13 Thera VI Andropause/Testosterone Cosep Flashcards Preview

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Flashcards in 13 Thera VI Andropause/Testosterone Cosep Deck (46):
1

What is Andropause?

Often referred to as "male menopause" or ADAM (Androgen deficiency in the aging male). Testosterone decreases as men age

2

What is the prevalence of Andropause?

20% of men 60-80 years of age have low testosterone

3

What are the physical symptoms of low testosterone?

Fatigue. Muscle weakness. Decreased bone mineral density. Decreased muscle mass. Increased fat. Impaired hematopoiesis

4

What are the sexual/emotional symptoms of low testosterone?

Decreased libido. ED. Oligospermia. Depression. Anxiety. Mood swings. Loss of memory. Cognitive dysfunction

5

What are the hormone levels like in Primary low testosterone?

Low testosterone levels, high gonadotropines/LH/FSH

6

What are the hormone levels like in Secondary low testosterone?

Low testosterone and low gonadotropine releasing hormone (GnRH)

7

What is testosterone production like with age?

Younger men have diurnal variation in serum testosterone concentrations. Older men lose this diurnal rhythm. Sex-hormone-binding globulin (SHBG) increases. Leydig cells decrease. Blood supply to gonads impaired

8

What is testosterone binding like?

60% of testosterone is bound to SHBG. 38% bound to Albumin. 2% Free T

9

What are the causes of primary (testicular failure) hypogonadism?

Klinefelter's syndrome. Vanishing testes syndromes. Fetal testicular loss. Anorchia

10

What are the causes of secondary (pituitary failure) hypogonadism?

Kallman's syndrome. Prader-Willi syndrome. Pituitary adenoma

11

What are some chronic diseases linked to hypogonadism?

Obesity. DM. CVD. Lung cancer. Prostate disease. Inflammatory diseases. Endocrine disorders

12

What are some medications associated with hypogonadism?

Alcohol. Opioids. Anabolic steroids. Ketoconazole. GLucocorticoids. Spironolactone. Cimetidine. Phenytoin. Flutamide

13

What are the normal Serum Total Testosterone levels?

300-1050 ng/dL

14

What are the normal Free Testosterone levels?

50-210 ng/L

15

What are some potential benefits of testosterone replacement?

Bone. Body composition. Cardiovascular. Sexual effects. Emotional effects

16

What are the ADRs associated with Testosterone Replacement?

Acne. Fluid retention. Edema. Polycythemia. Suppression of sperm production. Gynecomastia. Sleep apnea. Increase in lean body mass. Weight gain. Aggressive behavior. Hepatic dysfunction

17

What are the Safety issues in testosterone replacement?

Increase LDL and TGs, decrease HDL. Induce insulin resistance and carbohydrate intolerance. Increase risk for prostate and breast cancer

18

What are the pretreatment screenings that should be done?

Baseline hemoglobin/hematocrit. Prostate-specific antigen (PSA) level. Digital rectal exam (DRE). Liver function tests. Lipid profile

19

What are the oral testosterone replacement medications?

Methyltestosterone. Fluoxymesterone

20

What is the approximate oral medication dose?

10-40mg/day. Given in divided daily doses

21

What are the limitations of oral testosterone replacement?

Poor oral BA. Poor androgen effect. Adverse lipid changes. Priapism. Increase risk of hepatic side effects!!

22

What is the buccal preparation used?

Striant. 30mg applied BID. Avoid in soy allergies

23

What are the advantages of the buccal preparation?

Closely approximates physiological testosterone levels (higher in morning, lower in evening). BID dosing allows for normal testosterone levels throughout the day. Not affected by eating, tooth brushing, gum chewing, or alcoholic beverages

24

What are the disadvantages of the buccal preparation?

BID dosing required. Some initial gum irritation

25

What is the transdermal patch used?

Androderm. Applied every evening b/w 8pm to midnight. Never apply to genitals/damaged skin. If falls off, may press back on or replace before noon

26

What is the usual Androderm dose?

2.5mg/day to 7.5mg/day

27

What are the advantages of the transdermal patch?

Closely mimics normal diurnal changes in testosterone levels in men. Once daily dosing

28

What are the disadvantages of the transdermal patch?

Skin irritation. Problems with patch adhering properly

29

What are the topical gel preparations used?

Androgel. Testim

30

What is the usual dose of topical gel preparations?

5g/day (max 10g/day)

31

What type of allergy should topical gel preparations be avoided in?

Soy

32

Where should androgel/testim be applied?

Androgel: upper arms or stomach. Testim: upper arms

33

How should topical gel preparations be applied?

Same time each day (morning). Entire contents should be applied immediately to application sites. Do not swim/shower for 5-6 hours after application. Hands should be washed with soap and water after application. Never apply to genitals/damaged skin

34

What are the subcutaneous implants used?

Testopel (75mg). SQ implantation only

35

What is the usual subcutaneous implant dose?

150-450mg Q3-6 months

36

What are the advantages of subcutaneous implants?

Long-acting. Convenient delivery system (every 3-6 months)

37

What are the disadvantages of subcutaneous implants?

Potential fluctuations in testosterone levels. Inflammation and pain at pellet site. Difficulty adjusting dose. Pellet extrusion (8%-10% of patients). Invasive nature of administration

38

What are the intramuscular injections used?

Testosterone cypionate (Depo-Testosterone). Testosterone enanthate (Delatestryl)

39

What is the usual IM dose?

50-400mg IM every 2-4 weeks

40

What are the advantages of intramuscular injections?

Safe delivery system. Convenient schedule (every 2-4 weeks)

41

What are the disadvantages of intramuscular injections?

Potential for significant fluctuations. Longer intervals - may have greater fluctuations and lead to variations in effects

42

What are the general contraindications to testosterone replacement?

Males with carcinoma of the breast. Males with known or suspected carcinoma of the prostate gland. Women who are or who may become pregnant

43

When is systemic testosterone replacement use contraindicated?

Patients with serious cardiac, hepatic, or renal disease. BPH with obstruction. Undiagnosed genital bleeding. Hypercalcemia

44

Which medications should be avoided with soy allergies?

Androgel. Testim. Striant

45

What are the warnings/precautions with testosterone replacement?

Patients with other risk factors for prostate cancer. Cardiovascular disease/edematous conditions. Prolonged oral use --> serious hepatic effects. May potentiate sleep apnea. Transdermal patch may contain conducting metals

46

What is a DDI associated with testosterone replacement?

May increase the effects of warfarin