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NUR 325 Patho > Male reproductive > Flashcards

Male reproductive Flashcards

1
Q

Significance of testicular cancer

A

1% of all male cancers
Major cancer in men 25-34

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2
Q

Risk factors of testicular cancer

A

Family history
Caucasian
Cryptorchidism
HIV infection

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3
Q

2 types of germ cell tumors

A

seminomas

nonseminomas

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4
Q

what are seminomas

A

Arise from immature germ cells
Slow growing, nonaggressive
Easily cured with radiation

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5
Q

what are nonseminomas

A

Arise from mature germ cells
More aggressive
Usually treated with surgery

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6
Q

early clinical manifestations of testicular cancer

A

Enlargement of testicle

Painless mass noted

If discomfort present
Ache in groin
Sensation of heaviness

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7
Q

Late clinical manifestations of testicular cancer

A

Possible frank pain
Manifestations based on metastatic spread:
Cough
Hemoptysis
Swelling of lower extremities
Back pain
Dizziness

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8
Q

location, weight, and production of the prostate

A

Gland surrounding the urethra
Produces seminal fluids
Weighs between 4-20 gm

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9
Q

what is benign prostate hyperplasia

A

Nonmalignant enlargement of prostate
↑ epithelial cells = average 11.9%
↑ smooth muscle cells = average 38.8%
Stromal cells = average 38.6%

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10
Q

Risk factors of BPH

A

Age
Family history
Race/Ethnicity

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11
Q

Symptoms of BPH mimic what

A

lower urinary tract symptoms

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12
Q

2 theories of BPH etiology

A
  1. Hormone Imbalance
    Testosterone and estrogen (estradiol)
  2. *DHT Accumulation
    What is DHT and where is it formed?
    Testosterone + 5 alpha-reductase -> DHT

why is it important in development of BPH?
Acts on skin: acne
Acts on hair follicles: hair on chest BUT off scalp
Stimulates growth of prostate cells

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13
Q

BPH Clinical manifestations

A

Frequency and urgency

Delay in initiation

Reduction in force

Increased urination time

Dribbling

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14
Q

Complications of BPH

A

Obstruction
UTI
Renal problems

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15
Q

treatment of BPH

A

Mild symptoms = watchful waiting
Moderate symptoms = drug therapy
5-alpha reductase inhibitors
Alpha1-adrenergic antagonists
Severe symptoms = invasive options

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16
Q

Finasteride (Proscar) CLASS

A

5--reductase inhibitors

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17
Q

Indication of Finasteride (Proscar)

A

Mechanical obstruction of urethra

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18
Q

Finasteride MOA

A

Blocks conversion of testosterone to DHT (alpha 1 receptors)
Decreases epithelial tissue in prostate

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19
Q

Finasteride adverse effects

A

Impotence
Decreased libido (5-10%)
Gynecomastia

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20
Q

SIDE NOTES for Finasteride

A

Decreases prostate specific antigen (PSA) levels
Used for male-pattern baldness

Caution in Handling

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21
Q

Dutasteride (Avodart)

A

5-α reductase inhibitors

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22
Q

Indication of Dutasteride (Avodart)

A

Mechanical obstruction of urethra

23
Q

MOA of Dutasteride

A

Blocks conversion of testosterone to DHT (alpha 1 &2 receptors)
Decreases epithelial tissue in prostate

24
Q

Adverse Effects of Dutasteride

A

Similar to finasteride

25
Q

Tamsulosin (Flomax) class

A

Alpha1-Adrenergic Antagonists

26
Q

MOA of Tamsulosin

A

Relaxes smooth muscle cells
Selective for alpha receptors in the prostate

27
Q

indication of tamsulosin

A

Dynamic obstruction of urethra

28
Q

Adverse effects of Tamsulosin

A

Well tolerated
Abnormal ejaculation

29
Q

What is Jalyn

A

Prototype: dutasteride and tansulosin

FDA approved for BPH

30
Q

how does Jalyn work

A

Combining a 5-alpha-reductase inhibitor with an alpha blocker is superior to either agent alone

