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Y2 - CPT > Lecture 9 - Repro And Post Repro Health > Flashcards

Lecture 9 - Repro And Post Repro Health Flashcards

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1
Q

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

A

Cholesterol

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2
Q

Where are Theca cells and granulosa cells located?

A

Ovarian follicles

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3
Q

What is the function of the Theca cells?

A

Produce androgens

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4
Q

What is the function of Granulosa cells?

A

Convert androgens produced by the Theca cells to oestrogen

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5
Q

What is the enzyme that converts testosterone to Dihydrotestosterone?

A

5a- REDUCTASE

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6
Q

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

A

Finasteride

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7
Q

What part of the cell do steroid hormones act on?

What effect does this produce?

A

Nuclear receptors

Exerts effects through increasing gene transcription

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8
Q

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

A

Prednisolone

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9
Q

What type of drug is Prednisolone?

A

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

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10
Q

What sex hormone causes endometrial proliferation?

A

Oestrogen

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11
Q

What sex hormone increases the risk of blood clots?

A

Oestrogen

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12
Q

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

A

Testosterone
Progesterone

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13
Q

What is the most androgenic to least androgenic sex hormone?

A

Testosterone
Progesterone

Oestrogen

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14
Q

What sex hormone inhibits bone resorption?

A

Oestrogen

When post menopausal women are at an increased risk of oesteoporosis

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15
Q

What is the main hormone increasing muscle mass?

A

Testosterone

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16
Q

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

A

Thickening and proliferation of endometrium

Thin alkaline cervical mucus
Nice skin, hair changes and metabolism

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17
Q

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

A

Produces secretory endometrium

Thickening of myometrium

Thick acidic cervical mucus
Breast tissue
Inc body temp

THE HORMONE THAT MAINTAINS PREGNANCY
Leads to mood changes

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18
Q

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

A

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

Metabolised in liver

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19
Q

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

A

Oral bioavailability low

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

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20
Q

What organ metabolises both oestrogen and progesterone?

A

Liver

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21
Q

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

A

CYP450 enzymes

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22
Q

What type of substances affect the oral contraceptive efficacy?

A

Enzyme (CYP450) inducing drugs reduce their efficacy

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23
Q

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

A

GPRS CellPhone

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24
Q

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

A

Griseofulvin
Phenytoin
Rifampicin
Smoking

Carbamazepine
Phenobarbitone

St John’s Wort also does

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25
Q

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

A

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

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26
Q

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

A

Thickens cervical mucus

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27
Q

How is the combined oral contraceptive pill normally taken?

A

Every day for 21 days with a 7 day break

28
Q

What are the advantages of taking the COCP?

A

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

29
Q

What are the disadvantages of the COCP?

A

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

30
Q

What is the role of high dose progesterone?

A

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

31
Q

What is the rol of low level progesterone?

A

Mainly affects the mucus thickening the cervical mucus

32
Q

What levels of progesterone does the progesterone only pill contain?

How frequently is it taken?

A

Low dose

Taken every. Day no breaks

33
Q

What is the main action of the progesterone only pill?

A

Thickens cervical mucus

34
Q

What is the secondary action of the progesterone only pill?

A

Reduced cilia activity in the fallopian tubes

35
Q

What are the advantages of the progesterone onl ypill?

A

Reliable

Can be used if COCP contraindicated

36
Q

What are the disadvantages of the progesterone only pill?

A

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

37
Q

What hormone dramatically drops in menopause?

Why does this happen?

A

Levels of oestrogen fall

Run out of follicles (contain theca cells and granulosa cells)

38
Q

What are some consequences of oestrogen deficiency (menopause)?

A

Hot flushes
Sweating
Vaginal atrophy
Osteoporosis
Atherosclerosis
Cardiovascular disease

39
Q

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

A

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)

40
Q

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

A

Low dose vaginal oestrogen

41
Q

What type of oestrogen is given in HRT?

A

Natural oestrogen

42
Q

What type of progesterone is used in HRT?

A

Synthetic

43
Q

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

A

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

44
Q

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

A

VTE

45
Q

What type of HRT increases risk of breast cancer?

A

Oestrogen and progesterone

46
Q

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

A

60

47
Q

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

A

Endometrial cancer

48
Q

What type of drug is used to treat osteoporosis?

A

Bisphosphonates

49
Q

How do bisphosophonates work to treat osteoporosis?

A

Reduce osteoclast activity and so reduce bone turnover

50
Q

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

A

Alendronic acid

51
Q

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

A

Paget’s disease of bone
Bone malignancy

52
Q

How must bisphosphonatees be taken and why?

A

On empty stomach
Since poor gut absorption

53
Q

What are the adverse drug reactions of bisphosphonates?

A

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)

54
Q

What type of drug is Mifepristone?

A

Progesterone (and glucocorticoid) receptor antagonist

55
Q

What is mifepristone used for?

A

Termination of pregnancy

56
Q

How does Mifepristone work?

A

Anti progesterone (blocks receptors)

Sensitise myometrium to prostaglandin induced contraction (prostaglandins induce contractions)

57
Q

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

A

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

58
Q

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

A

Tamoxifen

59
Q

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

A

Antagonist to oestrogen in breast

60
Q

What cancer does tamoxifen treat but increase the risk of?

A

Antagonist to oestrogen in breast

Agonist to oestrogen in endometrium

61
Q

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

A

Raloxifene
Agonist of oestrogen on bone so reduces bone resorption

62
Q

Hoe dos raloxifene prevent oesteoporosis?

A

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

63
Q

What is clomiphene?

What does it do?

A

Non steroidal ovulatory stimulant

Used to sstimulate ovulation

64
Q

How does clomiphene stiualte ovulation?

Is it a SERM?

A

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

65
Q

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

A

Ulipristal acetate (Ella one)

66
Q

How does Ulipistral acetate act?

A

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

Y2 - CPT (30 decks)

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