Mens Health Therapeutics

Question 0

Alfuzosin

Answer 0

Alpha blocker 2nd gen

Least potential for hypotension, dizziness, less ejaculatory dysfunction than tamsulosin

Question 1

BPH

Prostate normally secretes alkaline fluid during ejaculation

Prostrate presses on bladder neck and excessive alpha adrenergic tone

Incomplete bladder emptying

Answer 1

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

Question 2

Tamsulosin

Answer 2

3rd generation selective alpha 1 blocker

No effect on blood pressure
Take with meals

AE: abnormal ejaculation, dizziness

Cimetidine DDI decreased clearance

Question 3

Sildosin

Answer 3

~tamsulosin

Contraindicated in severe renal impairment (<30)

AE: retrograde ejaculation

Question 4

5a-reductive inhibitors

Answer 4

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

Question 5

Prostate tumor

Answer 5

PSA increases despite normal decrease in PSA with dutasteride

Question 6

Erectile dysfunction

Answer 6

Men > 40
Cardio disease, atherosclerosis, HTN

Organic and psychogenic
Hormonal: hypogonadism, low T, elevated prolactin, low LH

Smoking, alcohol, CNS depressant

Question 7

Erection

Vascular, CNS, hormonal, psychogenic

Answer 7

Arterial flow > venous flow out

Blood fills sinusoids

ACh produces vasodilation by NO
Increase cGMP / ACyclase

Visual stimuli and dopamine

Question 8

Priapism

Answer 8

Prolonged erection

Question 9

Meds that can cause ED

Answer 9

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

Question 10

ED treatment

Answer 10

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

Question 11

PDE5 inhibitor adverse effects

Answer 11

Sildenafil AE: abnormal vision

Tadalafil AE: nasal congestion

Question 12

PDE5 inhibitors increased by

Answer 12

Nitrates 
Alpha blockers
Azole 3A4 inhibitor
Protease inhibitor 
Erythromycin

Question 13

PDE5 inhibitors decreased by

Answer 13

3A4 inducers

Phenytoin
Rifampin
Carbamazepine

Question 14

Moderate risk CVD

PDE5

Answer 14

NYHA class 2

Do cardiac workout to see if PDE5 inhibitor is appropriate

Question 15

High CVD risk

Answer 15

Unstable angina
Uncontrolled HTN
NYHA class 3/4 heart failure

MI past 2 weeks

Avoid PDE5

Question 16

Alprostadil

ED injectable agent, intracavernous

Second line, more effective than intrautethral

Answer 16

Explain priapism, 1st at Dr office

Prostaglandin E1

AE penile pain, fibrosis, rash, hematoma

Contraindicated in sickle cell anemia

Question 17

Papaverine

Answer 17

Intracavernous injection

Increases cGMP and cAMP levels

Question 18

Intrautethral alprostadil

Medicated urethral system for Erection
MUSE

Answer 18

Penile pain, urethral burning

Contraindicated in sickle cell anemia

Question 19

Adjunctive ED therapy

Answer 19

Statins, metformin

Duloxetine improved pre-ejaculation

Quit smoking and

Question 20

Vacuum erection device

Answer 20

First line in older patients

Those with CVD risk who fail oral/injectable treatments

Caution those on anticoagulants

Contraindicated in sickle cell anemia

Question 21

Proposed premature ejaculation treatment

Answer 21

Priligy (dapoxetine)

Anesthetic spray of lidocaine and prilocaine

Question 22

Hypogonadism

Answer 22

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

Question 23

Oral testosterone

Answer 23

Discouraged because of hepatotoxicity risk

Question 24

Polycythemia/erythrocytosis

Answer 24

Increased RBC due to testosterone erythropoiesis

Can aggravate CVD

Greater risk with injection

Monitor Hgb/Hct

Question 25

Testosterone AE

Answer 25

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

Question 26

Anabolic steroids

Answer 26

Increase in bulk

Acne, testicular atrophy, weak sperm

Mood swings

Hairloss, deepened voice, decreased breasts, increased libido, amenorrhea in women

Question 27

Male hormone contraception

Answer 27

To induce azoospermia

Hormonal implant to replace testosterone

Every 4 months, reversed in 4 months

Can decrease HDL a