Male Health Flashcards
What is androgenic alopecia?
Hair loss
What are the causes of androgenic alopecia?
DHT on over sensitive hair follicles, any hair loss is irreversible.
What are the treatment options for alopecia? (4)
Minoxidil (Regaine) GSL
Finasteride 1mg (Propecia) POM
Zinc supplements or surgery
Scalp surgery (expensive)
Explain the use of Minoxidil for Alopecia.
5% foam or cutaneous solution.
Apply to dry scalp BD.
May take BD application for > 8 weeks before hair growth can be expected.
Discontinue tx if there’s no improvement seen after 16 weeks.
No evidence of benefits > 16 weeks.
C/I: HPT , Scalp abnormalities (psoriasis, sunburn), shaved scalp, other topical prep.
What are the causes of snoring? (2)
Obstruction
Loss of muscle tone
What are the physical features of snoring?
Fat deposits/weak chin
Small/collapsing nostrils
Deviated septum
Nasal congestion/catarrh or polyps
Large soft palate or uvula
What is the management of snoring?
Change lifestyle e.g. alcohol, smoking
Nasal spray/dilators
Oral shield/chin up strips
Surgery (apnoea), carried out as a last resort following sleep study
What are the storage symptoms of lower urinary tract?
Urgency
Daytime urinary frequency
Nocturia
Urinary incontinence
What are the voiding symptoms of lower urinary tract?
Slow stream
Splitting/spraying
Straining
Intermittency
Hesitancy
Straining
Terminal Dribbling
What are the post-mictrurition symptoms of lower urinary tract?
Post-mictrurition dribble
Incomplete emptying
What are the causes of LUT infections?
Structural/functional abnormalities on 1 or more parts of LUT.
CNS/peripheral abnormalities.
CV, Respiratory, renal or endocrine conditions affecting urine production.
Most elderly men have 1 LUTS.
What is BPE?
Benign prostatic enlargement.
What are the urinary symptoms of BPE? (6)
Incomplete emptying
Increased frequency
Intermittent flow
Urgency
Weak stream and straining
Nocturia
What are the tx options for BPE?
Tamsulosin 400mcg capsules (Flomax relief):
45-75 yrs.
Symptoms present for 3 months or more.
2 week initial support to px with BPH.
If improvement in urinary symptoms can make additional 4 weeks OTC supply of Tamsulosin.
Need to see GP within 6 weeks of starting.
After visiting GP can continue to purchase OTC as long as no changes in condition or new symptoms.
Good practice to use IPSS to assess BPH symptoms.
Supply is appropriate if px has symptom score of 8 or more OR symptom score of 1+ a QOL score of 4 or more.
What counselling is given for BPH?
Reduce alcohol, caffeine and fluid intake at specific times, especially before bedtime.
Tx constipation if present, to maintain a health lifestyle.
General lifestyle advice (weight, smoking, diet)
When not supply Tamsulosin OTC?
< 3 months symptoms
Px had prostate surgery
Undiagnosed diabetes
Liver,Kidney, Heart problem
Symptoms of postural hypotension
Cataract surgery
Px has blurred/cloudy vision that has not been examined by GP or optician (cataracts)
Px has allergy/hypersensitivity to Tamsulosin.
Other BPH tx is prescribed or if px takes any antihypertensives alphablocking activity.
What are the main features of Erectile Dysfunction?
Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
> 40 yrs.
It’s a symptom and not a disease and may be due to a primary organic or psychogenic cause or medications.
What are the complications of ED?
Performance Anxiety
Reduced Confidence
Depression
Relationship Difficulties
Increased risk of CVD
Stroke
All-cause mortality
What are the treatment options for ED?
Sildenafil 50mg (P)
Tadalafil 10mg tablets (Cialis)
Explain the main features of Sildenafil for BPH tx.
Indication: ED in male 18+
Dose: 1x 50mg tablets / day 1hr before sexual activity. Sexual stimulation required, taking with food can delay onset. Before ruling ineffective - try on different occassions.
S/E: Headache, flushing, dyspepsia, nasal congestion, dizziness, nausea, visual disturbances
What are the c/i of Sildenafil?
Female
< 18yrs
Allergy to Sildenafil
Men who don’t have ED
Premature ejaculation
Hypotension (<90/50mmHg)
Hepatic/severe liver impairment
Nitrate use
Alpha-blocker
Co-administration with CYP450 inhibitors.
Severe CVD (MI/Stroke/TIA in previous 6 months, unstable angina or severe HF)
What are the main features of Tadalafil?
ED in male > 18 yrs
1 x 10mg tablet at least 30 mins before sexual activity.
Sexual stimulation required
Not recommended for continuous daily use. (Men who use this product frequently at least twice weekly should consult HCP and before ruling ineffective = try on different occasions)
What are the c/i of Tadalafil?
Hypersensitivity
Nitrate use
Alpha blocker
MI within last 90 days
Unstable angina, angina occurring during sexual intercourse.
Uncontrolled arrythmias/hypotension (90/50mmHg) or hypertension.
Stroke or HF NYHA class 2 or more within the last 6 months.
What are the symptoms of Thrush? (4)
Irritation, burning, pain and redness around the head of the penis and under the foreskin.
Balanitis - glans penis inflammation
Posthitis - prepuce (foreskin) inflammation.
+/- white discharge
+/- Unpleasant smell
What are the tx options for thrush?
Only if symptomatic and sexual partner diagnosed.
Clotrimazole 2% cream:
- Sold OTC for male if partner has thrush.
- Should be applied to the end of the penis BD/TDS for up to 14 days.
Fluconazole 150mg caps (one cap stat):
- Sold OTC to men
What counselling is given to px with thrush?
Good daily hygiene
Wash daily with lukewarm water and to keep foreskin retracted until glans penis is dry where possible.
Avoid irritants e.g. soap, bubble bath or baby wipes.
Consider use of an emollient as a soap substitute.
What are the red flags for thrush?
Sexual partner doesn’t have candida infection.
Diabetic
2 episodes in 6 months.
Systemic symptoms: fever, chills, lower back pain.
Px/partner with Hx of STI (unusual discharge, sores, ulcers, blisters)
No improvement in 7 days.
What are the s/s of testicular cancer?
Lump in either testicle (refer)
Enlarged (swollen) testicle/ difference between 2
Dull aches in lower abdomen or groin
Sudden gathering of fluid in scrotum
Feeling of heaviness in the scrotum.
Explain the importance of health disparity.
HD and cancer
Obesity
Diabetes
Suicide
Lifestyle: High rates of smoking, salt, red meat, processed meat, too little fruits and veg, drink alcohol.
