Endocrine Tbl3 Ed/bph

Front 1

Anatomy of Corpus Cavernosum (4)

Back 1

1)paired cylinders of erectile tissue
2)composed of distensible lattice of blood sinusoids
3)which are surrounded by trabeculae of smooth muscle which control blood capacity
4)surrounded by tunica albuginea

Front 2

Anatomy of Corpus Spongiosum (3)

Back 2

1)surrounds the urethra
2)expands to form the sensitive glans penis
3)contains erectile tissue

Front 3

Tunica Albuginea (2)

Back 3

1)surrounds the corpus spongiosum
2)is thick and non-expansible

Front 4

Penile Arteries
a)origin
b)names of them (4)

Back 4

a1)originate from internal iliac arteries

b1)dorsal artery
b2)cavernosal artery
b3)bulbo-urethral artery
b4)helicine arteries

Front 5

Cavernosal artery (1)

Back 5

runs down the center of each corpus cavernosum

Front 6

Helicine arteries (2)

Back 6

1)numerous branches off the length of the cavernosal arteries
2)supply blood to the sinusoids of the erectile tissue

Front 7

Bulbo-cavernosal arteries

Back 7

supplies the corpus spongiosum

Front 8

Subtunical veins (3)

Back 8

1)collect blood from sinusoids
2)run obliquely under the tunica albuginea
3)blood from these veins is collected in several circumflex veins

Front 9

Circumflex veins (2)

Back 9

1)collect blood from subtunical veins
2)drain into the single deep dorsal vein

Front 10

Cavernosal veins (1)

Back 10

drain the proximal portions of the corpora cavernosum

Front 11

____ MODULATE penile erection (2)

Back 11

1)psychological factors
2)hormonal status

Front 12

Audiovisual stimuli effect on penile erection

Back 12

1)initiates neuroendocrine messages from the brain to the autonomic nuclei of the spinal erection center

Front 13

Tactile stimulation and penile erection

Back 13

may or may not be a part of the stimulation of the spinal erection center

Front 14

Spinal erection center and penile erection

Back 14

sends messages to the erectile tissue of the corpora cavernosa via the cavernosal nerves

Front 15

Spinal erection center?

Back 15

area in spinal cord in which the pelvic autonomic sensory and motor nerves form a reflex arc

Front 16

Role of:
a)SNS
b)PSNS
in erection

Back 16

a)control ejaculation and detumescence
b)principle mediators of erection

Front 17

Nitric Oxide and erection (5)

Back 17

1)MOST IMPORTANT
2)released from endothelium upon PSNS stimulation
3)goes into smooth muscle and activates guanylate cyclase 2nd messenger system
4)Guanylate cyclase converts GTP into cGMP which causes a decr in intracellular Ca resulting in smooth muscle relaxation
5)cGMP effect is ended by PDE5 enzyme breakdown

Front 18

Vasoactive Intestinal Polypeptide (VIP) and erection (2)

Back 18

1)stimulates making of cAMP from ATP
2)effect is reduction in intracellular Ca resulting in smooth muscle relaxation

Front 19

PGE1 (prostaglandin E1) and erection (2)

Back 19

1)stims production of cAMP from ATP
2)effect is reduction in intracellular Ca resulting in smooth muscle relaxation

Front 20

NE and erection (4)

Back 20

1)counterbalances smooth muscle relaxation mechanisms
2)released from SNS in the corpora and activates alpha1 receptors
3)stim of alpha1 receptors causes incr intracellular Ca in the smooth muscles of hecline arteries and trabecular smooth muscle
4)results in smooth muscle contraction

Front 21

Detumescence

Back 21

loss of erection usually after orgasm and ejactulation

Front 22

Psychogenic ED
a)def
b)causes (3)

Back 22

a)loss of libido

b1)performance anxiety
b2)depression (ED occurs in 70%)
b3)stress

Front 23

Neurogenic ED
a)def
b)causes (5)

Back 23

a)failure to initiate nerve impulse or interrupted neural transmission

b1)stroke
b2)Alzeheimer's
b3)spine injury
b4)diabetic neuropathy
b5)MS

Front 24

Hormonal ED
a)def
b)causes (3)

Back 24

a)loss of libido and inadequate NO release

b1)low testosterone levels
b2)high sex hormone binding globulin levels
b3)high prolactin levels

Front 25

Vasculogenic ED
a)def
b)causes (5)

Back 25

a)inadequate arterial flow or impaired veno-occlusion

b1)atherosclerosis
b2)HTN
b3)DM
b4)trauma
b5)Peyronie's disease

Front 26

Drug induced ED
a)drugs that cause it and mechanism (4)

Back 26

a1)antiHTN/depression (central suppression)
a2)antiandrogens (decr libido)
a3)alcohol abuse (alcoholic neuropathy)
a4)cig smoking (vascular insufficiency)

Front 27

Organic causes of ED (5)

Back 27

1)neurogenic
2)hormonal
3)vasculogenic
4)drug-induced
5)other/aging

Front 28

Other systemic diseases/aging causes of ED (4)

Back 28

1)old age
2)DM
3)chronic renal failure
4)CHD

Front 29

Most common cause of ED

Back 29

mixed psychogenic and organic

Front 30

LOOK OVER ANATOMY DIAGRAMS

Back 30

...

