Meds for Men's Health Flashcards
Name the predominant sex hormone in males
testosterone
Locate the sites of testosterone precursor production in females
adrenal cortex and ovaries (amount is 10-40 times loess than males)
Explain how menopause affects testosterone levels in women
testosterone level decreases
Recall the sites of testosterone production in males
Leydig cells in testes
List the roles of testosterone throughout the body
- Facial & body hair
- muscle mass & strength
- bone density
- fat distribution
- RBC production
- sperm production
Explain why men have a higher hematocrit than women
Testosterone promotes erythropoietin synthesis –> EPO acts on bone marrow to stimulate RBC production
Recite therapeutic uses for testosterone in women
Off-label for relief of menopause symptoms
Recite therapeutic uses for testosterone in men
Hypogonadism
**for both men & women, testosterone has off-label uses for anemias
Why would a patient receiving testosterone have an increased risk of stroke or MI?
Erythropoietic effect –> polycythemia –> increased risk of clots
List 5 risks of androgen therapy or elevated androgen levels
- Virilization (male physical characteristics)
- Premature epiphyseal closure
- Hepatotoxicity
- Edema (Na and water retention)
- Worsening of prostate cancer
Describe signs of virilization in women and girls
- Acne
- increase in facial hair + male-pattern baldness
- clitoral enlargement
- deeper voice
Describe signs of virilization in boys
- penile enlargement
- priapism (persistent erections) etc.
How do certain forms of androgens (17-alpha-alkylated) cause hepatotoxicity?
can lead to cholestatic hepatitis (bile release from liver is blocked)
same impact as a gallstone in the duct
Tell the effect of androgen therapy on cholesterol levels
May increase LDL and lower HDL
Recall which cancer risk is elevated with androgen therapy in males
prostate cancer
Review the contraindications of androgen administration
- pregnant women (androgen affects fetus)
- men with prostate/breast cancer
- for athletic performance enhancement
Identify the only approved indication for androgen therapy
hypogonadism
Define erectile dysfunction (ED)
the inability of a man to maintain an erection sufficient for sexual activity
What are some risk factors for ED
- chronic illness (diabetes, HTN, depression)
- some medications
- advancing age
What does PDE5, cGMP, and PDE5 inhibitor do?
PDE5: enzyme that breaks down cGMP
cGMP: enzyme responsible for facilitating penile engorgement
PDE5 inhibitor: less PDE5, more cGMP and vessels become dilated
Recall the suffix that follows the drug names of PDE5 inhibitors
“-afil”
Sildenafil, Tadalafil, Vardenafil, Avanafil
Explain the dose timing issues that occur with PDE5 inhibitors
The effect is not instantaneous–it can take 15-60 min. Mind the delay before sexual activity!
List the dietary precautions for patients taking a PDE5 inhibitor
- Do not take with grapefruit juice
- The response can be delayed if ingested with high fat meal
Recall a serious side effect of phosphodiesterase-5 inhibitor therapy when combined with nitrates or vasodilators
life-threatening hypotension!
Do not combine PDE5 meds + nitrates!
Explain a medication that is contraindicated with PDE5 inhibitors
Do not combine PDE5 meds + nitrates!
Can cause life-threatening hypotension!
Identify underlying medical conditions that may put a patient at risk of adverse effects when taking a PDE5 inhibitor
- Had cardiovascular event in the past 6 months (safety concern for intense physical activity)
- low BP
- high BP(safety concern)
- unstable angina
2 adverse effects of PDE5 meds
- hypotension
- priapism (painful erections lasting > 6 hours)
Go to the ER; otherwise, it will result in permanent damage.
Explain the common side effects of PDE5 inhibitors
headache, flushing, upset stomach
+
sleep apnea
Describe the symptoms of benign prostatic hyperplasia (BPH)
BPH puts pressure on the urethra & cause changes in the bladder
- obstructive (difficulty urinating)
- bladder changes (sudden urgency, multiple times a day, nocturia)
List 4 ways in which benign prostatic hypertrophy (BPH) can be treated
- surgery (TURP)
- Laser
- Prostatectomy
- Annual re-evaluation
What are 2 drug groups that could be combined to treat BPH?
- 5-alpha-reductase inhibitors
(finasteride, dutasteride) slow response - alpha-1-adrenergic antagonists
(tamsulosin) quick effects
Explain the role of 5 alpha reductase inhibitors in the treatment of BPH
Most effective for the large prostates
–> shrink prostate epithelial tissue & improve mechanical obstruction
Explain the role of alpha-1 adrenergic antagonists
Relax smooth muscle in the prostate
–> does not decrease prostate size but improve dynamic obstruction (better urine flow)
Explain why it is safer to take an alpha-1 adrenergic antagonist at bedtime
Tamsulosin can cause “first dose effect”–a sudden and severe fall in blood pressure
