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exam 1 Flashcards

1
Q

Ovary

A

site of ovum production & release

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2
Q

Uterine/fallopian tube

A

transport & site of fertilization for ovum

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3
Q

uterus

A

site of implanttion & growth of developing embryo

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4
Q

3 parts of uterus

A

fundus, body & cervix

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5
Q

vagina

A

site of delivery of sperm

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6
Q

GnRH is released from

A

hypothalamus

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7
Q

GnRH acts on

A

anterior pituitary to release LH and FSH

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8
Q

FSH and LH cause

A

growth of follicles & ovaries to secrete estrogen & progesterone

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9
Q

phases of the ovarian cycle

A

follicular & luteal phases

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10
Q

follicular phase

A
  • FSH & LH inc.
  • Growth of primordial follicles->primary->antral->vesicular
  • high [estrogen]
  • positive feedback between LH and estrogen
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11
Q

ovulation is caused by

A

a surge in LH

- follicle ruptures & ovum is discharged

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12
Q

luteal phase

A
  • remaining follicles-> lutein cells->corpus luteum

- estrogen & progesterone secreted by corpus luteum have feedback inhibition on ant. pit & decrease FSH & LH

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13
Q

corpus luteum secretes

A
  • progesterone>estrogen

- inhibin which <FSH

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14
Q

if fertilization occurs ___ maintains the corpus luteum

A

hCG

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15
Q

what causes involution of the corpus luteum?

A

< in estogen & progesterone & >inhibin which remove the feedback inhibition & FSH/LH increase & initiate growth of new follicles

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16
Q

most potent naturally occurring estrogen

A

17beta-estradiol (followed by estrone & estriol)

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17
Q

steroidal estrogens arise from androstenedione by aromatization catalized by

A

aromatase which is localized in ovarian granulosa cells

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18
Q

FSH/LH increase activity of

A

aromatase & facilitate the transport of cholesterol into the cells that synthesize estrogens

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19
Q

estrogen=

A

proliferation

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20
Q

progesterone=

A

pro-gestational=secretion

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21
Q

progesterone decreases

A

frequency & intensity of contractions

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22
Q

endometrial cycle is associated with

A

monthly production of estrogen & progesterone; change in endometrial lining

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23
Q

phases of the endometrial cycle

A
  • proliferative: preovulatory: follicular
  • secretoy: postovulatory: luteal
  • menses: desquammation of the endometrium
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24
Q

blood supply to the endometrium

A

spiral arteries of the functional zone restored during secretory phase

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25
Q

GnRH, LH, FSH are ____ & bind to ____

A

polar peptides; cell membrane receptors (GPCR)

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26
Q

estrogen & progesterone are ___ & bind to ____

A

lipophilic; cytoplasmic steroid receptors

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27
Q

when ovaries are no longer responsive to gonadotropins:

A

menopause occurs; estrogen & progesterone no longer produced by ovaries-> high levels of FSH/LH

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28
Q

gonadotropins

A

FSH & LH

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29
Q

most potent estrogen

A

estradiol but has poor oral bioavailability

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30
Q

circulating estrogens

A

estrone: 60-80%
estradiol: 10-20%
estriol: 10-20%

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31
Q

ethinyl estradiol & mestranol

A

ethinyl substitution on C17 & increases oral potency by <1st pass metabolism

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32
Q

estradiol esters

A

ester allows for longer duration of action with IM administration

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33
Q

conjugated estrogens

A

from prego mares (Equilin)

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34
Q

estrogen & progesterone is ___ protein bound

A

highly

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35
Q

pregnanes

A

medroxyprogesterone acetate

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36
Q

estrane

A

19-nortestosterone

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37
Q

gonanes

A

norgestrel; no estrogenic effect, diminished androgenic activity

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38
Q

in prego, progesterone

A

suppresses menstruation & uterine contraction

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39
Q

in CNS, progesterone

A

induces ~0.6*C increase in body temp & drowsiness

40
Q

metabolic effects of progesterone

A

decreases insulin EFFECTS and enhances fat deposition

41
Q

what increases amount of cervical mucous?

A

estrogen

42
Q

what causes a thickening of cervical mucous?

