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Block 10 Week 3 > Androgens, Antiandrogens, and Erectile Dysfunction-Burkin > Flashcards

Androgens, Antiandrogens, and Erectile Dysfunction-Burkin Flashcards

1
Q

What are the antiandrogen drugs?

A
  • Danazol
  • Finasteride
  • Bicalutamide
  • Flutamide
  • Leuprolide
  • Spironolactone
  • Cyproterone acetate
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2
Q

What are the androgen drugs?

A 
Methytestosterone
Fluoxymesterone
Stanozolol
Testosterone esters
PDEII inhibitors
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3
Q

What is this:

Enzyme that converts testosterone to DHT

A

5alpha-reductase

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4
Q

What is this:

androgen receptor agonists used for anabolic effects

A

Anabolic steroid

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5
Q

What is this:

genetic disease characterized by C1 esterase inhibitor deficiency

A

Hereditary angioedema

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6
Q

What do androgens do?

A

convert early bipotential gonad into testes
masculinization of the male fetus (penis and scrotum formation)
support sperm production
vocal chord enlargement
regulate sex drive and aggression
inhibit fat deposition
increase muscle mass

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7
Q

What does androgen do to skin?

A

growth of facial and body hair

baldness

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8
Q

What does androgen do to male sex organs?

A

sperm production
prostate growth
erectile function

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9
Q

What does androgen do to muscle?

A

muscle mass and strength

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10
Q

What does androgen due to bone marrow?

A

red blood cell production

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11
Q

What does androgen due to bone?

A

bone density maintenance

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12
Q

How many carbons do androgens have?

A

19 carbons

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13
Q

In males (blank) perecent of androgens are synthesized by the testes (leydig cells, under regulation of LH), 5% by the (blank)

A

95%

adrenal cortex

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14
Q

Adrenal pro-androgens are converted to androgens (DHT) in the (blank X 3)

A

liver, skin, and in adipose tissue

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15
Q

Where are androgens synthesized in females?

A

ovaries and adrenal cortex

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16
Q

Plasma testosterone concentration in males is (blank) times higher than in females

A

15 (2.5-10 mg/day males; .3 mg/day females)

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17
Q

(blank) percent of testosterone circulating in blood is bound to (blank)

A 
98%
plasma proteins (albumin and sex hormone-binding globulin)
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18
Q

The (blank) secrete small quantities of DHT. Larger quantities of DHT are synthesized from (blank) by their respective target cells.

A

testes

testosterone (via 5-alpha-reductase)

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19
Q

What are the 5 types of androgens?

A 
Testosterone
5a-dihydrotestosterone (DHT)
Dehydroepiandrosterone (DHEA)
Androstenedione (Andro)
Androstenediol
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20
Q

What is this:
a metabolite of testosterone
more potent than testosterone
produced by the adrenal cortex

A

DHT

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21
Q

What is this:

produced from cholesterol in the adrenal cortex and is th precursor of natural estrogens

A

DHEA (dehydroepiandrosterone)

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22
Q

What is this:
produced in the testes, adrenal cortex and ovaries
converted metabolically testosterone and other androgens

A

Androstenedione (Andro)

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23
Q

What stimulates leydig cells to secrete testosterone?

A

LH

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24
Q

What are the active metabolites of testosterone?

A

Dihydrotestosterone

Estradiol

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25
Q

What are the inactive metabolites of testosterone?

A

Androsterone

Etiocholanolone

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26
Q

What does FSH do to the male genitalia?

A

stimulates sperm cells to make sperm

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27
Q

What does inhibin do?

A

inhibits hypothalamic GnRH

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28
Q

Fill in the blank

GhRh->LH-> testis-> testosterone-> (blank) -> dihydrotestosterone

A

5 alpha reductase

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29
Q

What does testosterone do?

A
  • gonadotropin regulation
  • spermatogenesis
  • sexual differentiation of Wolffian stimulation
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30
Q

What does DHT?