Front 31

ANDROGENS and ED
a)indication
b)actions (2)
c)CI (2)

Back 31

a)primary hypogonadism

b1)improved libido/sexual fxn/mood
b2)enhance release of NO

c1)prostate cancer
c2)obstruction of bladder neck caused by prostatic hypertorphy

Front 32

ANDROGENS and ED
a)montoring (4)

Back 32

a)testosterone levels
b)HCT
c)lipids
d)PSA

Front 33

Oral preps of ANDROGENS
a)drugs (2)
b)dosing
c)disadv (2)

Back 33

a)Methyltestosterone (methitest), Fluoxymesterone (androxy)

b)Methyltestosterone 10-40mg qd
Fluoxymesterone 5-20mg qd

c2)associated w/ idiosyncratic hepatotoxicity
c3)less effective than intramuscular and transdermal preps

Front 34

Mucoadhesive preps of ANDROGENS
a)drugs
b)dosing

Back 34

a)Striant
b)30mg q12h

Front 35

Injectable preps of ANDROGENS
a)drugs (2)
b)dosing
c)disadv (2)

Back 35

a)Testosterone cypionate (Depo-Testosterone)
Testosterone enanthate (Delatestryl)

b)50-400mg IM q2-4 weeks (usually 200mg)

c1)tendency to NOT produce an even response b/w doses
c2)pain w/ deep intramuscular injection

Front 36

Transdermal ANDROGENS
a)drug
b)dosing (2)
c)ADR's (3)

Back 36

a)Androderm

b)2.5mg/24h (on back,abs,arms,thigh)
5mg/24h (on back,abs,arms,thigh)

c1)skin irritation
c2)contact dermatitis
c3)itching

Front 37

Implantable pellets ANDROGENS
a)drug
b)dose
c)disadv

Back 37

a)Testopel
b)two 75mg pellets for each 25mg of injectable testosterone reqd weekly
c)in the face of complications the pellets would have to be removed

Front 38

Gel testosterone formulations ANDROGENS
a)drugs (2)
b)dose (2)

Back 38

a)AndroGel 1%
b)5g of gel qd to clean skin (shoulders/upper arms)

a)Testim 1%
b)one 5g tube applied qd to shoulders/upper arms

Front 39

PDE5 Inhibitors
a)ADR's (4)
b)Cardiovascular counseling (2)

Back 39

a1)HA
a2)flushing
a3)dyspepsia
a4)hypotension

b1)men taking organic/amyl nitrate should be told about hypotensive interaction
b2)warn about taking viagra 24h b4/after taking a nitrate prep

Front 40

PDE5 Inhibitors
a)dosing viagra
b)dosing vardenafil
c)dosing tadalafil

Back 40

a)50mg 1hr b4 sex (but in range of 0.5-4h is acceptable), can be incr to 100mg or decr to 25mg

b)10mg one hour b4 sex, can be incr to 20mg or decr to 5mg

c)10mg b4 sex w/ or w/o food, can be incr to 20mg or decr to 5mg; daily dose of 2.5mg can be take w/o regard to planned sex

Front 41

Adrenergic-receptor antagonist
a)drug
b)dose
c)ADR's (4)

Back 41

a)Yohimbine (Yocon)
b)5.4mg TID

c1)palpitation
c2)tremor
c3)incr BP
c4)anxiety

Front 42

Transurethral therapy
a)drug
b)mechanism
c)adv (3)

Back 42

a)Alprostadil
b)stable, synthetic PGE1

c1)local application
c2)minimal systemic effects
c3)rare drug interaxns

Front 43

Transurethral (Alprostadil)
a)ADR (4)
b)dosing
c)counsel (2)

Back 43

a1)penile pain
a2)urethral pain
a3)urethral bleeding
a4)hypotension

b)initiate therapy in Dr's office @ 500mcg (usual maintenance is 250-1000mcg per application)

c1)urinate b4 inserting MUSE applicator
c2)refrigerate unopened foil packages of MUSE

Front 44

Intracavernous therapy
a)drug (2)
b)ADR (2)
c)dosing

Back 44

a1)Caverject
a2)Regitine (not approved in USA)

b1)priapism
b2)fibrosis

c)5-20mcg, but start w/ 2.5mcg

Front 45

Alternative ED tx (3)

