Pharm - Male Genital Tract

Question 1

Testosterone

Answer 1

androgen agonist
Use: male hypogonadism
MOA: androgen receptor agonist
Adverse: testicular shrinkage, infertility, gynecomastia, virulisation (women)
CI: breast/prostate cancer, pregnancy

Question 2

Oxandrolone

Answer 2

androgen agonist
Use: catebolic states, renal insufficiency, sport
MOA: increased ratio anabolic:androgenic activity
Adverse: cholestatic jaundice, hepatotoxicity

Question 3

Danazol

Answer 3

androgen agonist
Use: endometriosis, inhibit gonadal function
MOA: direct binding
Adverse: thromboembolism, hepatotoxicity
CI: pregnancy, undiagnosed bleeding

Question 4

Abiraterone

Answer 4

anti-androgen
Use: BPH
MOA: inhibit 17-alfa hydroxylase

Question 5

Dutasteride & Finasteride

Answer 5

anti-androgen
Use: prostate cancer, BPH
MOA: inhibit 5a-reductase

Question 6

Tamsulosin

Answer 6

anti-androgen
Use: relax bladder, urethra, prostate sm - relieve urinary symptoms from BPH
MOA: competitive a1-blocker
Adverse: orthostatic hypotension

Question 7

androgen receptor antagonists

Flutamide
Bicalutamide
Cyproterone
Spirolactone

Answer 7

Use: with GnRH analog - prostate cancer
MOA: non-steroidal competitive antagonist at androgen receptor
Adverse: gynecomastia, impotence, hot flashes, hepatitis

Question 8

sindelafil, tadalafil, vardenafil

Answer 8

Use: erectile dysfunction
MOA: PDE-5 inhibitors (phosphodiesterase),
Adverse: headache, hypotension, blue vision, hearing loss
Interactions: alpha blockers = life threatening hypotension (nitrates), avoid CYP3A4 inhibitors

Question 9

Peyronie’s disease

Answer 9

Penile pain, nodule, curvature
Pentoxifylline - PDE inhibitor
Collagenase - reduce plaque size
Vitamin E - antioxidant
Colchicine - analgesic

Question 10

Premature ejaculation

Answer 10

Early, loss of control, psychological distress
Paroxetine, fluoxetine - SSRI (first line)
Clomipramine - TCA
PDE-5 inhibitors
Lidocaine + prilocaine spray - anaesthetic topical
Alprostadil cream

Question 11

Anejaculation

Answer 11

Lack of ejaculation, LGT syndrome
Tamsulosin, Afluzosin

Question 12

testicular cancer chemotherapy & Adverse effects

Answer 12

Cycles, last 3-4 weeks
Regimes: BEP, EP, VIP
Cisplatin - oto, neuro, nephron
Etoposide
Bleomycin - pulmonary fibrosis
Ifosfamide
Pacilitaxel - neuro, BMS
Vinblastine - BMS

Question 13

prostate cancer hormone treatment

Answer 13

Androgen deprivation therapy
LHRH - LH releasing hormone agonists
Leuprolide
Buserelin
Goserelin
Combo with antiandrogen
Flutamide
Bicalcutamide
Enzalutamide
Nilutamide
+ chemotherapy / immunotherapy

Question 14

prostate cancer chemotherapy

Answer 14

Docetaxel
Prednisone
Mitoxantrone
Immunotherapy:
Provenge
Frequently used: GnRH agonist + flutamide, docetaxel + prednisone & mitoxantrone

Question 15

what reduces initial testosterone surge at commencement of prostate therapy?

Answer 15

antiandrogen
Flutamide
Bicalcutamide
Enzalutamide
Nilutamide
= reduces initial testosterone surge at start of therapy

Question 16

Abiraterone + prednisone

Answer 16

Use: prostate cancer - progressive disease
MOA: irreversibly inhibits CYP17-hydroxylase –> decreases testosterone synthesis

Question 17

what commonly used ‘drug’ impairs male reproductive tract:

Answer 17

ethyl alcohol:
sexual dysfunction, sperm production
suppress testicular testosterone
testicular atrophy (oxidants)
elevates prolactin - gynecomastia - testosterone suppression

Question 18

Drugs adverse to male reproductive tract:

Answer 18

Ethyl alcohol
Antipsychotics - D2 blockers
Marijuana
SSRIs
Isotretinoin

Question 19

Drugs causing gynecomastia:

Answer 19

Oxandrolone
Flutamide
Cimetidine
Finasteride
Spirolactone
Ketoconazole
Oestrogens