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Male HRT and BPH Flashcards

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1
Q

What morning T levels are considered low?

A

<300 ng/dl

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2
Q

How many low morning T levels are needed for diagnosis of hypogonadism?

A

2

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3
Q

What ar sx of low T?

A
  1. low sex drive
  2. fatigue
  3. loss of body hair
  4. muscle loss
  5. ED
  6. osteoporosis
  7. infertility
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4
Q

What T agents are given orally?

A
  1. Methyltestosterone
  2. Fluoxymesterone
  3. Testosterone Undecanonate
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5
Q

Why should PO T be avoided?

A
  1. A large 1st pass effect leads to decreased bioavailability
  2. higher risk of hepatotoxicity
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6
Q

What risk is low with Testosterone Undecanonqate?

A

hepatic dysfunction

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7
Q

What is the benefit to buccal testosterone?

A

no 1st pass metabolism

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8
Q

What are disadvantages to buccal T?

A

dislodged during eating, discard old system and reapply new buccal system

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9
Q

What T agents are available IM?

A
  1. Testosterone Cypionate
  2. Testosterone Enanthate
  3. Testosterone Undecanoate
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10
Q

What are disadvantages to peaks and troughs seen with IM T?

A

supratherapeutic levels produced leading to meed swings

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11
Q

What are advantages to Testosterone patch?

A

not as many peaks and troughs as IM
more used i. practice

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12
Q

What are the counseling points for T patch?

A

avoid swimming, showering, or washing administration sites for 3 hours after administration

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13
Q

What are the counseling points for T gel and transdermal spray?

A
  1. cover application to avoid transfer to other people
  2. avoid swimming, showering, or washing administration sites for 2 hours after administration
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14
Q

Where and how should T transdermal solution be applied?

A
  1. armpit (axilla area) only
  2. apply deodorant
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15
Q

What are advantages to T SQ implant pellet?

A

less peaks and troughs

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16
Q

What are disadvantages to T SQ implant pellet?

A

must be administered by a healthcare professional

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17
Q

What are disadvantages to T nasal gel?

A

higher risk of intranasal adverse effects

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18
Q

Why does Testosterone undecanonate injection have a REMS program?

A

risk of administration and respiratory reaction

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19
Q

What should be monitored when receiving male HRT?

Study These Flashcards
A
  1. BP
  2. signs of edema
  3. lipids
  4. Hematocrit
  5. PSA
  6. AST/ ALT
20
Q

When should T be D/C in a patient?

Study These Flashcards
A

Hematocrit (HCT) exceeds 55% at any time

21
Q

What are SEs with T?

Study These Flashcards
A
  1. sodium and water retention
  2. hyperlipidemia
  3. increased hematocrit
  4. gynecomastia
  5. sleep apnea
  6. increased libido
  7. mood swings
  8. hepatotoxicity
  9. prostate enlargement
  10. worsen LUTS
22
Q

What are CIs to T?

Study These Flashcards
A
  1. prostate cancer
  2. men with breast cancer
23
Q

What meds can contribute to ED?

Study These Flashcards
A
  1. antidepressants (SSRI, SNRI)
  2. anti- HTN (beta-blockers, clonidine)
  3. antipsychotics (haloperidol, chlorpromazine, risperidone, paliperidone)
  4. BPH meds (FInasteride , Dutasteride)
  5. others (anticholinergics, alcohol, nicotine)
24
Q

What is the MOA of phosphodiesterase inhibitors?/

Study These Flashcards
A

competitive irreversible inhibitor of PDE-5 that prevents the breakdown of cGMP

25
Why should alcohol be avoided with PDE-5 inhibitors?
orthostatic hypotension and drowsiness
26
What PDE-5 inhibitors have a 4-5 h duration?
1. Sildenafil 2. Vardenafil 3. Avanafil
27
What PDE-5 inhibitors have a duration of up to 36 hours?
Tadalafil
28
When should PDE-5 dose be reduced?
1. >65 y/o 2. using alpha 1 blocker 3. moderate/strong CYP3A4 inhibitor 4. severe renal/liver disease
29
What are reduced doses for PDE-5 inhibitors?
Sildenafil 25mg Tadalafil/ Vardenafil 5mg Avanafil 50mg
30
What are SEs with PDE-5 inhibitors?
1. headache 2. flushing 3. nasal congestion 4. dizziness 5. hypotension 6. muscle weakness 7. nonarteritic anterior ischemic optic neuropathy 8. priapism
31
What are specific SEs with Taladafil?
1. least risk of hypotension 2. muscle weakness due to PDE_11
32
What are specific SEs with Sildenafil, Vardenafil, and Avanafil?
visual light sensitivity and blurred vision due to effect on PDE 6
33
What is the MOS of alprostadil?
stimulated adenyl cyclase leading to increase in cAMP and eventual smooth muscle relaxation of the arterial blood vessels
34
What are SEs with Alprostadil?
1. priapism 2. injection site reaction 3. dizziness/ syncope
35
What are treatment recommendations for ED?
1. used PDE-5 unless CI 2. use T is low T 3. use Alprostadil if PDE5 CI
36
What meds worsen BPH symptoms?
1. anticholinergics 2. antihistamine 3. caffeine 4. decongestants 5. diuretics 6. SNRIs/TCAs 7. T products
37
What are static BPH factors?
related to size of prostate
38
What are dynamic BPH factors?
excess alpha activation nocturia urge
39
What are the 2nd gen alpha 1 antagonists?
1. Prazosin 2. Terazosin 3. Doxazosin
40
What are the 3rd gen alpha 1 antagonists?
1. Alfuzosin 2. Tamsulosin 3. Silodosin
41
What are SEs with BPH meds?
1. Dizziness 2. insomnia 3. floppy iris syndrome- do not use prior to catartct surgery 4. hypotension (2nd gen) 5. rhinitis 6. abnormal ejaculation
42
What are the 5 alpha reductase inhibitors?
1. Finasteride 2. Dutasteride
43
What are SEs with 5 alpha-reductase inhibitors?
1. ED 2. decreased libido 3. gynecomastia 4. ejaculatory dysfunction
44
What pregnancy category are alpha 5 reductase inhibitors?
Category X- women that are pregnant or seeking to become pregnant do not handle drugs without gloves or come into contact with semen from men
45
How should BPH be treated?
1. 3rd gen alpha 1 antagonist 2. addition 5 alpha-reductase inhibitor can prevent progression of LUTS secondary to BPH with prostatic enlargement
46
Which BPH agents should not be combined?
Taladafil and alpha blockers

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