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)