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Spring Pharm > Men's Health > Flashcards

Men's Health Flashcards

1
Q

Endocrine hormone influences

A
  • Lutenizing hormone –> stimulates production of testosterone
  • Follicle-stimulating hormone –> testicular growth & sperm maturation
  • Estrogen –> converted from testosterone to aromatase
  • Testosterone
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2
Q

Hypogonadism

A

Diminished functional activity of the gonads & diminished sex hormone production

  • Primary: chemo/radiation, autoimmune, genetic, infection
  • Central: poor nutrition, steroids, pituitary injury, alcoholism
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3
Q

Hypogonadism symptoms

A
  • loss of body hair
  • muscle loss
  • abnormal breast growth
  • reduced growth of penis & testicles
  • erectile dysfunction
  • osteoporosis
  • low or absent sex drive
  • infertility
  • fatigue
  • hot flashes
  • difficulty concentrating
  • decreased libido
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4
Q

Testosterone

A

Class: androgen
Indication: expression of male sex characteristics, libido maintenance, skeletal muscle growth, male hypogonadism, delayed puberty, hormone replacement therapy
Admin: topical, implants, IM (PO not available in the US)

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5
Q

Testosterone adverse effects

A
  • priapism
  • premature epiphyseal closure
  • gynecomastia
  • profound secondary sex characteristics
  • acne
  • decreased HDL & increased triglycerides (leading to cardiac problems)
  • bone demineralization
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6
Q

Testosterone nursing implications

A
  • education on adverse effects
  • admin instructions: topical should go on upper arms, upper thighs or axilla (axilla can increase concentrations because it doubles the skin contact for the med); for arms/legs be careful other people don’t touch & absorb med
  • monitoring of anticipated outcomes
  • maintenance of scheduled dose
  • maintain physical activities (to decrease bone demineralization & keep bones strong)
  • monitor labs: cholesterol, triglycerides & electrolytes
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7
Q

Anabolic-Androgenic steroids

A

No true medical use (athlete use to build up muscle tissue)
-benefits endurance athletes more than strength athletes (makes muscles work longer & harder)
Indications: increase protein synthesis within cells, buildup of muscle tissue, virilizing properties
Admin: IM

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8
Q

Anabolic-Androgenic steroids adverse effects

A
  • increased LDL
  • decreased HDL
  • acne
  • HTN
  • liver damage
  • left ventricular structural changes (because steroids increase workload of all muscles in body)
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9
Q

Spironolactone

A

Class: androgen antagonist
Indications: increased androgen; hormone associated conditions, BPH, prostate cancer, endometriosis, male-pattern baldness, acne, hirsutism
Off-Label uses: (to decrease levels of systemic testosterone) acne vulgarism, PCOS, MTF hormone therapy

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10
Q

Sprinolactone adverse effects

A
  • electrolyte abnormalities (hyperkalemia)
  • dehydration
  • gynecomastia
  • impotence
  • orthostatic hypotension
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11
Q

Reasons for sexual dysfunction

A
  • erectile dysfunction
  • ejaculatory dysfunction
  • failure of detumescence
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12
Q

Erectile dysfunction non-pharm therapies

A
  • Herbal: improvement in blood flow, urethral irritation
  • Hormonal: testosterone
  • Injection/intraurethral pellet: causes vasodilation of penile arteries
  • can include implanted devices in the penis (used for BPH too): opens up where the prostate narrows down on the urethra
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13
Q

Erectile dysfunction

A
  • Causes: psychogenic, physiologic, pelvic trauma, medication induced
  • Pharm treatment: phosphodiesterase inhibitors, hormone therapy, injection therapy, herbal therapy
  • Non-pharm treatment: topical, mechanical
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14
Q

Sildenafil

A

Class: Phosphodiesterase inhibitors (PDE-5)
Indications: erectile dysfunction, pulmonary HTN (increases effects of nitric oxide & produces smooth muscle relaxation –> pulmonary veins & arteries dilate)
-NOT for arousal/stimulation/libido
Admin: oral; onset & duration is variable (depends on patient’s preference/goals)

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15
Q

Sildenafil adverse effects

A
  • headache
  • hypotension/syncope
  • priapism
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16
Q

Sildenafil nursing implications

A
  • educate regarding the use of nitrates (also affect nitric oxide. If used together, can have profound vasodilation)
  • BP monitoring with syncope/pre-syncope
  • seek medical attention for priapism
  • encourage discussions & questions
17
Q

Failure of detumescence - ischemic priapism

A

Causes:
-impaired venous flow: blood flow to the penis is normal, but the blood isn’t allows out of the penis through the venus system (so much pressure on the veins they’re collapsed & not letting blood out of oxygenated blood back in)
-penile trauma
-systemic vascular disease
-neuroregulation
-drug effects
Treatment:
-direct admin of arterial constrictors into the penis (if this doesn’t work, then surgery to relieve pressure on venous system & allow blood flow to normalize)
-immediate medical/surgical emergency (tissue necrosis can occur)

18
Q

Failure of detumescence - nonischemic priapism

A

Causes:
-increased arterial flow: increased blood flow to penis, but it’s not allowed out through the venus system
-AV fistula
-neuroregulation
Treatment: not a medical emergency, but need to treat the underlying problem

