The 2·3 Pattern of Smoking Cessation

• Onset of withdrawal is 2-3 hours after last cigarette

• Peak withdrawal is at 2-3 days

• Expect improvement of withdrawal symptoms at 2-3 weeks

• Resolution of withdrawal at 2-3 months

• Highest relapse rate within 2-3 months

Androgen replacement therapy

Indications:
hypogonadism(=impaired production or function of gametes or sex hormones or both

Contraindications:
1. prostate cancer
2. breast cancer
3. hematocrit >52%
4. congestive heart failure (CHF)

Types:
1. oral
-testosterone undeconate
-more negative effect on liver

2. muscular
-mixture of testosterone esters
-testosterone isobutyrate
-testosterone undeconate
-once every 2-3 weeks

3. buccal
-mouth patch/mucoadhesive polymer with testosterone

4. transdermal
patch(andropatch)
-testosterone patches are worn either on the body or on the scrotum
-body patch application is rotated between the buttocks, arms, back or abdomen
-applied once a day
gel(testogel)
-testosterone gels that are applied daily to the shoulders, upper arms, or abdomen.

5. implantation of testosterone capsule
-about 6 months

Monitor/follow:
1. Prostate-Specific Antigen (PSA)
2. Digital rectal examination (DRE)
3. lipid
4. liver function test (LFT)
5. hematocrit

Adverse effects:
1. benign prostatic hyperplasia (BPH)
2. prostate cancer
3. gynecomastia
4. fluid retention--> worsen hypertension and heart failure
5. liver damage
6. headache
7. polycythemia--> myocardial infarction, stroke, clot development
8. sleep apnea

4 cardiovascular drugs which are used for more than 50 years

1. Aspirin
-antiplatlet

2. Warfarin
-vitamin K antagonist

3. Digoxin
-cardiac glycosides

4. Spironolactone
-aldosterone antagonist