Final Exam - NR566 / NR 566 (Latest 2023 / 2024)

Primary Hypogonadism<<Ans>> results of testicular failure and is characterized by low testosterone and elevated gonadotropins Secondary Hypogonadism<<Ans>> result of hypothalamic-pituitary failure and is characterized by low testosterone and low normal gonadotropins Congenital hypogonadism<<Ans>> - result of insufficient amounts of testosterone produce by the gonads during puberty. -Delayed, arrested, or absent testicular growth and delayed development of secondary sexual characteristics are hallmark signs - Physical signs include a voice that does not deepen, no muscle mass increase, and male sex organs that do not develop and mature Symptoms of Hypogonadism in adults<<Ans>> Depression Development of male breasts Erectile dysfunction Failure of facial and body hair to grow Increase in body fat, loss of energy Inhibited sexual desire Loss of muscle mass Onset of osteoporosis Shrinking and softening of the testicles Rational Drug Selection for ED<<Ans>> treatment includes phosphodiesterase type 5 (PDE-5) inhibitors, or TRT phosphodiesterase type 5 (PDE-5) inhibitors<<Ans>> sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) Contraindications of PDE-5 inhibitors<<Ans>> - if taken concurrently with nitrates (nitroglycerine) there is potential for fatal hypotension - acute myocardial infarction, stroke, or arrhythmia in past 6 months - HIV protease inhibitors - riociguat or other guanylate cyclase stimulator ADE of PDE 5 inhibitors<<Ans>> - fatal hypotension if taken with nitrates - vision and hearing problems in rare cases - MI - Sickle Cell Anemia with vasoocclusive crisis - optic neuropathy -retinal hemorrhage - priapism Testosterone therapy effects<<Ans>> - Stimulates erythropoiesis - Increased bone mass in eugonadal men - Long-term benefit of TRT on bone mineral density is not known. - May improve cognitive functioning - Improves insulin sensitivity - No association between TRT and cardiac events - Has variable effects on mood, energy, and sense of well-being - Muscle mass and strength - May reverse age-dependent body composition changes and associated morbidity - Associated with a greater improvement in grip strength than a placebo Sexual desire, function, and performance - May benefit men with erectile dysfunction (ED) caused by hypogonadism - Enhances libido Erythrocytosis from overuse or abuse of testosterone<<Ans>> - Close monitoring is needed - monitoring of hemoglobin and hematocrit is required - Hgb > 17.5 or Hct > 54% suggests overtreatment - Mechanisms involving iron bioavailability, erythropoietin production, and bone marrow stimulation have been postulated to explain the erythrogenic effect of TRT TRT Monitoring Timelines<<Ans>> - Evaluate efficacy at 3 to 6 months of therapy. - Evaluate testosterone level at 3 to 6 months from starting therapy. *Goal is mid-normal range. - Evaluate Hct/Hgb at 3 and 6 months, then annually. - Evaluate bone mineral density at 1 to 2 years. - Evaluate PSA levels and digital rectal exam before beginning therapy and at 3 and 6 months. Contraindications for TRT<<Ans>> -Male breast cancer - Pregnancy or use in Women - Prostate Cancer Pharmacokinetic gender differences (men)<<Ans>> - Men are less likely to receive annual exams and health screening - leading causes of death in men are heart disease, cancer, and unintentional accidents Men who have sex with men<<Ans>> - have higher rates of HIV infection and sexually transmitted infections - African American and Latino American MSM are twice as likely to contract HIV - Healthcare for gay men and other MSM is complicated due to physical, psychosocial, and cultural dynamics that require practitioner awareness Non-pharm tx for menopause<<Ans>> -turn down thermostat, dressing in layers, avoid alcohol and spicy foods, reduce obesity, reduce stress - SSRI/SNRI - Gabapentin/Pregabalin - Clonidine if above meds aren't working or not tolerated - OTC: Black Cohosh, Omega 3 , Red Clover, Vitamin E