Chapter 21: men's health

Question 1

health concern related specifically to men

Answer 1

erectile dysfunction

benign prostate hyperplasia

male pattern baldness

male androgen deficiency

prostatitis

Question 2

drugs classes used to treat erectile dysfunction

Answer 2

orl phosphodiesterase inhibitors (PDE5)

injectable prostaglandins

Question 3

drug classes used to treat BPH

Answer 3

alpha-1 blockers

5-alpha reductase inhibitors

Question 4

medication class used to treat male pattern baldness

Answer 4

5-alpha reductase inhibitors

Question 5

drug used to treat male androgen deficiency

Answer 5

exogenous testosterone

Question 6

drug classes used to treat prostatitis

Answer 6

ABTs

(ampicillin, ciprofloxin)

Question 7

six main categories of ED

Answer 7

vasculogenic

psychogenic

neurogenic

hormonal

drug use

other (physical anomaly, chronic illness, surgery, etc)

Question 8

PDE5 inhibitors

mechanism of action

Answer 8

inhibits smooth muscle relaxation in arteries and the corpus cavernosum by inhibiting the conversion of cGMP

discovered while searching for a new antihypertensive agent

Question 9

examples of PDE5 inhibitors

Answer 9

sildenafil (Viagra)

vardenafil (Levitra)

tadalafil (Cialis)

Question 10

selectivity of PDE5 medications

Answer 10

sildenafil (Viagra): 10-fold

tadalafil (Cialis): 10,000 fold

vardenafil (Levitra): 15 fold

Question 11

PDE5 parmacokinetics

Answer 11

well absorbed orally

extensive distribution

CYP450 system metabolism into active metabolite in urine

excreted mostly in feces

Question 12

which PDE5’s absorption is inhibited by food

Answer 12

sildenafil (Viagra)

Question 13

Adverse reactions of PDE5 inhibitors

Answer 13

• CV: flushing
• EENT: rhinitis, sinusitis
• GI: dyspepsia, nausea
• GU: priapism and prolonged erections are RARE
• MISC: flu-like symptoms
• NEURO: headache

Question 14

Which medications interact with PDE5 inhibitors

Answer 14

Nitrates (most serious)

antihypertensives

macrolides, antifungals, diuretics (require dosage adjustments)

Question 15

PDE5 inhibitor contraindications

Answer 15

nitrate therapy or any patient who sees a drop in BP

sickle cell, myeloma, leukemia

retinitis pigmentosa

elderly or any patient with renal impairment

Question 16

injectable prostaglandin mechanism of action

Answer 16

vasoactive

relaxes arterial smooth muscle by stimulating an increase on intracellular cyclic necleotides to increase blood flow to the corpus cavernosum causing erection

Question 17

examples of injectable prostaglandins

Answer 17

alprostadil (Caverject)

papaverine (Regitine)

vasoactive intestinal polypeptides (UIP

Question 18

administration of injectible prostaglandins

Answer 18

intracavernosum cavity or transurethal

teach how to administer at lowest possible effective dose

Question 19

incidence of penile pain with injectible prostaglandins

Answer 19

37%

Question 20

contraindications for injectible prostaglandins

Answer 20

penile deformity

penile implant

patients with conditions that predispose them to priapism

Question 21

conditions that predispose a patient to priapism

Answer 21

sickle cell, leukemia, multiple myeloma, polycythemia, thrombocythemia

Question 22

drugs that can worsen BPH symptoms

Answer 22

first-generation antihistamines, decongestants, narcotics, diuretics, tricyclic antidepressants, and other anticholinergic medications

Question 23

drug classes used to treat BPH

Answer 23

alpha blockers

5-alpha reductase inhibitors

Question 24

alpha blockers mechanism of action

Answer 24

relaxes smooth muscle in the prostate gland to decrease obstruction of urine flow

Question 25

examples of nonselective alpha blockers

Answer 25

doxazosin (Cardura) prazosin (Minipress) terazosin (Hytrin)

Question 26

examples of selsctive alpha blockers

Answer 26

alfuzosin (Uroxatral) tamsulosin (Flomax)

Question 27

effectiveness of alpha blockers to treat BPH

Answer 27

effectiveness within 1 month effect ceases when medication is stopped

Question 28

patient education for drugs used to treat BPH

Answer 28

discuss all medications and possible interactions cannot donate blood while on these medications of for 6 months after treatment is not a cure, only for symptom relief

Question 29

pharmacokinetics of alpha blockers

Answer 29

all are well absorbed except Flomax all are well distributed and metabolized in liver excreted in both urine and feces

Question 30

alpha blockers adverse effects

Answer 30

* CV: orthostatic hypotension * EENT: rhinitis * ENDO: decreased libido * GI: distress * MS: muscle and back pain * NEURO: headache, dizziness

