infertility is inability to conceiver after ___ of intercourse w/o contraception.
how many eggs are women born with? how many eggs mature?
drugs that affect ___ and ___ hormones will affect infertility.
how do drugs directly affect infertility in women?
- affect gonadal fxn (ovaries)
- dec FSH and LH
how do drugs indirectly affect infertility in women?
inhibit pituitary secretion of gonadotropin
drugs that cause infertility in women.
- chemo: alkylating agent, anthracycline, bleomycin, etoposide, fluorouracil, platinum, vinca alkaloid
- methotrexate, thalidomide
- antiepileptic (reversible)
mechanism of chemo therapy for infertility (F).
- DIRECT effect on oocyte, decrease follicular formation, permanently halt ovulation
- usually NOT reversible
mechanism of anti-epileptic for female infertility.
- increase hormone binding globulin
- decreasing estradiol binding
- decrease ovarian fxn
- may REVERSE after d/c
chemotherapy/radiation effects on fertility depend on...
- dose intensity
- dose and/or radiation field
- route of admin (IV more harmful than PO)
- pre-treatment fertility of patient
what defines HIGH risk (>80%) of chemotx on female gonadal fxn?
- 6 cycles in women >40 yo
- (cyclophosphamide, epirubicin, doxorubicin, methotrexate, fluorouracil)
what defines INTERMEDIATE risk of chemotx on female gonadal fxn?
6 cycles in women 30-39 yo
what defines LOW risk of chemotx on female gonadal fxn?
6 cycles in women <30 yo
what can NSAID cause for infertility in women?
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
do oral contraceptives cause infertility after d/c? (female)
prolonged infertility is more common with combined preps or sequential use of estrogen/progesterone? [f]
does Depo Provera cause infertility? (f)
- (medroxyprogesterone acetate depot)
- cause transient ovulatory dysfxn after d/c
causes of infertility (m)
- sperm defect
- coital factors (impotence, retrograde ejaculation)
decreased sperm count.
absent sperm production.
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
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
wait at least ___ after chemotx to conceive.
agents associated with sexual dysfxn in women.
how to manage drug induced sex dysfx in women?
- dec dose
- switch to alt med
- temporary cessation of med
how long does it take to see effects of manage of sex dyfxn in women?
how to manage SSRI induced sex dysfx in women?
- add bupropipon 200mg
- sildenafil (off label)
- SL apomorphine
what antidepressant does NOT cause sex dysfx in women?
- it can be added to SSRI to dec sex dysfx actually!
4 types of sex dysfx in men?
- 1) disorder of libido
- 2) erectile dysfx
- 3) ejaculatory disorder
- 4) priapism
ED often occurs with what conditions.
- heart disease
- peripheral vasc disease (PVD)
- spinal cord injury
- pelvic or perineal radiotherapy/sx
- smoking, alcohol
very impt to counsel pts about sex dyfxn with ___ meds.
increased serotonin/dopamine (inc/dec) emission in male.
which beta blocker is more prevalent with ED in male?
- lipid soluble beta blocker
is there sex dysfx with ACEi?
which SSRI has the lowest incidence of sex dysfx reported?
which anti-dep has failure of orgasm in both sexes?
how to TCAs cause sex dysfx?
- impo and delayed or retrograde ejac.
- maybe due to alpha blocking activity
what are phenothiazines?
- chlorpromazine, thioridazine
what sex dysfx do phenothiazines cause?
what are 3 mechanisms?
- erectile dysfx, ejac dysfx
- antidopamine, anticholinergic, alpha block
which antipsych have fewer sex dysfx in men?
chronic alcoholism result in liver dysfx. 3 things happen that lead to impotence.
- inc estrogen
- dec testosterone
- alcohlic polyneuropathy
suppress LH secretion and dec testosterone.
what sex dysfx in opiates?
reduce libido and impotence
normal testosterone level
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
25-100mg po 1hr before sex
onset is not delayed by high fat meal.
PDE-11. no visual disturbance.
more back pain, myalgia b/c not PDE6.
contraindicated med with pde-5 inhib.
nitrates!!!! b/c BP dec
drugs that interact with PDE5 inhibitors. what to do?
- protease inhib
- k-sparing diuretic
- non-selective beta block
- dec pde5 inhib starting dose.
do not take this if QTC prolongation or meds.
which meds cause qtc prolongation.
- procainamide, quinidine, amiodarone
5-20mg po 1 hr before sex
- 2.5 - 5mg po qd or 10-20 mg 1 hr before sex
- unlike others, this has qd dose avail.
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.
drug induced priapism can occur if alpha adrennoreceptor is ___ (agonist/anta)
goal in priapism.
- prevent fibrosis/gangrene
- phenylephrine - vasoconstrict
- aspire blood
what med pops into head when priapism???