Exam 4: Wed 3.23. hormones, being preggers, and organ systems Flashcards
Purpose of male and female hormones
Control reproductive function and secondary sexual characteristics in respective gender groups
How are homones technically classified?
as steroids
Where are male and female hormones produced?
- Primarily produced by the gonads
- A small amount in the adrenal cortex (insignificant amounts to produce physiologic effects)
What are male and female hormones called?
Male hormones
called androgens
Female hormones
- Estrogens (primarily estradiol, usually referred to as estrogen)
- Progestins (progesterone)
Endocrine feedback loop of testosterone (3)
- Testosterone made in testes, regulated by anterior pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
- LH and FSH regulated by gonadotropin-releasing hormone (GnRH) from the hypothalamus
- ↑testosterone in circulation inhibits production of these hormones (negative feedback) – levels are fairly constant at all times, until aging process ↓production
How does replacement therapy of male hormones affect the body? (8) G-LiMB2S
Reported benefits:
- Glucose metabolism
- Libido
- Mood (can be negative too)
- Body composition
- Bone mineralization (reduces risk of osteoporosis)
- Strength
Negative:
- Concern that there may be ↑ risk of prostate cancer
- small balls
Medical Reasons Androgens may be prescribed by Doc (5)
- Can be administered medically for protein loss, muscle catabolism, effects of HIV, rarely the treatment of choice by physicians – and mixed success
- Delayed puberty – androgens may be used on short-term basis to “kick start” puberty, as long as no underlying pathology exists
- Limited use in hormone-sensitive tumors
- Anemia – testosterone is potent stimulator of EPO, but other more direct drugs are preferable
- Hereditary angioedema (defect in clotting factors) – androgens may be used prophylactically due to their action on liver to restore clotting factors
Adverse effects of Androgen supplementation for women (4)
- masculinizing effects
- hirsutism (abnormal growth of face and body hair)
- deepening voice
- enlarged external genitalia
*reversible
Adverse effects of Androgen supplementation for men (5) B2ErPS
- Bladder irritation
- Breast swelling and soreness
- Frequent or prolonged Erections
- Increased risk of Prostate cancer
- Small balls (if you haven’t seen it, it is a strange sight)
*reversible
Adverse effects of Androgen supplementation for children (2)
- accelerated sexual maturation
- premature closure of epiphyseal plates
Long term effects of Androgen supplementation (3)
- liver damage/carcinoma
- hypertension
- fluid retention
Antiandrogens- what do they do and what are they used for?
- Inhibit synthesis or effects of androgen production
- May be used in treatment of prostate cancer or benign prostatic hypertrophy
- Names: Finasteride (Propecia, Proscar), dutasteride (Avodart)
Points about androgen abuse and athletics- use, prevelance, ect.. (6)
- Anabolic steroids used to enhance athletic performance,↑ muscle size and strength
- Increasingly seen in younger athletes – at least 6% of high school athletes admit to use
- Usually obtained illegally, taken in “stacking” dosage to ↑ effects
- Use a steroid dosing cycle – athletes have a variety of ways to avoid detection during sports drug testing
- No question athletic performance is improved, as is lean body mass and muscle strength - but how much is undetermined
- Athletes also use other performance-enhancing techniques such as blood doping, growth hormones
Adverse effects of androgen abuse outlined with the athletics powerpoints (7) MR LASH2
- Mood (“roid rage”)
- Changes in Reproductive function
- Liver damage
- Cardiomyopathy Arrhythmias
- Effects can be Severe and fatal
- Hepatic tumors
- ↓HDL lipids
When asking athlete about possible steroid abuse, what are a couple of approaches?
- Ask about any additional meds or supplementation (more non-threatning word choice)
- Can ask if they take any supplements in a cycle if they respond with saying they take a variety of things
- How do the supplements help you?
- Important to prevent pt. for getting defensive.
The role of estrogen in puberty (5) PEPS2
initiates:
- Puberty
- Epiphyseal plates closure
- Pelvic girdle widening
- Subcutaneous fat stores
- Sexual organs maturation
Progesterone. What is it good for?
