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Special Populations > Male HRT and BPH > Flashcards

Male HRT and BPH Flashcards

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?

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?

A

Hematocrit (HCT) exceeds 55% at any time

21
Q

What are SEs with T?

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?

A
  1. prostate cancer
  2. men with breast cancer
23
Q

What meds can contribute to ED?

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?/

A

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

25
Q

Why should alcohol be avoided with PDE-5 inhibitors?

A

orthostatic hypotension and drowsiness

26
Q

What PDE-5 inhibitors have a 4-5 h duration?

A
  1. Sildenafil
  2. Vardenafil
  3. Avanafil
27
Q

What PDE-5 inhibitors have a duration of up to 36 hours?

A

Tadalafil

28
Q

When should PDE-5 dose be reduced?

A
  1. > 65 y/o
  2. using alpha 1 blocker
  3. moderate/strong CYP3A4 inhibitor
  4. severe renal/liver disease
29
Q

What are reduced doses for PDE-5 inhibitors?

A

Sildenafil 25mg
Tadalafil/ Vardenafil 5mg
Avanafil 50mg

30
Q

What are SEs with PDE-5 inhibitors?

A
  1. headache
  2. flushing
  3. nasal congestion
  4. dizziness
  5. hypotension
  6. muscle weakness
  7. nonarteritic anterior ischemic optic neuropathy
  8. priapism
31
Q

What are specific SEs with Taladafil?

A
  1. least risk of hypotension
  2. muscle weakness due to PDE_11
32
Q

What are specific SEs with Sildenafil, Vardenafil, and Avanafil?

A

visual light sensitivity and blurred vision due to effect on PDE 6

33
Q

What is the MOS of alprostadil?

A

stimulated adenyl cyclase leading to increase in cAMP and eventual smooth muscle relaxation of the arterial blood vessels

34
Q

What are SEs with Alprostadil?

A
  1. priapism
  2. injection site reaction
  3. dizziness/ syncope
35
Q

What are treatment recommendations for ED?

A
  1. used PDE-5 unless CI
  2. use T is low T
  3. use Alprostadil if PDE5 CI
36
Q

What meds worsen BPH symptoms?

A
  1. anticholinergics
  2. antihistamine
  3. caffeine
  4. decongestants
  5. diuretics
  6. SNRIs/TCAs
  7. T products
37
Q

What are static BPH factors?

A

related to size of prostate

38
Q

What are dynamic BPH factors?

A

excess alpha activation
nocturia
urge

39
Q

What are the 2nd gen alpha 1 antagonists?

A
  1. Prazosin
  2. Terazosin
  3. Doxazosin
40
Q

What are the 3rd gen alpha 1 antagonists?

A
  1. Alfuzosin
  2. Tamsulosin
  3. Silodosin
41
Q

What are SEs with BPH meds?

A
  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
Q

What are the 5 alpha reductase inhibitors?

A
  1. Finasteride
  2. Dutasteride
43
Q

What are SEs with 5 alpha-reductase inhibitors?

A
  1. ED
  2. decreased libido
  3. gynecomastia
  4. ejaculatory dysfunction
44
Q

What pregnancy category are alpha 5 reductase inhibitors?

A

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
Q

How should BPH be treated?

A
  1. 3rd gen alpha 1 antagonist
  2. addition 5 alpha-reductase inhibitor can prevent progression of LUTS secondary to BPH with prostatic enlargement
46
Q

Which BPH agents should not be combined?

A

Taladafil and alpha blockers

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