Pharmacology Of The Uterus Flashcards

1
Q

Describe the structure of the Myometrium

A

Has 3 different layers of smooth muscles
- An outer layer with Longitudinal fibres
- Middle figure eight fibres (mesh like)
- Inner circular fibres

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2
Q

What are some mechanical properties of the Myometrium?

A

Rhythmic contractions
- Spontaneously active
- Vary during menstrual cycle and pregnancy
- Force content towards the cervix

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3
Q

Where do these rhythmic contractions originate from?

A
  • Contractions originate in the muscle itself
  • doesn’t require neuronal or hormonal input
  • But highly sensitive to sex hormones
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4
Q

What initiates the contractions?

A
  • Spontaneous depolarisation of pacemaker cells
  • These give rise to action potentials
  • Electrical communication between cells
  • Gap junctions spread depolarisation
  • Myometrium can function as a syncytium
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5
Q

Describe the excitation contraction coupling mechanism

A
  • Mechanical activity of smooth muscle causes an increase in tension
  • Membrane potential of pacemakers
  • This causes electrical activity being conducted by syncytium to SMCs
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6
Q

How are pacemakers and smooth muscle responses controlled?

A

Slow waves of pacemakers and smooth muscle responses are modulated by neurotransmitters and hormones

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7
Q

Describe the steps in which a contraction is caused by hormones/neurotransmitters

A
  • Ca2+ Calmodulin
  • Forms myosin Light chain Kinase
  • Myosin light chain/actin interactions
  • Contractions
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8
Q

Describe some properties of the uterus

A
  • Has strong contractile properties due to smooth muscle content of the Myometrium
  • Spontaneously contractile
  • Pacemaker cells initiate depolarisation which can spread from cell to cell
  • Depolarisation results in calcium entry = contraction
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9
Q

What are the 2 hormones used in sex regulation?

A

Progesterone
Oestrogen

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10
Q

State some similarities and differences between progesterone and oestrogen

A
  • Oestrogen increases contraction
  • Progesterone inhibits contraction
  • Both act at nuclear and membrane receptors
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11
Q

How are neurotransmitters used in regulation?

A

Sympathetic innervation
- Expression of alpha and beta adrenoreceptors
- A adrenoceptor agonist: Contraction
- B2 adrenoceptor agonist: Relaxation

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12
Q

Describe the hormonal changes of the uterus during pregnancy

A
  • Weak and uncoordinated contractions in early pregnancy (high progesterone)
  • 7 month til term: Oestrogen increases, Progesterone stays constant
  • Oestrogen/Progesterone ratio increases throughout last trimester culminating with strong coordinated contractions for delivery
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13
Q

Where are non peptide hormones synthesised and released into?

A
  • Non peptide hormone synthesised in hypothalamus
  • It is then released from the posterior pituitary gland
  • Released in response to suckling and cervical dilatation
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14
Q

What does Oestrogen release?

A

Oxytocin

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15
Q

What does Oxytocin do?

A
  • Increases the expression of oxytocin receptors
  • Also increases the synthesis of prostaglandins
  • Oxytocin stimulates the release of prostaglandins
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16
Q

What does Prostaglandins induce?

A

Myometrial contraction (PGE and PGF)

17
Q

What does prostaglandins have a role in?

A

Role in:
- Dysmenorrhea
- Menorrhagia
- Pain after parturition

18
Q

What are NSAIDs? What do they do?

A
  • NSAIDs are effective
  • Reduce contraction and pain
19
Q

Provide a summary of this part

A
  • Myometrial contractility is sensitive to sex hormones, oxytocin and prostaglandins
  • Progesterone and oestrogen have opposite effects which links to contractility during menstrual cycle or in pregnancy
  • Oxytocin and prostaglandins increase contractility
  • Oestrogen can stimulate oxytocin release, oxytocin stimulates PG synthesis: act in concert for delivery
20
Q

State the contractile agents of the Myometrium

A
  • Ergots
  • Oxytocin
  • Prostaglandins
21
Q

What is an Ergot?

A
  • A fungus that grows on some cereals and grasses
  • Contains Ergometrine
22
Q

What action does an Ergot carry out?

A

Powerful and prolonged uterine contraction

23
Q

What is the neuro mechanism of the Ergot?

A

Stimulation of the ã adrenoceptors, 5 HT receptors

24
Q

Describe what Oxytocin is used for

A
  • Used to induce/augment labour
  • Dose dependent increases in contraction
  • But too much can cause sustained contraction and fetal distress
  • Also used in postpartum haemorrhage
25
Q

Describe what prostaglandins are used for

A
  • Induction of labour
  • Induce abortion
  • Postpartum bleeding
26
Q

Describe Myometrial relaxants

A
  • Relaxants May be used in premature labour
  • Delay delivery by 48 hours so mother can be transferred to specialist unit and given antenatal corticosteroids to aid foetal lung maturation and increase survival
  • Progesterone can be used in preterm labour or to prevent miscarriage
27
Q

What are some Myometrial relaxants?

A
  • Ca2+ channel antagonists e.g nifedipine
  • Oxytocin receptor antagonists e.g Retosiban
  • Ā2 adrenoceptor stimulants e.g terbutaline sulfate
  • Relax uterine contractions by a direct action on the Myometrium
  • Used to reduce strength of contractions in premature labour
  • No longer recommended in uncomplicated preterm labour