Men's Health

Question 1

what is the principle endogenous androgen in both males and females?

Answer 1

Testosterone

Question 2

what are the principle adverse effects of testosterone?

Answer 2

virilization and hepotoxicity

Question 3

what other effects does testosterone have?

Answer 3

effects sex characteristics in males
anabolic effects
increases muscle mass
increases synthesis of erythropoietin

Question 4

what are the therapeutic uses of testosterone?

Answer 4

male hypogonadism
replacement therapy
delayed puberty
muscle wasting in patients with AIDS
anemias (stimulates synthesis of erythropoietin

Question 5

adverse effects of testosterone

Answer 5

virilization in women, girls, boys
premature epiphyseal closure
hepatotoxicity
effects cholesterol level (increases LDL, decreases HDL)
prostate cancer - doesn’t cause it but promotes growth of cancer cells for someone who already has it
edema - androgen induced water & salt retention
gynecomastia
abuse potential (athletic performance)

Question 6

what is the pregnancy category of testosterone?

Answer 6

category X - AVOID in pregnancy

Question 7

what should you watch out for with the transdermal gel testosterone?

Answer 7

only 10% is absorbed, other 90% stays on the skin
so it can transfer to other people easily - wash contaminated skin immediately if you come in contact with it
if wife or someone is pregnant, they should not touch it

Question 8

what are some anabolic steroids?

Answer 8

nandrolone, stanozolol, methalone

Question 9

what are the risks of androgen abuse?

Answer 9

HTN
testicular shrinkage - suppression of release of LH and FSH
sterility
gynecomastia
acne
reduction in HDL
increase in LDL
renal damage
could intensify aggression

Question 10

what classes of drugs are used for BPH?

Answer 10

5-alpha-reductase inhibitors

alpha1 antagonists

Question 11

what drugs are 5-alpha-reductase inhibitors? and what are they used for?

Answer 11

Finasteride, Dutasteride (avodart)

used for BPH - for very large obstruction - mechanical obstruction

Question 12

what is the MOA of 5-alpha-reductase inhibitors?

Answer 12

delays growth of prostate and causes shrinkage of enlarged prostate tissue by blocking hormone
inhibits 5-alpha-reductase which is an enzyme that converts testosterone to DHT

Question 13

adverse effects of finasteride?

Answer 13

decrease ejaculate volume and libido
gynecomastia
decreases levels of prostate specific antigen (PSA)
pregnancy category X - should not touch pill

Question 14

adverse effects of dutasteride

Answer 14

same as finasteride

Question 15

what are two differences between dutasteride and finasteride?

Answer 15

Dutasteride reduction in circulating DHT is more complete
Dutasteride has an extremely long half-life (5 weeks) so it takes months to clear after stopping - men should not donate blood for 6 months

Question 16

what drugs are alpha1 antagonists?

Answer 16

alfuzosin
doxazosin
silodosin
tamsulosin
terazosin

Question 17

MOA of alpha1 antagonists

Answer 17

blockade of alpha1 receptors relaxes smooth muscle in the bladder neck, prostate capsule, prostatic urethra –> reduces dynamic obstruction of urethra - DOES NOT REDUCE PROSTATE SIZE

Question 18

adverse effects of alpha1 antagonists

Answer 18

selective blockers: abnormal ejaculation
nonselective blockers: hypotension, fainting, dizziness, somnolence, nasal congestion

increased risk of floppy iris syndrome with cataract surgery - patients needs to tell ophthalmologist and postpone alpha blocker therapy until after surgery

Question 19

what is the first dose phenomenon with alpha1 antagonists?

Answer 19

sudden and severe drop in BP when going from lying to standing

syncope

reduce orthostatic hypotension by:
start with small dose
give at night so less risk of fall
hold diuretics for 24 hours

Question 20

what drugs are non-selective alpha1 antagonists?

Answer 20

alfuzosin
doxazosin
terazosin

Question 21

what happens with the non-selective alpha1 antagonists?

Answer 21

they also block receptors in the blood vessels –>
promote vasodilation–> can lower BP
good for men with BPH and HTN

Question 22

what drugs are the PDE 5 inhibitors

Answer 22

Sildenafil (viagra)
verdenafil
tadalafil

Question 23

what are the PDE 5 drugs used for?

Answer 23

erectile dysfunction

Question 24

what is important patient teaching for PDE 5 inhibitors?

Answer 24

if erections lasts >4 hrs, they need to go to ER

can damage penile tissue and cause permanent loss of impotency

Question 25

adverse effects of sildenafil

Answer 25

hypotension
priapism (painful erection lasting >6 hrs)
HA
dyspepsia
flushing
nasal congestion
diarrhea
rash
dizziness
mild transient visual disturbances
intensification of obstructive sleep apnea

Question 26

rare effects of sildenafil

Answer 26

nonerteritic ischemic optic neuropathy - irreversible blurring or loss of vision from blockage of blood to optic nerve

sudden hearing loss, usually in 1 ear with dizziness, vertigo, tinnitus

Question 27

drug interactions of sildenafil

Answer 27

absorption is slowed with high fat meals

nitrates - life threatening hypotension

alpha blockers - dilate arterioles - hypotension

inhibitors of cytochrome P450 (azole drugs, erythromycin, cimetidine, saquinavir, ritonavir, grapefruit juice) - can suppress metabolism of sildenafil

Question 28

MOA of PDE 5 inhibitors

Answer 28

relaxes arterial and trabecular smooth muscle in the penis

Question 29

adverse effects of vardenafil

Answer 29

same as sildenafil

can prolong QT interval

Question 30

adverse effects of tadalafil

Answer 30

same as sildenafil

effects can last up to 36 hours