Men's Health Flashcards
What occurs in hypothalamic-Pituitary-Gonadal-Axis
The hypothalmus releases GnRH -> GnRH stimulates the pituitary to release FSH and LH
What hormone stimulates tesosterone, spermatogenesis
Lutenizing hormone, follicle stimulating hormone
What enzyme converts testosterone, to what
5-alpha reductase, dihydrotestosterone
What is the primary causes of primary hypogonadism
Testes/ low serum testosterone, impaired spermatogenesis, increased gonadotropin concentrations (LH/FSH high)
What are the primary causes of secondary hypogonadism
hypothalmus or pituitary gland/ low serum testosterone, reduced spermatogenesis, low or inappropriately normal concentrations of gonadotropins (LH/FSH low)
What are non specific hypogonadism
Fatigue, depression, decreased libido, decreased energy
What are the consequences of having hypogonadism before pubery
micropenis, high pitched voice, small prostate
What is a low total testosterone to diagnose hypogonadism, what is a low free testosterone to diagnose hypogonadism
Less than 300 ng/dL, less than 64 pg/ml
How dose total testosterone bind in the body
38% to albumin, 60% to sex hormone binding globulin, 0.5-2% circulate in free form (Tfree)
T/F: As a patient gets older there is an increase in sex hormone binding globulin and less testosterone is produced
True
What are IM injections for testosterone and when do they occur
Testosterone enanthate, every 2-4 weeks/ testosterone cypionate, every 2-4 weeks, testosterone undecanoate, 750 mg inititially at week 4, then every 10 weeks
What is the testosterone product that can be injected SQ, how often
Testosterone propionate pellet every 3-6 months (new insert site must be used each time)
What is the testosterone product that can be taken orally, counseling points for absorption
Testosterone undecanoate: 3-4 capsule a day for 2-3, may decrease 1-3/ Taken with a high fat meal due route of absorption being the lymphatic system
How often is buccal testosterone used a day
Twice
What are the transdermal testosterone gels
Androgel 1%, Androgel 1.62%, Fortesta, Testim, Vogelxo
Where and when are the testosterone gels applied
Shoulders and upper arms, mornings (mimic circadian profile)
What is the testosterone patch, where can it be applied, when, most common AE
Androderm/ upper arm, back, or thigh/ nightly (released during the day)/ Skin irritation
What is the transdermal solution that is applied to the armpit, when is it applied
Axiron, in the morning
T/F: Non male patients who come into contact with these testosterone products will have no effects
False: Patients affected could have increases in dihydrotestsosterone so washing the hands is IMPERATIVE BEFORE AND AFTER
What patients have contraindications to testosterone treatment
Prostatic cancer or nodules, unsually high prostate antigens, breast cancer, increase in hematocrit by 50%, BPH, IPSS score greater than 19, heart failure, untreated or severe sleep apnea
T/F: TRT increases risk of heart disease but it could also be due to age of the patient
True
How does TRT effect prostate disease
Significant reduced risk in prostate cancer BUT if prostate cancer is diagnosed it the risk is higher it will be more severe
How should the prostate be monitored if using
TRT, when should urological consulation be sought
Every 3 months/ verified PSA greater than 4ng/mL, increase in PSA greater than 1.4ng/ml within any 12 month period of treatment, PSA velocity greater than 0.4ng/ml/year, detection of prostatic abnormality
What are the four categories of erectile dysfunction
Psychological, horomonal, neurological, vascular
What are the class of drugs most commonly used to treat erectile dysfunction, what are they, when should they be taken
Phosphodiesterase inhibitors (PDEI)/ Sildenafil, Tadalafil, Vardenafil, Avanafil/ one hour before sex
T/F: PDEIs heighten arousal, stimulation, and libido
False: PDEIs DO NOT heighten arousal, stimulation, or libido
Which PDEI lasts the longest, which can be taken as early as 15 mins
Tadalafil, Avanafil
What drug-drug interaction needs to be avoided when using PDEI
Nitrates
What are the local treatments of ED, what is the mechanism of action
Intra-cavernosal injection (Caverject), Intra-utethral suppository (Alprostadil)/ smooth muscle vasodilator
What is the natural product used to get an erection
Yohimbine
How does the vacuum constriction device work, how long is the erection, contraindications
Penis placed in tube, air evacuated from tube, blood trapped in penis with ring/ sickle cell patients and use of anticoagulation
What is the last resort for an erection
Penile implant
T/F: BPH happens to all men sometime naturally
True
What are the possible scores for IPSS what do they mean
1-7 mild, 8-19 moderate, 20-35 severe
What is the MOA of medications that treat BPH
Alpha-1 adrenergic blckers: antagonize the smooth mucscle of the prostate and bladder neck
What are the non-selective alpha blockers for BPH
Doxazosin and Terazosin (dossed at night due to orthostatic hypotension), Alfuzosin
What are the selective alpha-1 blocking agents for BPH
Tamsulosin and Siodosin
What are the adverse effects of alpha blockers
hypotension, orthostasis, dizziness
What are the 5-alpha reductase inhibiotors, what is the biggest benefit
Finasteride, Dutasteride/ reduction in prostate size and increase in urinary peak flow
