Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PT4023 CA2 > L12 Female Reproduction > Flashcards

L12 Female Reproduction Flashcards

1
Q

What is the principal source of circulating oestrogen in premenopausal women?

A

Ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the main secretory product from the ovaries?

A

Oestradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examples of ways oestrogens can be produced

A
  • by the ovaries
  • from androgens by the actions of aromatase
  • from oestrogen conjugates by hydrolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are oestrogens largely responsible for?

A

pubertal changes in girls and secondary sexual characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is oestrogen production tightly controlled?

A

Oestrogen production is under tight neuroendocrine control via the HPO hormone feedback regulation axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do oestrogens exert their effects?

A

By interaction with nuclear receptors: ERα (encoded by ESR1) and ERβ (encoded by ESR2). Oestrogen receptors act as transcription factors - transcriptional regulatory effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do oestrogens have positive effects on bone mass?

A

Osteoclasts and osteoblasts express both ERα (plays a greater role) and ERβ. They regulate bone remodelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where is progesterone secreted from and when?

A

Progesterone is secreted by the ovary, mainly from the corpus luteum, during the second half of the menstrual cycle (secretory/luteal phase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

__, acting via its __, stimulates progesterone secretion during the normal cycle.

A

LH, acting via its GPCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

2 most frequent uses of progestins

A
  1. For contraception, either alone or with an oestrogen
  2. In combination with oestrogen for hormone therapy of postmenopausal women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effects of progestins on the reproductive system

A

Progesterone decreases oestrogen-driven endometrial proliferation. This leads to the development of a secretory endometrium. The abrupt decline in progesterone at the end of the cycle is the main determinant of the onset of menstruation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effect of progesterone on mammary glands

A

Mammary gland development requires both oestrogen and progesterone. During pregnancy, progesterone acts with oestrogen to bring about proliferation of the acini of mammary glands. Towards the end of pregnancy, the acini fill with secretions and the vasculature of the gland notably increases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effect of progesterone on the CNS

A

Increase in basal body temp of ~0.6℃ mid-cycle (correlating with ovulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolic effects of progesterone

A
  • increases basal insulin levels and the rise in insulin after carb ingestion, but it does not normally alter glucose tolerance
  • stimulates lipoprotein lipase activity and seems to enhance fat deposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Example of a more potent progestin that may decrease glucose tolerance

A

Norgestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Naturally occurring progestin

A

the endogenous steroid hormone progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

To which series do 17α-acetoxyprogesterone derivatives belong?

A

the pregnane series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

To which series do 19-nortestosterone derivatives belong?

A

the estrane series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

To which series do Norgestrel and related compounds belong?

A

the gonane series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most widely used method for contraception?

A

oral contraceptive pill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 types of oral contraception

A
  • combination pills
  • progestin-only pills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the pharmacologic activity of progestins based on?

A

the progestational activity and bioavailability of each progestin, as well as the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Place the following progestins in order of decreasing relative potency:
norgestrel, norethindrone, levonorgestrel

A

levonorgestrel > norgestrel > norethindrone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the active oestrogen component of oral contraceptives?

A

ethinyl oestradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do pharmacologic doses of progestin inhibit ovulation?

A
  • by suppressing GnRH and possibly inhibiting pituitary release of LH
  • impair implantation and produce cervical mucus that retards sperm penetration
26
Q

How does ethinyl oestradiol work?

A
  • helps prevent the selection of a dominant follicle by suppressing pituitary FSH
  • provides stability to the endometrium, decreasing breakthrough bleeding
  • upregulates the progesterone receptor and decreases clearance, thereby potentiating the activity of the progestin
27
Q

Adverse effects of OCP

A
  • up to 12-fold increased risk of cardiovascular events in patients with cardiovascular risk factors e.g. hypertension
  • increased risk of cardiovascular events in women >35 and smokers
  • 2-3 fold increased risk of DVT & PE (increased clotting factors, activation of platelets, decreased fibrinolytic activity)
  • 3-fold increased risk of cervical cancer among HPV carriers with 5-9 years OCP use
28
Q

What should women taking oral contraceptives be regularly screened for?

