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PHRM 825 > Men's Health > Flashcards

Men's Health Flashcards

1
Q

Number 1 Male Health Issue

A

Coronary Heart Disease

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2
Q

Delayed Sexual Maturity is due to

A

hypogonadism

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3
Q

Young men are most at risk for (2)

A
  • testicular cancer
  • alopecia
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4
Q

Hypogonadism

  • incomplete/delayed puberty and lack of testicular growth at ___ yo
  • ___ % of adolescent population
  • ___ (CDGP) is most common cause.
  • Functional hypogonadism (secondary to another ___)
  • organic/___ hypogonadism
A
  • 14
  • 2
  • Constitutional delay of growth and puberty
  • chronic illness
  • genetic
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5
Q

Testicular Cancer

Prognosis
* ___ yr survival rate of ___%
* ___% cure rate even if stage III
Treatment
* surgery - ___
* radiation
* chemotherapy

A
  • 5 year, 95%
  • 80%
  • orchiectomy
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6
Q

Alopecia

Major type

male pattern baldness

A

androgenic alopecia

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7
Q

Androgenic Alopecia

  • affect ___% of men
  • hereditary
  • hairs change to short, wispy, and non-pigmented
  • increased ___ could be the cause
A
  • 50
  • DHT
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8
Q

What type of alopecia is this?

A

Alopecia areata

Autoimmune; small round patches

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9
Q

What type of alopecia is this?

A

Alopecia universalis

Complete hair loss on scalp and body

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10
Q

Traction alopecia
* caused by ___

A

man buns

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11
Q

Drug-induced alopecia examples

A
  • anabolic steroids
  • Cancer chemotherapy
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12
Q

Alopecia Treatment

Finasteride (Propecia®)
MOA: inhibits ___ which stops the conversion of testosterone to ___
Dose: ___ mg po ___ daily
SE: decreased ___; ED; dec volume of ___

A
  • type II 5-alpha reductase, DHT
  • 1, once
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13
Q

T or F: women of child bearing age should avoid handling Finasteride

A

True

alters sexual development of the fetus

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14
Q

Alopecia Treatment

Minoxidil (Rogaine®)
MOA: enlarging miniaturized hair follicles by increasing ____ to the follicle. Stimulates hair folicle from ___ (resting phase) to ___ (growth phase)
Dose: ___% foam/solution applied to dry scalp ___ daily every day
* may take ___ months to see results

A
  • blood flow, telogen, anagen
  • 5%, twice
  • 4
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15
Q

Diagnosis of Hypogonadism

must have both low ___ levels with symptoms

A

testosterone

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16
Q

examples of specific signs/symptoms of low testosterone

A
  • reduced libido
  • gynecomastia
  • loss of body hair
  • reduced muscle bulk and strength
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17
Q

T or F: initial diagnostic blood testing for testosterone can be done any time during the day

A

false; should be done in the morning

Confirm with 2nd test; Free testosterone level less than 5 ng/dl

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18
Q

T or F: Low testosterone is less than 300 ng/dL

A

True

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19
Q

What dosage form of testosterone is most similar to physiologic levels

A

the patch

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20
Q

T or F: Oral testosterone capsules (Jatenzo) must be taken with food

A

True

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21
Q

Most OTC products are hormone
____ derived from natural
products.

A

precursors

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22
Q

Testosterone undecanoate capsules

Jatenzo
Dosing: 150-___ mg ___ daily with food
Measure serum testosterone levels 6 hours after AM dose

A
  • 396, twice
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23
Q

Contraindications to THT

  • ___ and ___ cancer
  • Hematocrit >50%
  • Baseline PSA greater than ___ ng/mL or PSA > ___ ng/mL in men with high risk for prostate cancer
  • recent or poorly controlled ___
A
  • prostate, breast
  • 4, 3
  • CVD
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24
Q

Black Box Warnings

  • gel formulation has concerns of secondary exposure to ___
  • controversy regarding ____ risk (injection > patches and gels)

FDA voted to add strict new limitations to testosterone inidustry

A
  • children
  • cardiac
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25
Q

Monitoring

  • Patients should be monitored ___ months after initiating therapy
  • Goal levels: ___ ng/dL
  • if hematocrit goes above ___%, therapy should be stopped
A
  • 3-6
  • 400-700
  • 54%
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26
Q

What drugs cause drug induced sexual dysfunction? (5)

A
  • antidepressants
  • antihypertesnisve agents
  • estrogens
  • 5 alpha reductase inhibitors
  • cancer chemotherapy
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27
Q

T or F: “if you don’t use it, you lose it.” Regular sex protects against ED

A

True

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28
Q

three subtypes of erections

A
  • psychogenic
  • reflexogenic
  • nocturnal
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29
Q

T or F: erections are initiated by the sympathetic nervous system and suppressed by the parasympathetic system

A

False; difficult to run away from a mountain lion with a full erection

initiated by parasympathetic, suppressed by sympathetic

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30
Q

erection 101

  1. Upon sexual stimulation, ___ is released which casues release of ___ from the ___ neurons in the penis.
  2. NO activates ___ which converts GTP to ___.
  3. Elevated levels of cGMP results in ___ release and produces smooth muscle ___ in the penis.
  4. This results in ___ flooding the penis chambers and veins being ___ to prevent draining.
A
  • ACH, nitrous oxide, NANC
  • guanylate cyclase, cGMP
  • Ca2+, relaxation
  • arterial blood, squeezed shut
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31
Q

Nocturnal Erections

  • ___ is important to penile health
  • normal range of nocturnal erections per night: ___
  • frequency influenced by ___ levels
  • controlled by ___ nerves
  • associated with ___ sleep and suppression of the ___ system
  • full ___ may mildly stimulate this nerve
A
  • oxygen
  • 3-6
  • testosterone
  • sacral
  • REM, sympathetic
  • bladder
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32
Q

Step-wise treatment of ED

  1. treat/eliminate known causes
  2. oral ___ inhibitors ( ____ if contraindicated)
  3. Intra ___ or intra ___ Tx
  4. possible ___ therapy
  5. Penile prosthesis
A
  • PDE-5, vacuum
  • urethral, cavernous
  • combo
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33
Q

PDE-5 inhibitors

  • originially intended for ___
  • promotes smooth muscle ___ by stopping the hydrolyzation of ___ to 5’GMP
  • Sexual stimulation is required
  • enhances development and ___ (more rigid and longer lasting)
  • decreases ___ period
A
  • angina
  • relaxation
  • cGMP
  • maintenance
  • refractory
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34
Q

PDE-5 inhibitors Dosing

Sildenafil (Viagra)
* Common strengths: ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* DI with ___ inhibitors
* Lower dose with ___ blockers
* take on ___ stomach

A
  • 25, 50, 100 mg
  • 50 mg
  • 100 mg
  • 30-60 min
  • 4 hrs
  • CYP3A4
  • alpha
  • empty

25 mg starting dose in patients > 65 yo, hepatic impairment, CrCl < 30

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35
Q

PDE-5 inhibitors Dosing

Vardenafil (Levitra)
* Common strengths: ___ , ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* take on ___ stomach

A
  • 2.5, 5, 10, 20 mg
  • 10 mg
  • 20 mg
  • 30-60 min
  • 4 hrs
  • empty
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36
Q

PDE-5 inhibitors Dosing

Tadalafil (Cialis)
* Common strengths: ___ , ___ , ___ , and ___
* Starting dose: ___ ( ___ if daily)
* Max dose: ___
* Onset ___
* Duration: ___
* does NOT decrease ___
* indicated for ___
* Okay to take with ___
* daily low dose may be more effective for some patients

A
  • 2.5, 5, 10, 20 mg
  • 10 mg, 2.5-5 mg
  • 20 mg
  • 60 min
  • 36 hrs
  • BP
  • BPH
  • food
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37
Q

PDE-5 inhibitors Dosing

Avanafil (Stendra)
* Common strengths: ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* DI with ___ inhibitors
* Lower dose with ___ blockers
* Okay to take with ___

A
  • 50, 100, 200 mg
  • 100 mg
  • 200 mg
  • 30-60 min
  • 6 hrs
  • CYP3A4
  • alpha
  • food
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38
Q

PDE-5 inhibitors

T or F: 30-40% of men may not respond to the initial dose

A

True

next step is to try a larger dose

39
Q

T or F: there is tachyphylaxis with PDE-5 inhibitiors

A

False

no known tachyphylaxis

40
Q

CYP3A4 inhibitors (5)

A
  • cimetidine
  • ketoconazole
  • erythromycin
  • ritonavir
  • grapefruit
41
Q

T or F: Food delays the absorption of many PDE-5 inhibitors

A

True

Fatty meal can delay absorption of Viagra and Levitra by 1 extral hour

42
Q

PDE-5 inhibitors Side Effects

SE are dose related, mild, and self limiting (6)

A
  • headsche
  • flushing
  • dyspepsia (indigestion)
  • nasal congestion
  • light sensitivity
  • NAION non-artermitic ischemic optic neuropathy (sudden loss in vision)
43
Q

