Men's Health Flashcards
(93 cards)
1
Q
Number 1 Male Health Issue
A
Coronary Heart Disease
2
Q
Delayed Sexual Maturity is due to
A
hypogonadism
3
Q
Young men are most at risk for (2)
A
- testicular cancer
- alopecia
4
Q
Hypogonadism
- incomplete/delayed puberty and lack of testicular growth at ___ yo
- ___ % of adolescent population
- ___ (CDGP) is most common cause.
- Functional hypogonadism (secondary to another ___)
- organic/___ hypogonadism
A
- 14
- 2
- Constitutional delay of growth and puberty
- chronic illness
- genetic
5
Q
Testicular Cancer
Prognosis
* ___ yr survival rate of ___%
* ___% cure rate even if stage III
Treatment
* surgery - ___
* radiation
* chemotherapy
A
- 5 year, 95%
- 80%
- orchiectomy
6
Q
Alopecia
Major type
male pattern baldness
A
androgenic alopecia
7
Q
Androgenic Alopecia
- affect ___% of men
- hereditary
- hairs change to short, wispy, and non-pigmented
- increased ___ could be the cause
A
- 50
- DHT
8
Q
What type of alopecia is this?
A
Alopecia areata
Autoimmune; small round patches
9
Q
What type of alopecia is this?
A
Alopecia universalis
Complete hair loss on scalp and body
10
Q
Traction alopecia
* caused by ___
A
man buns
11
Q
Drug-induced alopecia examples
A
- anabolic steroids
- Cancer chemotherapy
12
Q
Alopecia Treatment
Finasteride (Propecia®)
MOA: inhibits ___ which stops the conversion of testosterone to ___
Dose: ___ mg po ___ daily
SE: decreased ___; ED; dec volume of ___
A
- type II 5-alpha reductase, DHT
- 1, once
13
Q
T or F: women of child bearing age should avoid handling Finasteride
A
True
alters sexual development of the fetus
14
Q
Alopecia Treatment
Minoxidil (Rogaine®)
MOA: enlarging miniaturized hair follicles by increasing ____ to the follicle. Stimulates hair folicle from ___ (resting phase) to ___ (growth phase)
Dose: ___% foam/solution applied to dry scalp ___ daily every day
* may take ___ months to see results
A
- blood flow, telogen, anagen
- 5%, twice
- 4
15
Q
Diagnosis of Hypogonadism
must have both low ___ levels with symptoms
A
testosterone
16
Q
examples of specific signs/symptoms of low testosterone
A
- reduced libido
- gynecomastia
- loss of body hair
- reduced muscle bulk and strength
17
Q
T or F: initial diagnostic blood testing for testosterone can be done any time during the day
A
false; should be done in the morning
Confirm with 2nd test; Free testosterone level less than 5 ng/dl
18
Q
T or F: Low testosterone is less than 300 ng/dL
A
True
19
Q
What dosage form of testosterone is most similar to physiologic levels
A
the patch
20
Q
T or F: Oral testosterone capsules (Jatenzo) must be taken with food
A
True
21
Q
Most OTC products are hormone
____ derived from natural
products.
A
precursors
22
Q
Testosterone undecanoate capsules
Jatenzo
Dosing: 150-___ mg ___ daily with food
Measure serum testosterone levels 6 hours after AM dose
A
- 396, twice
23
Q
Contraindications to THT
- ___ and ___ cancer
- Hematocrit >50%
- Baseline PSA greater than ___ ng/mL or PSA > ___ ng/mL in men with high risk for prostate cancer
- recent or poorly controlled ___
A
- prostate, breast
- 4, 3
- CVD
24
Q
Black Box Warnings
- gel formulation has concerns of secondary exposure to ___
- controversy regarding ____ risk (injection > patches and gels)
FDA voted to add strict new limitations to testosterone inidustry
A
- children
- cardiac
25
# Monitoring
* Patients should be monitored ___ months after initiating therapy
* Goal levels: ___ ng/dL
* if hematocrit goes above ___%, therapy should be stopped
* 3-6
* 400-700
* 54%
26
What drugs cause drug induced sexual dysfunction? (5)
* antidepressants
* antihypertesnisve agents
* estrogens
* 5 alpha reductase inhibitors
* cancer chemotherapy
27
T or F: "if you don't use it, you lose it." Regular sex protects against ED
True
28
three subtypes of erections
* psychogenic
* reflexogenic
* nocturnal
29
T or F: erections are initiated by the sympathetic nervous system and suppressed by the parasympathetic system
