PC 707 Module 8 Exam - Endocrine Q& A If all of a sudden a patient who was previously in euthyroid state becomes symptomatic, what is important to check
... [Show More] for? -medication adherence -review how they take the medication -potentially other drug interactions -some questions to ask---> -are they pregnant? -recently stopped taking an oral contraceptive? -recently started an antidepressant such Zoloft or a tricyclic? -have they recently started tegretol or dilantin? Testosterone deficiency: -primary if testicular in origin -secondary if a hypothalamus/pituitary dysfunction -diagnose only after 2 low levels on two separate occasions -diagnosis based on low levels & symptoms* -may measure levels even without symptoms if they have a history of certain disorders which may indicate low testosterone (diabetes, infertility, HIV, etc.) -if patient is >40 years old--rule out prostate cancer* What treatment options are available for testosterone deficiency? -testosterone hormone replacement (gels/creams, patch, buccal, IM, sublingual pellets, nasal spray) -aromatase inhibitor -HCG replacement -selective estrogen receptor modulators (SERMs) How often should prostate cancer be ruled out during testosterone therapy? -prior to therapy* -PSA levels quarterly during 1st year then annually -digital rectal exam (DRE) every 6 months What blood test should be completed prior to initiation of testosterone therapy? -Hgb/Hct -treatment can cause polycythemia What is the goal of testosterone therapy? -improve sexual, physical, psychological health, mood, energy levels, bone and muscle mass -may low blood sugar levels Men with testosterone deficiency who are interested in fertility should have what kind of evaluation prior to treatment? -reproductive health evaluation* Patients must be educated on the potential risks of _______________ prior to initiation of testosterone therapy? -cardiovascular risk -it is not clearly known if therapy increases or decreases this risk--so prescribe with caution* There is not adequate evidence to support the concern of increased prostate cancer risk with testosterone therapy. True or false? -true BBW of testosterone therapy: -secondary exposure to children by transdermal gel or solution could cause virilization (male pattern hair growth & masculine traits)--make sure they avoid contact with unwashed or unclothed application sites* -pulmonary oil micro-embolism--urge to cough, dyspnea, throat tightening, chest pain, dizziness, syncope, episodes of anaphylaxis--make sure to keep patient in the medical setting for 30 minutes post every injection to monitor* A/E of testosterone therapy: -worsening sleep apnea -gynecomastia -acne -accelerated male patterned baldness -polycythemia -male breast cancer (long term use of parenteral >10 years) -potential to worsen CVD -dyslipidemia--caution with history of MI or CAD -increased risk of BPH -fluid retention -DVT or PE If a patient has had a cardiovascular event, how long should they wait to begin testosterone therapy? -at least 3-6 months* How often should testosterone levels be measured during therapy? -every 3-12 months* Contraindications for testosterone therapy: -prostate cancer -breast cancer What HCT level requires discontinuation of testosterone therapy? >54% Erectile dysfunction: -persistant inability to maintain or sustain erection sufficient for sexual intercourse -testosterone levels should be measured -ED is a risk marker for underlying CVD* -if invasive therapy is warranted--consult urology* -most commonly treated with pharmacotherapy* What is the main medication used for treatment of ED? -PDE-5 inhibitors -PDE-5 is the enzyme that breaks down cGMP (cGMP is what accumulates to increase nitrous oxide levels to maintain vasodilation of the penis) -inhibiting the breakdown of cGMP enhances and prolongs the vasodilatory effects of nitrous oxide* -only works during sexual stimulation--when PDE-5 is present* -Ex: sildenafil, tadalafil, vardenafil, avanafil PDE-5 inhibitors for treatment of ED may be more effective if also combined with: -testosterone therapy* Education regarding use of PDE-5 inhibitors: -take orally 30 minutes-4 hours before sexual intercourse -do not take more than one time a day* -do not take with a fatty meal--may decrease absorption--with the exception of Tadalafil* -Taladafil has a long half-life--duration up to 36 hours* A/E of PDE-5 inhibitors: -H/A, flushing, dyspepsia, dizziness, nausea, nasal congestion, rhinitis, altered vision, back pain, myalgia Drug interactions with PDE-5 inhibitors: -may potentiate hypotensive effects if taken with nitrates, alpha blockers, antihypertensives* -levels might be increased by drugs that are CYP34A inhibitors---azoles, erythromycin, grapefruit juice, protease inhibitors -levels might be decreased by rifampin (a CYP3A4 inducer) Contraindications for use of PDE-5 inhibitors: -active peptic ulcer disease -predisposition to priapism -recent history of stroke -recent history of MI (within past 3 months) -significant hypotension -uncontrolled hypertension [Show Less]