Meds for Men's Health

Question 1

Name the predominant sex hormone in males

Answer 1

testosterone

Question 2

Locate the sites of testosterone precursor production in females

Answer 2

adrenal cortex and ovaries (amount is 10-40 times loess than males)

Question 3

Explain how menopause affects testosterone levels in women

Answer 3

testosterone level decreases

Question 4

Recall the sites of testosterone production in males

Answer 4

Leydig cells in testes

Question 5

List the roles of testosterone throughout the body

Answer 5

• Facial & body hair
• muscle mass & strength
• bone density
• fat distribution
• RBC production
• sperm production

Question 6

Explain why men have a higher hematocrit than women

Answer 6

Testosterone promotes erythropoietin synthesis –> EPO acts on bone marrow to stimulate RBC production

Question 7

Recite therapeutic uses for testosterone in women

Answer 7

Off-label for relief of menopause symptoms

Question 8

Recite therapeutic uses for testosterone in men

Answer 8

Hypogonadism

**for both men & women, testosterone has off-label uses for anemias

Question 9

Why would a patient receiving testosterone have an increased risk of stroke or MI?

Answer 9

Erythropoietic effect –> polycythemia –> increased risk of clots

Question 10

List 5 risks of androgen therapy or elevated androgen levels

Answer 10

1. Virilization (male physical characteristics)
2. Premature epiphyseal closure
3. Hepatotoxicity
4. Edema (Na and water retention)
5. Worsening of prostate cancer

Question 11

Describe signs of virilization in women and girls

Answer 11

• Acne
• increase in facial hair + male-pattern baldness
• clitoral enlargement
• deeper voice

Question 12

Describe signs of virilization in boys

Answer 12

• penile enlargement
• priapism (persistent erections) etc.

Question 13

How do certain forms of androgens (17-alpha-alkylated) cause hepatotoxicity?

Answer 13

can lead to cholestatic hepatitis (bile release from liver is blocked)
same impact as a gallstone in the duct

Question 14

Tell the effect of androgen therapy on cholesterol levels

Answer 14

May increase LDL and lower HDL

Question 15

Recall which cancer risk is elevated with androgen therapy in males

Answer 15

prostate cancer

Question 16

Review the contraindications of androgen administration

Answer 16

• pregnant women (androgen affects fetus)
• men with prostate/breast cancer
• for athletic performance enhancement

Question 17

Identify the only approved indication for androgen therapy

Answer 17

hypogonadism

Question 18

Define erectile dysfunction (ED)

Answer 18

the inability of a man to maintain an erection sufficient for sexual activity

Question 19

What are some risk factors for ED

Answer 19

• chronic illness (diabetes, HTN, depression)
• some medications
• advancing age

Question 20

What does PDE5, cGMP, and PDE5 inhibitor do?

Answer 20

PDE5: enzyme that breaks down cGMP
cGMP: enzyme responsible for facilitating penile engorgement
PDE5 inhibitor: less PDE5, more cGMP and vessels become dilated

Question 21

Recall the suffix that follows the drug names of PDE5 inhibitors

Answer 21

“-afil”
Sildenafil, Tadalafil, Vardenafil, Avanafil

Question 22

Explain the dose timing issues that occur with PDE5 inhibitors

Answer 22

The effect is not instantaneous–it can take 15-60 min. Mind the delay before sexual activity!

Question 23

List the dietary precautions for patients taking a PDE5 inhibitor

Answer 23

1. Do not take with grapefruit juice
2. The response can be delayed if ingested with high fat meal

Question 24

Recall a serious side effect of phosphodiesterase-5 inhibitor therapy when combined with nitrates or vasodilators

Answer 24

life-threatening hypotension!
Do not combine PDE5 meds + nitrates!

Question 24

Explain a medication that is contraindicated with PDE5 inhibitors

Answer 24

Do not combine PDE5 meds + nitrates!
Can cause life-threatening hypotension!

Question 25

Identify underlying medical conditions that may put a patient at risk of adverse effects when taking a PDE5 inhibitor

Answer 25

1. Had cardiovascular event in the past 6 months (safety concern for intense physical activity)
2. low BP
3. high BP(safety concern)
4. unstable angina

Question 26

2 adverse effects of PDE5 meds

Answer 26

1. hypotension
2. priapism (painful erections lasting > 6 hours)

Go to the ER; otherwise, it will result in permanent damage.

Question 27

Explain the common side effects of PDE5 inhibitors

Answer 27

headache, flushing, upset stomach
+
sleep apnea

Question 28

Describe the symptoms of benign prostatic hyperplasia (BPH)

Answer 28

BPH puts pressure on the urethra & cause changes in the bladder

• obstructive (difficulty urinating)
• bladder changes (sudden urgency, multiple times a day, nocturia)

Question 29

List 4 ways in which benign prostatic hypertrophy (BPH) can be treated

Answer 29

1. surgery (TURP)
2. Laser
3. Prostatectomy
4. Annual re-evaluation

Question 30

What are 2 drug groups that could be combined to treat BPH?

Answer 30

1. 5-alpha-reductase inhibitors
   (finasteride, dutasteride) slow response
2. alpha-1-adrenergic antagonists
   (tamsulosin) quick effects

Question 31

Explain the role of 5 alpha reductase inhibitors in the treatment of BPH

Answer 31

Most effective for the large prostates
–> shrink prostate epithelial tissue & improve mechanical obstruction

Question 32

Explain the role of alpha-1 adrenergic antagonists

Answer 32

Relax smooth muscle in the prostate
–> does not decrease prostate size but improve dynamic obstruction (better urine flow)

Question 33

Explain why it is safer to take an alpha-1 adrenergic antagonist at bedtime

Answer 33

Tamsulosin can cause “first dose effect”–a sudden and severe fall in blood pressure