Men's Health Flashcards
Number 1 Male Health Issue
Coronary Heart Disease
Delayed Sexual Maturity is due to
hypogonadism
Young men are most at risk for (2)
- testicular cancer
- alopecia
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
- 14
- 2
- Constitutional delay of growth and puberty
- chronic illness
- genetic
Testicular Cancer
Prognosis
* ___ yr survival rate of ___%
* ___% cure rate even if stage III
Treatment
* surgery - ___
* radiation
* chemotherapy
- 5 year, 95%
- 80%
- orchiectomy
Alopecia
Major type
male pattern baldness
androgenic alopecia
Androgenic Alopecia
- affect ___% of men
- hereditary
- hairs change to short, wispy, and non-pigmented
- increased ___ could be the cause
- 50
- DHT
What type of alopecia is this?
Alopecia areata
Autoimmune; small round patches
What type of alopecia is this?
Alopecia universalis
Complete hair loss on scalp and body
Traction alopecia
* caused by ___
man buns
Drug-induced alopecia examples
- anabolic steroids
- Cancer chemotherapy
Alopecia Treatment
Finasteride (Propecia®)
MOA: inhibits ___ which stops the conversion of testosterone to ___
Dose: ___ mg po ___ daily
SE: decreased ___; ED; dec volume of ___
- type II 5-alpha reductase, DHT
- 1, once
T or F: women of child bearing age should avoid handling Finasteride
True
alters sexual development of the fetus
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
- blood flow, telogen, anagen
- 5%, twice
- 4
Diagnosis of Hypogonadism
must have both low ___ levels with symptoms
testosterone
examples of specific signs/symptoms of low testosterone
- reduced libido
- gynecomastia
- loss of body hair
- reduced muscle bulk and strength
T or F: initial diagnostic blood testing for testosterone can be done any time during the day
false; should be done in the morning
Confirm with 2nd test; Free testosterone level less than 5 ng/dl
T or F: Low testosterone is less than 300 ng/dL
True
What dosage form of testosterone is most similar to physiologic levels
the patch
T or F: Oral testosterone capsules (Jatenzo) must be taken with food
True
Most OTC products are hormone
____ derived from natural
products.
precursors
Testosterone undecanoate capsules
Jatenzo
Dosing: 150-___ mg ___ daily with food
Measure serum testosterone levels 6 hours after AM dose
- 396, twice
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 ___
- prostate, breast
- 4, 3
- CVD
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
- children
- cardiac
Monitoring
- Patients should be monitored ___ months after initiating therapy
- Goal levels: ___ ng/dL
- if hematocrit goes above ___%, therapy should be stopped
- 3-6
- 400-700
- 54%
What drugs cause drug induced sexual dysfunction? (5)
- antidepressants
- antihypertesnisve agents
- estrogens
- 5 alpha reductase inhibitors
- cancer chemotherapy
T or F: “if you don’t use it, you lose it.” Regular sex protects against ED
True
three subtypes of erections
- psychogenic
- reflexogenic
- nocturnal
T or F: erections are initiated by the sympathetic nervous system and suppressed by the parasympathetic system
False; difficult to run away from a mountain lion with a full erection
initiated by parasympathetic, suppressed by sympathetic
erection 101
- Upon sexual stimulation, ___ is released which casues release of ___ from the ___ neurons in the penis.
- NO activates ___ which converts GTP to ___.
- Elevated levels of cGMP results in ___ release and produces smooth muscle ___ in the penis.
- This results in ___ flooding the penis chambers and veins being ___ to prevent draining.
