DRUGS FOR THE FEMALE REPRODUCTIVE SYSTEM

Question 1

Binding of water soluble hormones:

Answer 1

Typically, binding of water soluble hormones to cell surface receptors leads to the manufacture of second messengers (cAMP or IP3) which alerted cell function

Question 2

Water soluble endocrine hormones that activate G proteins include:

Answer 2

Norepinephrine, epinephrine and oxytocin

Question 3

What is the function of lipid soluble hormones?

Answer 3

Move through the blood stream bound to a transport protein (estrogen, testosterone, progesterone, thyroid hormone, cortisol, aldosterone)

These hormones from a complex with their receptor and then bind to the DNA and act as a transcription factor

Question 4

How to hormonal changed during the ovarian and uterus cycles effect the hypothalamus?

Answer 4

It releases GnRH and stimulates the production of LH and FSH by the anterior pituitary- stimulates follicle maturation

Question 5

How to hormonal changed during the ovarian and uterus cycles effect estrogen?

Answer 5

High levels of estrogen released by ovaries in the pre ovulatory phase induces a surge in LH and FSH release, stimulating ovulation

Question 6

How to hormonal changed during the ovarian and uterus cycles effects progesterone and estrogen?

Answer 6

Increased estrogen and progesterone production promotes endometrial vascularization and thickening

Question 7

How to hormonal changed during the ovarian and uterus cycles effects GnRH, LH and FSH levels?

Answer 7

They fall, progesterone and estimates secretion is inhibited

Menstruation begins

Question 8

What are the steps of regulation of reproductive hormone?

Answer 8

1. Gonadotroptin releasing hormone (GnRH) is produced in the hypothalamus and stimulates the…
2. Anterior pituitary to produce luteinizing hormone (LH) and follicle stimulating hormone (FSH) which act on…
3. Ovaries to stimulate follicle maturation
4. As ovarian follicles mature, estrogen and progesterone levels rise
5. Elevated levels of estrogen and progesterone provide negative feedback to inhibit GnRH, LH and FSH secretion
   — this negative feedback loop is exploited by hormonal forms of concentration

Question 9

What are the 3 types of estrogens?

Answer 9

Estradiol, Estriol and estrone

Question 10

What is Estradiol?

Answer 10

Major ovarian estrogen and most potent of all three estrogens

Question 11

What is Estriol?

Answer 11

Produced by the placenta, becomes the primary estrogen during pregnancy

Question 12

What is Estrone?

Answer 12

Predominant circulating form of estrogen after menopause, formed in adipose tissue and adrenal glands; can convert to estriol

Question 13

What is progesterone?

Answer 13

Is the primary progestognenic hormone synthesized by the human body

Question 14

What are biological effects of estrogens?

Answer 14

• growth and maturation of reproductive organs (vagina, uterus, fallopian tubes and ovaries)
• appearance of secondary sexual characteristics
• increased bone deposition
• decreased LDL and increased HDL formation
• increased coagulation
• increased production of clotting factors
• production of thin , clear, watery and elastic cervical mucous

Question 15

What are the biological effects of progesterones?

Answer 15

• increase mucous thickness and limits movement of sperm
• stabilizes endometrial growth
• inhibits myometrial contractions

Question 16

What are oral combination contraceptives (COCs)?

Answer 16

• consist of a synthetic estrogen and progestin to form a “combination contraceptive”
  — synthetic estrogens have a much longer half life
  — synthetic progestins are orally active
  — many products and formulations available

Question 17

How is ovulation inhibited?

Answer 17

• low dose, synthetic estrogens suppresses FSH levels
• low dose, synthetic progestins suppresses LH surge
• in the absence of LH and FSH, the ovarian follicle does not mature and ovulation is inhibited

Question 18

What do synthetic progestins produce?

Answer 18

• a thin and inactive endometrium
• thick cervical mucous to inhibit sperm migration

Question 19

What are the benefits of combination oral contraceptives?

Answer 19

• highly effective and reversible
• does not interfere with sex
• may resume menstrual flow and cramps
• regulates cycle and decreases pre-menstrual symptoms
• decreased acne
  Etc

Question 20

What is extended duration oral formulations?

Answer 20

84 days of hormone therapy, 7 days of placebo or low dose estrogen
Only 4 menstrual periods per year

Question 21

What is a contraceptive patch?

Answer 21

Changed every 7 days for 3 weeks, week 4 patch is free

Question 22

What is vaginal ring?

Answer 22

3 weeks of hormone therapy, removed on week 4 (nuva ring)

Question 23

What are adverse effects of combination contraceptives?

Answer 23

• breast milk production
• increased blood glucose
• hypertension

Question 24

What are contraindications?

Answer 24

• breast cancers and others estrogen dependent tumours
• severe hepatic cirrhosis
• major surgery with prolonged immobilization
• migraines
• smoke
• drug drug interactions

Question 25

What is the MiniPill (micronor)?

Answer 25

Higher failure rate than the combination oral contraceptives
If a client had had unprotected sex after missing a pill by >3 hours, emergency contraception is recommended
Creating a thick, viscous mucous, preventing sperm movement accords the cervix and induces endometrial changes that inhibit zygote implantation

Question 26

What is a contraceptive implant (nexplanon)?

Answer 26

Inserted into the arm just below the skin; 3 years of protection, can be removed at any time

Question 27

What is intramuscular infection (depo provera)?

Answer 27

3 months of protection, achieved within 24 hours, mean time to pregnancy 6-10 months post discontinuation

Question 28

What is hormonal intrauterine contraceptives?

Answer 28

Most effective form of contraceptives, up to 8 years of protection

Question 29

What are what is levonorgestrel (plan B)?

Answer 29

Used to prevent pregnancy after unprotected sex or contraceptive failure, inhibits ovulation
Side effects: nausea vomiting

Question 30

What is mifegymiso (RU486)?

Answer 30

Used for medical termination of an intrauterine pregnancy with a gestational age up to 63 days as measured by the first day of LMP
Covered by OHIP

Question 31

What is mifepristone?

Answer 31

Progesterone receptor modulator
Single dose, blocks the effects of progesterone on the endometrium and myometrium

Question 32

What is misoprostol?

Answer 32

Prostaglandin receptor agonist
4 tablets
Induces contractions of the uterine myometrium and cervical dilation

Question 33

What is menopause?

Answer 33

12 months after a persons menstrual period
Between ages 45-55
Hormonal fluctuations that result in irregular periods and symptoms

Question 34

What is menopausal hormonal therapy (duavive)?

Answer 34

Used for management of vasomotor symptoms associated with menopause (hot flashes) osteoporosis prevention