19
Q

Types of ejaculatory dysfunction

A

Premature: sooner than desired
Inhibited: prolonged
Retrograde: backward flow of semen into the bladder instead of through the urethra
-not harmful, but has associated infertility

20
Q

Ejaculatory dysfunction treatment

A
  • psychogenic
  • pelvic floor exercises
  • pharmacologic
  • androgen deficiency
21
Q

Benign prostatic hypertrophy

A
  • hyperplasia of prostatic tissue

- symptoms: urinary hesitancy, frequency & dribbling, nocturne, urinary bladder fullness

22
Q

Tamsulosin

A

Class: alpha 1 adrenergic blocker
MOA: blocks receptor sites at the neck of the bladder (and some in the kidney)
Indications: BPH
Off-Label use: passage of kidney stones < 5mm
Admin: oral

23
Q

Tamsulosin adverse effects

A
  • hypotension
  • orthostasis
  • dizziness
24
Q

Tamsulosin nursing implications

A
  • symptoms of orthostatic hypotension
  • do NOT crush
  • education on how they’ll know it’s working correctly (ie. relief of their specific BPH symptoms)
25
Q

Transgender definition

A

-when natal sex does not correlate with identified gender
MTF: male to female; larger social stigma/bullying/violence
FTM: female to male; less aggression as androgyny in females is more accepted in US

26
Q

Gender dysphoria

A
  • strong persistent feelings of identification with the opposite gender
  • discomfort with one’s own assigned sex that results in significant distress or impairment
  • incidences are more difficult to track in younger ages
  • Tanner 2 stage creates the most dysphoria
27
Q

Gender dysphoria model (former model)

A

5 goals in treating gender dysphoria: diagnostic assessment, psychotherapy & counseling, real-life experience, hormonal therapy, surgical treatment
Issues:
-doesn’t address non-binary, gender non-conforming or intersex
-requires real-life experience prior to hormone therapy
-requires a healthcare provider to determine “eligibility”

28
Q

Informed consent model (newer model)

A

Components: minimize number of clinic visits, client has better control of their outcomes, therapy is optional & not a requirement, doesn’t preclude mental health care
Overall goal of treatment:
-ameliorate gender dysphoria
-improve social & sexual functioning
-achieve serum hormone levels within physiologic normal biological range

29
Q

Pharmacologic goals of hormone therapy

A

-induce secondary sex characteristics of the identified gender
-induce virilization (ie. male-patterned hair growth, development of male physical contours, increased muscle mass, redistribution of fat deposits, cessation of menses, deepening of voice & increased libido)
-diminish secondary natal sex characteristics
-no randomized control trial data to support proper dosages or formulations
Screen for compounding issues: anxiety, depression, compulsivity, substance abuse

30
Q

Natal female to male

A

-hormone therapy may have permanent results
-may start at age of legal medical competence (in the US - 16 years old)
Hormone therapy:
-gonadotropin-releasing hormone agonist
-testosterone (main medication: target does between 50-100 mg IM weekly or 150-200 mg IM every other week; check levels every 2-3 months)
-progestin

31
Q

FTM physical changes 1-6 months

A 
maximum effect seen at 1-2 years
1-2 months:
-decreased breast glandular tissue
-decreased fertility
1-6 months:
-acne
-skin oiliness
-fat redistribution (continues up to 5 years)
-cessation of menses (2-6 months)
-clitoral enlargement (3-6 months)
-vaginal atrophy (3-6 months)
32
Q

FTM physical changes 6-12 months

A 
maximum effect seen at 2-5 years
6-12 months:
-facial hair/body hair growth
-scalp hair loss
-increased muscle mass &amp; strength
-deepening of voice (3-12 months)
33
Q

FTM psychological outcomes

A
  • acceptance
  • improved intimate relationships
  • no reports of regrets (some physical changes aren’t reversible after meds have been used for an extended period of time)
34
Q

FTM hormone therapy adverse effects

A
  • Hormone-dependent cancers: ovarian, breast, vaginal, lung, colon, brain
  • Supra-therapeutic testosterone dose: polycythemia/erythrocytosis
  • Supra-therapeutic testosterone dose: bone demineralization
  • decreases HDL
  • increases triglycerides
  • transient transaminitis
35
Q

Contraindications to hormone therapy

A
  • current pregnancy: possible spontaneous abortion
  • unstable coronary artery disease: need to evaluate risk for CAD prior to beginning treatment
  • untreated polycythemia: testosterone will worsen this
36
Q

Post gender affirmation surgery

A
  • replacement requirements similar to hypogonadal client
  • failure of HR will cause symptoms & signs of hormone deficiency: vasomotor symptoms, osteoporosis
  • yearly blood work & cancer screening
  • not undergone mastectomy, oophorectomy or hysterectomy: breast exams, pelvic exams
  • cervical screening, regular pap, mammography per ACOG recommendations
37
Q

FTM Gender affirmation surgical options

A
  • mastectomy
  • hysterectomy & ovariectomy
  • vaginectomy
  • urethral reconstruction
  • scrotoplasty & penile reconstruction from a radial forearm flap
  • penile & testicular prosthetic implants
  • metoidoplasty
  • construct microphallus to permit urination standing up

Spring Pharm (8 decks)

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