A

puberty stuff

  • external virilization
  • sexual maturity at puberty
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31
Q

Normal function of the androgen receptor.
Testosterone (T) enters the cell and, if (blank) is present, is converted into dihydrotestone (DHT). Upon steroid binding, the androgen receptor (AR) undergoes a conformational change and releases (blank). Phosphorylation (P) occurs before or after steroid binding. The AR translocates to the nucleus where (blank), (blank), and the recruitment of (blank) occur. Target genes are transcribed (mRNA) and translated into proteins

A

5-alpha-reductase
heat-shock proteins (hsps)
dimerization, DNA binding, coactivators

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32
Q

When are plasma testosterone highest during gestation? When is the next time it peaks? When is it the highest after?

A

2nd trimester
6 months old
17-80

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33
Q

What are the 2 types of androgens?

A

anabolic and androgenic

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34
Q

What do anabolic androgens do?

A

increases skeletal muscle growth and stimulates erythropoiesis

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35
Q

What do androgenic androgens do?

A
  • male reproductive phenotype
  • growth of male genitalia at puberty
  • stimulation of long bone growth and eventual epiphyseal plate closure at puberty
  • maintenance of male characteristics
  • increased libido and aggressive behavior
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36
Q

What type of testosterone is this:

aqueous suspension for intramuscular use; 10-50 mg three times weekly

A

Testoject-50

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37
Q

What type of testosterone is this:

oily solution for intramuscular use: 10-25 mg 2 to 3 times weekly

A

Testex

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38
Q

What type of testosterone is this:

oily solution for intramuscular use: 50-400 mg every 2 to 4 weeks

A

Delatesiryl

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39
Q

What type of testosterone is this:

long acting oily solution for intramuscular use: 50-400 mg every 2 to 4 weeks

A

Depo-testosterone

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40
Q

Alkylation of the (blank) position decreases hepatic metabolism allowing these agents to be administered orally.

A

17a

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41
Q

Esterified derivative of testosterone decreases dissolution from depo injection allowing for (blank) administration

A

infrequent

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42
Q

What 17a -alkylated androgens are orally effective because they are able to decreae hepatic metabolism?

A

Danazol-danocrine

Methyltestosterone-oreton methyl, testre, virilon

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43
Q

What are the four types of 17a-alkylated androgens?

A
  • Danazol (danocrine)
  • Fluoxymesterone (halotestin)
  • Methylotestosterone (oreton methyl, testred, virilon)
  • Oxandrolone (oxandrin)
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44
Q

What do you use androgens for?

A
  • hypogonadism
  • reverse negative nitrogen balance in certain catabolic states
  • stimulate erythropoiesis in severe anemia
  • stimulation of bone growth in children
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45
Q

What is this:
infantile genitalia, long arms and legs, poor muscular development, increased body fat, reduced peak bone mass, high-pitched voice, sparse male-pattern body hair.

A

Prepubertal hypogonadism

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46
Q

Clinical manifestations of prepubertal androgen deficiency are usually obvious and associated with (blank)-the diagnosis is rarely missed.
How do you treat this?

A 
Psychosocial distress
Testosterone ester injections 2-3 years of therapy
-T ethanate
-Cypionate
-Proprionate
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47
Q

What is used to treat low T, post-pubertal hypogonadism, delayed puberty and is used orally?
What are the long term or high dose side effects?

A

Methyltestosterone (android, testred, virilon)

Heart disease, stroke, liver disease, ruptured tendons/ligaments, improper bone development in adolescents

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48
Q

When is testosterone therapy recommended in men?

A

for men with consistent symptoms AND unequivocally low serum T

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49
Q

Men will get testosterone therapy if they have a serum total testosterone level < (blank) or serum free testosterone level < (Blank)

A

8 nmol/L

225 pmol/L

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50
Q

T or F

Do not offer testosterone to older men with low T w/out clincally signif symptoms of androgen deficiency

A

T

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51
Q

What are the sexual indications for T therapy?

A

low libido

erectile dysfunction

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52
Q

What are the musculoskeletal indications for T therapy?

A
  • osteoporosis or high risk for fracture due to low bone mineral density
  • decreased muscle mass or strength in men > 65
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53
Q

What are the neuropsychological indications for T therapy?

A

impaired cognition, irritability, other, mood changes, or declining energy and stamina

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54
Q

What are the testosterone formulas?

