- Benefits and drawbacks of progestin-only contraception Krystal Paz Alvarez
Pg. 442
Benefits for progestin-only: do not cause thromboembolic disorders,
... [Show More] headaches, nausea, or most of the other adverse effects associated with combo OCs.
Drawbacks: Less effective and are more likely to cause irregular bleeding (breakthrough bleeding, spotting, amenorrhea, inconsistent cycle length, variations in volume and duration of monthly flow). Must take the pill at the same time very day for effectiveness. Even taking it a few hours late can reduce their efficacy and a use of back up protection or emergency contraception is recommended.
Guidelines for missed pill:
-if one pill is missed, must be taken as soon as remembered and backup contraception should be used for at least 2 days. Pills should be resumed as scheduled on the next day
-if two pills are missed, the regimen should be restarted and backup contraception should be used for at least 2 days.
-if two or more pills are missed and no beeding occurs, a pregnancy test should be done.
- What are the most effective forms of contraception? Krystal Paz Alvarez
Pg. 437
The most effective methods are an etonogestrel implant (Nexplanon), an intrauterine device (IUD), and sterilization (vasectomy and tubal ligation). Oral contraceptives, depo, contraceptive ring and patch are close behind. Least reliable methods include barrier methods, periodic abstinence, spermicides, and withdrawal.
- Testosterone replacement Bailey Ward
o Administration
● Transdermal Patches - male hypogonadism
○ Applied daily to the upper arm, back, or abdomen.
● Testosterone gel is also available.
o Patient Teaching
● Transdermal patches:
○ good hand washing is required after application
○ cover application site with clothing after medication has dried
○ wash the application site before skin-to-skin contact with another person
■ females and children may experience negative effects from exposure to testosterone
■ if cross contamination occurs, wash the affected area with soap and water to prevent absorption
- Treatment of delayed puberty Bailey Ward
o When is it appropriate to initiate androgen therapy (short course and long-term)
● Short term: The psychological pressures of delayed sexual maturation are causing a boy significant distress. In these cases, a limited course of androgen therapy is indicated.
○ Both fluoxymesterone (Androxy, Halotestin) and methyltestosterone (Methitest) are approved for this purpose.
● Long term: If delayed puberty is the result of true hypogonadism
- Androgen therapy Shelby Bernaix
Androgens and antiandrogens are commonly prescribed for men and women. (Hormone therapy) the main androgens in the body are testosterone and dihydrotestosterone (DHT)
o Effects
▪ Therapeutic - Endogenous androgens are responsible for key functions in
the body such as the normal growth and maturation of sex organs, skeletal growth, activation of sebaceous glands during puberty, as well as enhancing the production of erythropoietic stimulating factor for red blood cell production and contributing to libido.
▪ Adverse - Hot flashes, bone fractures, disturbed libido, insulin resistance, erectile dysfunction, gynecomastia, acne, HTN, LDL Increase, HDL decrease, menstrual disturbances, sterility, hepatotoxicity, mood swings/ aggression.
o Monitoring Needs- Lipids, blood glucose, androgen levels such as testosterone monitoring, Prostate specific antigen testing, H&H, CBC, BMP
o Role of androgens in treating anemia - Androgen therapy will increase bone marrow stimulation to make more RBCs.
- Preferred administration route of alprostadil and why Shelby Bernaix
Alprostadil is usually shot directly INTO the penis in order to achieve an erection. The medication comes as a power that is then mixed with water and inserted via syringe. Can also be administered IV in a hospital setting.
- Treatment of hypogonadism Haley Herrera
o Benefits
o Administration methods for transdermal preparations Oral Androgens
Only two androgens are approved for oral therapy of male hypogonadism. Despite the advantages of cost and ease of administration, these are not first-line agents. The androgenic effects of oral androgens are erratic. Furthermore, both fluoxymesterone and methyltestosterone are 17-α-alkylated androgens and therefore pose a risk for hepatotoxicity. Accordingly they should not be used long term.
Transdermal Testosterone
Testosterone is available in three transdermal formulations: patch, gel, and liquid. With all three formulations, testosterone is absorbed through the skin and then slowly absorbed into the blood.
