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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
Q

cryptorchidism

A

one or both testes is undescended from abdomen into scrotum
exact cause unknown
common in premature males

26
Q

cryptorchidism TX

A

wait

may require surgery if doesn’t descend on its own (orchiopexy)

27
Q

cryptorchidism complications

A 
testicular cancer (3-5x)
fertility problems
testicular torsion
trauma
inguinal hernia
28
Q

varicocele

A 
enlargement of veins in scrotum 
may cause fertility issues
"bag of worms" 
DX: physical exam
no treatment
29
Q

hydrocele

A 
common in newborns
fluid-filled sack around testicle
can be from trauma/inflammation in older males 
DX: physical exam
TX: none
30
Q

spermatocele

A 
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
Q

epididymitis

A 
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
Q

orchitis

A

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
Q

orchitis s/s

A 
sudden symptoms
swelling in testicles
pain
tenderness
fever
nausea
vomiting
34
Q

testitcular torsion

A

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
Q

testicular torsion s/s

A

severe unilateral scrotal pain followed by swelling
1/3 N/V
in newborns: firm/hard/scrotal mass fixed to scrotal skin

36
Q

testicular torsion DX

A 
TWIST scoring (testis swelling, hard testis, absent cremasteric reflex, n/v, high-riding testes
TX: surgical repair w/in 6H to salvage testicle
37
Q

testicular cancer

A

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
Q

testicular cancer s/s

A

dull ache in groin
painless lump (maybe swelling, enlargement or hardening of testes)
gynecomastia
TX: radical orchiectomy, chemo, radiation

39
Q

hypospadias

A

abnormal position of urethral meatus
congenital abnormality
meatus develops on ventral (under) portion of penis
TX: surgical repair

40
Q

epispadias

A

rare, abnormal positon of urethral meatus
congenital abnormality
meatus develops on dorsal (upper) portion of penis
TX: surgical repair

41
Q

phimosis

A

disorder of foreskin (can’t retract over glans)

no TX

42
Q

balanitis

A

inflammation of glans

43
Q

balanoposthitis

A

inflammation of both blans & prepuce

44
Q

balanitis& balanoposthitis causes

A

poor hygiene

phimosis w/out circumcision

45
Q

paraphimosis

A

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
Q

priapism

A

prolonged erection for hours
painful blood cannot leave penis
uncommon
common in males w/ sickle cell

47
Q

priapism causes

A 
blood disorders
medications
erectile dysfunction meds
spider/scorpion bites
spinal cord injury
gout
penile cancer
48
Q

priapism DX and TX

A

physical exam, CBC, u/s, Toxicology
TX: medical emergency, drain blood from penis
medication injections to constrict blood flow

49
Q

peyronie disease

A

fibrous plaque affects tunica albuginea causing bend or curve
unknown cause
bend causes painful rections

50
Q

peyronie disease TX

A

may resolve on own
oral/injected meds
u/s to break up plaque
surgery last resort

51
Q

erectile dysfunction

A

inability to maintain/sustain erection for at least 3 months
disruption of normal neurovascular
most common male disorder

52
Q

erectile dysfunction TX

A 
lifestyle changes (diet exercise healthy body weight, abstinence from alcohol and tobacco)
pharm: sildenafil, tadalafil, vardenafil
53
Q

ED: harm

A

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
Q

sildenafil

A

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
Q

male infertility

A

30-40% infertility due to male infertility
difficult to treat pharm (expensive, many injections, not usually endocrine related)
other means of conception explored

56
Q

TX male infertility for hypogonadism

A

human chorionic gonadotropin (increases testosterone & sperm production)
menotropin (mixture of FSH & LH)
testosterone therapy

57
Q

antiestrogens

A

tamoxifen

clomiphene

58
Q

male infertility abnormal sperm

A

head defects
neck and pidpeiece defects
tail defects

59
Q

penile cancer

A 
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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