A 
testosterone gel (androgel, testim)
metered-dose pump (fortesta)
Transdermal patch (androderm)
Testosterone injections (2-4 weeks IM)
Buccal tablet
Subq pellet
Oral preparations
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55
Q

What are the IM testosterone injections?

A

Testosterone cypionate

Testosterone enanthate

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56
Q

What are the subq pellets of T?

A

testosterone proprionate

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57
Q

What are the oral preparations of T?

A

Testosterone undecanoate

mesterolone

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58
Q

What are the adverse effects of T?

A
  • erthrocytosis: monitor hematocrit levels
  • acne, oily skin
  • Prostate cancer: monitor PSA and rectal exam
  • May increase CV events
  • Induction or worsening of obstructive sleep apnea
  • Gynecomastia or Breast tenderness
  • Reduced HDL cholesterol
  • Formulation specific adverse effects
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59
Q

What are the contraindications for T?

A 
Breast cancer
PROSTATE CANCER
ERYTHROCYTOSIS
obstructive sleep apnea
Heart failure
lower urinary tract symptoms due to BPH
Desire for fertility
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60
Q

What is fluoxymesterone? What is the half life of it? Is it more or less potent than methyltestosterone?

A

Anabolic steroid
Long half life (9.5 hrs)
5x as potent as methyltestoterone

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61
Q

What is fluoxymesterone used to treat?

A

hypogonadism and delayed puberty

In women, for breast neoplasms

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62
Q

Androgen receptor agonist are used for (blank) effects. How does it work?

A

anabolic

mimics testosterone to build muscle tissue and promote muscle repair

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63
Q

What are anabolic steroids used to treat?

A

breast cancers, endometriosis

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64
Q

(small/large) doses required to produce profound effects on skeletal muscle growth

A

Large

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65
Q

What is stanozolol?
How is it taken?
What is it used to treat?

A

A synthetic anabolic steroid derived from DHT
High oral bioavailability
Anemia, and hereditary angioedema

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66
Q

What are the three synthetic anabolic steroids?

A

Stanozolol
Nadrolone
Methenolone

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67
Q

What are the anabolic steroid side effects?

A

-liver cancer, livere damage/ jaundice
-high BP
-stroke
-heart disease/ heart failure
-acne
-mood swings
-uncontrollable anger/aggression
-shrunken testicles/azoospermia
-infertility
-baldness
-gynecomastia
-enlarged prostate/prostate cancer
-kidney cancer
-halts bone growth
-suppression of GnRH release and endogenous testosterone/estrogen
In women: irreversible masculinization (facial hair, cessation of menses, deeper voice, smaller breasts)

68
Q

What are the commonly abused oral steroids?

A
  • anadrol
  • oxandrin
  • diancbol
  • winstrol
69
Q

What are the commonly injected steroids?

A
  • Deca-durabolin
  • durabolin
  • Depo-testosterone
  • Equipoise
70
Q

Steroid abuse is higher among males than females but is growing amount young women.

71
Q

What do you use cyproterone acetate for?

A

for severe hirsuitism

72
Q

What do you use flutamide for?

A

metastatic prostatic carcinoma

73
Q

What do you use finasteride for?

A

benign prostatic hyperplasia

74
Q

What is Danazol?

A

a testosterone derivative with mild androgenic activity

75
Q

What does Danazol do?

A
  • Indirecty reduces estrogen production by lowering output of FSH and LH
  • inhibits adrenal and gonadal steroidogenesis (binds to numerous steroid hormone receptors and blocks the syntehesis of estradiol, progesterone, testosterone, and glucocorticoids)
76
Q

What do you use danazol for?

A

endometriosis and hereditary angioedema

77
Q

How long do you use Danazol for endometriosis? Why does it work for this?

A
  • usually taken for 6 month period
  • Interferes with ovulation and E2 production (high androgen, low estrogen environment)
  • causes atrophy of ectopic endometrial tissue
78
Q

Does Danazol work?

A

80% of women have pain relief and shrinkage of esions

79
Q

What are the SEs of Danazol?

What SE is not reversible?