Back 45

1)Vacuum constriction (cock ring)
2)semi-rigid or inflatable prostheses implanted
3)vascular surgery is curative in youngins w/ congenital/traumatic ED

Front 46

Possible fxns of the prostate (3)

Back 46

1)neutralizing acidity of fluid from the vas deferens and associated w/ vaginal secretions
2)nourishing sperm
3)aide in successful fertilization of ovum

Front 47

2 major risk factors necessary for BPH

Back 47

1)presence of testes
2)aging

Front 48

Proposed reasons for BPH (3)

Back 48

1)prostate becomes more sensitive to androgens as it enlarges and as levels of testosterone decr
2)estrogen levels in men incr w/ age
3)which acts w/ dihydrotestosterone to cause prostate growth by incr androgen receptor protein in the tissue

Front 49

Symptoms of BPH (8)

Back 49

1)hard to pee
2)weak/interrupted stream
3)urgency
4)leaking (incontinence)
5)nocturia
6)sensation of incomplete emptying of bladder
7)UTI
8)bladder stones

Front 50

Relationship b/w BPH and prostate cancer?

Back 50

BPH does NOT predispose to the development of prostatic cancer

Front 51

Look over BPH anatomy!!!

Back 51

...

Front 52

First 3 BPH diagnostic tests

Back 52

1)DRE (1st one done)

2)PSA blood test (used to rule out prostate cancer)

3)Urine flow study (best non-invastive study)

Front 53

Second 3 BPH diagnostic tests

Back 53

1)Intravenous pyelogram (IVP) (X-ray of urinary tract to see obstructions)

2)Cystoscopy (visualizes prostate and determines size/obstruction)

3)Urinalysis (determines if UTI or stones)

Front 54

Alpha-blockers and BPH
a)drugs (5)

Back 54

a1)Terazosin (Hytrin)
a2)Doxazosin (Cardura)
a3)Tamsulosin (Flomax)
a4)Alfuzosin (Uroxatral)
a5)Prazosin (Minipres)

Front 55

Alpha-blockers and BPH DOSING (starting and maintenance)
a)Prazosin
b)Terazosin
c)Doxazosin
d)Tamsulosin
e)Alfuzosin

Back 55

a)start 1mg BID-TID; 6-20mg in 2-3 doses

b)start 1mg HS; 5-20mg qd

c)1mg qd; 1-8mg qd

d)0.4mg qd; 0.4-0.8mg qd

e)10mg qd; 10mg qd

Front 56

Alpha-blockers and BPH
a)ADR's (2)
b)interactions
c)time for it to work

Back 56

a1)dizziness/orthostasis
a2)QT prolongation w/ alfuzosin

b1)CYP3A4 inhibitors (ketoconazole or ritonavir) or liver dysfxn may incr BP w/ alfuzosin

c)2-6weeks

Front 57

5-alpha reductase inhibitors
a)drugs (2)
b)dosing

Back 57

a1)Finasteride (Proscar)
b1)5mg qd w/ or w/o meals

a2)Dutasteride (Avodart)
b2)0.5mg qd w/ or w/o meals

Front 58

5-alpha reductase inhibitors
a)ADR's (4)
b)time to work

Back 58

a1)ED
a2)decr ejaculate
a3)decr libido
a4)NOT TO BE HANDLED BY PREGO WOMEN

b)6-12months

Front 59

Only drug mentioned not FDA approved for BPH

Back 59

Prazosin (Minipres)

Front 60

Saw Palmetto
a)where it comes from
b)supposed mechanism (5)
c)approval?

Back 60

a)extract of sitosterols

b1)anti-androgenic
b2)anti-estrogen
b3)anti-inflammatory
b4)in high doses they inhibit testosterone-5-alpha-reductase
b5)inhibit binding of andorgen to its receptors

c)not approved to treat BPH and lacks data that it works

Front 61

Saw Palmetto ADR's (5)

Back 61

1)HA
2)GI upset
3)HTN
4)impotence
5)decr libido

Front 62

Physiology of an erection (4) and what is it called

Back 62

1)dilation of the cavernosal and helicine arteries, increasing blood flow into the lacunar sinusoidal spaces
2)relaxation of cavernosal smooth muscle, opening the vascular lacunar spaces
3)expansion of the lacunar spaces against the tunica albuginea, compressing the subtunical veins
4)this decr venous outflow and produces an erection


VENO-OCCLUSIVE MECHANISM

Front 63

Function of PDE5 and mechanism of PDE5 inhibitor

Back 63

inactivates cGMP

incr cGMP []s in ALL tissues of penis (pretty much)

Front 64

Carvernous nerves fxn (2)

Back 64

1)union of penile PSNS and SNS nerves from the pelvic plexus
2)run behind the prostate and into base of the penis