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Pharm Year 3 Sem1 patient > patient semester 1 hormones and reproduction female > Flashcards

patient semester 1 hormones and reproduction female Flashcards

1
Q

name the main anatomical features of the female tract

A

vagina, cervix , uterine corpus Fallopian tubes, ovaries

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2
Q

describe layers of uterus

A

myometrium (thick contracting layer) and endometrium (thin shedding layer)

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3
Q

describe the changes to the lumen space during the menstrual cycle

A

during menses, the endometrium sheds leaving just the basal endometrium and this causes the lumen space to increase, then as the endometrium regrows this space decreases

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4
Q

what are the ovaries

A

the ovaries are the site of ovulation

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5
Q

describe hormone changes during the menustrual cycle

A

oestrogen dominates the follicular stage whilst progesterone dominates the luteal

steady slow pulse Gnrh causes release of slow rising FSH, causes oestrogen levels being to rise about a week after ovulation
progesterone is fairly steady then rises around day 14
when levels of steroids begin to drop body is getting ready for next menstruation

gonadtrophins:
LH surge occurs before ovulation and FSH

steady slow pulse Gnrh causes release of slow rising FSH (promote follicle cohort), causing the increase in oestrogen. when it begin to rise FSH levels drop. (neg feedback)

close to ovulation you have an increase of LH caused by increasing levels of oestrogen
(positive feedback)

in the late luteal phase oestrogen levels decline and return to negative feedback as well as progesterone negative feedback. as a result GnRH levels drop causing LH and FSh levels to drop post ovulation.

Spike of LH occurs roughly 36 hours before ovulation

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6
Q

what drives the regrowth of the endometrium?

A

oestrogen

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7
Q

what is menarche

A

onset of ovulation

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8
Q

where are the oocytes stored?

A

in the ovaries whilst in utero

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9
Q

when does menopause occur on average?

A

51

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10
Q

what is considered to be out of the norms for a menstrual cycle length

A

less than 22 days or more than 35 days

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11
Q

name te stages in menstrual cycle (ovarian)

A

day 1-5 = menses
days 5-14 = follicular phase (variable in length) - it isn’t possible to accurately time ovulation
14-28 = luteal phase

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12
Q

when talking about the uterus and endometrium what are the stages of the menstrual cycle

A

the prolifitive (growth of endometrium ) and secretory stages (endometrium glands secrete)

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13
Q

ovulation

A

occurs around day 14 of 28
follicle ruptures releasing egg
corpus lutem remains for another week unless rescued in pregnancy

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14
Q

describe the differences between gonadatrophins and steroid hormones in therms of structure

A

gonadatrophins are polypeptide, direct gene products, water soluble , circulate

steroid hormones are produced by enzyme and are insoluble
found in the cell nucleus

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15
Q

describe sex steroid synthesis

A

cholesterol is a starting product for all sex steroids

androgens give rise to by androgen catalysing oestrogen

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16
Q

target tissue

A

a tissue that expresses a receptor

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17
Q

where are major steroid receptors found?

A

intracellular (nuclear)

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18
Q

where does transcription occur

A

nucleus

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19
Q

where does translation occur

A

cytoplasm

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20
Q

nuclear receptor superfamily

A

proteins that have binding sites for both steroids and DNA.

they are receptors for all major classes of steroids, *androgens, oestrogen’s and progestins etc

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21
Q

what happens when a steroid ligand binds to the nuclear steroid receptor ?

A

produces a complex that acts on DNA and alters the expression of genes
proteins produced therefore change

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22
Q

steroid receptor can be described as what?

A

a transcription factor

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23
Q

steroid receptor can be described as what?

A

a transcription factor

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24
Q

what receptors do the gonadatrophins bind to?

A

cell surface receptor FSHR and LHR

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25
Q

how is production of the gonadatrophins regulated

A

by the hypothalamic pituitary axis.
HPO axis - GnRH is released in a pulsing action (this frequency changes in women) (fast pulse = LH
slow pulse = FSH)

this causes the release of the gonadatrophins from the anterior pituitary

these travel in the blood to the ovaries: causing production and release of steroid hormones and follicle for ovulation and egg production
(control follicle maturation)

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26
Q

describe GnRh

A

GPCR
10 amino acid
affected by sex steroid feedback
agonists and antagonists are both used in ART to shut down ovary and advance controlled cycle of ovulatory

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27
Q

describe how GnRH is manipulated in assisted reproduction

A

agonists and antagonists are both used in ART to shut down ovary (by blocking GnRH receptor, stopping downstream hormone production and release) and advance controlled cycle of ovulatory

