TESTOSTERONE Effects on sex characteristics in females Clitoral growth Anabolic

Testosterone effects on sex characteristics in

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TESTOSTERONE Effects on sex characteristics in females Clitoral growth Anabolic effects Skeletal muscle Erythropoietic effects Synthesis of erythropoietin Men have greater hematocrit than women
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CLINICAL PHARMACOLOGY OF THE ANDROGENS Therapeutic uses Male hypogonadism Replacement therapy Delayed puberty Breast cancer Replacement therapy in menopausal women Wasting in patients with AIDS Anemias
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CLINICAL PHARMACOLOGY OF THE ANDROGENS Adverse effects Virilization Premature epiphyseal closure Hepatotoxicity Effects on cholesterol levels Use in pregnancy Prostate cancer Edema Gynecomastia Abuse potential (athletic performance)
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CLINICAL PHARMACOLOGY OF THE ANDROGENS Androgen preparations for male patients Hypogonadism Oral androgens Intramuscular testosterone ester Transdermal testosterone patches Transdermal testosterone gels Implantable testosterone pellets Testosterone buccal tablets
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ANDROGEN (ANABOLIC STEROID) ABUSE BY ATHLETES Many athletes use to enhance athletic performance Significant risks Hypertension, suppression of release of LH and FSH, testicular shrinkage, sterility, gynecomastia, acne, reduction in HDL and increase in LDL Hepatotoxicity with 17-alpha-alkylated compounds Renal damage Psychologic effects Mentally healthy: minimal impact Psychologically unbalanced: could intensify aggression
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DRUGS FOR UROLOGIC DISORDERS
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ERECTILE DYSFUNCTION ED, also known as impotence Persistent inability to achieve or sustain an erection suitable for satisfactory sexual performance Affects up to 30 million men ED commonly associated with chronic illnesses Risk for ED increases with advancing age
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Copyright © 2015 Wolters Kluwer • All Rights Reserved CHAPTER 32 Figure 32.2
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MEDICATION-INDUCED ERECTILE DYSFUNCTION Anticholinergic properties Antihistamines, TCAs, anti-Parkinson’s, antipsychotics, antiemetics, muscle relaxants Alteration in centrally-acting dopamine, serotonin and/or adrenergic neurotransmitters SSRI, alpha-2 agonists, antipsychotics Reduction in blood flow to the penis (volume depletion) Beta-Blockers, thiazides Reduces libido Estrogens, antiandrogens, Reduction in response to sexual psychogenic stimuli (CNS depression) Narcotics, benzodiazepines, barbiturates, alcohol
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TREATMENT FOR ED Drugs Oral agents: PDE5 inhibitors Sildenafil, vardenafil, and tadalafil Nonoral agents Papaverine plus phentolamine, and alprostadil Psychotherapy Surgical implantation of penile prosthesis
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PHYSIOLOGY OF ERECTION Phosphodiest erase type-5 (PDE5) Inhibitors Synthetic prostaglandi n E1 analog
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Copyright © 2015 Wolters Kluwer • All Rights Reserved CHAPTER 32 Figure 32.3
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SILDENAFIL (VIAGRA) Phosphodiesterase type 5 (PDE5) inhibitor I First oral agent for ED: introduced in 1998 Generally well tolerated
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