(to be sung to the tune of ‘War’)
- Facilitates and maintains pregnency
- Less important in sexual maturation
The female cycle and hormone activity (4)
- FSH released by anterior pituitary in follicular phase, which matures into ovum
- LH released by anterior pituitary at menstrual midpoint, with smaller burst of FSH, for ovulation – follicle releases ovum, then becomes infiltrated with lipids (corpus luteum)
- Corpus luteum controls second half of menstrual cycle – continues to grow for ~1 week post ovulation, secreting estrogen and progesterone – thickens uterine lining, and progesterone stimulates mucus for potential implantation of a fertilized egg
- If no fertilization, corpus luteum regresses and menstruation occurs
If the egg is fertilized in the uterus, then……..(4)
- human chorionic gonadotropin (HCG) is released, takes over the role of LH and prevents destruction of corpus luteum
- Corpus luteum persists until 9-14th week of gestation, producing progesterone to facilitate uterine environment
- Placenta produces estrogen and progesterone thereafter – also facilitates development of mammary glands for lactation
- Estrogen may play a role in parturition (labor)
7 Pharmacological Uses of Estrogen and Progesterone
C2HEF- MO
- Contraceptives - altering control between pituitary and ovarian hormones
- Carcinoma – metastatic breast cancer treated by estrogen
- Hypogonadism – low ovarian function, bleeding abnormalities
- Endometriosis – progesterone and estrogen/progesterone combos
- Failure of ovarian development
- Menstrual irregularities (amenorrhea, dysmenorrhea)
- Osteoporosis – estrogen replacement
Women who have multiple miscarriages may take _____ to help maintain pregnancy
progesterone
Points about HRT (hormone replacement therapy)- the good and the bad (7) BP C3oST2
- Improves Bone mineralization
- Improves Plasma lipids
- Controversial
- Cardiovascular improvement- possibly
- Several RCTs have shown↑ risk of Stroke, Thromboembolic disease
- Timing may be important – start HRT when women are <60 y.o. and within 10 years of reaching menopause
- Zero benefit in protecting Cognitive decline of Alzheimer’s, mixed results in other cognitive studies
Adverse effects of taking estrogen and/or progesterone (6) STAMP
- Stroke
- Thromboembolism
- Abnormal blood clotting
- Menstrual function may be altered with prolonged use
- PE
- Cannot use estrogen with estrogen-sensitive breast cancers – importance of screening for women on contraceptives
What do Selective Estrogen Receptor Modulators (SERMs) do?
- Bind to and activate estrogen receptors on certain tissues while blocking the effects on other tissues (Dr. T thinks this is really cool)
- Can reduce carcinogenic effects of estrogen on breast and uterine tissue while producing favorable effects on bone mineralization and cardiovascular function
Name 2 Selective Estrogen Receptor Modulators (SERMs)
- Tamoxifen (Tamofen, Nolvadex)
- Raloxifene (Evista)
Use and side effects of Raloxifene (Evista)
- primarily used to treat osteoporosis
- may also give protection against breast cancer
- side effects
- hot flashes
- bone/joint pain
- GI effects
- “flu-like” symptoms
True or False: Tamoxifen can increase fertility
True (happened to Dr. T’s friend at age 41)
What do Anti-estrogens (Clomiphene) do? (2)
- treats infertility by promoting ovulation
- Fulvestrant (Faslodex) – an antiestrogen used to treat estrogen-sensitive breast cancers
What muppet was MB most like?
What may Antiprogestins be used for? (3)
- termination of pregnancy (RU486)
- treatment of uterine fibroids and endometriosis
- Cushing syndrome (blocks cellular glucocorticoid receptors)
3 points about oral contraceptives
- almost 100% effective when taken correctly
- Varying levels of estrogen/progesterone combos
- LH and FSH are inhibited, no ovulation
Points about adverse effects with oral contraceptives (not a list per se, more concept) - 3
- Adverse effects have ↓ with newer drugs – less estrogen, better forms of progestins
- Still may have risk of thromboembolism, cardiovascular events – usually associated with risk factors of smoking, hypertension, hyperlipidemia
- May actually protect against endometrial and ovarian cancers; relationship to breast cancer more complicated
Which organ systems are affected by pregnancy?
All of them
Something to consider about any patients we have who are on oral contraceptives
They are effective when taken correctly. If taking at varied times or if there are inconsistancies with taking teh med, then there is a chance the patient can be pregnant.
When do many of the changes for a pregnant woman begin and name a couple of general changes that occur
- Most changes begin early
- Even before pregnancy recognized
- Most are hormonally driven
- Progesterone, estrogen, renin / aldosterone, cortisol, insulin
- Some ‘mechanically’ driven
- Designed to optimize conditions for fetus & prepare for delivery
- Delivery of oxygen & nutrients
Vascular and hematologic changes that occur in pregnant women from the PP (7)
Note: Info is from PP, but Dr. T said most of what we need to know is covered in the book. Going to pick out points that she spent more time with on the slides, so you are not overwhelmed with info to memorize.