A
  • weight gain, edema, decreased breast size, acne, oily skin, hirsuitism, deepening of the voice, headache, hot flashes, changes in libido, and mood changes
  • all are reversible except for voice changes but the return to normal may take months
80
Q

What is this:
inherited disorder characterized by a deficiency in C1 esterase inhibitor (C1 INH), a serum inhibitor of the activated first component of complement which increases complement protein synthesis by the liver.
What can you treat this with?

A

Hereditary angioedema

Danazol-incresed C1 INH (doesnt possess progestogenic activity, does not suppress release of corticotropin from pituitary, or cortisol from the adrenal)

81
Q

(blank) is also used for fibrocystic breast disease and you should initiate therapy during (blank), otherwise perform appropriate lab test to ensure that patient is not pregnant

A

Danazol

menstruation

82
Q

High doses of Danazol can cause (blank and blank)

A

irregular menstrual patterns and amenorrhea

83
Q

When will breast pain and tenderness be relieved with the use of Danazol?

A

substantially relieved during the first month of therapy and eliminated in 2-3 months

84
Q

With the use of Danazol, elimination of nodularity in fibrocystic breast disease usually requires (blank) months of uninterrupted therapy

85
Q

What are the contraindications and adverse effects Danazol?

A
  • Pregnancy Cat X
  • serious and potentially life-threatening thrombembolic events reported
  • serious and potentially life-threatening hepatic effects
  • contraindicated in patients with impaired hepatic, renal, or cardiac function
  • Risk of pseudotumor cerebri
86
Q

What is a pseudotumor cerebri?

A
  • benign intracranial HTN
  • Manifested by papilledema, HA, N/V, and/or visual disturbances
  • If papilledema present discontinue immediately and refer patient to a neurologist
87
Q

What are the 5a-reductase inhibitors?

What is it usd for?

A

Finasteride (proscar, propecia)
Dutasteride (Avodart, Jalyn)

to treat BPH and prostate cancer

88
Q

How does Finasteride work?

A

acts as a competitive, specific inhibitor of type II 5-alpha reductase (a synthetic 4-aza analog of testosterone)
Does not affect libido

89
Q

The type II 5a-reductase isozyme is primarily found in (blank x 5)

A

prostate, seminal vesicles, epididymides, hair follicles, as well as liver

90
Q

(blank) is responsible for 2/3ds of circulating DHT

A

the type II 5a-reductase isozyme

91
Q

(blank) is the primary androgen that stimulates the development of prostate tissue.

92
Q

Propecia (an oral dosage of type II 5a-reductase isozyme) is approved for the tx of (blank)

A

male pattern baldness (androgenetic alopecia)-> effective for mild to moderate hair loss of the vertex and anterior mid-scalp area

93
Q

What are the contraindications and adverse effect of finasteride?

A

Pregnancy category X

impotence, decreased libido, ejaculation disorder, breast enlargement

94
Q

5-alpha reductase inhibitors

A

(blank)may reduce prostate cancer but may increase risk of high-grade prostate cancer

95
Q

T or F

A decrease in PSA value should be interpreted as a therapeutic effect on prostate cancer

96
Q

Is finasteride FDA labeled for prevention of prostate cancer?

97
Q

What is an oral nonsteroidal antiandrogane? What does it do?

A

Flutamide

-inhibits AR binding of testosterone and DHT in protatic tissue

98
Q

What is flutamide used to treat?

A

first-line therapy for prostate cancer when used with GnRH agonists (leuprolide acetate)

99
Q

Can you use flutamide for breast cancer or BPH?

100
Q

Who do you give flutamide to?

A

men only!!!

101
Q

What are the SEs of flutamide?

A

severe liver injury

  • measure serum transaminase concentrations prior to initiation of therapy
  • monthly during first 4 months, and periodically therafter, immediatly if manifestations suggest liver dysfunction (n/v abdominal pain, fatigue, anorexia, flu-like symptoms, hyperbilirubinuria, jaundice, right upper quadrant tenderness) occur
102
Q

What is this:
an oral nonsteroidal antiandrogen structurally related to flutamine.
What is it used for?

