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Pathophysiology and Pharmacology 2 > Male Reproductive System > Flashcards

Male Reproductive System Flashcards

1
Q

Prostatitis causes

A 
acute bacterial (least common by gram negative)
chronic bacterial (usually recurrent UTIs)
chronic pelvic pain syndrome (most common, inflamm or non inflamm sometimes autoimmune)
asymptomatic inflammatory (inflammation w/out GU symptoms)
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2
Q

prostatitis s/s

A 
fever
chills
arthralgia
low back pain
perineal fullness
dysuria
urinary frequency/urge
nocturia
painful ejaculation
foul-smelling urine
hematuria
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3
Q

prostatitis DX

A 
Digital rectal exam
urinalysis
urine culture
semen analysis
CT
needle biopsy
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4
Q

prostatits TX

A 
ABX if infection 
anticholinergics (for incontinence)
alpha blockers (for GU syms)
stool softeners (decrease pain from BM)
analgesics
muscle relaxants
antipyretics
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5
Q

bph

A

nonmalignant enlargement of prostate
increased estrogen w/ aging or more estrogen than testosterone
not a precursor to cancer

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6
Q

bph aggravating factors

A 
alpha-adrenergic agonists
anticholinergics
testosterone
anabolic steroids
caffeine
alcohol
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7
Q

bph s/s

A 
related to obstruction & decreased flow
difficult starting flow even when straining
hematuria
weak urine flow
multiple interruptions of urine flow
bladder fullness feeling
nocturia
dribbling once urination complete
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8
Q

bph DX

A

DRE

prostate specific antigen

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9
Q

bph TX

A

watchful waiting
avoid excess fluids in evening
no caffeine or alcohol
static pharm (relates to anatomical enlargement)
dynamic pharm (for alpha-adrenergic receptors compression urethra)
finasteride
5-alpha-reductace inhibitors
AA blockers: doxazosin, terazosin, tamsulosin
intermittent catheterization
severe: transurethral resection of prostate

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10
Q

finasteride

A

antiprostatic
inhibits 5-alpha-reductase (that converts testosterone to dihydrotestosterone which proliferates prostate)
shrinks enlarged prostate (most effective with large prostate)
TX: BPH and hirsutism in women (can take 6-12 months for maximum benefit)
SE: sexual dysfunction, diminished libido, HA, rash, dizziness, increased risk for prostate canccer, hypotension, bradycardia/bronchoconstriction
contra: pregnancy, lactation, children
interx: anticholinergics (decreased finasteride)
testosterone (reduction in both)
saw palmetto (increases finasteride)

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11
Q

prostate cancer

A 
second most common cancer in men 
peripheral zone most susceptible 
tumors go unnoticed until pain
often mets to lymph/lungs
usually curable when localized
response well to treatment
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12
Q

prostate cancer s/s

A 
local my be asymptomatic
frequent urination 
weak urine flow
frequency (nocturia)
blood in semen
erectile dysfunction 
dysuria
discomfort while sitting
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13
Q

Prostate Cancer DX and TX

A

tissue samples from 2+ sites
tx: surgery (radical prostatectomy), radiation (concern for bladder/bowel), cryotherapy (liquid nitrogen to freeze), ablative hormone therapy (testosterone suppression for bone metastasis)
chemo

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14
Q

hypogonadism

A

lack of testosterone
primary: mumps, trauma, inflammation
secondary: inadequate FSH & LH (cushing’s thyroid)
diminished secondary sex characteristics

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15
Q

testosterone and related hormones

A

control many male repro functions

women have small amount of androgens

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16
Q

lack of androgens

A

primary: due to testicular failure
secondary: due to lack of FSH or LH
s/s: sparse hair, increased subQ fat, small testes

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17
Q

androgen pharmacology

A

TX hypogonadism, increase libido, correct erectile dysfunction, TX certain cancers

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18
Q

TESTOPEL

A 
implantable pellets (1-6) doses last 304 months
inflamm or infection can occur
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19
Q

testosterone cypionate & testosterone enanthate

A

IM
doses last 2-4 weeks
serum levels vary widely
can cause mood/energy swings

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20
Q

testosterone undecanoate

A

intranasal
easy to use
can be 3 doses/day
can cause naspharyngitis/epistaxis/rhinorrhea

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21
Q

buccal testosterone

A

continuous supply of testosterone in blood

local irritation to buccal mucosa

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22
Q

transdermal gel testosterone

A

absorbed into skin (30 min and relased slowly into blood)

can be transfered by skin-to-skin contact

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23
Q

anabolic steroids

A

testosterone-like compounds
frequently abused by athletes
SE: hyperlipidemmia, low sperm count, impotence, aggresion, psychological dependence, feminzation

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24
Q

testosterone

A

male sex hormone
stimulates RNA synthesis/protein metabolism
high doses may suppress spermatogensis
SE: virilization (development of male characteristics: body hair, muscles, hirsutism, male-pattern baldness, deep voice, clitoral enlargement)
sodium/water retention
liver damage (rare)
increased or decreased libido
abuse: feminization due to excess metabolized to estrogen
BBW: children/women should avoid application sites
contra: breast or prostate cancer, pregnant or potentially pregnant, pre-existing enlarged prostate, renal/hepatic disease
interx: w/ anticoagulants = risk for severe bleeding
X