False; difficult to run away from a mountain lion with a full erection
| initiated by parasympathetic, suppressed by sympathetic
30
# erection 101
1. Upon sexual stimulation, ___ is released which casues release of ___ from the ___ neurons in the penis.
2. NO activates ___ which converts GTP to ___.
3. Elevated levels of cGMP results in ___ release and produces smooth muscle ___ in the penis.
4. This results in ___ flooding the penis chambers and veins being ___ to prevent draining.
* ACH, nitrous oxide, NANC
* guanylate cyclase, cGMP
* Ca2+, relaxation
* arterial blood, squeezed shut
31
# Nocturnal Erections
* ___ is important to penile health
* normal range of nocturnal erections per night: ___
* frequency influenced by ___ levels
* controlled by ___ nerves
* associated with ___ sleep and suppression of the ___ system
* full ___ may mildly stimulate this nerve
* oxygen
* 3-6
* testosterone
* sacral
* REM, sympathetic
* bladder
32
# Step-wise treatment of ED
1. treat/eliminate known causes
2. oral ___ inhibitors ( ____ if contraindicated)
3. Intra ___ or intra ___ Tx
4. possible ___ therapy
5. Penile prosthesis
* PDE-5, vacuum
* urethral, cavernous
* combo
33
# PDE-5 inhibitors
* originially intended for ___
* promotes smooth muscle ___ by stopping the hydrolyzation of ___ to 5'GMP
* Sexual stimulation is required
* enhances development and ___ (more rigid and longer lasting)
* decreases ___ period
* angina
* relaxation
* cGMP
* maintenance
* refractory
34
# PDE-5 inhibitors Dosing
Sildenafil (Viagra)
* Common strengths: ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* DI with ___ inhibitors
* Lower dose with ___ blockers
* take on ___ stomach
* 25, 50, 100 mg
* 50 mg
* 100 mg
* 30-60 min
* 4 hrs
* CYP3A4
* alpha
* empty
| 25 mg starting dose in patients > 65 yo, hepatic impairment, CrCl < 30
35
# PDE-5 inhibitors Dosing
Vardenafil (Levitra)
* Common strengths: ___ , ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* take on ___ stomach
* 2.5, 5, 10, 20 mg
* 10 mg
* 20 mg
* 30-60 min
* 4 hrs
* empty
36
# PDE-5 inhibitors Dosing
Tadalafil (Cialis)
* Common strengths: ___ , ___ , ___ , and ___
* Starting dose: ___ ( ___ if daily)
* Max dose: ___
* Onset ___
* Duration: ___
* does NOT decrease ___
* indicated for ___
* Okay to take with ___
* daily low dose may be more effective for some patients
* 2.5, 5, 10, 20 mg
* 10 mg, 2.5-5 mg
* 20 mg
* 60 min
* 36 hrs
* BP
* BPH
* food
37
# PDE-5 inhibitors Dosing
Avanafil (Stendra)
* Common strengths: ___ , ___ , and ___
* Starting dose: ___
* Max dose: ___
* Onset ___
* Duration: ___
* DI with ___ inhibitors
* Lower dose with ___ blockers
* Okay to take with ___
* 50, 100, 200 mg
* 100 mg
* 200 mg
* 30-60 min
* 6 hrs
* CYP3A4
* alpha
* food
38
# PDE-5 inhibitors
T or F: 30-40% of men may not respond to the initial dose
True
| next step is to try a larger dose
39
T or F: there is tachyphylaxis with PDE-5 inhibitiors
False
| no known tachyphylaxis
40
CYP3A4 inhibitors (5)
* cimetidine
* ketoconazole
* erythromycin
* ritonavir
* grapefruit
41
T or F: Food delays the absorption of many PDE-5 inhibitors
True
| Fatty meal can delay absorption of Viagra and Levitra by 1 extral hour
42
# PDE-5 inhibitors Side Effects
SE are dose related, mild, and self limiting (6)
* headsche
* flushing
* dyspepsia (indigestion)
* nasal congestion
* light sensitivity
* NAION non-artermitic ischemic optic neuropathy (sudden loss in vision)
43
