Male Repro Pharm

Question 1

When is testosterone replacement therapy indicated?

1.

2.

3.

4.

Answer 1

Male hypogonadism

Low Testosterone in the aging male

Androgen deficiency in women

Anemia associated with hypogonadism

Question 2

What are the Anabolic effects of testosterone

Answer 2

in muscle and increased red blood cells and maintains bone density.

Question 3

Flutamide MOA: Indication

Answer 3

Nonsteroidal competitive antagonist of AR

Used to block androgen-dependent growth in prostate cancer

Question 4

Finasteride

MOA

Indication

Answer 4

1. Block 5 alpha reductase
2. Used in BPH and hair loss (male pattern Baldness)
   note: Prostate cells and hair follicles both use DHT rather that T

Question 5

Leuprolide MOA

Answer 5

Agonist of GnRH,

decreases hormone production in testes and ovaries;(decreases LH/FSH secretion) Flare effect

Desensitizes GnRH receptors and

Question 6

Leuprolide

1.

2.

3.

4.

Answer 6

1. Central precocious puberty: Treatment of children with central precocious puberty
2. Endometriosis: Management of endometriosis, including pain relief and reduction of endometriotic lesions
3. Prostate cancer: Palliative treatment of advanced prostate cancer
4. Uterine leiomyomata (fibroids): Treatment of anemia caused by uterine leiomyomata (fibroids)

Question 7

Options for Prostate Cancer He will only ask about three main drugs

Answer 7

1. Androgen Depletion Therapy (ADT) Leuprolide Flutamide Surgical castration (orchiectomy) Combination with docetaxel
2. Castration-dependent disease Have response to ADT
3. Castration-resistant disease Patients on ADT who have evidence of disease progression (PSA, metastasis)

Question 8

When is watchful waiting a recomended response in men with BPH?

Answer 8

1. (AUA Standard) mild symptoms (American Urological Association Symptom Index [AUASI] score < 8)
2. moderate or severe symptoms (AUASI score ≥ 8) who are not bothered by their LUTS symptoms
3. behavioral strategies (diet and activity) that may reduce urinary symptoms include limiting fluid intake in evening avoiding excess alcohol and highly seasoned or irritative foods increasing physical activit

Question 9

Causes of Erectile Dysfunction

Answer 9

CV disease

Drugs

Psychosocial

Neurologic

Bicycling

Endocrine disorders

Question 10

Drugs that cause ED:

6 of them

Answer 10

Drugs Antidepressants – particular, the SSRIs

Spironolactone

Sympathetic blockers: clonidine, guanethidine, or methyldopa

Thiazide diuretics

Ketoconazole : Note: inhibit steroid synthesis (17,20 desmolase and 17 alpha hydroxylase)

H2 Receptor blockers: Cimetidine, but apparently not ranitidine or famotidine

Question 11

Premature Ejaculation

1.

2.

3.

Answer 11

Management depends upon the etiology,

1. selective serotonin reuptake inhibitors (SSRIs),

Note: Paroxetine has shown the best efficacy (9 minutes over baseline)

2. topical anesthetics: Tramadol, lidocaine
3. psychotherapy when psychogenic and/or relationship factors are present.

Question 12

Erectile Dysfunction

First Line thearapy:

MOA

Aavanafil vs tadalafil

Answer 12

PD5- inhibitors: All have “Fil”–> think… it helps Fil the penis to keep hard!

inhibit PD-5–> ^cGMP–> prolonged smooth muscle relaxation in response to NO–> ^ blood flow to corpus cavernosum–>decrease pulmonary vascular resistance.

Sildenafil, vardenafil, tadalafil, and the

newest option, avanafil, appear to be equally effective, but tadalafil has a longer duration of action and avanafil may have a more rapid onset

Question 13

First Line thearpy for ED

Answer 13

phosphodiesterase-5 (PDE-5) inhibitors because of their efficacy, ease of use, and favorable side effect profilee

Question 14

If First Line thearpy for ED doesn’t work

Answer 14

vacuum devices, penile self-injectable drugs, and intraurethral alprostadil as second-line therapy.