Men's Health Flashcards
how is ED diagnosed?
which medical conditions can commonly cause ED?
cannot consistently achieve an erection for over 3 months
HPT, Hyperlip, diabetes, psychiatric disorders
describe vasculature in the flaccid state and erect state
flaccid: arterial vessels constricted and venous vessels are noncompressed
erect: smooth muscle relaxation causes increased blood flow. venous outflow drops as the cavernosal spaces compress the venous plexus and the larger veins
meds/conditions that can cause ED:
beta-blockers
diuretics
SSRIs/TCAs/SNRIs
H2 antags
what NTs play a role in mediating arterial vasodilation in an erection?
Ach
NO
cGMP
cAMP
what are first line, second line, and third line tx for ED?
1st: PDE-5 inhibitors
2nd: intracevernosal or intraurethral alprostadil
3rd: surgical/prosthetic
MoA of PDE-5 inhibitors?
which one has the fastest onset?
inhibit catabolism of cGMP increasing smooth muscle relaxation. they also enhance insulin signaling, eNOS activity and NO production
sildenafil (viagra)
what is the MoA of alprostadil?
prostaglandin E1, stimulates adenyl cyclase to increase cAMP causing smooth muscle relaxation
what is androgenic alopecia?
aka male pattern baldness - androgens cause hair follicles to have an abnormally shorter growth phase
what are the two treatments for androgenic alopecia/MoA?
minoxidil (Rogaine): lengthens growth phase of hair follicles
finasteride: reduces production of androgenic hormones
what are signs of androgen deficiency?
incomplete/delayed sexual development
loss of body hair
very small testes
hyperprolactinemia and diabetes are causes of?
secondary hypogonadism
To determine testosterone deficiency, the pt should measure their morning fasting total testosterone. if it is low, what are the following steps?
if confirmed low T, pt should measure their LH and FSH, depending on their levels, what is the diagnosis?
confirm by repeating morning fasting total T
if still low, diagnosis of hypogonadism is confirmed.
if low LH and FSH, pt has secondary hypogonadism and measure prolactin and iron saturation. if high, pt has primary hypogonadism and should obtain karyotype to diagnose Klinefelter syndrome
it is recommended to start testosterone therapy in hypogonadal men to induce and maintain secondary _______________ and correct symptoms of _____________
sex characteristics, testosterone deficiency
what are contraindications for starting testosterone replacement therapy for men?
-want to maintain fertile
-breast or prostate cancer
-risk of prostate cancer
-elevated hematocrit
-severe sleep apnea
-severe urinary symptoms
-uncontrolled HF
-heart attack/stroke within last 6 months
-thrombophilia (easy clotting blood)
what formulations are available for testosterone RT?
subQ, IM, topical, patch, buccal, implantable pellets, and oral
what is Jantezo?
oral TRT
what should be monitored within 3-6 months of starting TRT, then at 12 months, and then annually?
what tests should be performed 3-12 months after initiation for prostate monitoring?
Testosterone and hematocrit
prostate specific antigen (PSA) blood test and digital rectal examination (DRE)
Monitoring of TRT:
injectables:
Gels:
Patches:
inject: make sure T interval is between 350-600
gel: monitor T concentration 2-8 hours after applying
patch: assess 3-12 hours after applying
what is the Prostate/Androgen pathophysiology?
hypothalamus release GnRH to pituitary. Pituitary releases LH and FSH to testes and ACTH to adrenal system to produce testosterone and androstenedione respectively. These are converted to dihydrotestosterone (DHT) by 5-a reductase in the prostate which induces growth and development of the prostate gland
IPSS Prostate Symptoms Score: what AUA Sx Score classifies the disease severity?
7 or less = mild
8-19 = moderate
20 or more = severe
when would surgery be required to treat BPH?
if pt has:
urinary retention
recurrent UTI
recurrent or persistent hematuria
bladder stones
renal insufficiency
what are the pharmacological treatments for BPH?
PDE-5i: Tadalafil
a1 blockers: alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin
5-alpha-reducatase inhibitors (ARIs): finasteride and dutasteride
anticholinergics (only if PVR less than 250)
which BPH treatments helps relax prostatic smooth muscle and relieves bladder obstruction, but don’t decrease prostate size or disease progression?
alpha blockers and PDE-5 inhibitors
which BPH treatment does not relax prostatic smooth muscle, but relieves bladder obstruction and decreases prostate size and disease progression?
5-a-reductase inhibitors
what alternative supplements can treat BPH?
none
what do we measure to determine prostate cancer?
prostate-specific antigen test and digital rectal exam (DRE)
The gleason score is used to determine how the cancer looks, and typical scores range from ____, and the higher the score means?
6-10. the more likely the cancer will grow and spread quickly
what is the 5-year survival rate of prostate cancer based on stage I-IV?
stage I: 90-95%
stage II: 60-70%
stage III: 30-40%
stage IV: 20%
what is androgen deprivation therapy and when do we use it?
a treatment for prostate cancer if cancer has spread too far to be cured by surgery or radiation, or if cancer remains after radiation or surgery
what LHRH agonists treat prostate cancer?
leuprolide
goserelin
triptorelin
histrelin
what LHRH antags treat prostate cancer?
degarelix and relugolix
what are the names of the anti-androgens used for prostate cancer?
flutamide… all end in lutamide
testosterone gel placement for:
1%
1.62%
2%
1% upper arms, shoulders or stomach
1.62%: upper arms or shoulders
2%: front/inner thighs
what is Xyosted?
subQ testosterone
why not use anticholinergics if PVR is over 300?
it means pt has urinary retention and ACs cause urinary retention
you should only give a pt finasteride for BPH if?
the prostate is enlarged
what should always be given with GnRH agonists in initial treatment for prostate tumors and why?
anti-androgens like flutamide b/c of initial flare
how long does it take for anticholinergics to work for BPH?
1-2 wks
how long does it take for alpha blockers to work for BPH?
1-6 wks
how long does it take for PDE5i to work for BPH?
4 wks
how long does it take for 5AR to work for BPH?
3-6 wks
don’t initiate testost therapy if PSA is?
over 4
PDE5i should not be combined with what other drug class that treats BPH?
alpha blockers
