Podcast
Questions and Answers
Which of the following are forms of testosterone? (Select all that apply)
Which of the following are forms of testosterone? (Select all that apply)
- Oral form
- Intramuscular (correct)
- Topical forms (correct)
- Pellets (correct)
Testosterone can be used to treat athletic performance issues.
Testosterone can be used to treat athletic performance issues.
False (B)
What condition should be confirmed before administering testosterone therapy?
What condition should be confirmed before administering testosterone therapy?
Testosterone deficiency due to hypogonadism
The major adverse effect of PDE-5 inhibitors like Sildenafil is _____
The major adverse effect of PDE-5 inhibitors like Sildenafil is _____
Which of the following are adverse effects of Sildenafil? (Select all that apply)
Which of the following are adverse effects of Sildenafil? (Select all that apply)
Match the drug with its appropriate use or indication:
Match the drug with its appropriate use or indication:
What is the primary use of Tadalafil in relation to BPH?
What is the primary use of Tadalafil in relation to BPH?
5-alpha-reductase inhibitors can be harmful to a developing fetus.
5-alpha-reductase inhibitors can be harmful to a developing fetus.
What should be monitored in children receiving testosterone therapy?
What should be monitored in children receiving testosterone therapy?
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Study Notes
Testosterone
- Testosterone comes in IM, pellets, and topical forms, all of which are Schedule III
- Indicated for patients with confirmed testosterone deficiency due to hypogonadism, replacement therapy when testicular failure occurs, delayed puberty, and off-label for menopausal women (must be given with estrogen) and transgender men
- Adverse effects include virilization in women, girls, and boys, premature epiphyseal closure, hepatotoxicity, lowering of HDL and elevation of LDL, prostate cancer, edema, risk for thromboembolic events, and abuse potential
- Baseline data required before administration include serum testosterone concentration, CBC, lipid panel, liver function, and PSA
- Contraindications include pregnant women, men with prostate or breast cancer, and athletic performance
Erectile Dysfunction (ED)
- Oral treatment: PDE-5 inhibitors (e.g., sildenafil) are first-line therapy
- Sildenafil's adverse effects include hypotension, priapism, ischemic optic neuritis, hearing loss, headache, flushing, and dyspepsia
- Contraindication: do not administer with nitrates
- Sildenafil only works for men who have ED
Non-Oral Treatment for ED
- Papaverine + phentolamine can be used as a non-oral treatment option
Benign Prostatic Hyperplasia (BPH)
- Two major drug classes for treatment: 5-a-reductase inhibitors and A1-adrenergic antagonists
- 5-a-reductase inhibitors (e.g., dutasteride, finesteride) are most appropriate for men with very large prostates (mechanical obstruction)
- Dutasteride's adverse effect: harmful to developing fetus
- Finesteride's adverse effects include decreased ejaculate volume and libido, gynecomastia, and decreased PSA levels
- A1-adrenergic antagonists (e.g., alfuzosin, terazosin, doxazosin, silodosin, and tamsulosin) are most appropriate for men with small prostates (dynamic obstruction)
- Silodosin and tamsulosin have minimal effects on vascular smooth muscle but can cause abnormal ejaculation, while non-selective agents do not
- Non-selective agents (e.g., alfuzosin, terazosin, and doxazosin) block in prostate and blood vessels, making them suitable for those with hypertension
- Adverse effects of non-selective agents include hypotension, dizziness, fainting, and nasal congestion
- Tadalafil is approved for men with BPH alone or BPH combined with ED, producing a modest decrease in symptoms but not improving urinary flow rate
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