Question 31

alpha blockers interactions

Answer 31

caution with any medications that may decrease BP

Question 32

alpha blockers patient education

Answer 32

first-dose reactions (orthostatic hypotension) are likely early side effects will likely disapear with continued use

Question 33

5-alpha reductase inhibitors mechanism of action

Answer 33

supress testosterone formation in the prostate gland

Question 34

5-alpha reductase inhibitors affect on PSA levels

Answer 34

increases and therefore abnormal values used for cancer screening in these patients should be adjusted

Question 35

examples of 5-alpha reductase inhibitors

Answer 35

dutasteride (Avodart) finasteride (Proscar)

Question 36

what is also treated by finasteride besides BPH

Answer 36

male pattern baldness (Propecia) lower dosage than for BPH

Question 37

5-alpha reductase inhibitor pregnancy category

Answer 37

X for producing genital abnormalities in male offspring

Question 38

adverse reactions of 5-alpha reductase inhibitors

Answer 38

* CV: postural hypotension * EENT: rhinitis * ENDO: impotence, decreased libido, gynecomastia (2%) * GU: finasterides causes a decrease in PSA even in the presence of cancer * MS: weakness * NEURO: dizziness, somnolence * PUL: dyspnea

Question 39

5-alpha reductase inhibitor interactions

Answer 39

MANY including: cimetidine, cipro, diltiazem, ketoconozole, ritonavir, verapimil, st. john's wort

Question 40

contraindications for 5-alpha reductase inhibitors

Answer 40

serious skin reactions pediatric patients should not be handled by women pregnant or trying to become pregnant

Question 41

how long does it take to see results from 5-alpha reductase inhibitor therapy

Answer 41

3-6 months

Question 42

symptoms of hypogonadism

Answer 42

depressed mood, diminished energy, decreased muscle strength and bulk, increased fat mass, impaired cognition, anemia, diminished bone density, fatigue, increased insulin resistance, multiple impaired sexual functions

Question 43

exogenous testosterone pharmacokinetics

Answer 43

complete absorption with IM administration 99% protein bound to globulin first pass metabolism in liver to active metabolite excreted in urine

Question 44

clinical uses of exogenous testosterone

Answer 44

androgen replacement therapy in treatment of delayed male puberty maly hypogonadism replacement therapy in cases of deficient endogenous hormone

Question 45

adverse effects of testosterone replacement

Answer 45

* CV: edema, flushing, HTN, vasodilation * DERM: acne, alopecia, dry skin, erythema, hirsutism * ENDO: breast tenderness, gynecomastia * GI: n/v, distress * GU: impotence, testicular atrophy, bladder issues * HEME: leucopenia, suppression of clotting * MS: weakness * NEURO: aggression, amnesia, headache, parathesia, nervousness * OTHER: pain at injection site

Question 46

conscientious considerations for testosternoen replacement therapy

Answer 46

require careful monitoring for side effects change therapy if no visible response in 3-4 months

Question 47

labs to monitor when patient is on testosterone replacement therapy

Answer 47

lipids, PSA, HCT, and DRE if oral form, LFTs as well

Question 48

testosterone contraindications

Answer 48

breast cancer prostate cancer pregnancy

Question 49

testosterone interactions

Answer 49

oral anticoagulants can cause hypoprothrombinemic response

Question 50

patient education for testosterone therapy

Answer 50

age and physical condition may limit results women of chid-bearing age should not handle must not use if they have BPH an abnormal lipid profile need to screen for prostate and breast cancer

Question 51

drugs used to treat male pattern baldness

Answer 51

finasteride (Propecia) minoxidil (Rogaine)

Question 52

minoxidil mechanism of action

Answer 52

appears to have a direct effect on hair follicles by stimulating resting hair follicles into active growth no drug interactions because it is topical

Question 53

when are medications for male pattern bladness less effective

Answer 53

temporal or frontal hair loss

Question 54

new hair growth with use of medications for male pattern baldness

Answer 54

results are not seen for 2-6 months of daily use and new hair will be lost within 4-6 months of discontinuing treatment

Question 55

patient education for drugs for male pattern baldness

Answer 55

finasteride should not be handled by children or pregnant females do not donate blood while on this or for six months after

Question 56

male specific infections of the GU tract

Answer 56

prostatitis epididymitis orchitis STDs

Question 57

epididymitis and orchitis in males 14-35

Answer 57

typically due to an STD

Question 58

epididymitis and orchitis in males younger than 14 or older than 35

Answer 58

typically due to e.coli

Question 59

medications used to treat male UTIs

Answer 59

ceftriaxone (Rocephin) doxycycline (Vibramycin) azithromycin (Zithromax)