- RBC (25-40%) and blood volume (50-100%) increase (around 20th week)
- Can be anemia early on as body begins to increase RBC production
- Become Hypercoagulable, so increased risk for thromboembolic events
- Decrease in platelets and increase in WBC to accomidate growth of baby
- Will see changes in EMG and may need to adjust electrodes due to growth of baby (may need to move to left)
- Murmers may be detected
- Increase in HR to accommodate for increased blood volume
True or False: Pregnant women experience electrolyte disturbances such as hypokalemia
True
True or false: A pregnant woman could have postural hypotension or hypertension related to their their pregnancy
True
What does the placenta produce?
hormones
True or false: The placenta does not require as much O2 as the fetus
False
It is the baby’s environment and requires just as much O2
What is a general concept of things to consider with regards to exercise and a pregnant woman?
- Decreased tolerance to exercise
- Increase risk/rate of dyspnea
- Heart is working hard to produce enough blood for the baby and placenta
- Key Point: need to monitor vitals more closely than you may with a non-pregnant pt.
Changes that occur in the kidneys of our pregnant patients
- increased production of renin (affects BP). Stimulated by progesterone and placenta
- retain a lot more water (6-8 liters). can affect electrolyte balance
- kidneys need to filter more blood than normal
- overall more stress put on kidneys in pregnant women
Respiratory changes in pregnant patient
- Increased tidal volume
- Compensatory respiratory alkalosis (pH increase)
- Decreased residual volume
GI changes in pregnant patient (5) C2- SaNG
- Constipation due to slowed GI motility and binding of proteins
- Early Satiety (no room)
- Nausea and vomiting- can continue throughout pregnancy
- Increased risk of GERD
- Sustained Compression of growing baby can affect the general stasis of many organs. can cause issues such as gall stones as a result.
Misc changes (pretty general and obvious) in the pregnant patient (4) J- FaGG
- Joint laxity is greater (ex: symphysis pubis)
- Fatigue / somnolence
- Altered Gait
- Center of Gravity- altered
Changes in skin with the pregnant patient (7)
- Spider angiomata (spider veins)
- Striae gravidarum (stretch marks)
- Palmar erythema (seen with liver problems too)
- Mucosal hyperemia
- Hair growth (abdomen and face)
- Hyperpigmentation (esp. linea nigra)
- Rashes and acne relatively common
Early signs of pregnancy (9) B -CHeF- S2PerM2
- Bloating
- Cramps
- Frequent mild Headache
- Fatigue
- Sensitivity to smells
- Sore breasts and/or dark nipples
- Unusual Period spotting
- Mood swings
- Subtle Motion sickness
What does para mean?
number of births, regardless of number of infants born
What does gravita mean?
number of pregnancies
How are para and gravita combined?
Example, “G3P2” or gravida 3 para 2 means 3 pregnancies, 2 deliveries
Another method uses 4 numbers
•# fullterm infants
•#preterm infants
•#abortions
•#children currently alive
•3-1-2-3 means . . .
What is Preeclampsia and what type of response does it require when it is discovered?
- sudden ↑in BP, usually signals kidney damage
- cause unknown, although may be pressure in placental blood vessels
- signals need for immediate delivery
What is nullipara?
a woman who has not completed a pregnancy beyond 20 wweeks of gestation
What is primipara?
a woman who has had one delivery beyond 20 weeks of gestation
What is multipara?
a woman who has delivered 2 or more pregnancies beyond 20 weeks of gestation regardless of whether baby lived or was stillborn (not the number of fetuses delivered)
Define gestation
Duration of the pregnancy, usually 40 weeks, marked from the first day of the last menstral period
What does paturient mean?
a woman in labor
What is considered preterm labor?
labor that starts after the 20th week ut before the 37th week
What is considered term labor?
labor initiated after 37th week but before the 42nd week
What is considered post-term?
pregnancy that goes beyond 42nd week
What is ectopic pregnancy and what type of response does it require?
- egg implanted in fallopian tube instead of uterus
- emergent response
What type of response does pregnancy-induced hypertension require?
- Urgent response
- can progress to preeclampsia
- want to make sure we have follow up questions if we detect high BP, such as change in stress levels
What is abruptio placentae and what type of response does it require?
- Placental abruption – placenta peels away from uterus, may deprive fetus of oxygen, may require early delivery
- emergnet response
What type of response of fetal distress require?
- emergent
- decreased fetal movement
What type of response does pregnancy related osteoporosis require?
routine follow up, not emergent or urgent
What is placenta previa and what type of response does it require?
- placenta covering cervix; may resolve itself, or may require early delivery
- vaginal bleeding
- urgent
What type of response is requires with a retained placenta?
- emergent, but occurs in the delivery room typically
- gotta get that thing out of there
What type of response does mastitis require?
- routine, refer
- pt. will have localized breast tenderness
What type of response does a UTI cystitis require?
- urgent
- need to be referred back to OB/GYN or PCP
What type of response does acute pyelonephritis require?
- urgent
- pt. will have flank pain, fever, chills, malaise, increase urgency/frequency with urination
