06 Oct Support with more information of the drug and cond
Support with more information of the drug and condition and if they are better medicine for the condition. don’t copy the same information add information and education. other secondary effects 45 year-old male diagnosed with hypogonadism. Definition Hypogonadism in males is a clinical syndrome that comprises symptoms and/or signs, along with biochemical evidence of testosterone deficiency. The male gonads (testes) have 2 primary functions: testosterone production (by the Leydig cells) and spermatogenesis. Hypogonadism in men occurs where there is dysfunction in the normal physiologic mechanism of the hypothalamic-pituitary-gonadal axis that results in a decreased ability to carry out either of these functions. (Epocrates) 3. Briefly report on each of the following items for the diagnosis given in each case: Etiology of the diagnosis According to our textbook, it is said that hypogonadism is thought to be one of the main causes of male infertility problems, occurs in an estimated 13 million men in the United States. Hypogonadism refers to the failure of the testes to produce androgen, sperm, or both. It affects a man’s fertility because the lack of testosterone makes it difficult for men to properly produce sperm. Hypogonadism is characterized by low serum testosterone levels (<300 ng/dl) together with clinical symptoms. Symptoms of postpubertal hypogonadism include sexual dysfunction, such as reduced libido, erectile dysfunction, diminished penile sensation, difficulty attaining orgasm, as well as reduced ejaculate with orgasm. Pathophysiology of the diagnosis Pathology at any level of the hypothalamic-pituitary-gonadal axis may result in hypogonadism. The causes include genetic diseases, head or testicular trauma, tumors, radiation injury, alkylating agents, hyperprolactinemia, and infiltrative diseases. Primary hypogonadism is an end organ disease. It occurs due to pathology of either Leydig cells or seminiferous tubules or both. Injury to Leydig cells results in decreased testosterone production, while seminiferous tubule involvement results in decreased or absent spermatogenesis Secondary hypogonadism is a central disease. Causes include genetic mutations or destruction/compression of the gonadotrophs. Chronic diseases such as metabolic syndrome and diabetes can lead to secondary hypogonadism. (Epocrates) Epidemiology of the diagnosis It is estimated that there are approximately 2.4 million American men with androgen deficiency. The prevalence of hypogonadism increases with age. About a quarter of the US male population have total testosterone levels that are below 300 nanograms/dL. It is estimated that the incidence of hypogonadism in American men between the ages of 40 and 69 years is approximately 481,000 new cases per year. It is now recognized that there is a higher prevalence of hypogonadism in men with diabetes, HIV, coronary heart disease, or renal disease, or receiving opiate or glucocorticoid therapy. (Epocrates) Diagnostic Criteria (What history and physical exam findings, lab results /or other diagnostic testing results or maneuvers will confirm the diagnosis?) A complete physical history should be performed for the patient where the patient can be questioned about signs and symptoms that he has been experienced, including perhaps loss of libido, erectile dysfunction, and or shrinking of testes. Genital exam should evaluate for underdeveloped scrotum, along with a digital rectal exam. A total testosterone level and PSA level will also be checked. Testosterone level will be expected to be below the 300 in order to help confirming the diagnosis, then a semen analysis may be performed as well. Goals of Drug Therapy The goal of the drug therapy is to restore serum testosterone levels to the mid-normal range of 400 to 600 ng/dL. The patient will experience increase libido as testosterone level will start to increase. Given that the goals of treatment has been discussed with the patient and he has agreed to cost effective and affordability, the medication will be administered via intramuscular route. Choice of route of administration is guided by patient preference, ease of use, and affordability. The adequacy of testosterone therapy is assessed by clinical symptoms and serum hormone levels. 4. Write the prescription(s) for the medication(s) you are going to prescribe. Use the prescription template given below. Depot Esters 200 mg IM every 2 weeks. 5. Explain the mechanism of action for the medication that you have picked. Be specific. Testosterone esters in oil injected intramuscularly are absorbed slowly from the lipid phase; thus, testosterone cypionate can be given at intervals of two to four weeks. Testosterone in plasma is 98 percent bound to a specific testosterone-estradiol binding globulin, and about 2 percent is free. Generally, the amount of this sex-hormone binding globulin in the plasma will determine the distribution of testosterone between free and bound forms, and the free testosterone concentration will determine its half-life. About 90 percent of a dose of testosterone is excreted in the urine as glucuronic and sulfuric acid conjugates of testosterone and its metabolites; about 6 percent of a dose is excreted in the feces, mostly in the unconjugated form. Inactivation of testosterone occurs primarily in the liver. Testosterone is metabolized to various 17-keto steroids through two different pathways. The half-life of testosterone cypionate when injected intramuscularly is approximately eight days. 6. Describe the “watch outs” for the medication. Be specific and include common adverse effects, drug interactions and contraindications. The common adverse effects for this medication are reduced serum testosterone levels have been associated with an increased risk of the development of Cardio Vascular Disease, including ischemic heart disease and stroke. Drug to drug interaction is it may increase sensitivity to oral anticoagulants. Contraindications: Known hypersensitivity to the drug Males with carcinoma of the breast Males with known or suspected carcinoma of the prostate gland Patients with serious cardiac, hepatic or renal disease 7. What patient education will you give? The patient will: Report any of the following symptoms: nausea, vomiting, changes in skin color, ankle swelling, too frequent or persistent erections of the penis. Avoid showering, swimming, and sexual activity for 4 hours after application. May experience local skin irritation at the injection site. Not take any OTC without notifying the healthcare provider. Not drink any alcohol during the drug therapy. 8. How will you monitor the patient for medication effectiveness? (How often will you perform recommended lab or other diagnostic tests and how soon will you reschedule the patient for evaluation)? Hematocrit and PSA will be checked at regular intervals weekly after initiation of therapy for the first 3 months, then annually. A digital rectal exam will be a frequent part of the exam. Hemoglobin and hematocrit level will be checked periodically. An evaluation of benefits and side effects will also be considered. 9. Find a clinical guideline that supports your treatment decision. How was the clinical practice guideline developed and by whom? Consider the strength of the evidence (clinical trials, cohort studies, consensus, etc.) upon which the recommendation is based. The Endocrine Society recommends this treatment decision. It is a professional, international medical organization in the field of endocrinology and metabolism, founded in 1916 in Detroit, MI as The Association for the Study of Internal Secretions. The official name of the organization was changed to the Endocrine Society on January 1, 1952. It is a leading organization in the field and publishes four leading journals. It has more than 18,000 members from over 120 countries. Its headquarter is in Washington D.C. Recommendations are based on dedication that provide the field of endocrinology with timely, evidence-based suggestions for clinical care and practice. They continually create new guidelines and update existing guidelines to reflect evolving clinical science that support effective treatment in patients.
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