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infertility is inability to conceiver after ___ of intercourse w/o contraception.
1 year
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how many eggs are women born with? how many eggs mature?
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drugs that affect ___ and ___ hormones will affect infertility.
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how do drugs directly affect infertility in women?
- affect gonadal fxn (ovaries)
- dec FSH and LH
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how do drugs indirectly affect infertility in women?
inhibit pituitary secretion of gonadotropin
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drugs that cause infertility in women.
- chemo: alkylating agent, anthracycline, bleomycin, etoposide, fluorouracil, platinum, vinca alkaloid
- methotrexate, thalidomide
- antiepileptic (reversible)
- caffeine
- NSAID
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mechanism of chemo therapy for infertility (F).
- DIRECT effect on oocyte, decrease follicular formation, permanently halt ovulation
- usually NOT reversible
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mechanism of anti-epileptic for female infertility.
- increase hormone binding globulin
- decreasing estradiol binding
- decrease ovarian fxn
- may REVERSE after d/c
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chemotherapy/radiation effects on fertility depend on...
- age
- sex
- disease
- dose intensity
- dose and/or radiation field
- route of admin (IV more harmful than PO)
- pre-treatment fertility of patient
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what defines HIGH risk (>80%) of chemotx on female gonadal fxn?
- 6 cycles in women >40 yo
- (cyclophosphamide, epirubicin, doxorubicin, methotrexate, fluorouracil)
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what defines INTERMEDIATE risk of chemotx on female gonadal fxn?
6 cycles in women 30-39 yo
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what defines LOW risk of chemotx on female gonadal fxn?
6 cycles in women <30 yo
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what can NSAID cause for infertility in women?
mechanism?
is this reversible?
- luteinizing un-ruptured follicle syndrome.
- clinical signs of ovulation but failure of follicles to burst and release eggs
- NSAIDs inhibit COX-2, which is active in ovaries during follicular development
- yes reversible
- avoid NSAID if getting pregnant
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do oral contraceptives cause infertility after d/c? (female)
nope, rarely
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prolonged infertility is more common with combined preps or sequential use of estrogen/progesterone? [f]
combined preps
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does Depo Provera cause infertility? (f)
- (medroxyprogesterone acetate depot)
- cause transient ovulatory dysfxn after d/c
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causes of infertility (m)
- sperm defect
- hypogonadism
- coital factors (impotence, retrograde ejaculation)
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decreased sperm count.
A) oligospermia
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absent sperm production.
a) oligospermia
b) azoospermia
c) asthenospermia
d) teratozospermia
b) azoospermia
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decreased motility.
a) oligo
b) azo
c) astheno
d) terato
c) astheno
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malformed sperm.
a) oligo
b) azo
c) astheno
d) terato
d) terato
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what agents cause sperm issue
- antineoplastics (chlorambucil, vinblastine, prednisone): azoosperm
- hormonal (estrogen, progestin, anabolic steroids): dec libido, azosperm, dec testicle size
- sulfasalazine: dec sperm production, maturation and motility
- erythromycin: dec sperm motility and #
- nitrofurantoin: inhibit sperm maturation and motility
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what does sulfasalazine do to sperm? when are the effects seen? when does the normal fertility restore?
- dec sperm production, maturation and motility
- 2 weeks
- when switch to mesalazine
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wait at least ___ after chemotx to conceive.
1 year
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agents associated with sexual dysfxn in women.
- antidepressant
- antipsychotic
- antiepileptic
- antihypertensive
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how to manage drug induced sex dysfx in women?
- dec dose
- switch to alt med
- temporary cessation of med
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how long does it take to see effects of manage of sex dyfxn in women?
2wk
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how to manage SSRI induced sex dysfx in women?
- add bupropipon 200mg
- sildenafil (off label)
- SL apomorphine
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what antidepressant does NOT cause sex dysfx in women?
- bupropion
- it can be added to SSRI to dec sex dysfx actually!
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4 types of sex dysfx in men?
- 1) disorder of libido
- 2) erectile dysfx
- 3) ejaculatory disorder
- 4) priapism
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ED often occurs with what conditions.
- diabetes
- heart disease
- htn
- peripheral vasc disease (PVD)
- spinal cord injury
- pelvic or perineal radiotherapy/sx
- smoking, alcohol
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very impt to counsel pts about sex dyfxn with ___ meds.
antipsychotic
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increased serotonin/dopamine (inc/dec) emission in male.
dec
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which beta blocker is more prevalent with ED in male?
- propranolol
- lipid soluble beta blocker
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is there sex dysfx with ACEi?
nope
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which SSRI has the lowest incidence of sex dysfx reported?
Luvox (fluvoxamine)
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which anti-dep has failure of orgasm in both sexes?
fluoxetine (prozac)
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how to TCAs cause sex dysfx?
- impo and delayed or retrograde ejac.
- maybe due to alpha blocking activity
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what are phenothiazines?
- antipsychotic
- chlorpromazine, thioridazine
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what sex dysfx do phenothiazines cause?
what are 3 mechanisms?
- erectile dysfx, ejac dysfx
- antidopamine, anticholinergic, alpha block
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which antipsych have fewer sex dysfx in men?
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chronic alcoholism result in liver dysfx. 3 things happen that lead to impotence.
- inc estrogen
- dec testosterone
- alcohlic polyneuropathy
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suppress LH secretion and dec testosterone.
a) hctz
b) bupropion
c) opiate
d) TCA
c) opiate
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what sex dysfx in opiates?
reduce libido and impotence
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normal testosterone level
300-1100 ng/dL
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if testosterone is low, what can you use? what to monitor
- testosterone cypionate or enanthate 200mg im q3-4 wk (use im)
- monitor hgb, hct, LFT, lipids
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sildenafil dose
25-100mg po 1hr before sex
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onset is not delayed by high fat meal.
C) tadalafil
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PDE-11. no visual disturbance.
B) cialis
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more back pain, myalgia b/c not PDE6.
A) cialis
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contraindicated med with pde-5 inhib.
nitrates!!!! b/c BP dec
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drugs that interact with PDE5 inhibitors. what to do?
- protease inhib
- cimetidine
- k-sparing diuretic
- non-selective beta block
- erythromycin
- ketoconazole
- itraconazole
- dec pde5 inhib starting dose.
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do not take this if QTC prolongation or meds.
C) levitra
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which meds cause qtc prolongation.
- levitra
- procainamide, quinidine, amiodarone
- sotalol
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levitra dose.
5-20mg po 1 hr before sex
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cialis dose
- 2.5 - 5mg po qd or 10-20 mg 1 hr before sex
- unlike others, this has qd dose avail.
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if emision failure, what can you use?
- imipramine 25 - 50mg qd for 7 days prior to intercourse
- or start pseudoephedrine 60mg qid for 3 days before sex.
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drug induced priapism can occur if alpha adrennoreceptor is ___ (agonist/anta)
antagonized
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goal in priapism.
- prevent fibrosis/gangrene
- phenylephrine - vasoconstrict
- aspire blood
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what med pops into head when priapism???
trazodone!!!
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