31
Q

Prostate Cancer characteristics

A

Most common male cancer in US
2nd to lung cancer in cancer related death
Varies among races
African-American men = highest
Asians and Native American men = lowest
Incidence increases rapidly after 50
> 80% of all cases in men > 65 yo

32
Q

Risk factors of prostate cancer

A

Age
Familial tendency
High fat diet

33
Q

Clinical manifestations of of prostate cancer

A

Early
Later
BPH type presentation
Metastasis
Bone
Lungs
Prognosis
Stage dependent
Early diagnosis

34
Q

controversy topics with prostate cancer

A

Prostate cancer is a common cause of cancer death
BUT many cases of prostate cancer never become clinically relevant
Most prostate cancers grow so slowly that men die of other causes
PSA screening was widely adopted before we had evidence for supporting its use

35
Q

Benefits of PSA screenings

A

Small survival benefit with PSA screening in randomized trials

Use of the PSA test was associated with a 50% drop in prostate cancer deaths in the U.S.

36
Q

Harms of PSA screenings

A

Would take 48 diagnoses of prostate cancer to prevent 1 death
Only 1 in 3 men with a positive PSA will have prostate cancer

Many unnecessary biopsies
Side effects of unnecessary treatment include erectile dysfunction, urinary incontinence, bowel problems

37
Q

Prognosis of prostate cancer

A

Low, intermediate, and high-grade CA
Severity depends on a couple things:
Gleason score (higher = worse)
Tumor volume
PSA Level (higher and rapid rise = worse)
Number of “cores” positive (more = worse)

38
Q

what is erectile dysfunction

A

Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse

39
Q

erectile dysfunction is also known as

A

impotence

40
Q

classes of ED

A

Primary (rare)

Secondary (most common)

41
Q

what is primary ED

A

Life-long inability to have a normal erection:
Severe psychiatric problems
Early vascular trauma

42
Q

what is secondary Ed

A

ED in someone with a history of normal erections

43
Q

Organic causes of secondary ED

A

Peripheral vascular disease
•Arterial insufficiency
•Excessive venous drainage
•Sedentary lifestyle (risk factor)
Medications
•Antidepressants
•Antihypertensives
Endocrine problems
Trauma, Surgery (Radical prostatectomy)

44
Q

Psychogenic causes of Secondary ED

A

Depression
Low desire
Performance anxiety
Strained relationship

45
Q

physiology of normal erection

A

Sexual arousal
_PNS and nitric oxide release
Activation of cGMP
Relaxation of arteries and smooth muscles
Increased inflow and reduced outflow
Engorgement and erection

46
Q

Class of Sildenafil (Viagra)

A

PDE-5 Inhibitors

47
Q

MOA of sildenafil

A

Inhibits PDE5
Increases and preserves cGMP levels
Only enhances the normal response to sexual stimuli

48
Q

indications of sildenafil

A

Relief of ED
Pulmonary arterial hypertension
BPH

49
Q

Timing of sildenafil

A

up to 4 hours before ssexual activity (onset 30-60 minutes)

50
Q

adverse effects of sildenafil

A

most common HA (16%)
flushing (10%)
dyspepsia (7%)

51
Q

Cautions of sildenafil

A

preexisting CV disease if on nitrate Rx
hypotension

52
Q

safety issues with sildenafil

A

Do not take if you are taking any nitrates

If you have chest pain or other signs of a heart attack during sex, stop and call 911

Sudden loss of vision in one or both eyes, sudden loss of hearing

No more than once per day

Priapism - erection is painful or lasts more than 4 hours - medical emergency

53
Q

What cells make up about 95% of all testicular cancers

A

Germ cell tumors

NUR 325 Patho (18 decks)

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