g. oral capsule
b. patch
subQ pellets for testosterone therapy have a delayed onset of how many months?
3-4 months
testosterone undecanoate capsules brand name?
Jatenzo
dose for Jatenzo for THT
158 to 396 mg BID with food
(measure serum testosterone level 6 hrs after AM dose)
contraindications to THT (5)
-prostate cancer
-breast cancer
-hematocrit > 50%
-baseline PSA (prostate specific antigen) > 4 ng/mL, or PSA > 3 ng/mL in men at high risk of prostate cancer
-recent or poorly controlled CVD
black box warning for testosterone gel formulation
concerns with secondary exposure to children
patients should be monitored ___ - ____ months after initiating THT
3-6 months
goal testosterone levels after THT therapy?
400-700 ng/dL
goal testosterone levels after THT therapy?
400-700 ng/dL
goal testosterone levels after THT therapy?
400-700 ng/dL
if hematocrit is > ___ %, testosterone therapy should be stopped
54%
diseases and conditions that can cause ED (5)
-diabetes mellitus
-hypertension
-CAD
-MS - Parkinsons - stroke
-low testosterone levels
what class of drugs are most noted for drug-induced sexual dysfunction?
antidepressants
(SSRIS - up to 70%)
three subtypes of erections
-psychogenic (happens in brain)
-reflexogenic (something stimulates it)
-nocturnal (bedtime, morning wood)
erections are initiated by
a. sympathetic NS
b. parasympathetic NS
b. parasympathetic NS
in erections, ___ is released which causes release of ___ from the NANC neurons in the penis. NO activates guanylate cyclase, which converts ___ to ___, which results in ___ release and produces smooth muscle relaxation
ACh
NO (nitrous oxide)
GTP
cGMP
Ca+
nocturnal erections are controlled by which nerves?
sacral nerves
how many nocturnal erections occur per night?
3-6 /night
first line oral treatment for ED
PDE-5 inhibitors
(promotes sm. muscle relaxation by inhib of PDE-5)
true or false: PDE-5 inhibitors increase the refractory period between erections
false
(decreases refractory period)
4 PDE-5 inhibitors
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra)
avanafil (Stendra)
drug interactions with PDE-5 inhibitors: CYP3A4 inhibitors (5)
cimetidine
ketoconazole
erythromycin
ritonavir
grapefruit juice
etc.
true or false: food delays absorption of PDE-5 inhibitors
true
(fatty meal can delay absorption of Viagra and Levitra by 1 additional hour)
most common side effect of PDE-5 inhibitors
headache
NAION (non-arteritic ischemic optic neuropathy) is a possible side effect of PDE-5 inhibitors. What does it mean?
sudden vision loss
true or false: patients on oral or transdermal nitrates can use PDE-5 inhibitors such as Viagra
false
(don’t use; nitrates cause vasodiation, can cause massive drop in bp)
true or false: patients on alpha-blockers should start PDE-5 inhibitors at a higher dose
false
(start at lower dose)
PDE-5 inhibitors for pulmonary hypertension; what dose of Revatio and Adcirca do you use?
Revatio (sildenafil) 20 mg po tid
Adcirca (tadalafil) 40 mg po once daily
true or false: vacuum erection devices should be avoided in sickle cell patients
true
alprostadil pellets brand name
Muse
alprostadil pellets are ___ effective than injection
less
what should you do first before using alprostadil pellets?
urinate first
alprostadil injection brand name
Caverject
alprostadil injection (Caverject) is best for which type of ED?
neurogenic
true or false: alprostadil injections require sexual stimulaion
false
(no sexual stim. required)
what are the 3 components of the Trimix injection?
papaverine
phentolamine
prostaglandin E1
what is priapism?
prolonged erection
what is Peyronie’s Disease (PD)?
having a bent erection (at least 30 degrees); includes penile plaques
drug to treat Peyronie’s Disease
Xiaflex (collagenase clostridium histolyticum injection)
which group is most likely to develop prostate cancer?
a. non-hispanic white
b. non-hispanic black
c. asian & pacific islander
d. american indian and alaska native
e. hispanic/latino
b. non-hispanic black
most common type of cancer in men
prostate cancer (1:7)
_____ score rates tumor grade in prostate cancer
Gleason
PSA screening: most men w/o prostate cancer have PSA levels under ___ ng/mL of blood
4 ng/mL
PSA level between 4 and 10 have about a 1 in ___ chance of having prostate cancer
4
(25%)
if PSA is more than ___, the chance of having prostate cancer is over 50%
10
normal prostate gland is less than ___ grams
20
true or false: type-II 5 alpha reductase in the prostate gland is responsible for prostate enlargement and growth
true
nocturia (needing to pee 2+ times per night) is common with which disease?
BPH
AUA for mild BPH
less than or equal to 7
AUA for moderate BPH
8-19
AUA for severe BPH
greater than or equal to 20
why do we avoid drugs with strong anti-cholinergic properties in BPH?
decreases contractility of bladder detrusor muscle; results in urinary retention
(ex. antihistamines like benadryl, TCA’s, cogentin, artane, scopolaimine, anti-muscarinics like ditropan)
what is post-void residual?
amount of urine left in bladder after peeing
saw palmetto is used to treat mild ___?
BPH
(160 mg po bid)
alpha-1 adrenergic blockers (5)
terazosin
doxazosin
tamsulosin
alfuzosin
silodosin
what drugs are used to treat moderate BPH?
alpha-1a adrenergic blockers/blockade
(relaxes sm. muscle tone of prostate gland AND bladder neck; improves urine flow)
true or false: alpha-1a adrenergic blockade reduces the size of the prostate gland
false
(does not reduce size; it does dec. AUA by 30-40%; onset is 1-6 weeks)
when should tamsulosin be taken for BPH?
1/2 hour after same meal each day (enhances AUA)
true or false: silodosin can be taken with or without a meal
false
(take w/ meal)
most common side effect of alpha-1 adrenergic blockers
dizziness (orthostatic hypotension)
orthostatic hypotension is common in first dose with
a. Uroxatrol and Flomax
b. Cardura and Hytrin
c. Rapaflo and Flomax
d. Cardura and Rapaflo
b. Cardura and Hytrin
(doxazosin and terazosin)
which is most selective for alpha-1a receptors in urinary tract?
a. terazosin
b. doxazosin
c. tamsulosin
d. alfuzosin
e. silodosin
c. tamsulosin
what syndrome has been observed during cataract surgery in patients treated with Flomax?
intra-operative floppy iris syndrome
tadalafil can be used for ED and BPH, 5 mg daily, but 2.5 mg should be used if CrCl is in what range?
30-50 mL/min
do not use tadalafil if CrCl < ___ mL/min
30 mL/min
dose for finasteride (Proscar) for BPH
5 mg po daily
dose for dutasteride (Avodart) for BPH
0.5 mg po daily
which type of BPH requires minimally invasive/invasive surgical therapies?
a. mild
b. moderate
c. severe
c. severe
what is transurethral resection of the prostate (TURP)?
scraping done to reduce the size of prostate tissue
true or false: botox injections can be used for severe BPH
true
(used to induce prostatic atrophy in group of patients who were not surgical candidates)
