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NURS 424 > Week 11 - Androgens and Anti-Androgens > Flashcards

Week 11 - Androgens and Anti-Androgens Flashcards

1
Q

Testosterone: function

A

Principle endogenous androgen responsible for promoting growth and development of male sex organs and maintaining secondary sex characteristics

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2
Q

Testosterone: indications

A
  • Male (primary) hypogonadism
  • Male (hypogonadotropic) hypogonadism
  • Delayed male puberty
  • Hormone therapy in transgender males (off label use)
  • Endometriosis and some postmenopausal symptoms in women (not FDA approved)
  • Male climacteric (male version of menopause)
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3
Q

Effects of testosterone on the skin

A
  • Hair growth
  • Collagen growth
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4
Q

Effects of testosterone on the muscles

A
  • Muscle growth
  • Increased strength
  • Increased endurance
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5
Q

Effects of testosterone on the bones

A

Bone mass density maintenance

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6
Q

Effect of testosterone on the brain

A
  • Increased sex drive
  • Improved mood
  • Confidence
  • Memory function
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7
Q

Effects of testosterone on the bone marrow

A

RBC production

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8
Q

Effects of testosterone on the sex organs

A
  • Sperm production
  • Erectile function
  • Prostate growth
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9
Q

S/s of androgen deficiency

A
  • Low libido
  • Decreased morning erections
  • Low bone mineral density
  • Gynecomastia
  • Small testes
  • Loss of body hair
  • Fatigue, depression, anemia, reduced muscle mass, increased fat mass
  • Low morning (8-10 AM) serum testosterone
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10
Q

When is testosterone therapy indicated?

A

ONLY for testosterone deficiency; NOT impaired spermatogenesis

  • Can suppress spermatogenesis if [testosterone] is normal
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11
Q

Testosterone: clinical effects

A
  • Virilization/sexual function
  • Improved muscle strength and reduced fat mass
  • Improves bone density
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12
Q

When will patients start seeing effects from testosterone therapy?

A

3-6 months except bone density which won’t be seen until 24 months

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13
Q

Testosterone: ADR

A
  • Acne
  • Prostate disorders
  • Sleep apnea
  • Erythrocytosis
  • Hepatitis, hepatic neoplasm, cholestatic hepatitis, jaundice, hepatocellular carcinoma

Men: gynecomastia, reduced sperm levels, decreased libido at high levels, depression

Women: menstrual irregularities, virilization

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14
Q

True/False: providers should recommend against testosterone use on “trial” basis in healthy, middle-aged men

A

True

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15
Q

Testosterone: formulations

A
  • Gel (AndroGel, Testim, Fortesta)
  • Transdermal (no longer available in U.S.)
  • Intramuscular (enanthate, cypionate)
  • SQ injection and pellet

NOT given orally b/c testosterone is metabolized rapidly by the liver

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16
Q

Testosterone: contraindications

A
  • Prostate cancer
  • Male breast cancer
  • Severe lower urinary tract symptoms
  • Erythrocytosis (HCT over 50)
    • Increased blood clot risk
  • Severe, untreated sleep apnea
    • If on CPAP, can start testosterone therapy
  • Uncontrolled CHF
    • Increased sodium retention
  • Pregnancy (category X) and lactation
17
Q

Testosterone: drug interactions

A
  • Anticoagulants (e.g. warfarin)
  • Diabetic agents
  • Corticosteroids
18
Q

Testosterone: monitoring

A
  • Testosterone level 2-3 months after starting therapy and when changing doses
    • Once stable, check every 6-12 months
  • Endocrine Society recommends reevaluation for prostate cancer at 3 months and 1 year after starting treatment
    • PSA and DRE
  • Check HCT 3-6 months after starting treatment, then annually
  • Lipids, liver function, CBC
19
Q

5-alpha reductase inhibitors: example

A

Finasteride (Proscar, Propecia)

20
Q

5-alpha reductase inhibitors (finasteride): indications

A
  • BPH
  • Male pattern baldness
21
Q

5-alpha reductase inhibitors (finasteride): MOA

A

Inhibits enzymes that converts testosterone to DHT

22
Q

5-alpha reductase inhibitors (finasteride): caution

A

Prostate evaluation required for any increase in PSA while on medication

23
Q

GnRH analogues: example

A

Leuprolide (Lupron)

24
Q

GnRH analogues (leuprolide): MOA

A
  • LH-releasing hormone antagonist
  • Creates reversible chemical orchiectomy state in males
  • Creates reversible chemical oophorectomy state in females
25
Q

GnRH analogues (leuprolide): indications

A
  • Advanced prostate cancer
  • Advanced breast cancer
  • Management of endometriosis and uterine fibroids (leiomyomata)
  • Precocious puberty
  • Pubertal suppression in transgender adolescents
26
Q

Aldosterone antagonist: example

A

Spironolactone

27
Q

Aldosterone antagonist (spironolactone): MOA

A
  • Aldosterone antagonist and inhibitor of 5-alpha reductase
  • Potassium sparing diuretic
28
Q

Aldosterone antagonist (spironolactone): indications

A
  • Polycystic ovary syndrome
  • Acne
  • Hirsutism
29
Q

Aldosterone antagonist (spironolactone): ADR

A
  • GI upset
  • Gynecomastia
  • Pregnancy category X
30
Q

Erectile dysfunction drugs

A

Phosphodiesterase type 5 inhibitors (PDE5)

  • Sildenafil citrate (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
31
Q

Phosphodiesterase type 5 inhibitors (PDE5): contraindications

A

In patients using nitrates b/c of risk of severe, fatal hypotension

Alpha blockers have additive hypotensive effect

NURS 424 (35 decks)

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