A
  • cardiovascular risk factor
  • cervical cancer
29
Q

Contraindications to combination oral contraceptive use

A

pregnancy, increased thromboembolic risk, smoking & >35, hepatoma, breast/endometrial cancer, uncontrolled HTN, history of cerebrovascular or CVD, undiagnosed vaginal bleeding

30
Q

Examples of progestin-only pills (‘minipill’)

A
  • Ortho Micronor, Nor-QD
  • Ovrette
31
Q

Type and dose of progestin in Ortho Micronor

A

0.35mg norethindrone

32
Q

Type and dose of progestin in Ovrette

A

0.075mg levonorgestrel

33
Q

Target population for administration of progestin-only contraception

A
  • women with contraindications to oestrogen
  • breastfeeding mothers
  • older women
34
Q

Progestin-only administration results in…

A

lower steady state levels and a shorter half-life compared with concomitant administration with oestrogen

35
Q

Major side effect of progestin-only pills

A

breakthrough bleeding (40-60%)

36
Q

Besides breakthrough bleeding, what other side effects are associated with progestin-only pills?

A

acne and persistent ovarian cysts
(risks associated with progestin-only pills are minimal)

37
Q

Example of a subdermal implant and what is consists of

A

Norplant is a subdermal implant that consists of 6 capsules providing levonorgestrel

38
Q

Significance of low concentrations of progestin in subdermal implant

A

no real effect on FSH

39
Q

What causes erratic bleeding associated with subdermal implants?

A

irregular serum peaks (often prolonged) and declines in serum oestrogen levels

40
Q

By 5 years of using Norplant, >50% of the cycles are ovulatory. However, ovulatory cycles have been associated with…

A

luteal phase insufficiency

41
Q

Most common side effect of subdermal implants

A

menstrual disturbances (40-80%, especially in the first 2 years)

42
Q

8-fold increased risk of __ is associated with subdermal implant use

A

ovarian cyst formation

43
Q

What happens when the supply of eggs in ovaries declines?

A

Ovulation becomes irregular and the ovarian follicles fail to develop and secrete normal amounts of oestrogen. Low levels of oestrogen result in increased FSH secretion.

44
Q

Main symptoms of menopause

A
  • vasomotor symptoms (hot flushes) - about 75-85% of women
  • osteoporosis
  • depression
45
Q

How is menopause treated?

A

HRT: oestrogen, progestin, or in combination

46
Q

Which therapy provides the best treatment for severe vasomotor symptoms, reducing their frequency and severity?

A

oestrogen therapy

47
Q

How does oestrogen therapy act?

A

via the inhibition of bone resorption, to improve both bone mineral density and fracture rate

48
Q

The effect of cessation of oestrogen therapy for menopause

A

A rapid and progressive loss of bone mineral content

49
Q

Examples of SERMs used in the treatment of osteoporosis

A

Clomiphene, Tamoxifen, Raloxifene, Toremifene, Ospemifene, Baxedoxifene

50
Q

What is Clomiphene, how does it work and what is it used for?

A
  • SERM
  • acts as a weak oestrogen agonist and moderate antagonist
  • used to treat PCOS
  • prevents oestrogen feedback inhibition of GnRH, thereby increasing FSH & LH
51
Q

Side effect of Clomiphene

A

multiple births

52
Q

What is Tamoxifen and what is it used for?

A
  • SERM
  • prodrug that is converted to active metabolites in the liver (i.e. 4-hydroxytamoxifen)
  • both estrogenic and anti-estrogenic
  • acts as an antagonist at ER in breast tissue (forms an ER complex that recruits corepressors of DNA transcription to inhibit HER2 and breast cancer cell proliferation)
53
Q

Tamoxifen is associated with an increased risk of…

A

endometrial cancer (because it can stimulate proliferation of endometrial cells)

54
Q

What is Toremifene used to treat?

A

metastatic breast cancer

55
Q

Clinical indication of Raloxifene

A

osteoporosis - has strong estrogenic effects on bone and lipid metabolism

56
Q

What is Ospemifene used to treat?

A

dyspareunia (painful intercourse)

57
Q

Clinical indications of Baxedoxifene

A

used to treat vasomotor symptoms associated with menopause and osteoporosis

58
Q

Example of an anti-progestin

A

Mifepristone, a synthetic steroid compound

59
Q

How does Mifepristone work?

A
  • acts as a progesterone receptor antagonist when progesterone is present (in the absence of progesterone, it acts as a partial agonist)
  • competitive antagonist at GC receptor
60
Q

What is Mifepristone approved for?

A

medical termination of pregnancy through 49 days of gestation - causes breakdown of the decidua, leading to detachment of the blastocyst from the endometrium

61
Q

How is Mifepristone administered?

A

as a single dose, followed by a prostaglandin (e.g. misoprostol) 48 hours later to stimulate uterine contractions

62
Q

Major adverse effects of Mifepristone

A

anorexia, nausea, vomiting, abdominal pain, fatigue, heavy uterine bleeding

PT4023 CA2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions