EXAM 4- Krinsky, Kline, Ochs

Define CAM therapy according to the National Center for Complementary and Alternative medicine:

"a group of diverse medical and health care systems, practices, and products that are not presently consider to be part of conventional medicine”

(basically means CAM are products that are NOT standard medical care and should not try to treat/cure a condition")

What is the name of the resource to look up CAM medications?

NATMED

What supplements have a “possible efficacy” for reducing blood sugar in diabetes?

• (i don’t think that important)

Aloe, berberine, chromium, fenugreek, ivy gourd, Mg, prickly pear cactus, soy, stinging nettle, zinc

What diets have a “possible efficacy” for reducing blood sugar in diabetes?

DASH, keto, Mediterranean, vegetarian, weight watchers’ diet

For thyroid disorders and CAM is there any evidence to support their use?

no evidence at all

What is the impact of nutrition on thyroid drugs?

diet rich in calcium, soy, or high fiber can change absorption

What medications can reduce absorption of thyroid medications?

• iron

• multivitamins

• calcium

• antacids

WHAT 3 MAIN SUPPLEMENTS have a "possible efficacy” for MENOPAUSAL SYMPTOMS?

• Black Cohosh- has SERM activity

• Soy- has SERM activity

• St. John’s wort

• Others: equol, rhubarb, royal jelly, sage, yoga

WHAT 3 MAIN SUPPLEMENTS have a "possible efficacy” for PREMENSTRUAL SYMPTOMS?

• Mg

• Vitamin B6

• Vitamin E

What is hypogonadism?

testes fail to produce enough testosterone and or sperm

What is the general tx for hypogonadism?

testosterone

What are sign/symptoms of hypogonadism?

• delayed sexual development

• loss of body hair

• very small testes

• reduced libido

• ED

• gynecomastia

• infertility

• short, low size

In primary hypogonadism, where is the problem?

testes

In secondary hypogonadism, where is the problem?

HT or Pit

Causes of primary hypogonadism include…

• Klinefelter’s

• cryptorchidism

• age

• physical damage to testes

  • chemo/radiation

  • orchidectomy(remove balls), orchitis (ball inflammation)

  • trauma to testis (like hit really hard)

Causes of secondary hypogonadism include…

• anything in the brain/body

• tumor/disease/illness in HT or Pit

• iron overload

• hyperprolactinemia

• drugs- opiods, steroids

• obesity

• organ failure

How is hypogonadism diagnosed? Are all criteria necessary to diagnose?

MUST HAVE BOTH!!!

1. signs/symptoms of hypogonadism

2. LOW SERUM T LEVELS

For low serum T levels, how many tests do you need and on how many days?

need ≥2 TESTS on 2 DIFFERENT mornings

What is the normal level of testosterone? (ng/dL)

300-1000 ng/dL

What are the C/I’s to testosterone therapy?

• if you wanna have a baby

• cancer (breast/prostate)

• high PSA

  • >4 ng/mL

  • >3 ng/mL if risk of prostate cancer

• increased Hct

• Severe lower urinary tract symptoms

How does testosterone effect fertility in primary and secondary hypogonadism?

primary- fertility cannot be restored

secondary- fertility can be restored

What are the risks and ADR’s of testosterone therapy?

• erythrocytosis

• CV risk

• increased PSA

• infertility

• risk of abuse (C-III)

What are the brand names of each of the following testosterones:

• buccal

• topical gel

• topical axillary

• intranasal gel

• transdermal

• SQ

• IM

• buccal- STRIANT

• topical gel- ANDROGEL, FORTESTA, VOGELXO, TESTIM

• topical axillary- AXIRON

• intranasal gel- NATESTO

• transdermal- ANDRODERM

• SQ- XYOSTED

• IM- DELATESTYRL, AVEED

What is the BBW for topical testosterones?

watch for secondary exposure to children

When is testosterone topical gel like “Androgel” applied?

in the morning

Where is Axiron testosterone applied?

under arms/ armpits

Natesto has an increased risk of ________________.

rhinitis

What is the BBW of Xyosted or SQ Testosterone?

increase BP

What is the BBW of Aveed or testosterone undeconate?

POME (pulmonary oil microembolism)

• REQUIREMENTS REMS PROGRAM

What is the definition of each of the following:

• gender affirming care

• sex

• gender

• cisgender

• transgender

• gender diverse

• gender dysphoria

• gender affirming care- any combo of social, legal, and medical measures that help people feel happy, healthy and safe in their gender

• sex- BIOLOGICAL characteristics on a person based on BIRTH

• gender- rooted in SOCIETAL NORMS and how an individual identifies

• cisgender- a person’s gender identity/expression and sex assigned at birth MATCH

• transgender- a person’s gender identity/expression and sex assigned at birth DO NOT match

• gender diverse- gender expression differs from expected expression based on sex

• gender dysphoria- sense of misalignment with assigned gender

What are the 2 components when transitioning from MALE TO FEMALE?

1. suppress androgen

2. supplement estrogen

What drugs can I use to suppress androgens?

• Antiandrogens

  • SPIRONOLACTONE!!!!!!!!!!!!!!!!!

• GnRH agonists

• Progestin

For supplementing estrogen in a M—>F, what is the risk with estrogen therapy?

thromboembolic risk (VTE, PE, etc.)

What estrogen therapy is preferred for M—>F?

patch

If a M—>F patient GETS BOTTOM SURGERY (cut off penis), what needs to be stopped?

antiandrogen therapy!!!!!!!!! like spironolactone

For F—>M patients, what is the main monotherapy?

testosterone supplementation

What are some parental and transdermal options for F—>M patients?

parental- testosterone enanthate, cypionate, or undecanoate

transdermal- gel or patch

What are some ADRs of testosterone therapy?

• increase in RBCs (erythrocytosis)

• lipid changes- decrease HDL

• vaginal/cervical atrophy

• acne, alopecia

• Hct increase

In adolescents/children what are the names of 3 puberty blockers that can be used?

1. leuprolide

2. triporelin

3. histerelin