25
cryptorchidism
one or both testes is undescended from abdomen into scrotum exact cause unknown common in premature males
26
cryptorchidism TX
wait | may require surgery if doesn't descend on its own (orchiopexy)
27
cryptorchidism complications
``` testicular cancer (3-5x) fertility problems testicular torsion trauma inguinal hernia ```
28
varicocele
``` enlargement of veins in scrotum may cause fertility issues "bag of worms" DX: physical exam no treatment ```
29
hydrocele
``` common in newborns fluid-filled sack around testicle can be from trauma/inflammation in older males DX: physical exam TX: none ```
30
spermatocele
``` inflammation of epididymis may be acute or chronic infectious process, difficult to identify infections agent s/s: visible cyst on epididymis DX: physical exam TX: none ```
31
epididymitis
``` inflammtion of epididymis may be acute or chronic infectious process hard to determine s/s: pain/swelling over several days DX: STD screening, urinalysis, ultrasound TX: ABX (paitient & partner) rest & ice ```
32
orchitis
inflammation of one or both testes can be virus (STD) or bacteria (sexually active w/ BPH) DX: STD screening, urinalysis, ultrasound TX: ABX, rest & ice
33
orchitis s/s
``` sudden symptoms swelling in testicles pain tenderness fever nausea vomiting ```
34
testitcular torsion
spermatic cord twists w/in testicle = cuts off blood supply to testis (MEDICAL EMERGENCY) intravaginal; tunica vaginalisis genetically too high = rotation extravaginal: tunica vaginalis not firmly secured (most often in newborn)
35
testicular torsion s/s
severe unilateral scrotal pain followed by swelling 1/3 N/V in newborns: firm/hard/scrotal mass fixed to scrotal skin
36
testicular torsion DX
``` TWIST scoring (testis swelling, hard testis, absent cremasteric reflex, n/v, high-riding testes TX: surgical repair w/in 6H to salvage testicle ```
37
testicular cancer
exact cause unknown RF: mumps, low birth weight, trauma to testes, family HX, age, congenital abnormality, caucasian DX: physical exam, u/s, CT, biopsy
38
testicular cancer s/s
dull ache in groin painless lump (maybe swelling, enlargement or hardening of testes) gynecomastia TX: radical orchiectomy, chemo, radiation
39
hypospadias
abnormal position of urethral meatus congenital abnormality meatus develops on ventral (under) portion of penis TX: surgical repair
40
epispadias
rare, abnormal positon of urethral meatus congenital abnormality meatus develops on dorsal (upper) portion of penis TX: surgical repair
41
phimosis
disorder of foreskin (can't retract over glans) | no TX
42
balanitis
inflammation of glans
43
balanoposthitis
inflammation of both blans & prepuce
44
balanitis& balanoposthitis causes
poor hygiene | phimosis w/out circumcision
45
paraphimosis
disorder of foreskin occurs in uncircumcised or partially circumcised males retracted foreskin trapped behind coronal sulcus s/s: swollen & painful glans medical emergency puncture, aspiration, vertical incision, emergent circumcision
46
priapism
prolonged erection for hours painful blood cannot leave penis uncommon common in males w/ sickle cell
47
priapism causes
``` blood disorders medications erectile dysfunction meds spider/scorpion bites spinal cord injury gout penile cancer ```
48
priapism DX and TX
physical exam, CBC, u/s, Toxicology TX: medical emergency, drain blood from penis medication injections to constrict blood flow
49
peyronie disease
fibrous plaque affects tunica albuginea causing bend or curve unknown cause bend causes painful rections
50
peyronie disease TX
may resolve on own oral/injected meds u/s to break up plaque surgery last resort
51
erectile dysfunction
inability to maintain/sustain erection for at least 3 months disruption of normal neurovascular most common male disorder
52
erectile dysfunction TX
``` lifestyle changes (diet exercise healthy body weight, abstinence from alcohol and tobacco) pharm: sildenafil, tadalafil, vardenafil ```
53
ED: harm
successfully TXd by phosphodiesterase-5 inhibitors sildenafil: only enhances erection vardenafil: faster onset, longer than sildenafil tadalafil: acts w/in 30 min and lasts 24-36 hours
54
sildenafil
phosphodiesterase-5 inhibitor relaxes smooth muscle in corpus cavernosum, allows increased blood floor increased blood flow results in firmer & longer lasting erection onset relatively rapid <1 hour & effects up to 4 hours also used for pulmonary arterial hypertension SE: serious hypotension, HA, dizziness, flushing, rash, nasal congestion, diarrhea, dyspepsia, UTI, chest pain, indigestion, blurred vision, changes in color perception, priapism WARNING: >6 hour pripaism = permanent damage contra: nitrates, severe CV disease, recent MI, CVA, heart failure, dysrhythmias, anatomical deformities of penis interx: nitrates (hypotension) protease inhibitors (sildenafil toxicity) grapefruit juice (increases plasma concentration), erythromycin & ketoconazole (increased levels)
55
male infertility
30-40% infertility due to male infertility difficult to treat pharm (expensive, many injections, not usually endocrine related) other means of conception explored
56
TX male infertility for hypogonadism
human chorionic gonadotropin (increases testosterone & sperm production) menotropin (mixture of FSH & LH) testosterone therapy
57
antiestrogens
tamoxifen | clomiphene
58
male infertility abnormal sperm
head defects neck and pidpeiece defects tail defects
59
penile cancer
``` most common: squamous cell carcinoma cause: HPV infection occurs on glans/shaft most common in uncircumcised males may mets ot inguinal nodes but not further usually ```

Pathophysiology and Pharmacology 2 (27 decks)

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