A

Bicalutamide

Tx of metastatic prostatic carcinoma in combo with LHRH agonists (leuprolide)

103
Q

(blank) are more selective for peripheral androgen receptors. Less effect on the hypothalamic pituitary axis.

A

Bicalutamide

104
Q

What is this:
synthetic analog of naturally occuring GnRH
Provides medical castration
How do you administer it?

A

Leuprolide

As an injection

105
Q

Sustained activity of (blank) leads to down-regulation of the GnRH receptors and decreased production of FSH and LH

A

leuprolide

106
Q

In the male, what will leuprolide do?

A

stop testosterone production in the testes

107
Q

In the female, what will leuprolide do?

A

it stops estrogen production in the ovaries

108
Q

Why can leuprolide work to get rid of tumors? What tumors in particular?

A

deprives hormonally dependent tumors of testosterone or estrogen
-advanced prostatic cancer or breast cancer, and as hormonal therapy in the tx of endometriosis

109
Q

What is this:
antimineralcorticoid
weak antiandrogen and antiprogestin
What does it treat?

A

Spironolactone

  • Hirsuitism (PCOS), androgenic aopecia, acne
  • used in combo with estrogen in transgender women
110
Q

What are causes of male infertility?

A

lifestyle
prestesticular
testicular
post-testicular

111
Q

What is this:
absence of GnRH

How can you remedy this?

What are other syndromes that lead to GnRH deficiency?

A

Gonadotropin deficiency (Kallman syndrome)

Virilization and fertility can be achieved when FSH and LH are given to stimulate testis function.

Prader-willi syndrome
Bardet-Biedl syndrome

112
Q

What does hormone levels look like in isolated LH deficiency “fertile eunuch””?

A

Plasma FSH normal, serum LH and testosterone low

113
Q

What is this:
patients are normally virilized
testicular size is normal, and lH and T levels are normal
FSH levels are uniformly low and DO NOT respond to stimulation with GnRH

A

Isolated FSH deficiency

114
Q

What causes pituitary insufficiency?

A

-from tumors, surgery, radiation, or infiltrative and granulomatous processes

115
Q

In (blank) pituitary and testicular microinfarcts may cause infertility

A

sickle cell anemia

116
Q

What is prolactinemia most commonly due to?
What are the hormone levels like?
What are the clinical manifestations?

A
  • prolactin-secreting pituitary adenoma
  • results in decreased FSH, LH, and T leading to infertility
  • loss of libido, impotence, galactorrhea, and gynecomastia
117
Q

Excess estrogen decreases gonadotropin secretion and causes (blank) failure. What can cause this?

A

testis

sertoli cell tumor, obesity, hepatic cirrhosis

118
Q

What will excess glucocorticoids do to your hormones? what will it induce?

A

depress LH secretion, induce secondary testis failure (chronic therapy for ulcerative colitis, asthma, or RA, Cushings syndrome)

119
Q

T or F
thyroid balance is important for normal hypothalamic hormone secretion and sex hormone binding protein levels that govern T:E ratio

120
Q

0.5% of infertile men have deficient responses to (blank) an (blank) treatment improves semen quality

A

GH

GH treatment

121
Q

What are the testicular causes of infertility?

A 
Chromosomal
Gonadotoxins
Systemic Disease
Defective androgen activity
Testis injury
Cryptorchidism
Varicocele
Idiopathic (25-50%)
122
Q

What are gonadotoxins that cause testicular infertility?

A 
Radiation
Drugs and medications
-Ketoconazole, spironolactone, alcohol inhibit T synthesis 
-Cimetidine: androgen antagonist
-Marijuana, heroin, methadone lower T
123
Q

What are the systemic diseases that cause testicular infertility?

A

-renal failure
-liver cirrhosis
-sickle cell disease
(microinfarcts can cause damage to testis and/or pituitary)

124
Q

What causes defective androgen activity results in testicular infertility?

A
  • 5-alpha reductase deficiency

- androgen receptor deficiency

125
Q

What are the testicular injuries that can cause testicular infertility?

