Lecture 9 - Repro And Post Repro Health

Question 1

What is the precursor molecule for all steroid hormones including Sex steroid hormones?

Answer 1

Cholesterol

Question 2

Where are Theca cells and granulosa cells located?

Answer 2

Ovarian follicles

Question 3

What is the function of the Theca cells?

Answer 3

Produce androgens

Question 4

What is the function of Granulosa cells?

Answer 4

Convert androgens produced by the Theca cells to oestrogen

Question 5

What is the enzyme that converts testosterone to Dihydrotestosterone?

Answer 5

5a- REDUCTASE

Question 6

What drug is used to treat BPH and is a 5a REDUCTASE inhibitor preventing the conversion of testosterone to its more potent form Dihydrotestosterone?

Answer 6

Finasteride

Question 7

What part of the cell do steroid hormones act on?

What effect does this produce?

Answer 7

Nuclear receptors

Exerts effects through increasing gene transcription

Question 8

Sex steroids are considered anabolic steroids, what is an example of a catabolic steroid?

Answer 8

Prednisolone

Question 9

What type of drug is Prednisolone?

Answer 9

Corticosteroid (catabolic steroid so have to be careful of prolonged use leading to muscle wastage)

Question 10

What sex hormone causes endometrial proliferation?

Answer 10

Oestrogen

Question 11

What sex hormone increases the risk of blood clots?

Answer 11

Oestrogen

Question 12

What 2 sex hormones have androgenic properties so can cause acne?

Answer 12

Testosterone
Progesterone

Question 13

What is the most androgenic to least androgenic sex hormone?

Answer 13

Testosterone
Progesterone

Oestrogen

Question 14

What sex hormone inhibits bone resorption?

Answer 14

Oestrogen

When post menopausal women are at an increased risk of oesteoporosis

Question 15

What is the main hormone increasing muscle mass?

Answer 15

Testosterone

Question 16

What are the actions of oestrogen in the follicular. Phase?

Answer 16

Thickening and proliferation of endometrium

Thin alkaline cervical mucus
Nice skin, hair changes and metabolism

Question 17

What are the actions of progesterone in the luteal. Phase?

Answer 17

Produces secretory endometrium

Thickening of myometrium

Thick acidic cervical mucus
Breast tissue
Inc body temp

THE HORMONE THAT MAINTAINS PREGNANCY
Leads to mood changes

Question 18

What are the pharmacokinetics of oestrogen in terms of ability to be absorbed?

Answer 18

Well absorbed in GI tract
Readily absorbed from skin and mucous membranes too

Metabolised in liver

Question 19

What are the pharmacokinetics of progesterone in terms of its absorption?

Answer 19

Oral bioavailability low

Progesterone that is injected is bound to albuminii with some stored in adipose tissue

Question 20

What organ metabolises both oestrogen and progesterone?

Answer 20

Liver

Question 21

What enzyme metabolises the COCP and POP (progesterone only pil)?

Answer 21

CYP450 enzymes

Question 22

What type of substances affect the oral contraceptive efficacy?

Answer 22

Enzyme (CYP450) inducing drugs reduce their efficacy

Question 23

What is the Pneumonic for remembering the drugs/substances that Induce CYP450 enzymes?

Answer 23

GPRS CellPhone

Question 24

What are some substances that induce CYP450 enzymes and so reduce efficacy of oral contraceptives using the pneumonic GPRS CellPhone?

Answer 24

Griseofulvin
Phenytoin
Rifampicin
Smoking

Carbamazepine
Phenobarbitone

St John’s Wort also does

Question 25

What is the main action of the Combined Oral Contraceptive Pill (COCP)?

Answer 25

Prevent ovulation (need to have been taken for at least 7 days)

Question 26

What is the secondary action of the combined oral contraceptive pill?

Answer 26

Thickens cervical mucus

Question 27

How is the combined oral contraceptive pill normally taken?

Answer 27

Every day for 21 days with a 7 day break

Question 28

What are the advantages of taking the COCP?

Answer 28

Reliable Can relieve menstrual disorders Dec risk of ovarian and endometrial cancer since less ovulations Reduced acne

Question 29

What are the disadvantages of the COCP?

Answer 29

User dependant No STI protection Contraindications (raised BMI, migraines with aura and breast cancer) Side effects (menstrual irregularities, mood disturbance) Inc risk of CVD, stroke, VTE, breast cancer and cervical disease

Question 30

What is the role of high dose progesterone?

Answer 30

Enhances negative feedback on oestrogen preventing oestrogen levels becoming high enough to cause the LH surge leading to ovulation

Question 31

What is the rol of low level progesterone?

Answer 31

Mainly affects the mucus thickening the cervical mucus

Question 32

What levels of progesterone does the progesterone only pill contain? How frequently is it taken?

Answer 32

Low dose Taken every. Day no breaks

Question 33

What is the main action of the progesterone only pill?

Answer 33

Thickens cervical mucus

Question 34

What is the secondary action of the progesterone only pill?