Do not use PDE-5 inhibitors on patients on oral or transdermal ___

A

nitrates

severe hypotension

44
Q

patients on ___ blockers require a lower dose of PDE-5 inhibitors

A

alpha

45
Q

Pulmonary Hypertension dosing

Sildenafil (Revatio) Dosing:
___ mg po ___ daily

generic available

A

20 mg, three times

46
Q

Pulmonary Hypertension dosing

Tadalafil (Adcirca) Dosing:
___ mg po ___ daily

A

40 mg, once

47
Q

vacuum are contraindicated in patients with ____

A

sickle cell anemia

48
Q

Transurethral Suppositories

  • Alprostadil Pellets (Muse) common strengths: ___ , ___ , ____ , and ___
  • less effective than ___
  • onset within ___
  • penile pain 30%, burning 10%
A
  • 125, 250, 500, 1000 mcg
  • injection
  • 5-10 minutes
49
Q

Alprostadil Pellets (Muse counseling points)

  • before you insert, make sure to ___
  • ___ penis for 10-30 seconds
  • max of __ doses per day
A
  • pee
  • roll
  • 2
50
Q

Intracavernosal Injections

Alprostadil injections (Caverject)
* Drug of choice is patient fails with ___ inhibitors
* Highly effective
* best for ___ ED
* onset within ___
* duration ____
* Max of ___ inj/day; ___ per week
* NO ___ stimulation required

A
  • PDE-5
  • neurogenic
  • 5 min
  • 1 hr
  • 1, 3
  • sexual
51
Q

Alprostadil injections (Caverject) side effects

  • local irritation
  • burning/dull penile pain
  • risk of ___
  • cavernosal ___ or areas of ___
A
  • priapism
  • plaques, fibrosis
52
Q

Alprostadil injections (Caverject) counseling points

  • use a ___ gauge needle
  • start at ___ mcg (many start at ___ mcg)
  • max dose: ___
  • ___ to dose that produces an erection lasting 1 hour
A
  • 27-30
  • 2.5, 10 mcg
  • 60 mcg
  • titrate
53
Q

Penile Prostheses

  • irreversible
  • only use when other treatments fail
  • replace every ___ years
A

5-10

54
Q

T or F: ischemic priapism is not painful

A

False; ischemic priapism is painful, non-ischemic is not painful

55
Q

Drug-Induced Priapism

  • ED drugs
  • antidepressants (5)
  • antipsychotics (2)
  • anticoagulants (2)
  • cocaine
  • Others (3)
A

Antidepressants
* bupropion
* trazadone
* fluoxetine
* sertraline
* Li

Antipsychotics
* clozapine
* chlorpromazine

Anticoagulants
* heparin
* warfarin

Others
* EtOH
* prazosin
* hydroxyzine

56
Q

Tx of Priapism

ischemic
* phenylephrine ___ mg
* blood ___
* saline ___

non-ischemic
* cold packs and compression

A
  • 0.1-1 mg
  • aspiration
  • irrigation
57
Q

Peyronie’s Disease (PD)
is also known as ___ disease

A

bent carrot

58
Q

Peyronie’s Disease

bent erections (at least ___ degrees)
* pain
* palpable penile ___

A
  • 30 degrees
  • plaques
59
Q

Peyronie’s Disease treatment

Xiaflex
* ___ clostridium histolyticum Injection
* 2 treatments over ___ days; can be repeated up to __ cycles
* $26k
* penile ___ TID

A
  • Collagenase
  • 3, 4
  • stretching
60
Q

Prostate cancer has high prevalence in ___ individuals

A

non-hispanic black

61
Q

T or F: prostate cancer is the most common type of cancer in men

A

True

62
Q

T or F: 80% of prostate cancer diagnosis is in stages III and IV

A

False: most are in stage I or II

Most men with diagnosis do not die from it

63
Q

PSA Screening

Normal range: ___
Borderline range (25% risk) : ___
50% Risk: ___

A
  • < 4 ng/mL
  • 4-10 ng/mL
  • > 10 ng/mL
64
Q

yearly screening for people with PSA level greater than or equal to ___

A

2.5 ng/mL

65
Q
  • Routine PSA screening recommended for men ___ and over
  • Start baseline screening for ___ men ages ___ with FH of prostate cancer
A
  • 70
  • african american, 40-45
66
Q

normal size of prostate gland
* growth is commonn for men over ___ years old

A
  • 20 mg
  • 40
67
Q

What type of receptors are in the prostate gland?

A

alpha-1a adrenergic

68
Q

___ reductase in prostate converts testosterone to ___, which is respinsible for prostate growth

A

type-II alpha, DHT

69
Q

Obstructive Symptoms (5)

A
  • Decreased force of stream
  • Hesitancy to initiate voiding
  • Strain or push to urinate
  • Terminal dribbling
  • Intermittency
70
Q

Irritative Symptoms
* incomplete ___ emptying
* ___uria (night)
* ___uria (pain)
* frequency
* urgency
* Incontinence

A
  • bladder
  • noct
  • dys
71
Q

Nocturia is __ or more voids per night
* redistribution of ___

A

2
* edema

72
Q

BPH diagnosis requires ___ symptoms and a ___ exam

A
73
Q

Complications of BPH

  • chronic ___ failure
  • overflow urinary ___
  • recurrent ___
  • diminishes ___ of life
A
  • renal
  • inconinence
  • UTIs
  • quality
74
Q

