Week 3 - Part 2

Question 1

Testosterone drugs

Answer 1

Testosterone: transdermal
Cypionate: ester, IM injection, slow release
Stanozolol: oral, alkylated, hepatotoxicity
Used: male hypogonadism (due to hypotestosterone)
sides: diminished fertility, decreases testicular size, erythrocytosis, gynecomastia

Question 2

Anti-androgen drugs

Answer 2

Leuprolide: GnRH analog (inhibits LH secretion)(use: prostate cancer, endometriosis, fibroids, precocious puberty, sides: hot flashes, bone loss, vaginal dryness, ED)
Finasteride: 5a-reductase inhibitor (used for BPH and male baldness)
Flutamide: androgen receptor antagonist (use in conjunction with GnRH analog,, use for metastatic prostate cancer,, side: galactorrhea, gynecomastia, hot flashes, *hepatic failure)

Question 3

Impotence drugs

Answer 3

Alprostadil: PGE1, intracavernous injection, dilates arteries, lasts 1-3hrs
Tadalafil, vardenafil, sildenafil: PDE5 inhibitors (stops breakdown of cGMP, thus more cGMP and NO, which relaxes corpus cavernosum smooth muscle) (sides: headaches, flushing, visual disturbance, *contra in pts with Nitrates due to extreme hypotension

Question 4

Testosterone and DHT actions

Answer 4

testosterone- 5a-reductase- DHT
testo: gonadotropin feedback, spermatogenesis(FSH too via sertoli cell), wolffian duct differentiation, behavior
DHT: external virilization, anabolism, muscle mass

LH stimulates Leydig cell to make testosterone which stimulates sertoli cell (FSH does too), which makes inhibin which feedbacks to pituitary/GnRH

Question 5

Delayed male puberty

Answer 5

absence of 2ndary sex char by age 14 in US
defect in GnRH- LH/FSH- testicular steroid axis (low testosterone)
Primary (high LH/FSH): get karyotype- Klinefelter(xxy), gonadal dysgenesis,, if normal then test for adrenal insuff, tumor, trauma, torsion, postinfxn
Secondary (low FSH/LH): if fam hx+ then adrenal insuff or constitutional delay,, if anosmia then Kallman syndrome,, if not then check anorexia, prolactin, IHH, tumor, iron

Question 6

Klinefelter’s Syndrome

Answer 6

delayed male puberty, low T
long bone abnormality of leg
psychosocial abn, ADD
pulm probs, cancer, SLE, DM
XXY

Question 7

Causes of male infertility

Answer 7

testicular: most common,, usually reversible,, varicoceles, gonadotoxins, primary testicular probs
Post-testicular: obstruction, ejaculation probs
HPG-axis (testosterone, LH/FSH)
changes take 90 days to reflect in the sperm
CBAVD
always get at least 2 semen analysis

Question 8

Congenital bilateral absence of vas deferens

Answer 8

cause of infertility
autosomal recessive,, mostly CFTR gene, usually 2 mutations, 2nd in 5T allele
cause involution of genital ducts during embryo
spermatogenesis is not impaired
If CFTR is neg, then renal anomalies are common, defects in mesonephric duct

Question 9

Control of bladder/sphincter/urination

Answer 9

CNS: voluntary control via inhibition of reflex detrusor contraction
Pontine micturition center coordinates contractions and relaxations
Parasympathetic: direct motor activation of detrusor contraction (ACh-muscarinic)
Sympathetic: inhibition of detrusor (B3-adrenergic) and contraction of internal sphincter (a-adrenergic)
Somatic: control of external urethral sphincter
Reflex: stretch receptors in bladder via spinal cord promotes detrusor contraction

Question 10

Detrusor-sphincter dyssynergia

Answer 10

damage to brainstem/pons/spinal cord that causes discoordination of micturition
detrusor and external sphincter contract- high bladder pressure

Question 11

Voiding dysfunction of urine

Answer 11

Failure to store:
-urge incontence: detrusor overactivity
-overflow incontenence: underactive detrusor
-stress incontinence: urethral sphincter weakness
Failure to empty:
-weak/areflexic detrusor
-urethral obstruction (prostate, surgery, hyperactive (neurogenic)

If you have both detrusor and sphincter probs= mixed urinary incontinence (MUI)

Question 12

Overactive bladder

Answer 12

urinary urgency, frequency, nocturia, urge incontinence
causes: inflammation/UTI, neurologic, metabolic(diabetes), urethral obstruction
Risks: menopause, obesity, prolapse
Tx: restrict fluids, kegels, anticholinergics, B3-agonists, surgery

Question 13

Commensals role in UTIs, etc

Answer 13

lower vaginal pH (lactic acid- H2O2), compete for resources with pathogens
females: mostly Lactobacillus

Question 14

Immune defenses in urinary tract

Answer 14

more limited than in other areas

• physical force of urine flow (transitional epithelium)
• exfoliation (cells in urine= sign of infxn)
• AMPs(defensins, cathelicidins) and THP(Tamm-Horsfall, uromodulin, produced in loop of henle)

Question 15

UTIs

Answer 15

female more than male
many are nosocomial
gram neg bacteremias
Sx: burning pain while urinating, abd pain, low fever
Urinalysis: nitrites=G- bacteria,, Luekocyte esterace= WBCs in urine,, squamous epithelial= contaminated specimen
Half will have microhematuria, but should be checked if persistent bc urologic ds or GU malignancy
Uncomplicated: E coli usually, use TMP/SMX
Complicated: worry about kidney failure, diabetes, etc, use Cipro
-Always culture recurrent UTIs, can use long term prophylaxis
Warning signs: more than 3 UTIs/year, complicated UTIs, L-sided pyelonephritis in pregnancy
-asymptomatic bacteruria is common and doesn’t need treatment