Men's Health Flashcards
what is the principle endogenous androgen in both males and females?
Testosterone
what are the principle adverse effects of testosterone?
virilization and hepotoxicity
what other effects does testosterone have?
effects sex characteristics in males
anabolic effects
increases muscle mass
increases synthesis of erythropoietin
what are the therapeutic uses of testosterone?
male hypogonadism replacement therapy delayed puberty muscle wasting in patients with AIDS anemias (stimulates synthesis of erythropoietin
adverse effects of testosterone
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)
what is the pregnancy category of testosterone?
category X - AVOID in pregnancy
what should you watch out for with the transdermal gel testosterone?
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
what are some anabolic steroids?
nandrolone, stanozolol, methalone
what are the risks of androgen abuse?
HTN testicular shrinkage - suppression of release of LH and FSH sterility gynecomastia acne reduction in HDL increase in LDL renal damage could intensify aggression
what classes of drugs are used for BPH?
5-alpha-reductase inhibitors
alpha1 antagonists
what drugs are 5-alpha-reductase inhibitors? and what are they used for?
Finasteride, Dutasteride (avodart)
used for BPH - for very large obstruction - mechanical obstruction
what is the MOA of 5-alpha-reductase inhibitors?
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
adverse effects of finasteride?
decrease ejaculate volume and libido
gynecomastia
decreases levels of prostate specific antigen (PSA)
pregnancy category X - should not touch pill
adverse effects of dutasteride
same as finasteride
what are two differences between dutasteride and finasteride?
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
what drugs are alpha1 antagonists?
alfuzosin doxazosin silodosin tamsulosin terazosin
MOA of alpha1 antagonists
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
adverse effects of alpha1 antagonists
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
what is the first dose phenomenon with alpha1 antagonists?
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
what drugs are non-selective alpha1 antagonists?
alfuzosin
doxazosin
terazosin
what happens with the non-selective alpha1 antagonists?
they also block receptors in the blood vessels –>
promote vasodilation–> can lower BP
good for men with BPH and HTN
what drugs are the PDE 5 inhibitors
Sildenafil (viagra)
verdenafil
tadalafil
what are the PDE 5 drugs used for?
erectile dysfunction
what is important patient teaching for PDE 5 inhibitors?
if erections lasts >4 hrs, they need to go to ER
can damage penile tissue and cause permanent loss of impotency
adverse effects of sildenafil
hypotension priapism (painful erection lasting >6 hrs) HA dyspepsia flushing nasal congestion diarrhea rash dizziness mild transient visual disturbances intensification of obstructive sleep apnea
rare effects of sildenafil
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
drug interactions of sildenafil
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
MOA of PDE 5 inhibitors
relaxes arterial and trabecular smooth muscle in the penis
adverse effects of vardenafil
same as sildenafil
can prolong QT interval
adverse effects of tadalafil
same as sildenafil
effects can last up to 36 hours