Do not use PDE-5 inhibitors on patients on oral or transdermal ___
nitrates
| severe hypotension
44
patients on ___ blockers require a lower dose of PDE-5 inhibitors
alpha
45
# Pulmonary Hypertension dosing
Sildenafil (Revatio) Dosing:
___ mg po ___ daily
| generic available
20 mg, three times
46
# Pulmonary Hypertension dosing
Tadalafil (Adcirca) Dosing:
___ mg po ___ daily
40 mg, once
47
vacuum are contraindicated in patients with ____
sickle cell anemia
48
# Transurethral Suppositories
* Alprostadil Pellets (Muse) common strengths: ___ , ___ , ____ , and ___
* less effective than ___
* onset within ___
* penile pain 30%, burning 10%
* 125, 250, 500, 1000 mcg
* injection
* 5-10 minutes
49
# Alprostadil Pellets (Muse counseling points)
* before you insert, make sure to ___
* ___ penis for 10-30 seconds
* max of __ doses per day
* pee
* roll
* 2
50
# Intracavernosal Injections
Alprostadil injections (Caverject)
* Drug of choice is patient fails with ___ inhibitors
* Highly effective
* best for ___ ED
* onset within ___
* duration ____
* Max of ___ inj/day; ___ per week
* NO ___ stimulation required
* PDE-5
* neurogenic
* 5 min
* 1 hr
* 1, 3
* sexual
51
# Alprostadil injections (Caverject) side effects
* local irritation
* burning/dull penile pain
* risk of ___
* cavernosal ___ or areas of ___
* priapism
* plaques, fibrosis
52
# Alprostadil injections (Caverject) counseling points
* use a ___ gauge needle
* start at ___ mcg (many start at ___ mcg)
* max dose: ___
* ___ to dose that produces an erection lasting 1 hour
* 27-30
* 2.5, 10 mcg
* 60 mcg
* titrate
53
# Penile Prostheses
* irreversible
* only use when other treatments fail
* replace every ___ years
5-10
54
T or F: ischemic priapism is not painful
False; ischemic priapism is painful, non-ischemic is not painful
55
# Drug-Induced Priapism
* ED drugs
* antidepressants (5)
* antipsychotics (2)
* anticoagulants (2)
* cocaine
* Others (3)
Antidepressants
* bupropion
* trazadone
* fluoxetine
* sertraline
* Li
Antipsychotics
* clozapine
* chlorpromazine
Anticoagulants
* heparin
* warfarin
Others
* EtOH
* prazosin
* hydroxyzine
56
# Tx of Priapism
ischemic
* phenylephrine ___ mg
* blood ___
* saline ___
non-ischemic
* cold packs and compression
* 0.1-1 mg
* aspiration
* irrigation
57
Peyronie’s Disease (PD)
is also known as ___ disease
bent carrot
58
# Peyronie’s Disease
bent erections (at least ___ degrees)
* pain
* palpable penile ___
* 30 degrees
* plaques
59
# Peyronie’s Disease treatment
Xiaflex
* ___ clostridium histolyticum Injection
* 2 treatments over ___ days; can be repeated up to __ cycles
* $26k
* penile ___ TID
* Collagenase
* 3, 4
* stretching
60
Prostate cancer has high prevalence in ___ individuals
non-hispanic black
61
T or F: prostate cancer is the most common type of cancer in men
True
62
T or F: 80% of prostate cancer diagnosis is in stages III and IV
False: most are in stage I or II
| Most men with diagnosis do not die from it
63
# PSA Screening
Normal range: ___
Borderline range (25% risk) : ___
50% Risk: ___
* < 4 ng/mL
* 4-10 ng/mL
* > 10 ng/mL
64
yearly screening for people with PSA level greater than or equal to ___
2.5 ng/mL
65
* Routine PSA screening recommended for men ___ and over
* Start baseline screening for ___ men ages ___ with FH of prostate cancer
* 70
* african american, 40-45
66
normal size of prostate gland
* growth is commonn for men over ___ years old
* 20 mg
* 40
67
What type of receptors are in the prostate gland?