Androgen
INDICATIONS
Hypogonadis m (Male)
Replacement Therapy (Male)
Delayed Puberty (Male)
Catabolic States
Testosterone and Testosterone Esters
Testost erone ✓ ✓
Testost erone cypion ate ✓ ✓
Testost erone enanth ate ✓ ✓
17-α-Alkylated Androgens
Fluoxy mester one ✓ ✓ ✓
Methyl testost erone ✓ ✓ ✓
Oxandr olone ✓
Male Hypogonadism
Hypogonadism is a condition in which the testes fail to produce adequate amounts of testosterone. Male hypogonadism may be hereditary, or it may result from other causes, including pituitary failure, hypothalamic failure, and primary dysfunction of the testes.
Replacement Therapy
Androgen replacement therapy is beneficial when testicular failure occurs in adult males. Some studies demonstrate that treatment restores libido, increases ejaculate volume, and supports expression of secondary sex characteristics. However, treatment will not restore fertility. The principal drugs employed for testosterone replacement are testosterone itself and two testosterone esters: testosterone enanthate and testosterone cypionate
- Treatment of BPH Haley Herrera
o Know examples of drugs in each major drug class
o Adverse effects of common therapies
▪ 5-α-Reductase Inhibitors
▪ α1 Blockers
▪ Phosphodiesterase-5 Inhibitor
▪ α1a Blocker/5-α-Reductase Inhibitor
Generic Name
Trade Name
Actions in BPH
Adverse Effects
5-α-Reductase Inhibitors
Dutasteride
Avodart
Reduce
Decreased
dihydrotestoste ejaculate
rone volume and
production, libido.
which causes Teratogenic to
Finasteride Proscar the prostate to the male fetus.
shrink, which
reduces
mechanical obstruction of the urethra. May also delay BPH progression. Benefits take months to develop.
α1 Blockers
Selective α1a Blockers
Silodosin
Rapaflo
Blockade of α1a
Abnormal
receptors ejaculation
relaxes smooth (ejaculation
muscle in the failure,
bladder neck, reduced
Tamsulosin Flomax prostate
capsule, and ejaculate
volume,
prostatic retrograde
urethra, and ejaculation).
thereby Risk of floppy-
decreases iris syndrome
dynamic during cataract
obstruction of surgery.
the urethra.
Benefits
develop rapidly.
Nonselective α1 Blockers
Alfuzosin
Uroxatral,
Same as the
Hypotension,
Xatral selective α1a fainting,
blockers. dizziness,
Doxazosin Cardura, Cardura XL somnolence, and nasal congestion
(from blocking
α1 receptors
Terazosin Hytrin on blood
vessels)
Phosphodiesterase-5 Inhibitor
Tadalafil
Cialis
Smooth muscle relaxation in the bladder, prostate, and urethra
Hypotension, priapism
α1a Blocker/5-α-Reductase Inhibitor
Tamsulosin
Jalyn
Combination of
Decreased
/dutasterid the effects of 5- libido and
e α-reductase abnormal
inhibitors and ejaculation
selective α1a (ejaculation
blockers failure,
reduced
ejaculate
volume,
retrograde
ejaculation)
o Therapeutic Effects
-Two 5-α-reductase inhibitors are available: finasteride and dutasteride. Both drugs can reduce prostate size, although several months are required for a noticeable effect. There is no proof that one drug works better than the other.
- National STI/STD Curriculum Noel Machado
o Treatment of STIs/STDs
▪ Chlamydia
Azithromycin, 1 g PO once or Doxycycline, 100 mg PO 2 times/day × 7 days
▪ Uncomplicated gonococcal urethritis
Ceftriaxone, 250 mg IM once, plus azithromycin, 1 g PO once
▪ Bacterial Vaginosis
Metronidazole, 500 mg PO 2 times/day × 7 days or Metronidazole gel (0.75%), 1 full applicator (5 g) intravaginally once/day × 5 days or Clindamycin cream (2%), 1 full applicator (5 g) intravaginally at bedtime × 7 days
▪ Herpes Simplex Virus Noel Machado
▪ Trichomoniasis Noel Machado
▪ Syphilis Noel Machado
Week 6
- PD on exam is Parkinson Disease - Dyskinesia (disorders of movement), tremors at rest, rigidity,postural instability, bradykinesia.
- Management of PD
● Early stages -begin with MAO-B inhibitor, with severe start with levodopa with carbidopa or a dopamine agonist
● Combination therapy
● Medications used to treat “off” times including “wearing off” experiences - Off times is when there is a loss of symptom relief which can be reduced with 3 types of drugs
1. Dopamine agonist
2. COMT inhibitors [Show Less]