- ACH, nitrous oxide, NANC
- guanylate cyclase, cGMP
- Ca2+, relaxation
- arterial blood, squeezed shut
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
- oxygen
- 3-6
- testosterone
- sacral
- REM, sympathetic
- bladder
Step-wise treatment of ED
- treat/eliminate known causes
- oral ___ inhibitors ( ____ if contraindicated)
- Intra ___ or intra ___ Tx
- possible ___ therapy
- Penile prosthesis
- PDE-5, vacuum
- urethral, cavernous
- combo
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
- angina
- relaxation
- cGMP
- maintenance
- refractory
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
- 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
PDE-5 inhibitors Dosing
Vardenafil (Levitra)
* Common strengths: ___ , ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* take on ___ stomach
- 2.5, 5, 10, 20 mg
- 10 mg
- 20 mg
- 30-60 min
- 4 hrs
- empty
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
- 2.5, 5, 10, 20 mg
- 10 mg, 2.5-5 mg
- 20 mg
- 60 min
- 36 hrs
- BP
- BPH
- food
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 ___
- 50, 100, 200 mg
- 100 mg
- 200 mg
- 30-60 min
- 6 hrs
- CYP3A4
- alpha
- food
PDE-5 inhibitors
T or F: 30-40% of men may not respond to the initial dose
True
next step is to try a larger dose
T or F: there is tachyphylaxis with PDE-5 inhibitiors
False
no known tachyphylaxis
CYP3A4 inhibitors (5)
- cimetidine
- ketoconazole
- erythromycin
- ritonavir
- grapefruit
T or F: Food delays the absorption of many PDE-5 inhibitors
True
Fatty meal can delay absorption of Viagra and Levitra by 1 extral hour
PDE-5 inhibitors Side Effects
SE are dose related, mild, and self limiting (6)
- headsche
- flushing
- dyspepsia (indigestion)
- nasal congestion
- light sensitivity
- NAION non-artermitic ischemic optic neuropathy (sudden loss in vision)
Do not use PDE-5 inhibitors on patients on oral or transdermal ___
nitrates
severe hypotension
patients on ___ blockers require a lower dose of PDE-5 inhibitors
alpha
Pulmonary Hypertension dosing
Sildenafil (Revatio) Dosing:
___ mg po ___ daily
generic available
20 mg, three times
Pulmonary Hypertension dosing
Tadalafil (Adcirca) Dosing:
___ mg po ___ daily
40 mg, once
vacuum are contraindicated in patients with ____
sickle cell anemia
Transurethral Suppositories
- Alprostadil Pellets (Muse) common strengths: ___ , ___ , ____ , and ___
- less effective than ___
- onset within ___
- penile pain 30%, burning 10%
- 125, 250, 500, 1000 mcg
- injection
- 5-10 minutes
Alprostadil Pellets (Muse counseling points)
- before you insert, make sure to ___
- ___ penis for 10-30 seconds
- max of __ doses per day
- pee
- roll
- 2
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
- PDE-5
- neurogenic
- 5 min
- 1 hr
- 1, 3
- sexual
Alprostadil injections (Caverject) side effects
- local irritation
- burning/dull penile pain
- risk of ___
- cavernosal ___ or areas of ___
- priapism
- plaques, fibrosis
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
- 27-30
- 2.5, 10 mcg
- 60 mcg
- titrate
Penile Prostheses
- irreversible
- only use when other treatments fail
- replace every ___ years
5-10
T or F: ischemic priapism is not painful
False; ischemic priapism is painful, non-ischemic is not painful
Drug-Induced Priapism
- ED drugs
- antidepressants (5)
- antipsychotics (2)
- anticoagulants (2)
- cocaine
- Others (3)
Antidepressants
* bupropion
* trazadone
* fluoxetine
* sertraline
* Li
Antipsychotics
* clozapine
* chlorpromazine
Anticoagulants
* heparin
* warfarin
Others
* EtOH
* prazosin
* hydroxyzine
Tx of Priapism
ischemic
* phenylephrine ___ mg
* blood ___
* saline ___
non-ischemic
* cold packs and compression
- 0.1-1 mg
- aspiration
- irrigation
Peyronie’s Disease (PD)
is also known as ___ disease
bent carrot
Peyronie’s Disease
bent erections (at least ___ degrees)
* pain
* palpable penile ___
- 30 degrees
- plaques
Peyronie’s Disease treatment
Xiaflex
* ___ clostridium histolyticum Injection
* 2 treatments over ___ days; can be repeated up to __ cycles
* $26k
* penile ___ TID
- Collagenase
- 3, 4
- stretching
Prostate cancer has high prevalence in ___ individuals
non-hispanic black
T or F: prostate cancer is the most common type of cancer in men
True
T or F: 80% of prostate cancer diagnosis is in stages III and IV
False: most are in stage I or II
Most men with diagnosis do not die from it
PSA Screening
Normal range: ___
Borderline range (25% risk) : ___
50% Risk: ___
- < 4 ng/mL
- 4-10 ng/mL
- > 10 ng/mL
yearly screening for people with PSA level greater than or equal to ___
2.5 ng/mL
- Routine PSA screening recommended for men ___ and over
- Start baseline screening for ___ men ages ___ with FH of prostate cancer
- 70
- african american, 40-45
normal size of prostate gland
* growth is commonn for men over ___ years old
- 20 mg
- 40
What type of receptors are in the prostate gland?
