Hypogonadal Drugs

Question 1

When should you use GnRH pulsatile secretion?

Answer 1

To initiate puberty.

To treat hypothalamic causes of infertility.

Infusion pump.

Requires intact pituitary.

Question 2

When should you use GnRH continuously? (Long-acting)

What is continuous GnRH called?

Answer 2

Leuprolide.

Continously GnRH will suppress LH and FSH leading to low estrogen and testosterone.

To “turn off” precocious puberty.

To cause androgen deprivation in prostate cancer.

To cause estrogen deprivation in breast cancer.

To stop cyclic LH/FSH stimulation of endometriosis.

Question 3

How will pulsatile GnRH affect LH, FSH, testosterone, and estrogen?

Answer 3

Pulastile GnRH will increase LH and FSH leading to increased testosterone and estrogen.

Question 4

When to use LH/FSH boluses?

Answer 4

To treat hypothalamic or pituitary causes of infertility.

Women (Fertility): FSH daily and LH at midcycle to mimic menstrual cycle. Monitor estrogen levels and follicle development by ultrasound.

Men: LH and FSH doses constant. Monitor testosterone levels and sperm count.

Question 5

When to use sex steroids (estradiol with progesterone)?

Answer 5

To suppress GnRH, LH, and FSH.

Example drug: Contraceptive pills.

Question 6

Name an androgen receptor blocker?

Answer 6

Flutamide

Question 7

Name aromatase inhibitors.

Answer 7

Anastrozole, letrozole

Question 8

Name 5-alpha-reducatse inhibitors.

Answer 8

Finasteride

Question 9

Androgen receptor blockers are used to treat?

Answer 9

Prostate cancer

Question 10

Aromatase inhibitors: MOA and used to treat what condition?

Answer 10

Block conversion of testosterone to estrogen.

They are used to treat breast cancer.

Question 11

5-alpha reductase inhibitors: MOA and used to treat what conditions?

Answer 11

Blocks conversion of testosterone to DHT.

Used to treat prostatic hypertrophy or prostate cancer; OTC to block male balding.

Question 12

When does hormone replacement by estrogen happen? To treat which conditions?

Answer 12

Hot flashes: Short term E (<3 yrs). Not associated with breast cancer.

Vaginal/GU atrophy: Use vaginal E lotion.

Osteoporosis: SERM Raloxifene has E agonist effect on bone but antagonist effect on uterus/breast.

Question 13

What are estrogen replacement risks?

Answer 13

Venous thromboembolism
Gallbladder disease
Stroke
Heart disease
Breast cancer
Endometrial cancer (not increased when progesterone is used also in women with intact uterus).

Question 14

What are estrogen replacement contraindications?

Answer 14

Absolute:
Estrogen dep. cancer
Hx of thrombotic disease

Relative:
Hx of vascular disease, cancer, smoking.

Risks are dose related.

Question 15

What are testosterone replacement benefits?

Answer 15

Maintenance of secondary sex characteristics.

Increased muscle mass.

Increased bone density.

Improved energy.

Improved libido.

Young hypogonadal males SHOULD be placed on testosterone.

Question 16

Why is oral testosterone not recommended?

Answer 16

Delays metabolism by liver.

Can cause increased LFTs and hepatoma, cholestatic jaundice, hepatitis.

Question 17

What are risks associated with testosterone replacement?

Answer 17

Erythrocytosis
Prostate cancer
Sleep apnea
Gynecomastia
Skin reactions