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Pharmacology

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Cancer Chemotherapy

Question
65 out of 100
 

Drug causing oligospermia (DNB June 2010)


A Leflunomide
B d-penicillinamine

C Methotrexate
D Corticosteroids

Ans. D Corticosteroids

A. Leflunamide

a. It is an orotate dihydrogenase inhibitor (antipyrimidine) and the drug is used in rheumatoid arthritis. The drug is a DMARD and is used in late phase.

b. It forms an active metabolite and has a good oral absorption. Peak levels are reached in 6-12 hours.

c. The drug has been shown to reduce radiological progression of RA and produce symptomatic improvement.

d. Major side effects include hepatotoxicity and bone marrow depression leading to leucopenia or thrombocytopenia.

e. Serious skin rashes such as Steven-Johnson syndrome can also occur.

f. Rare side effect is interstitial lung disease.

B. d-penicillamine

a. It is a copper chelator and is used for Wilson’s disease and is also a DMARD.

b. It is a metabolite of penicillin but does not have antibiotic like activity. The drug reduces activity of T lymphocytes, macrophages and IL-1.

c. It also reduces the activity of RA factor as well. Side effects include a pemphigus like eruption and proteinuria.

d. Myopathy can occur and can persist even after the withdrawal of the drug.

C. Methotrexate

a. It is a DMARD that is used clinically for RA, psoriatic arthropathy and pustular psoriasis. It is also the drug of choice for ectopic pregnancy.

b. The drug is well absorbed but does not enter blood brain barrier. Hence it is given intrathecally. It is 50% protein bound and is eliminated unchanged.

c. The dose of drug, therefore, in renal failure is reduced. Most common side is hepatic fibrosis.

d. The drug can also cause pulmonary fibrosis and leukoencephalopathy when it is given intra-thecally.

e. It should not be given with potassium sparing diuretics as they interfere with renal elimination.

D. Corticosteroids

a. It down regulates T cells and are potent anti-inflammatory drugs.

b. Corticosteroids can inhibit hypothalamic pituitary adrenal axis and thus can reduce release of GnRH leading to azoospermia.

Causes Of Oligospermia:

Pre-testicular causes

  1. Hypogonadism due to various causes
  2. Drugs, alcohol, smoking
  3. Strenuous riding (bicycle riding, horseback riding)

Testicular factors

  1. Age
  2. Genetic defects on the Y chromosome

a. Y chromosome microdeletions

  1. Abnormal set of chromosomes: Klinefelter’s syndrome
  2. Hydrocele
  3. Mumps
  4. Malaria
  5. Neoplasms, e.g. seminoma
  6. Cryptorchidism
  7. Trauma
  8. Varicocele

Post-testicular causes

  1. Vas deferens obstruction
  2. Lack of Vas deferens, often related to genetic markers for Cystic Fibrosis
  3. Infection, e.g. prostatitis
  4. Ejaculatory duct obstruction

Idiopathic oligospermia

Cancer Chemotherapy Flashcard List

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