Male HRT and BPH Flashcards
What morning T levels are considered low?
<300 ng/dl
How many low morning T levels are needed for diagnosis of hypogonadism?
2
What ar sx of low T?
- low sex drive
- fatigue
- loss of body hair
- muscle loss
- ED
- osteoporosis
- infertility
What T agents are given orally?
- Methyltestosterone
- Fluoxymesterone
- Testosterone Undecanonate
Why should PO T be avoided?
- A large 1st pass effect leads to decreased bioavailability
- higher risk of hepatotoxicity
What risk is low with Testosterone Undecanonqate?
hepatic dysfunction
What is the benefit to buccal testosterone?
no 1st pass metabolism
What are disadvantages to buccal T?
dislodged during eating, discard old system and reapply new buccal system
What T agents are available IM?
- Testosterone Cypionate
- Testosterone Enanthate
- Testosterone Undecanoate
What are disadvantages to peaks and troughs seen with IM T?
supratherapeutic levels produced leading to meed swings
What are advantages to Testosterone patch?
not as many peaks and troughs as IM
more used i. practice
What are the counseling points for T patch?
avoid swimming, showering, or washing administration sites for 3 hours after administration
What are the counseling points for T gel and transdermal spray?
- cover application to avoid transfer to other people
- avoid swimming, showering, or washing administration sites for 2 hours after administration
Where and how should T transdermal solution be applied?
- armpit (axilla area) only
- apply deodorant
What are advantages to T SQ implant pellet?
less peaks and troughs
What are disadvantages to T SQ implant pellet?
must be administered by a healthcare professional
What are disadvantages to T nasal gel?
higher risk of intranasal adverse effects
Why does Testosterone undecanonate injection have a REMS program?
risk of administration and respiratory reaction
What should be monitored when receiving male HRT?
- BP
- signs of edema
- lipids
- Hematocrit
- PSA
- AST/ ALT
When should T be D/C in a patient?
Hematocrit (HCT) exceeds 55% at any time
What are SEs with T?
- sodium and water retention
- hyperlipidemia
- increased hematocrit
- gynecomastia
- sleep apnea
- increased libido
- mood swings
- hepatotoxicity
- prostate enlargement
- worsen LUTS
What are CIs to T?
- prostate cancer
- men with breast cancer
What meds can contribute to ED?
- antidepressants (SSRI, SNRI)
- anti- HTN (beta-blockers, clonidine)
- antipsychotics (haloperidol, chlorpromazine, risperidone, paliperidone)
- BPH meds (FInasteride , Dutasteride)
- others (anticholinergics, alcohol, nicotine)
What is the MOA of phosphodiesterase inhibitors?/
competitive irreversible inhibitor of PDE-5 that prevents the breakdown of cGMP
Why should alcohol be avoided with PDE-5 inhibitors?
orthostatic hypotension and drowsiness
What PDE-5 inhibitors have a 4-5 h duration?
- Sildenafil
- Vardenafil
- Avanafil
What PDE-5 inhibitors have a duration of up to 36 hours?
Tadalafil
When should PDE-5 dose be reduced?
- > 65 y/o
- using alpha 1 blocker
- moderate/strong CYP3A4 inhibitor
- severe renal/liver disease
What are reduced doses for PDE-5 inhibitors?
Sildenafil 25mg
Tadalafil/ Vardenafil 5mg
Avanafil 50mg
What are SEs with PDE-5 inhibitors?
- headache
- flushing
- nasal congestion
- dizziness
- hypotension
- muscle weakness
- nonarteritic anterior ischemic optic neuropathy
- priapism
What are specific SEs with Taladafil?
- least risk of hypotension
- muscle weakness due to PDE_11
What are specific SEs with Sildenafil, Vardenafil, and Avanafil?
visual light sensitivity and blurred vision due to effect on PDE 6
What is the MOS of alprostadil?
stimulated adenyl cyclase leading to increase in cAMP and eventual smooth muscle relaxation of the arterial blood vessels
What are SEs with Alprostadil?
- priapism
- injection site reaction
- dizziness/ syncope
What are treatment recommendations for ED?
- used PDE-5 unless CI
- use T is low T
- use Alprostadil if PDE5 CI
What meds worsen BPH symptoms?
- anticholinergics
- antihistamine
- caffeine
- decongestants
- diuretics
- SNRIs/TCAs
- T products
What are static BPH factors?
related to size of prostate
What are dynamic BPH factors?
excess alpha activation
nocturia
urge
What are the 2nd gen alpha 1 antagonists?
- Prazosin
- Terazosin
- Doxazosin
What are the 3rd gen alpha 1 antagonists?
- Alfuzosin
- Tamsulosin
- Silodosin
What are SEs with BPH meds?
- Dizziness
- insomnia
- floppy iris syndrome- do not use prior to catartct surgery
- hypotension (2nd gen)
- rhinitis
- abnormal ejaculation
What are the 5 alpha reductase inhibitors?
- Finasteride
- Dutasteride
What are SEs with 5 alpha-reductase inhibitors?
- ED
- decreased libido
- gynecomastia
- ejaculatory dysfunction
What pregnancy category are alpha 5 reductase inhibitors?
Category X- women that are pregnant or seeking to become pregnant do not handle drugs without gloves or come into contact with semen from men
How should BPH be treated?
- 3rd gen alpha 1 antagonist
- addition 5 alpha-reductase inhibitor can prevent progression of LUTS secondary to BPH with prostatic enlargement
Which BPH agents should not be combined?
Taladafil and alpha blockers