A

orchitis
torsion
trauma

126
Q

What is this:
0.8% of boys at 1 year of age
increases risk of infertility and cancer
prophylactic orchidopexy is performed by (blank) years of age

A

Cryptorchidism

2

127
Q

What is this:
dilated and tortuous scrota veins
surgically correctable
(blank) percent of men and (blank) percent of infertility patients

A

Varicocele
15%
40%

128
Q

What are the post-testicular causes of infertility?

A

Reproductive Tract Obstruction
Disorders of Sperm Function or Motility
Disorders of Coitus

129
Q

What are the congenita blockages of the reproductive tract?

A
  • Congenital Abscence of Vas Deferens (CAVD)
  • Young syndrome (abnormally viscous mucous)
  • Idiopathic Epididymal Obstruction
  • Adult Polycystic Kidney Disease
  • Blockage of the ejaculatory Ducts
130
Q

What is this:
accounts for 1-2% of infertility cases
80% of patients will harbor a detectable CF mutation
the vas deferens, seminal vesicles, and ejaculatory ducts are usually atrophic or absent, causing obstruction

A

CAVD (congenital absence of Vas Deferens)

131
Q

What are acquired blockages that cause reproductive tract obstruction?

A
  • vasectomy
  • groin/hernia surgery
  • E. coli or chlamydia
132
Q

What are the functional blockages that cause reproductive tract obstructions?

A

nerve injury or medications impair contractility of seminal vesicles or vasal musculature

133
Q

What are disorders of sperm function or motility?

A

immotile cilia syndromes
maturation defects
immunologic infertility
infection

134
Q

What is this:
abnormalities in the motor apparatus or axoneme of sperm and other ciliated cells
nonmotile but viable sperm in normal numbers

A

Immotile cilia syndromes

135
Q

What is this:
after vascetomy reversal
due to elevated epididymal intratubular pressure and epididymal dysfunction
Normal sperm counts but soerm do not regain the usual maturation and motility capacities

A

maturation defects

136
Q

(blank) is a post-testicular cause of infertility that is implicated as a cause of infertility in 10% of infertile couples

A

Immunologic infertility

137
Q

What are the disorders of coitus that can cause post-testicular infertility?

A

Impotence- low libido or ED, hormonal eval, situational impotence is treated with counseling and oral PDE inhibitors

Penile abnormalities- abnormal curvature, phimosis, HYPOSPADIAS, result in placement of the semen too far from the cervix

138
Q

(blank) is a congenital narrowing of the opening of the foreskin so that it cannot be retracted

139
Q

What are the 4 types of hypospadia?

A
  • coronal
  • penile/urethral
  • scrotal
  • peritoneal
140
Q

What is this:
elevated numbers of leukocytes in semen associated with (blank X 4)
How do you treat it?

A

Pyospermia

  • subclinical genital tract infection, elevated reactive oxygen species, and poor sperm function and infertility.
  • broad spectrum antibiotics (for both partners)
141
Q

How do you treat immunologic infertility?

A

corticosteroid suppression of the immune system.

IVF and ICSI is very effective

142
Q

How do you treat hyperprolactinemia?

A

bromocriptine

143
Q

What is this:
21-hydroxylase deficiency
excessive androgen levels suppress GnRH
Rare and classically presents as precocious puberty

How do you treat it?

A

Congenital Adrenal Hyperplasia

Corticosteroids

144
Q

How do you treat testosterone excess/deficiency?

A
  • GnRH replacement in a pulsatile manner by a portable infusion pump.
  • jump starting the testis with hCG (LH) and FSH
145
Q

How do you treat men with idiopathic infertility?

A
  • clomiphene citrate
  • antioxidant therapy
  • growth hormone
146
Q

What is this:
given for idiopathic low sperm count in settin gof low-normal LH, FSH and testosterone level.

How does it work?

A

clomiphene citrate

-synthetic nonsteroidal drug that acts as an antiestrogen, blocks action of estrogen on male axis, increases GnRH, FSH, and LH secretion, followed by increased T and spermatogenesis

147
Q

Up to 40% of infertile men have increased (blank) levels in the reproductive tract. How can you treat this?

A

ROS

-antioxidant therapy-> free radical scavengers may protect sperm from damage (glutathione or vit E)

148
Q

(blank) may be a new and effective tx for oligospermia

A

Growth Hormone

149
Q

What are medications associated with impaired ejaculation?