Answer 34

Reduced cilia activity in the fallopian tubes

Question 35

What are the advantages of the progesterone onl ypill?

Answer 35

Reliable Can be used if COCP contraindicated

Question 36

What are the disadvantages of the progesterone only pill?

Answer 36

No STI protection. Inc risk of ectopic pregnancy (reduced cilia activity in fallopian tubes) Menstrual irregularities

Question 37

What hormone dramatically drops in menopause? Why does this happen?

Answer 37

Levels of oestrogen fall Run out of follicles (contain theca cells and granulosa cells)

Question 38

What are some consequences of oestrogen deficiency (menopause)?

Answer 38

Hot flushes Sweating Vaginal atrophy Osteoporosis Atherosclerosis Cardiovascular disease

Question 39

What hormone replacement therapy (HRT) is usually given to treat vasomotor or mood disorders?

Answer 39

Oral or transdermal HRT Combined oestrogen adn progesterone if woman has uterus Oestrogen alone if she doesn’t have uterus (progesterone give to stop oestrogens proliferfative effect on the endometrium)

Question 40

What is given if a woman needs HRT and they’re having urogenital symptoms?

Answer 40

Low dose vaginal oestrogen

Question 41

What type of oestrogen is given in HRT?

Answer 41

Natural oestrogen

Question 42

What type of progesterone is used in HRT?

Answer 42

Synthetic

Question 43

Why is progesterone always given to women how are having HRT with oestrogen?

Answer 43

Progesterone inhibits the proliferation oestrogen causes helping decrease risk of endometrial cancer and menorrhagia

Question 44

What is a major risk factor of oral contraceptives containing oestrogen?

Answer 44

VTE

Question 45

What type of HRT increases risk of breast cancer?

Answer 45

Oestrogen and progesterone

Question 46

What age do you get increased risk of coronary heart disease and stroke if you start HRT after it?

Answer 46

60

Question 47

What is the main risk of oestrogen only HRT cancer wise?

Answer 47

Endometrial cancer

Question 48

What type of drug is used to treat osteoporosis?

Answer 48

Bisphosphonates

Question 49

How do bisphosophonates work to treat osteoporosis?

Answer 49

Reduce osteoclast activity and so reduce bone turnover

Question 50

What is an example of a bisphosphonate used to treat osteoporosis?

Answer 50

Alendronic acid

Question 51

What other conditions is alendronic acid (bisphosphonate) used for except osteoporosis?

Answer 51

Paget’s disease of bone Bone malignancy

Question 52

How must bisphosphonatees be taken and why?

Answer 52

On empty stomach Since poor gut absorption

Question 53

What are the adverse drug reactions of bisphosphonates?

Answer 53

Can causes oesophagitis if dont stay seated or stood 30mins after taking This reduces the amount hte drug comes into contact with the oesophageal lining reducing its irritation Hypocalcaemia (so check Ca2+ and Vit D before treatment)

Question 54

What type of drug is Mifepristone?

Answer 54

Progesterone (and glucocorticoid) receptor antagonist

Question 55

What is mifepristone used for?

Answer 55

Termination of pregnancy

Question 56

How does Mifepristone work?

Answer 56

Anti progesterone (blocks receptors) Sensitise myometrium to prostaglandin induced contraction (prostaglandins induce contractions)

Question 57

What are SERMs (Selective Estrogen Receptor Modulators) mechanism of action?

Answer 57

Interacts with oestrogen receptors as agonists or antagonists depending on the target tissue

Question 58

What is an example of a SERM that treats breast cancer?

Answer 58

Tamoxifen

Question 59

What is the mechanism of action of tamoxifen stopping breast cancer?

Answer 59

Antagonist to oestrogen in breast

Question 60

What cancer does tamoxifen treat but increase the risk of?

Answer 60

Antagonist to oestrogen in breast Agonist to oestrogen in endometrium

Question 61

What SERM prevents oesteoporosis in menopause pause and breast cancer and how does it do it?

Answer 61

Raloxifene Agonist of oestrogen on bone so reduces bone resorption

Question 62

Hoe dos raloxifene prevent oesteoporosis?

Answer 62

Agonist of oestrogen at bone so oreduces bone resorption/oesteoclast activity

Question 63

What is clomiphene? What does it do?

Answer 63

Non steroidal ovulatory stimulant Used to sstimulate ovulation

Question 64

How does clomiphene stiualte ovulation? Is it a SERM?

Answer 64

Competes with oestrogen for oestrogen receipt or binding making the brain think theres high level of oestrogen leading to LH surge

Question 65

What is an example of a Selective Progesterone Receptor Modulator (SPRMS)?

Answer 65

Ulipristal acetate (Ella one)

Question 66

How does Ulipistral acetate act?

Answer 66

Binds to the progesterone receptor acting as either an agonist or antagonist Emergency contraception by suppressing LH surge due to the body thinking theres high level progesterone