NR566 Final (Advanced Pharmacology
for Care of the Family)
NR566
Primary Hypogonadism - results of testicular failure and is characterized by low
testosterone and elevated gonadotropins
Secondary Hypogonadism - result of hypothalamic-pituitary failure and is characterized
by low testosterone and low normal gonadotropins
Congenital hypogonadism - - 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 - 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 - treatment includes phosphodiesterase type 5 (PDE-5)
inhibitors, or TRT
phosphodiesterase type 5 (PDE-5) inhibitors - sildenafil (Viagra), vardenafil (Levitra),
and tadalafil (Cialis)
Contraindications of PDE-5 inhibitors - - 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 - - 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 - - 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 - - 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 - - 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 - -Male breast cancer
- Pregnancy or use in Women
- Prostate Cancer
Pharmacokinetic gender differences (men) - - 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 - - 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
for Care of the Family)
NR566
Primary Hypogonadism - results of testicular failure and is characterized by low
testosterone and elevated gonadotropins
Secondary Hypogonadism - result of hypothalamic-pituitary failure and is characterized
by low testosterone and low normal gonadotropins
Congenital hypogonadism - - 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 - 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 - treatment includes phosphodiesterase type 5 (PDE-5)
inhibitors, or TRT
phosphodiesterase type 5 (PDE-5) inhibitors - sildenafil (Viagra), vardenafil (Levitra),
and tadalafil (Cialis)
Contraindications of PDE-5 inhibitors - - 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 - - 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 - - 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 - - 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 - - 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 - -Male breast cancer
- Pregnancy or use in Women
- Prostate Cancer
Pharmacokinetic gender differences (men) - - 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 - - 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