A 
Antihypertensive agents	
Alpha-adrenergic blockers 
    -(prazosin, phentolamine)
   -Thiazides	
Antipsychotic Agents
-Mellaril (thioradazine)
-Haldol (haloperidol)
  -Librium	
Antidepressants (SSRIs)
  -Imipramine 
  -Amitriptyline
150
Q

In an Erection:
info travels to nerve centers at the base of the (blank), where primary fibers connect to the penis and regulate blood flow.
Release of NO form the nerves trigger a series of events that ultimately cause smooth muscle (blank) in the penis, this dramatically increased BF. As the erectile tissue of the penis fills with blood, the veins are (Blank) which blocks outflow. Cessation of nervous impulses to the penis or sympathetic vasoconstrictor impulses act to (blank) the erection

A

spine
relaxation
compressed
abolish

151
Q

(blank) acts as a vasodilator. Where do you find nitric oxide synthase?

A

NO

  • cavernous nerve which innervates SM surrounding penile arteries
  • endothelial cells lining the deep arteries of the penis
  • arginine + O2-> citrulline + NO
152
Q

NO diffuses across the SMC membrane and activates (blank) which converts GTP to (blank). This will then activate cGMP dependent protein kinase which stimulates the uptake of (Blank) by the ER. The reduced levels of this will cause the muscle to relax and thus vasodilation occurs.

A

guanlyl cyclase and converts GTP to cyclic GMP

Calcium

153
Q

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and BVs.
T or F

154
Q

What are physical causes of ED?

A
  • heart and vascular problems
  • diabetes
  • parkinsons, MS, Peyronies disease (development of scar tissue inside the penis)
  • meds
  • tobacco and alcohol
  • prolonged cycling
155
Q

What are psychological causes of ED?

A

Depression
Anxiety
Mental health conditions
Stress
Relationship problems due to stress, poor communication or other concerns
Sometimes a combination of physical and psychological issues causes erectile dysfunction

156
Q

How do you decrease an erection?

A

cGMP is converted into GMP by phosphodiesterase (PDE)

157
Q

Oral admin of (blank) (PDEV is found in the corpus cavernosum) increases blood flow to the penis and offsets ED.

A

PDEV inhibitors

158
Q

What are the PDEV inhibitors?

A
  • Sildenafil (viagara)
  • Vardenafil (levitra)
  • Taldalafil (Cialis)
  • Avanafil (Stendra)
159
Q

What are the contraindications of PDEV inhibitors?

A 
Nitrate drugs (nitroglycerin)
Blood thinners
Alpha blockers for enlarged prostate
Heart disease/ heart failure
Have had a stroke
Hypotension or hypertension
Uncontrolled diabetes
160
Q

What are the SEs of viagra?

A
  • minor vision problems have been reported

- due to inhibition of PDE6->blindness

161
Q 
What is this:
Rare
prolonged erection in the absence of sexual arousal
dangerous if left untreated. 
What are the 2 causes of priapism?
A

Priapism

Non-ischemic
Ischemic

162
Q

What is this:
Priapism that usually results from an injury to the penis or perineum. Often clears up on its own without causing long-term damage. Treatment usually consists of an ice pack

A

Non-ischemic

163
Q

What is this:

blood flows into the penis but doesn’t flow out.

A

Ischemic priapism

164
Q

What causes ischemic priapism?
What happens if it is prolongd?
How do you treat this?

A

loss of circulation deprives the corpora cavernosa of oxygen-> causes painful, rigid erection

can damage erectile tissues, cause the formation of scar tissue and lead to a permanent loss of function

Tx:

  • therapeutic aspiration (resolves 30% of cases)
  • inject sympathomimetic agent (resolves 77% of cases)
165
Q

What are the sympathomimetic agents that can be injected to resolve ischemic priapism?
What if an aspiration or synpathomiment agent doesnt work?

A
  • Epinephrine
  • metaraminol
  • phenylephrine (least CV side effects)

urologist performs a surgical shunt

Block 10 Week 3 (9 decks)

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