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Flashcards in Androgens Deck (23):
1

What is the indication for testosterone?

Male hypogonadism

2

What are the adverse effects of testosterone?

Acne
Increased risk prostate cancer
Increased risk BPH
Worsening of sleep apnea
Erythrocytosis -> increased risk VTE
Increased risk CVD (vHDL, ^LDL)
Hepatic dysfunction (oral derivatives)
Suppression of spermatogenesis

3

What are the contraindications for testosterone?

Prostate cancer
High level PSA
Untreated sleep apnea

4

Name the 4 androgen receptor antagonists that we have to know.

Flutamide
Bicalutamide
Nilutamide
Enzalutamide (2nd gen)

"Lutamides antagonize androgens"

5

What is the MoA for androgen receptor antagonists?

For testosterone?

ARA: Directly inhibits action of testosterone and DHT at the AR

T: Direct agonism of AR to restore T to nl level.

6

What are the indications for flutamide, bicalutamide, nilutamide, and enzalutamide? (androgen-receptor antagonists)
What are they used in combination w/?

Which of them can women use, and as tx for what?

Tx of advanced prostate cancer.
Used in combination with androgen deprivation therapy (e.g. GnRH agonist/antagonist)

Flutamide also used for tx of hyperandrogenism in women (King Fish's sister plays the flute)

7

What are the adverse effects of androgen receptor antagonists?

What about rare SE's?

Men- typical effects of androgen deprivation. (e.g. sexual dysfunction, gynecomastia, vasomotor responses)

Rare side effects:
1st Gen- Hepatotoxicity
2nd Gen (Enzalutamide) - increased seizure risk

8

Which of the androgen-receptor antagonists is most potent?

Enzalutamide (2nd gen)

9

Recall: list the GnRH agonists.

What is their MoA?

Leuprolide, Goserlin, Buserelin, Triptorelin, Naferelin (Lewd Pro [Jeremy] Lin agonizes the pussy)

Sustained activation of GnRH receptor inhibits release of gonadotropins (even though they're agonists)

10

What are Leuprolide, Goserlin, Buserelin, Triptorelin, Naferelin (GnRH agonists) indicated for in males?

Advanced prostate cancer

Recall, in females: Controlled ovarian stimulation.
Palliative therapy of hormone-dependent tumors.
Suppression of inappropriate growth of hormone-dependent tissues (e.g. endometriosis & fibroids).
Tx of precocious puberty.
Suppression of endogenous puberty in gender dysmorphic adolescents.

11

Which GnRH antagonist is used in the tx of advanced prostate cancer?

Recall: what is the MoA?

Degarelix

Antagonize GnRH receptors, reduce gonadotropin release.

12

What are the adverse effects of both GnRH agonists and antagonists in males?

Sexual dysfunction
Osteoporosis & bone fractures
Vasomotor responses (hot flashes)
Loss of lean body mass & increased fat mass
Fatigue
Anemia (>90%)
Gynecomastia
Decreased penis and testicular size
Emotional & cognitive changes

(basically makes you more like a woman)

13

Recall: what are the adverse effects of GnRH agonists and antagonists in females?

Side effects associated with gonadal hormone deprivation, e.g.:
Hot flashes
Decreased bone density
Vaginal dryness/atrophy
Erectile dysfunction.

14

What type of drug is abiraterone?

What is its MoA?

Therefore, what are its adverse effects?

Androgen synthesis inhibitor

Inhibition of CYP17A1. Inhibits synthesis of testosterone (also affects cortisol, but not aldosterone)

Adrenocorticol insufficiency
Mineralocorticoid excess

15

Indications for abiraterone?

Hormone-resistant prostate cancer not responding to androgen deprivation therapy

16

What is the MoA for spironolactone?

Antagonist/weak partial agonist of androgen receptor

Also mineralocorticoid receptor antagonist- used as diuretic to treat HF

17

What are indications for spironolactone?

Treatment of women with acne, hirsutism, or androgenic alopecia

18

What are the adverse affects a/w spironolactone?

Menstrual irregularities
Breast tenderness
Orthostatic hypertension

19

Who is contraindicated in the use of spironolactone?

Should not be used in men w/prostate cancer

20

Name the 2 drugs that are 5alpha-reductase inhibitors.

What does this enzyme normally convert ?(inhibited by these drugs)

Finasteride
Dutasteride

Inhibits peripheral conversion of testosterone to DHT

21

What are the indications for 5alpha-reductase inhibitors?

BPH
Male pattern baldness
Female hirsutism

(those w/hair loss use sterides)

22

What is the adverse effect a/w dutasteride and finasteride?

Male sexual dysfunction

23

When are 5alpha-reductase inhibitors contraindicated?

Pregnancy