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28
Q

describe how GnRH is manipulated in assisted reproduction

A

agonists and antagonists are both used in ART to shut down ovary (by blocking GnRH receptor, stopping downstream hormone production and release) and advance controlled cycle of ovulatory

agonist e.g. buserelin causes down regulation

can then use external hormones to control cycle

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29
Q

describe the onset of puberty

A

leptin is released from fatty tissue
rising fat level produces more leptin
operates through kisspeptin neurone
kickstars GnRH pathway

overweight girls tend to start period early

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30
Q

describe the ovarian cycle

A

cohort of follicles recruited every month (about 20)
dominant follicles, usually 1 or 2 - moves to ovarian cortex
and ovulates
follicle enlarge due to oestrogen
tertiary follicles are fluid filled and fluid is released at ovulation
granulosa cells grow and surround follicle and can be released with oocyte at ovulation
follicles that don’t ovulate die via atresia process
FSH stimulates follicle maturation
LH then stimulates ovulation
corpus

31
Q

DESCRIBE GRANULOSA CELL

A 
somatic cells (full chromosome complement) grow in the follicle during ovarian cycle and surround the follicle 
and can be released with oocyte at ovulation
32
Q

describe the role of the corpus luteum

A

residual structure left on the surface of the ovary after ovulation
endocrine structure that produces progesterone

33
Q

describe the role of the corpus luteum

A

residual structure left on the surface of the ovary after ovulation
endocrine structure that produces progesterone and also oestrogen for a week
then it regresses after a week

34
Q

how are gametes produces

A

Meiosis

35
Q

what type of feedback is exhibited by progesterone?

A

negative

36
Q

what type of feedback is exhibited by oestrogen ?

A

negative mainly

positive in late follicular phase to cause increase in LH hormone

37
Q

describe briefly contraceptive options for women

A

combines oestrogen and progesterone which inhibit GnRh by negative feedback
prolonged high levels of oestrogen alone will also have this effect

38
Q

describe the dangers of unopposed/ prolonged oestrogen therapy

A

endometrial cancer

39
Q

describe effect of steroids on endometrium

A

estrogen stimulates the growth of endometrium

40
Q

mechanism of steroid hormone

A

steroids bind receptor in cell
complex go to nucleus
binds to steroid response element (SRE) on DNA
recruit co activatiors and alters rate of transcription
more mRNa production
more protein produced

41
Q

describe 2 major anti- oestrogen’s and their action on oestrogen receptors

A

a pure antiestrogen e.g fasolodex binds estrogen receptor, doesn’t produce correct complex can’t bind DNA so inactive and no effect on DNA transcription

tamoxifen is a partial antagonist. partial agonist can be used as anti breast cancer drugs

42
Q

what is an oestrogen?

A

biological activity on oestrogen receptor

43
Q

estrogen causes what to happen to uterine tissue

A

appearance of progesterone receptors

44
Q

what is menstruation?

A

shedding og superficial layer (functionalists) of endometrium

caused by withdrawal of sex steroid support which leads to :
vasoconstriction, tissue hypoxia
breakdown of connective tissue, fragmentation

local coagulation factors control blood loss locally

45
Q

how is blood loss controlled

A

local coagulation factors control blood loss locally

46
Q

describe endometriosis

A

ectopic endometrial tissue arises in over areas of the body
e.g. ovaries,

common
causes pain and infertility

mainly caused by reflux menustration - tissue shed at menses passes through Fallopian tubes establishing ectopic sites
these lesion continue to cycle under hormonal control but are not lost at menustration

47
Q

describe endometriosis

A

ectopic endometrial tissue arises in over areas of the body
e.g. ovaries,

common
causes pain and infertility

mainly caused by reflux menustration - tissue shed at menses passes through Fallopian tubes establishing ectopic sites
these lesion continue to cycle under hormonal control but are not lost at menstruation

alternatively occurs from progenitor cells in ectopic tissue
not clear why it only happens to some women

family history

48
Q

how do you treat or manage endometriosis

A

surgery an be used to remove lesions
treat using NSAIDS
or by blocking pharmacologically blocking cycle

aromatise inhibitor (inhibits production of oestrogen’s from androgens)
combined oral steroid contraceptive
gonadatrophin releasing hormone modulated (buterlin)

49
Q

how does fertilisation occur

A

sperm enters and fertilises egg
usually in the upper fallopian tube
preimplantation development occurs and moves further down fallopian tube
blastocyst implants in lining of womb

embryos must develop to the blastocysts stage before implantation to endometrium 
interstitial implantation (embryo buries in the uterus )
the embryo grows within the tissue
50
Q

at what day is endometrium receptive to embryo?