alpha-1a adrenergic
68
___ reductase in prostate converts testosterone to ___, which is respinsible for prostate growth
type-II alpha, DHT
69
Obstructive Symptoms (5)
* Decreased force of stream
* Hesitancy to initiate voiding
* Strain or push to urinate
* Terminal dribbling
* Intermittency
70
Irritative Symptoms
* incomplete ___ emptying
* ___uria (night)
* ___uria (pain)
* frequency
* urgency
* Incontinence
* bladder
* noct
* dys
71
Nocturia is __ or more voids per night
* redistribution of ___
2
* edema
72
BPH diagnosis requires ___ symptoms and a ___ exam
73
# Complications of BPH
* chronic ___ failure
* overflow urinary ___
* recurrent ___
* diminishes ___ of life
* renal
* inconinence
* UTIs
* quality
74
# BPH AUA scores
* Mild AUA: less than or equal to ___
* Moderate AUA: ___
* Severe AUA: greater than or equal to ___
* 7
* 8-19
* 20
75
# Non-Drug Therapy for BPH
Avoid drugs with strong ___ properties
* decreases ___ of bladder detrusor muscle
* results in urinary ___
What are some examples of these drugs? (4)
* anti-cholinergic
* contractility
* retention
* antihistamines (Benadryl)
* tricyclic antidepressants
* Cogentin, Artane, Scopolamine
* anti-muscarinics (Ditropan)
76
T or F: Approximately half of men with BPH also
have OAB (incontinence)
True
77
Men with both BPH and OAB have better results if they take a combo alpha antagonist and anti-muscarinic... but antimuscarinics ahould be avoided in BPH patients with post void residual > ___ mL or max urine flow rate of < ___ mL/s
* 200 mL
* 5 mL/s
78
Moderate BPH Treatments
* ___ blockers +/-
* ___ therapy
* ___ inhibitors
* alpha
* hormone
* PDE
79
Severe Treatment Option: ___
* TUIP
* TURP
* open prostatectomy
surgery
* Transurethral Incision of Prostate
* Transurethral Resection of the Prostate
| Picture is TURP
80
# Alpha-1a Adrenergic Blockade
* ___ smooth muscle
tone of prostate gland and
bladder neck
* improved urine ___
* Does NOT reduce ___ of prostate gland
* decreases AUA by ____ %
* relaxes
* flow
* size
* 30-40%
81
# Alpha-1 Adrenergic Blockers Dosing
Terazosin
Brand:
Starting Dose:
Maintenance Dose:
* Hytrin
* 1 mg hs
* 10-20 mg hs
82
# Alpha-1 Adrenergic Blockers Dosing
Doxazosin
Brand:
Starting Dose:
Maintenance Dose:
* Cardura
* 1mg hs
* 4-8 mg hs
83
# Alpha-1 Adrenergic Blockers Dosing
Tamsulosin
Brand:
Starting Dose:
Maintenance Dose:
* Flomax
* 0.4 mg hs
* 0.4-0.8 mg hs
| Take ½ hr after same meal each day!
84
# Alpha-1 Adrenergic Blockers Dosing
Alfuzosin
Brand:
Starting Dose:
Maintenance Dose:
* Uroxatrol
* 10 mg daily
* 10 mg daily
85
# Alpha-1 Adrenergic Blockers Dosing
Silodosin
Brand:
Starting Dose:
Maintenance Dose:
* Rapaflo
* 4 mg daily
* 4-8 mg daily
| Take with food!
86
# Alpha-1 Adrenergic Blockers Side Effects
* Dizziness
* Fatigue
* headache
* orthostatic hypotension (first dose with ___ and ___ )
* retrograde ejaculation ( espepcially with ___ and ___ )
* Floppy ___ Syndrome
* Cardura and Hytrin
* Rapaflo and Flomax
* Iris
87
# Moderate BPH Treatment
PDE Inhibitors
* effectiveness similar to alpha antagonists
* Tadalafil ___ mg daily
* ___ smooth muscle tone of
prostate gland and bladder neck
* improves urine ___
* 5 mg
* relaxes
* flow
88
# Hormonal Therapy for BPH
* ___ inhibitors which decreases
dihydrotestosterone (DHT) production
decreases size of prostate by ___ %
* men with prostate greater than ___ g benefit most
* onset of action may be as long as ___
* 5-alpha reductase
* 20-25%
* 40 g
* 6 months
89
# Hormonal Therapy
Finasteride (Proscar)
___ mg po daily
5 mg
90
Dutasteride (Avodart)
___ mg po daily
0.5 mg
91
# Side Effects of Hormonal Therapy
Mild and transient
* impotence
* decreased libido
* decrease volume of ejaculate
* breast enlargement/tenderness
92
T or F: Hormonal therapy decreases PSA by 50% in 6 monthes
True
93
# Combination therapy for BPH
* Jayln is made up of ___ and ___
* for BPH and ED
* for BPH and OAB
| more effective than either agent alone
* Dutasteride + Tamsulosin
* Finasteride + Tadalafil
* Tamsulosin + Tolterodine
