Mens Health

Question 1

Sildenafil (viagra)
*Tadalafil (cialis)
Vardenafil (levitra)
Avanafil (stendra)

Answer 1

PDE5 inhibitors

Question 2

PDE5 Inhibitors
Phosphodiasterase
PDE5- specific to penile tissue

Answer 2

Treat ED
Increase blood flow to penile tissue
Increase cGMP levels and inhibit its breakdown; last a long time
Get and maintain erection

Question 3

Alprostadil

Prostaglandin analog for ED

Answer 3

• prostaglandin E1: smooth muscle relaxation
• *injection or urethral tablet
• onset 5-10 min: duration 30-60 min
• burning, prolonged errction

Question 4

PDE5 AEs

Answer 4

Hypotension, back pain, headache, flushing, vision changes, heating problems

Question 5

PDE5 drug inx

Answer 5

CYP3A4 inhibitors/ inducers,
Nitrates
Alpha 1 inhibitors

Question 6

Selectivity of PDEs

Some effect other PDEs not only PDE5

Answer 6

Sildenafil: PDE6
Avanafil: PDE6
*Tadalafil: PDE11

Question 7

Androgen replacement
Uses
Products

Answer 7

Hypogonadism
Replacement therapy men and women
Delayed puberty

Testosterone and testosterone esters
17 alpha alkylated androgens (oral use only)

Question 8

Androgen replacement

AEs

Answer 8

Virilization: acne, deepening of voice, increase libido, increase facial hair and body hair, genital enlargement 
Increase prostate cancer growth 
Edema 
Abuse potential 
Gynecomastia

Question 9

Androgen replacement

Product comparison

Answer 9

1-injection esters
Testosterone cyponate, testosterone ethionate

2-implantable pellets (3-4 mths)

3-topical 
Patch (androgen) irritation 
Gel- risk of transfer with contact 
90% of topical stay on skin 
Androgel, testim, foresta, axiron 

4- 17-alpha alkylated androgens
Oral use only***

Question 10

17-alpha alkylated androgens

-oral use only

Answer 10

• fluoxymestrone (androxy)
• methyl testosterone (android, methitest, testred)
• oxandrone (oxandrin)

Oral admin

• hepatotoxicty: testing, short term use
• abused by body builders

Question 11

Benign prostatic hypertrophy (BPH)

Answer 11

Mechanical vs dynamic obstruction
Epithelial (glandular) vs smooth muscle
-glandular: testosterone/DHT regulated
-muscular: alpha1 receptor mediated

Question 12

Glandular

5a reductase inhibitors (2)

Answer 12

5a reductase inhibitors inhibit the conversion of testosterone to DHT
Finasteride (proscar) 70% Lower DHT
Dutasteride (avodart) 90% lower DHT

Full effects take 6-12 months: will decrease PSA levels (30-50%)

AE: Low ejaculate volume, low libido, gynecomastia
* risk to male fetus (enhaled from bottle)

Question 13

Muscular treatment

Alpha 1- antagonists

Answer 13

A1 receptor inhibition results in smooth muscle relaxation
Fast working
AE: hypotension, fainting, dizzy, fatigue, nasal congestion
* differ in prostate selectivity, PK minor
-silodosin, tamulosin ^ prostrate selectivity

Question 14

A1- antagonists

Muscular treatment of BPH

Answer 14

Prostate specific a1: “osins”
Non specific a1: all over body, lower BP, orthostatic hypotension “azosins”
All equally effective at treating BPH

Question 15

Finasteride

Dutasteride

Answer 15

5a- reductase inhibitors

Question 16

Tamsulosin

Sildosin

Answer 16

Prostate specific a1 inhibitors

Question 17

Tadalafil (cialis)

Answer 17

PDE5 used for ED
Also used for treatment of BPH- it’s effects on PDE11: smooth muscle in prostate and lower back
* back pain