A

day 7 after ovulation

where progesterone and oestrogen have not yet started to decline (causing menstruation)

51
Q

in contraception what hormones rise

A

Progesterone

rescues corpus luteum

52
Q

in contraception what hormones rise?

A

Progesterone and chorionic gonadotrophin (hCG)

rescues corpus luteum (producing oestrogen and progesterone)

53
Q

what is hCG and where is it produced?

A

human chorionic gonadotrophin (hCG) is a polypeptide hormone that rescues that corpus luteum
produced by placenta

detected in pregnancy test

54
Q

what accounts for the ‘closure’ of the receptive period for implantation?

A

lack of timely appearance of hCG i.e embryo can be implanted but won’t survive due to regression of corpus luteum

55
Q

describe hormone changes in pregnancy

A

hCg rises and peaks ar 8 weeks and declines thereafter

oestrogen and progestin rise dramatically

56
Q

what is the role of progesterone in pregnancy?

A

regulates transport of egg in Fallopian tubes (cilia moves egg
prepares uterus to receive implanting blastocyst
sustains uterine lining
inhibits myometrial contractility
influences the ovary
has effect on brain and sexual behaviour

57
Q

describe the luteoplacental endocrine switch

A

at 7-9 weeks the placenta (that has been growing steadily in first trimester) takes on oestrogen and progesterone production from the corpus luteum

corpus luteum is no longer major endocrinal organ

miscarriage likely here

58
Q

steroid production in pregnant women

A

cholesterol imported into the placenta from blood and converted to progesterone then
enters fetus and converted to androgen then back to the placenta as estrogen (this means aromatise present in placenta)

59
Q

describe ultrasound imaging importance

A

pregnancy is viable is heart can be (5 weeks post lmp transvaginally )
(6 weeks post LMP transabdominally)

60
Q

describe ectopic pregnancy?

A

embryo implants outsides of the uterus i.e. in the Fallopian tubes and grows
tubal rupture
can be fatal
surgery or use of methotrexate (folate antagonist, terminates pregnancy)

61
Q

how is ectopic pregnancy detected?

A

Abdominal pain
hCG
scan and no intrauterine body

62
Q

what is the decidua?

A

Decidua is the endometrium that has been exposed to progesterone for a prolonged time (pregnnacy) which is shed at birth
provides glycoprotein when breaksdown

63
Q

what is the limit for pregnancy termination?

A

Though the law permits terminations up to 24 weeks, the great majority are done before the 13th week.

64
Q

describe how mifepristone causes termination (an abortifacient)

A

antagonist binds to the progesterone receptor, blocks preparation of endometrium for pregnancy
counteracts the suppressive effect of p on myometrial contractility

65
Q

what is the decidua?

A

Decidua is the endometrium that has been exposed to progesterone for a prolonged time (pregnnacy) which is shed at birth

66
Q

what is hPL? what is its role?

A

hPL is a polypeptide hormone modulates intermediated metabolism by changing level of insulin like growth factor
females are resistant to insulin in pregnancy - inc circulating glucose
in turn inc in glucose and amino acids available to foetus

67
Q

planned induction of labour

A

occurs in pre - eclampsia or severe fatal growth restriction

glucocorticoid treatment oftenn used to advance to mature the fatal lungs to prepare for air phase

68
Q

describe hormonal control of labour

A

unsure how initiates , as progesterone levels stay high till after delivery
functional change where progesterone no longer has same effect on the uterus

myometrial muscle cells start to ‘communicate at junctions -> contraction coordinated from top of uterus
lower uterus and cervix need to expand
appearance of inflammatory cells

69
Q

how does infection effect late stage pregnancy

A

can induce labour or cause induction to be needed

oxytocin, thromboxane prostaglandin analogoues

70
Q

viability is affected by

A

lung phase difference in utero and in

71
Q

drug use in pregnancy

A

avoid all drugs in 1st trimester
essential therapy tapered down to lower effective dose prior to conception

most drugs can diffuse across the placenta and enter fatal ciculation

some drugs are effluxes out

lipophillic unionised drugs or weakly basic drugs don’t efflux out

72
Q

why can’t valproate be used in pregnancy

A

valproate causes birth defects
fetal valproate syndrome

PPP

73
Q

what is pre term labour defined as? what is survival rate at 23 weeks

A

pregnancy before 37 weeks
42 percent of babies survive at 23 weeks
significant affect in future

74
Q

how do we prolong pregnancy?

A

tocolytics
oxytocin antagonist e.g, atosiban,
beta adrenoreceptor e.g. ritodrine (crosses placenta membrane)
ca 2+ channel blocker nifedipine

Pharm Year 3 Sem1 patient (12 decks)

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