BPH AUA scores

  • Mild AUA: less than or equal to ___
  • Moderate AUA: ___
  • Severe AUA: greater than or equal to ___
A
  • 7
  • 8-19
  • 20
75
Q

Non-Drug Therapy for BPH

Avoid drugs with strong ___ properties
* decreases ___ of bladder detrusor muscle
* results in urinary ___

What are some examples of these drugs? (4)

A
  • anti-cholinergic
  • contractility
  • retention
  • antihistamines (Benadryl)
  • tricyclic antidepressants
  • Cogentin, Artane, Scopolamine
  • anti-muscarinics (Ditropan)
76
Q

T or F: Approximately half of men with BPH also
have OAB (incontinence)

A

True

77
Q

Men with both BPH and OAB have better results if they take a combo alpha antagonist and anti-muscarinic… but antimuscarinics ahould be avoided in BPH patients with post void residual > ___ mL or max urine flow rate of < ___ mL/s

A
  • 200 mL
  • 5 mL/s
78
Q

Moderate BPH Treatments
* ___ blockers +/-
* ___ therapy
* ___ inhibitors

A
  • alpha
  • hormone
  • PDE
79
Q

Severe Treatment Option: ___
* TUIP
* TURP
* open prostatectomy

A

surgery
* Transurethral Incision of Prostate
* Transurethral Resection of the Prostate

Picture is TURP

80
Q

Alpha-1a Adrenergic Blockade

  • ___ smooth muscle
    tone of prostate gland and
    bladder neck
  • improved urine ___
  • Does NOT reduce ___ of prostate gland
  • decreases AUA by ____ %
A
  • relaxes
  • flow
  • size
  • 30-40%
81
Q

Alpha-1 Adrenergic Blockers Dosing

Terazosin
Brand:
Starting Dose:
Maintenance Dose:

A
  • Hytrin
  • 1 mg hs
  • 10-20 mg hs
82
Q

Alpha-1 Adrenergic Blockers Dosing

Doxazosin
Brand:
Starting Dose:
Maintenance Dose:

A
  • Cardura
  • 1mg hs
  • 4-8 mg hs
83
Q

Alpha-1 Adrenergic Blockers Dosing

Tamsulosin
Brand:
Starting Dose:
Maintenance Dose:

A
  • Flomax
  • 0.4 mg hs
  • 0.4-0.8 mg hs

Take ½ hr after same meal each day!

84
Q

Alpha-1 Adrenergic Blockers Dosing

Alfuzosin
Brand:
Starting Dose:
Maintenance Dose:

A
  • Uroxatrol
  • 10 mg daily
  • 10 mg daily
85
Q

Alpha-1 Adrenergic Blockers Dosing

Silodosin
Brand:
Starting Dose:
Maintenance Dose:

A
  • Rapaflo
  • 4 mg daily
  • 4-8 mg daily

Take with food!

86
Q

Alpha-1 Adrenergic Blockers Side Effects

  • Dizziness
  • Fatigue
  • headache
  • orthostatic hypotension (first dose with ___ and ___ )
  • retrograde ejaculation ( espepcially with ___ and ___ )
  • Floppy ___ Syndrome
A
  • Cardura and Hytrin
  • Rapaflo and Flomax
  • Iris
87
Q

Moderate BPH Treatment

PDE Inhibitors
* effectiveness similar to alpha antagonists
* Tadalafil ___ mg daily
* ___ smooth muscle tone of
prostate gland and bladder neck
* improves urine ___

A
  • 5 mg
  • relaxes
  • flow
88
Q

Hormonal Therapy for BPH

  • ___ inhibitors which decreases
    dihydrotestosterone (DHT) production
    decreases size of prostate by ___ %
  • men with prostate greater than ___ g benefit most
  • onset of action may be as long as ___
A
  • 5-alpha reductase
  • 20-25%
  • 40 g
  • 6 months
89
Q

Hormonal Therapy

Finasteride (Proscar)
___ mg po daily

A

5 mg

90
Q

Dutasteride (Avodart)
___ mg po daily

A

0.5 mg

91
Q

Side Effects of Hormonal Therapy

Mild and transient

A
  • impotence
  • decreased libido
  • decrease volume of ejaculate
  • breast enlargement/tenderness
92
Q

T or F: Hormonal therapy decreases PSA by 50% in 6 monthes

A

True

93
Q

Combination therapy for BPH

  • Jayln is made up of ___ and ___
  • for BPH and ED
  • for BPH and OAB

more effective than either agent alone

A
  • Dutasteride + Tamsulosin
  • Finasteride + Tadalafil
  • Tamsulosin + Tolterodine

PHRM 825 (49 decks)

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