MENS HEALTH.docx

[MENS HEALTH] - Testosterone: IM, pellets, and topical forms. All forms are Schedule III - Uses: only for those pts w/confirmed testosterone deficiency due to hypogonadism, replacement therapy when testicular failure occurs, delayed puberty, and off label for menopausal...

[MENS HEALTH] - Testosterone: IM, pellets, and topical forms. All forms are Schedule III - Uses: only for those pts w/confirmed testosterone deficiency due to hypogonadism, replacement therapy when testicular failure occurs, delayed puberty, and off label for menopausal women (must be given w/estrogen), transgender men - AE: virilization in women, girls, and boys, premature epiphyseal closure, hepatotoxicity, lowering of HDL and elevation of LDL, prostate cx, edema, risk for thromboembolic events, and abuse potential - Baseline data: serum testosterone concentration, CBC, lipid panel, liver function, and PSA - Contra: pregnant women, for men who have prostate cx or breast cx, and athletic performance - Children: can decrease attainable adult height, monitor epiphyses w/ radiographs of the hand and wrist twice yearly - 17-a-alkylated androgens hepatotoxicity - [ED] - Oral - (PDE-5 inhibitors) "afil"- first line therapy - Sildenafil - AE: hypotension, priapism, ischemic optic neuritis, hearing loss, ha, flushing, and dyspepsia - Do not admin w/nitrates - Does not work on men who do not have ED - Non-oral - Papaverine + phentolamine - [BPH] can be tx w/two major drug classes: 1. 5-a-reductase inhibitors a. Most appropriate for men w/very large prostates (mechanical obstruction) i. Dutaseride 1. AE: harmful to developing fetus ii. Finesteride 2. AE: dec ejaculate volume and libido, gynecomastia, and dec levels of PSA 2. A1- adrenergic antagonists b. Most appropriate for men w/ small prostates (dynamic obstruction) iii. Alfuzosin, terazosin, doxazosin, silodosin, and tamsulosin iv. Silodosin and tamsulosin have minimal effects on vascular smooth muscle BUT can cause abnormal ejaculation whereas the non-selectives do not v. Non-selective: alfuzosin, terazosin, and doxazosin block in prostate and blood vessels thus great for those w/HTN 3. AE: hypotension, dizzy, fainting, nasal congestion Tadalafil: approved for men who have BPH by itself or BPH combined w/ED. It produces modest dec in symp but does not improve urinary flow rate