alpha-1a adrenergic
___ reductase in prostate converts testosterone to ___, which is respinsible for prostate growth
type-II alpha, DHT
Obstructive Symptoms (5)
- Decreased force of stream
- Hesitancy to initiate voiding
- Strain or push to urinate
- Terminal dribbling
- Intermittency
Irritative Symptoms
* incomplete ___ emptying
* ___uria (night)
* ___uria (pain)
* frequency
* urgency
* Incontinence
- bladder
- noct
- dys
Nocturia is __ or more voids per night
* redistribution of ___
2
* edema
BPH diagnosis requires ___ symptoms and a ___ exam
Complications of BPH
- chronic ___ failure
- overflow urinary ___
- recurrent ___
- diminishes ___ of life
- renal
- inconinence
- UTIs
- quality
BPH AUA scores
- Mild AUA: less than or equal to ___
- Moderate AUA: ___
- Severe AUA: greater than or equal to ___
- 7
- 8-19
- 20
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)
- anti-cholinergic
- contractility
- retention
- antihistamines (Benadryl)
- tricyclic antidepressants
- Cogentin, Artane, Scopolamine
- anti-muscarinics (Ditropan)
T or F: Approximately half of men with BPH also
have OAB (incontinence)
True
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
- 200 mL
- 5 mL/s
Moderate BPH Treatments
* ___ blockers +/-
* ___ therapy
* ___ inhibitors
- alpha
- hormone
- PDE
Severe Treatment Option: ___
* TUIP
* TURP
* open prostatectomy
surgery
* Transurethral Incision of Prostate
* Transurethral Resection of the Prostate
Picture is TURP
Alpha-1a Adrenergic Blockade
- ___ smooth muscle
tone of prostate gland and
bladder neck - improved urine ___
- Does NOT reduce ___ of prostate gland
- decreases AUA by ____ %
- relaxes
- flow
- size
- 30-40%
Alpha-1 Adrenergic Blockers Dosing
Terazosin
Brand:
Starting Dose:
Maintenance Dose:
- Hytrin
- 1 mg hs
- 10-20 mg hs
Alpha-1 Adrenergic Blockers Dosing
Doxazosin
Brand:
Starting Dose:
Maintenance Dose:
- Cardura
- 1mg hs
- 4-8 mg hs
Alpha-1 Adrenergic Blockers Dosing
Tamsulosin
Brand:
Starting Dose:
Maintenance Dose:
- Flomax
- 0.4 mg hs
- 0.4-0.8 mg hs
Take ½ hr after same meal each day!
Alpha-1 Adrenergic Blockers Dosing
Alfuzosin
Brand:
Starting Dose:
Maintenance Dose:
- Uroxatrol
- 10 mg daily
- 10 mg daily
Alpha-1 Adrenergic Blockers Dosing
Silodosin
Brand:
Starting Dose:
Maintenance Dose:
- Rapaflo
- 4 mg daily
- 4-8 mg daily
Take with food!
Alpha-1 Adrenergic Blockers Side Effects
- Dizziness
- Fatigue
- headache
- orthostatic hypotension (first dose with ___ and ___ )
- retrograde ejaculation ( espepcially with ___ and ___ )
- Floppy ___ Syndrome
- Cardura and Hytrin
- Rapaflo and Flomax
- Iris
Moderate BPH Treatment
PDE Inhibitors
* effectiveness similar to alpha antagonists
* Tadalafil ___ mg daily
* ___ smooth muscle tone of
prostate gland and bladder neck
* improves urine ___
- 5 mg
- relaxes
- flow
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 ___
- 5-alpha reductase
- 20-25%
- 40 g
- 6 months
Hormonal Therapy
Finasteride (Proscar)
___ mg po daily
5 mg
Dutasteride (Avodart)
___ mg po daily
0.5 mg
Side Effects of Hormonal Therapy
Mild and transient
- impotence
- decreased libido
- decrease volume of ejaculate
- breast enlargement/tenderness
T or F: Hormonal therapy decreases PSA by 50% in 6 monthes
True
Combination therapy for BPH
- Jayln is made up of ___ and ___
- for BPH and ED
- for BPH and OAB
more effective than either agent alone
- Dutasteride + Tamsulosin
- Finasteride + Tadalafil
- Tamsulosin + Tolterodine
