Mens Health Therapeutics Flashcards
Alfuzosin
Alpha blocker 2nd gen
Least potential for hypotension, dizziness, less ejaculatory dysfunction than tamsulosin
BPH
Prostate normally secretes alkaline fluid during ejaculation
Prostrate presses on bladder neck and excessive alpha adrenergic tone
Incomplete bladder emptying
Common, urinary discomfort
Asians lower risk
Obesity, cirrhosis
Prevention: daily NSAIDs 50%
Stromal tissue and capsule have alpha1 receptors: contraction
Tx: 1) tamsulosin, terazosin,
2) finasteride, dutasteride,
Digital rectal exam age 45
Clinical, phys, anatom, biochem (PSA)
Dried cranberries for LUTS
Tamsulosin
3rd generation selective alpha 1 blocker
No effect on blood pressure
Take with meals
AE: abnormal ejaculation, dizziness
Cimetidine DDI decreased clearance
Sildosin
~tamsulosin
Contraindicated in severe renal impairment (<30)
AE: retrograde ejaculation
5a-reductive inhibitors
DHT stimulates prostatic growth
Reduce DHT production, prostate size
Increase flow rate, improve voiding symptoms
More sexual side effects
Benefits in 6 months
Finasteride type 2 5a specific
Prostate tumor
PSA increases despite normal decrease in PSA with dutasteride
Erectile dysfunction
Men > 40
Cardio disease, atherosclerosis, HTN
Organic and psychogenic
Hormonal: hypogonadism, low T, elevated prolactin, low LH
Smoking, alcohol, CNS depressant
Erection
Vascular, CNS, hormonal, psychogenic
Arterial flow > venous flow out
Blood fills sinusoids
ACh produces vasodilation by NO
Increase cGMP / ACyclase
Visual stimuli and dopamine
Priapism
Prolonged erection
Meds that can cause ED
Anticholinergic Dop agonist: metoclopramide Estrogen, antiandrogens:ketoconazole CNS depressant: BZD, opioid, barb SSRI (can use bupropion for depression)
Decrease penile blood flow: diuretic, beta blocker
ED treatment
Weight loss
1) PDE5 inhibitors: decrease cGMP metabolism, selective for genital tissue
AVOID w/ nitrates!
Sildenafil on empty stomach
Take at least 5 doses before failure
Tadalafil long acting can be taken daily
Vardenafil fastest onset 16 min
AE: decrease BP, priapism
PDE5 inhibitor adverse effects
Sildenafil AE: abnormal vision
Tadalafil AE: nasal congestion
PDE5 inhibitors increased by
Nitrates Alpha blockers Azole 3A4 inhibitor Protease inhibitor Erythromycin
PDE5 inhibitors decreased by
3A4 inducers
Phenytoin
Rifampin
Carbamazepine
Moderate risk CVD
PDE5
NYHA class 2
Do cardiac workout to see if PDE5 inhibitor is appropriate
High CVD risk
Unstable angina
Uncontrolled HTN
NYHA class 3/4 heart failure
MI past 2 weeks
Avoid PDE5
Alprostadil
ED injectable agent, intracavernous
Second line, more effective than intrautethral
Explain priapism, 1st at Dr office
Prostaglandin E1
AE penile pain, fibrosis, rash, hematoma
Contraindicated in sickle cell anemia
Papaverine
Intracavernous injection
Increases cGMP and cAMP levels
Intrautethral alprostadil
Medicated urethral system for Erection
MUSE
Penile pain, urethral burning
Contraindicated in sickle cell anemia
Adjunctive ED therapy
Statins, metformin
Duloxetine improved pre-ejaculation
Quit smoking and
Vacuum erection device
First line in older patients
Those with CVD risk who fail oral/injectable treatments
Caution those on anticoagulants
Contraindicated in sickle cell anemia
Proposed premature ejaculation treatment
Priligy (dapoxetine)
Anesthetic spray of lidocaine and prilocaine
Hypogonadism
Andropause in older men
Testosterone replacement
Improved libido, bone density, muscle mass, mood
Limited data on long term effects: CVD, diabetes
Transdermal patch/gel daily less roller coaster over time, but irritation
Inject every week
Oral testosterone
Discouraged because of hepatotoxicity risk
Polycythemia/erythrocytosis
Increased RBC due to testosterone erythropoiesis
Can aggravate CVD
Greater risk with injection
Monitor Hgb/Hct
Testosterone AE
May increase prostate volume BPH
No significant change in flow rates/voiding
May make prostate cancer apparent
May increase PSA, do biopsy if PSA increases by 1ng/mL in 1 year
May down regulate FSH/LH fertility
Anabolic steroids
Increase in bulk
Acne, testicular atrophy, weak sperm
Mood swings
Hairloss, deepened voice, decreased breasts, increased libido, amenorrhea in women
Male hormone contraception
To induce azoospermia
Hormonal implant to replace testosterone
Every 4 months, reversed in 4 months
Can decrease HDL a