A

progestins

43
Q

some progestins show limited bioavailability due to

A

rapid first pass metabolism

44
Q

mini pill

A

progestin only
28 days of active hormone
micronor, nor-QD: norethindrone

45
Q

combination oral contraceptives work

A

before fertilization to prevent conception

46
Q

progestin actions

A

thickens mucous, slows tubal transport, endometrial alterations, suppress LH surge

47
Q

Estrogen actions

A

stabilizes endometrial lining; suppresses FSH (no dominant follicle)

48
Q

extended cycle OCs

A

84 +7 placebo

49
Q

continuous cycle OCs

A

active pills throughout the year. 21 + 4-7days very low dose estrogen & progestin

50
Q

blood clot symptoms

A

ACHES

51
Q

ACHES

A
  • A- abdominal pain (thrombosis in liver)
  • C-chest pain (MI/PE)
  • H-HA(vascular spasm/stroke)
  • E- eye problems (stroke, HTN, retinal artery thrombosis)
  • S- swelling/severe leg pain (DVT)
52
Q

noncontraceptive benefits: increase

A

menstrual regularity & [Hgb]

53
Q

ethinyl estradiol is metabolized by

A

CYP 3A4

54
Q

chewable OC

A

femcon FE

55
Q

quick start method

A

preferred

start the day of office visit & use back up for 7 days

56
Q

managing breakthrough bleeding

A
  • first make sure patient compliance

- can switch from a multiphasic to a monophasic or vise versa or can increase EE >20mcg

57
Q

yasmin/ yaz hormone

A

drospirenone

58
Q

drospirenone

A

no estrogenic effects & < andogenicity; similar structure to spironolactone; monitory serum K+

59
Q

benefits of drospirenone

A

PMDD & acne

60
Q

the “new” yaz

A

beyaz & safyral

61
Q

beyaz

A

EE 0.0.2mg, drospirenone 3mg & levomefolate calcium 0.451mg

levomefolate0.451mgX 4 days

62
Q

safyral

A

EE 0.03mg, drospirenone 3mg, levo 0.451mg

levo 0.451X 7days

63
Q

yasmin

A

EE 0.03mg, drospirenone 3mg- 7 inactive tabs

generic: ocella

64
Q

yaz

A

EE 0.02mg, drospirenone 3mg- 4 inactive

generic: gianvi

65
Q

2 studies reported that there is a greater risk of __ associated with drospirenone

A

VTE (2-6X greater than with levonorgestrel)

66
Q

injectable

A

depo-provea (DMPA) & depo-subQ provera

67
Q

implantable

A

implanon & nexplanon

68
Q

intrauterine

A

mirena & paragard

69
Q

transdermal

A

ortho evra

70
Q

intravaginal

A

nuvaring

71
Q

postcoital

A

emergency contraception

72
Q

depo-provera

A
  • progestin only (DMPA 150mg)
  • IM X3 months
  • fertility does not return for 10-12 months
73
Q

dep-subQ provera

A
  • medroxyprogesterone acetate 014mg
  • SQX3 months
  • less hormone but as efffective
74
Q

implantable contraceptives aka

A

long-acting reversible contraceptives (LARC)

75
Q

mirena

A

intrauterine
levonorgestral
- prevents ovulation & thickens mucous

76
Q

paragard T380A

A

intrauterine
releases copper
- interferes with sperm transport & prevents implantation

77
Q

implanon

A

implantable

etonorgestrel

78
Q

nexplanon

A

implantable

etonorgestrel

79
Q

ortho-evra

A

estrogen 20mcg & norelgestromin 150mcg

  • abs, butt, upper torso, upper outer arm
  • higher rates of failure in women >90kg
80
Q

nuva ring

A

EE 15mcg & etonogestrel 120mcg

- insert on of before day 5 of cycle

81
Q

plan B & next choice

A

levonorgestrel 1.5mg

82
Q

2013

A

no age restriction on planB

83
Q

2014

A

generic can be OTC as long as same labeling

84
Q

ella

A

emergency contraception
ulipristal acetate 30mg
RX only
may be taken 5 days after

85
Q

YuzpE method

A

200mcg EE+ 1mg levonorgestrel or 2 mg norgestrel in 2 divided doses
(both estrogen & progestin)

86
Q

> 35

A

should use < cancer risk & vasomotor symptoms

- bone mineral density benefits

87
Q

smoking

A

> 15 cigs- CI
OCS>50mcg EE associated w/ MI
- progestin ONLY should be considered

88
Q

HTN

A

progestin only (does not > BP)

89
Q

dyslipidemia

A
  • estrogens remove LDLs, > HDL & >TGs slightly
  • progestins: >LDL & <HDL
  • use non-hormonal contraception
90
Q

Diabetes

A

OK for OCs if non-smoker, <35 & no associated vascular disease

91
Q

progestins may alter

A

carb metabolism & insulin, glucose & glucagon release

EXCEPT levonorgestrel

92
Q

migraines

A

use progestin only, IUD or barrier method

93
Q

breast cancer

A

can consider if no disease for >5 years

94
Q

thromboembolism

A

use DMPA & levonorgestrel IUD

- greater risk w/ transdermal contraception

95
Q

estrogens increase production of

A

factors 8, 10 & fibrinogen

96
Q

Lupus

A

-antiphospholipid antibodies: progestin only

97
Q

sickle cell

A

use DMPA

Reproduction (12 decks)

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