Male Reproductive and Drugs Flashcards
1
Q
testicular cancer
A
- 1% of all male cancers
- major cancer for men 15-34
2
Q
risk factors testicular cancer
A
- fam hx
- caucasian
- crytochirdism (empty scrotum, testicles dont distend)
- HIV infection
3
Q
germ cells tumors
A
- seminomas
- nonseminomas
4
Q
seminomas
A
- arise from immature germ cells
- slow growing, non aggressive
- easily cured with radiation
5
Q
nonseminomas
A
- arise from mature germ cells
- more aggressive
- usually treated w surgery
6
Q
germ cell
A
sperm forming cells within the testicles
7
Q
early clinical manifestations of testicular cancer
A
- enlargement of testicles
- painless mass noted
- if discomfort present, ache in groin, sensation of heaviness
8
Q
late clinical manifestations of testicular cancer
A
- possible frank pain (rapid growth, hemorrhage)
manifestations based on where its spread - cough, hemoptysis, swelling of lower extremities, back pain, dizziness
9
Q
benign prostatic hyperplasia
A
nonmalignant enlargement of prostate due to inc epithelial cells or inc smooth cells
10
Q
prostate
A
gland that surrounds the urethra and produces seminal fluids
- weighs between 4-10 gms (walnut)
11
Q
risk factors of BPH
A
- age
- fam hx
- race/ethnicity
12
Q
symptoms of BPH
A
lower urinary tract symptoms
13
Q
theories of cause of BPH
A
- hormone imbalance
- DHT accumulation
14
Q
hormone imbalance of BPH etiology
A
- testosterone dec w aging
- estrogen can stimulate growth factors
15
Q
DHT accumulation BPH etiology
A
DHT=dihydrotestosterone
- formed by testosterone + 5 alpha reductase
- inc levels inc growth factors
- DHT acts on skin, hair follicles (on chest, off scalp), stimulates growth of prostate cells
16
Q
BPH clinical manifestations
A
- frequency and urgency
- delay in initiation
- reduction in force
- inc urination time
- dribbling
17
Q
complications of BPH
A
- obstruction
- UTI
- renal problems
18
Q
treatment of BPH
A
- mild symptoms: watchful waiting
- moderate: drug therapy
- severe: invasive options
19
Q
finasteride class
A
5-α-reductase inhibitors
20
Q
finasteride indications
A
mechanical obstruction of urethra
- also helps treat male pattern baldness
21
Q
finasteride moa
A
blocks conversion of testosterone to DHT (alpha 1 receptors)
dec epithelia tissue in prostate
22
Q
finasteride se
A
- impotence
- dec libido
- gynecomastia
23
Q
finasteride nc
A
- dec PSA levels
- caution when handling bc teratogenic
- only works for someone w a large prostate
- see results w/in 6-12 mons
24
Q
dutasteride class
A
5α reductase inhibitors
25
dutasteride indications
mechanical obstruction of urethra
26
dutasteride moa
blocks conversion of testosterone to DHT (alpha 1 and 2 receptors)
decreases epithelial tissue in prostate
27
dutasteride sd
similar to finasteride
- impotence
- dec libido
- gynecomastia
28
tamsulosin class
alpha 1 adrenergic antagonist
29
tamsulosin moa
- relaxes smooth muscle cells
- selective for alpha receptors in the prostate
30
tamsulosin indication
dynamic obstruction of urethra
31
tamsulosin nc
- immediate results
32
tamsulosin se
- well tolerated
- abnormal ejaculations
- doen't dec levels of PCA
33
combination therapy
durasteride + tamsulosin
FDA approved
combining a 5-alpha- reductase inhibitor w alpha blocker is superior to either alone
34
prostate cancer
most common cancer in males
varies among race (highest in african american, asian and native american lowest)
incidence inc rapidly after 50
35
prostate cancer risk factors
- age
- familial tendency
- high fat diet
36
clinical manifestions of prostate cancer
- early: asymptomatic
- later: BPH type presentation, metastasis (bone, lungs)
- prognosis: stage dependent, early diagnosis
37
controversy w prostate cancer
most prostate cancer is clinically irrelevant bc it grows so slowly
- PSA screening was widely adopted before we had evidence for supporting use
- survival dec once the cancer has spread
38
benefits of screening PSA
- small survival benefit w PSA screening in randomized
- use of the PSA test was associated w 50% drop in prostate deaths
39
harms of screening
- would take 48 diagnosis of prostate cancer to prevent 1 death
- only 1 in 3 men w positive PSA will have prostate cancer
- many unnecessary biopsies
- unnecessary treatment include erectile disfunction, urinary incontinence, bowel problems
40
prognosis of prostate cancer
does not kill everyone
- low, intermediate, high grade
- severity depends on gleason score, tumor volume, PSA levels, number of cores positive, how cancer was detected
41
erectile dysfunction
inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse
42
ED classification
- primary: life long inability to have a normal erection, severe psychiatric problems, early vascular trauma
- secondary: begins to be unable
43
organic causes of ED
- peripheral vascular disease (arterial insufficiency, excessive venous drainage, sedentary lifestyle)
- medication (antidepressants, antiHTN)
- endocrine problems
- trauma, surgery
44
psychogenic causes
- depression
- low desire
- performance
- strained relationship
45
physiology of a normal erection
- sexual arousal
- inc PNS and nitric oxide
- activation of cGMP
- relaxation of arteries and smooth muscles
- inc inflow and reduced outflow
- engorgement and erection
*PDE-5 removes cGMP*
46
sildenafil class
PDE-5 inhibitors
47
sildenafil moa
inhibits PDE5, inc and perserves cGMP levels
- only enhances the normal response to sexual stimuli
48
sildenafil indications
relief of ED
- pulmonary HTN
- BPH
49
sildenafil se
headache
flushing
dyspepsia
50
sildenafil nc
- use up to 4 hrs before sexual activity (onset30-60 mins)
- contraindicating if preexisiting CV disease if on nitrate or have hypotension
- if you have chest pain during sex stop and call 911
- sudden loss of vision or hearing
- no more than once per day
- priapism: painful erection or lasts more than 4 hrs = medical emergency
