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PT4023 CA2 > L13 Male Reproduction > Flashcards

L13 Male Reproduction Flashcards

(49 cards)

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1
Q

What enzyme converts testosterone to dihydrotestosterone (DHT)?

A

5α-reductase

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2
Q

Effects of DHT binding to androgen receptor

A

External genitalia: differentiation during gestation, maturation during puberty, adulthood prostatic diseases
Hair follicles: increased growth during puberty

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3
Q

Effects of testosterone binding to androgen receptor

A

Internal genitalia: Wolffian development during gestation
Skeletal muscle: increase mass & strength during puberty
Erythropoiesis
Bone

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4
Q

What enzyme converts testosterone to estradiol?

A

aromatase

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5
Q

Effects of estradiol binding oestrogen receptor

A

Bone: epiphyseal closure, increased density
Libido

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6
Q

What guidelines are followed for the treatment of male LUTS?

A

European Association of Urology

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7
Q

By the age of 80, what percentage of men will suffer from benign prostatic hyperplasia?

A

~90%

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8
Q

BPH is the most common cause of __.

A

Bladder outlet obstruction (BOO)

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9
Q

2 distinct mechanisms that cause BOO

A
  1. Static - prostate bulk encroaching on urethra (restrictive)
  2. Dynamic - tension of prostate smooth muscle (increased stromal smooth muscle tone)
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10
Q

What is used to determine the severity of LUTS?

A

International Prostate Symptom Score (IPSS)

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11
Q

Examples of lower urinary tract symptoms

A

incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia

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12
Q

Pharmacological treatment of BPH

A

α1-adrenoceptor antagonists (dynamic component and irritative symptoms)
5α-reductase inhibitors (static component and obstructive symptoms)

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13
Q

Examples of α1-adrenoceptor antagonists

A

terazosin, doxazosin, tamsulosin, alfuzosin, silodosin

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14
Q

How do α1-adrenoceptor antagonists treat BPH?

A
  • target α1A, α1B and α1D subtypes
  • reduce prostatic smooth muscle tone
  • relieve bladder outlet tension
  • increase urinary flow
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15
Q

Side effects of α1-adrenoceptor antagonists

A

dizziness, postural hypotension, rhinitis, sexual dysfunction

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16
Q

Examples of 5α-reductase inhibitors

A

finasteride, dutasteride

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17
Q

How do 5α-reductase inhibitors treat BPH?

A
  • 70-90% reduction in DHT
  • 20-30% reduction in prostate size
  • ~50% reduction in PSA
  • control the static obstructive component of LUTS
  • improvement in peak flow rate within 3-6 months
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18
Q

Adverse effects of 5α-reductase inhibitors

A

reduction in spermatogenesis, decreased libido

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19
Q

What is prostatic artery embolisation?

A

catheter insertion to cut off blood supply to prostate (microspheres cause calcification and inflammation) - prostate dies in situ and symptomology reversed

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20
Q

Symptoms of overactive bladder

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A

urinary urgency, with or without urinary incontinence, increased frequency and nocturia

21
Q

During storage phase, __ release is suppressed.

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A

parasympathetic (ACh)

22
Q

How is overactive bladder and detrusor overactivity treated?

Study These Flashcards
A

Anti-muscarinic treatment strategy - detrusor M3 receptor antagonists

23
Q

Examples of anti-muscarinic drugs

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A

oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin, trospium

24
Q

How do anti-muscarinics treat OAB?

Study These Flashcards
A
  • reduce spontaneous myocyte activity
  • decrease frequency and intensity of detrusor activity
  • suppress cholinergic signalling and prolong storage phase (reduced contraction of detrusor)
25
Side effects of anti-muscarinic treatment
- dry mouth (parotid glands) - constipation (intestinal smooth muscle) - headache - blurred vision (ciliary muscle) - non-selectivity of antagonists for M3 receptors (also targets other receptor subtypes) - systemic blockade - blockade of vagal inhibitory input, cardiac arrhythmia
26
Example of a B3 receptor agonist and how it can treat OAB
Mirabegron - enhances noradrenaline release - relaxes detrusor - improves bladder filling - reduces irritative OAB symptoms of urgency, frequency & nocturia
27
Side effect of Mirabegron use
increased blood pressure
28
Pharmacological treatment of erectile dysfunction
α1-adrenoceptor antagonists phosphodiesterase type 5 inhibitors
29
How do α1-adrenoceptor antagonists treat ED?
They relax smooth muscle in penile arteries or corpus cavernosum, resulting in increased blood flow, causing erection
30
Common adverse effect of α1-adrenoceptor blockade to treat ED
retrograde ejaculation, due to relaxation of the bladder neck (reduced smooth muscle tone)
31
Example of a PDE5 inhibitor and how it can treat ED
Sildenafil (Viagra) - vascular smooth muscle relaxation - increased blood flow to penis, causing erection
32
Why take caution when using a combination of PDE5 inhibitors and α1-adrenoceptor antagonists?
can cause significant hypotension
33
Rationale for endocrine treatment for prostate cancer
deprive cancerous cells of androgens, apoptotic regression
34
How is testosterone production eliminated in endocrine treatment for prostate cancer?
GnRH agonists and GnRH antagonists
35
Examples of GnRH agonists used to treat prostate cancer
Goserelin, buserelin, leuprolin, nafarelin
36
What does high concentration of GnRH agonist result in?
GnRH receptor desensitisation and subsequent testosterone suppression (in 95% of patients)
37
How are GnRH agonists administered in prostate cancer patients?
subcutaneous administration at 1-3 month intervals
38
Adverse effects of GnRH agonists?
tumour flare (lasts 1-2 weeks), bone pain due to bone metastases
39
Example of a GnRH antagonist
Abarelix
40
Why are GnRH antagonists usually preferred to GnRH agonists?
They avoid the 'tumour flare' response as they are associated with a more rapid reduction in testosterone levels (<1 day)
41
Why are anti-androgens used in prostate cancer endocrine treatment?
intermittent androgen deprivation; inhibition of androgenic-independent tumour cell development - improved quality of life. PSA monitored closely
42
Example of a steroidal anti-androgen
Cyproterone acetate - androgenic and progestogenic actions - suppresses LH release
43
Adverse effects of cyproterone acetate
Castration syndrome, hepatotoxicity
44
Examples of non-steroidal anti-androgens
Bicalutamide, flutamide - androgenic effects - LH release maintained
45
Adverse effects of non-steroidal anti-androgens
nausea, diarrhoea, hepatotoxicity
46
Symptoms associated with Castration syndrome
loss of libido and erectile function, hot flushes, anaemia, obesity, decrease in muscular strength, fatigue, decrease in physical activity, mood changes, depression
47
How is anaemia associated with Castration syndrome treated?
with recombinant human erythropoietin to help increase levels of RBCs
48
What is carried out to identify osteoporosis high-risk individuals before initiating treatment?
bone densitometry
49
How are men with Castration syndrome treated for osteoporosis?
- calcium supplementation - oestrogen and bisphosphonates - intermittent androgen deprivation treatment protocol

PT4023 CA2 (6 decks)

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