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πš™πš‘πš’πšœπš’πš˜πš•πš˜πšπš’ 𝟸 : πš›πšŽπš™πš›πš˜πšπšžπšŒπšπš’πš˜πš— > Pharmacology of the Uterus > Flashcards

Pharmacology of the Uterus Flashcards

1
Q

What are the three layers making up the smooth muscle of the uterus?

A

β†’ Outer longitudinal fibres
β†’ Middle figure eight fibres
β†’ Inner circular fibres

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2
Q

What are the three layers of the uterus?

A

β†’ endometrium
β†’ Myometrium
β†’ perimetrium

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3
Q

What do uterine contractions do?

A

β†’ Increase uterine pressure
β†’ Forces content towards the cervix
β†’ acts as a natural ligature to prevent blood loss

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4
Q

What is the activity of the myometrium like?

A

β†’ Spontaneously active basal electrical activity

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5
Q

What kind of contractions are there in parturition?

A

β†’ Rhythmic

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6
Q

What is the myometrium sensitive to?

A

β†’ Neurotransmitters

β†’ Hormones

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7
Q

What type of cells are in the myometrium?

A

β†’ ICC pacemaker cells

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8
Q

How is synchronous contraction achieved?

A

β†’ Electrical communication between gap junctions

β†’ electrical activity is transmitted to adjacent cells

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9
Q

Where is electrical activity transmitted between in the myometrium?

A

β†’ Between ICCs
β†’ between ICC and smooth muscle
β†’ between smooth muscle cell

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10
Q

How do the myometrium cells function as?

A

β†’ A syncytium

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11
Q

Describe how contraction occurs?

A

β†’ ICC periodic activation of inward currents
β†’ depolarisations
β†’ Ca2+ entry through VGCC
β†’ Intracellular calcium leads to contraction

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12
Q

What are the slow waves of ICCs and smooth muscle responses modulated by?

A

β†’ Neurotransmitters and hormones

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13
Q

Describe how calcium is increased inside the cell?

A 
Slow wave of depolarisation 
                      ↓
Ca2+ channels get activated
                       ↓
Ca2+ entry increases Ca2+ 
                     ↓
Ca2+ binds to calmodulin
                     ↓
This phosphorylates myosin light chain kinase 
                       ↓ 
actin interaction lead to contractions
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14
Q

Describe how oxytocin leads to increased Ca2+?

A 
Oxytocin is Gq couples 
                    ↓
Activation of phospholipase C 
                     ↓
PIP2 β†’ DAG + IP3 
                    ↓
IP3 binds to IP3 receptors in the SR 
                     ↓ 
Causes Ca2+ from the store to be released into the cytosol 
                      ↓ 
Ca2+ increases
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15
Q

What are smooth muscle cells joined by?

A

β†’ Gap junctions

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16
Q

How can intracellular calcium be reduced?

A

β†’ Na+/Ca2+ exchanger
β†’ Ca2+ pump
β†’ some Ca2+ gets taken into the mitochondria

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17
Q

What is the effect of low concentrations of stimulants on ICCs?

A

β†’ Increase in slow wave frequency producing

β†’ Increase in frequency of contractions

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18
Q

How is the myometrium similar to other smooth muscle tissues?

A

β†’ There is a graded response - no threshold

β†’ increases in Ca2+ lead to increases in force of contraction

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19
Q

What is the effect of higher concentrations of stimulants on ICCs?

A

β†’ Increased frequency of action potentials on top of slow waves
β†’ Increased frequency and force of contractions

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20
Q

What is the effect of even higher concentrations of stimulants on ICCs?

A

β†’ plateau of slow wave producing prolonged sustained contractions

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21
Q

What is the effect of large concentrations of stimulants on ICCs?

A

β†’ hypertonus (incomplete relaxation)
β†’Ca2+ extrusion process is not as effective
β†’ interferes with blood flow - fetal distress

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22
Q

What innervation does the myometrium have?

A

β†’ Sympathetic

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23
Q

What receptors does the myometrium express?

A

β†’ alpha and beta adrenoceptors

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24
Q

What is the effect of alpha 1 adrenoceptor agonist?

A

β†’ contraction

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25
Q

What is the effect of beta 2 adrenoceptor agonist?

A

β†’ relaxation

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26
Q

What are alpha 1 adrenoceptors coupled with?

A

β†’ Gq

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27
Q

What are beta 2 adrenoceptors coupled with?

A

β†’ Gs

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28
Q

How does the Gs transduction mechanism work?

A

β†’ Stimulates the formation of cAMP
β†’ cAMP inhibits myosin light chain kinase
β†’ less contractile force

29
Q

What effects do progesterone and estrogen have on contraction?

A

β†’ Progesterone - inhibits contraction

β†’ Estrogen - increases contraction

30
Q

What contractions does a non-pregnant uterus have?

A

β†’ Weak contractions early in the cycle

β†’ Strong during menstruation (increased prostaglandins

31
Q

Why does the myometrium contract during menstruation?

A

β†’ Increased prostaglandins and decreased progesterone

32
Q

What contractions does a pregnant uterus have?

A

β†’ Weak and uncoordinated in early pregnancy ( high progesterone)
β†’ strong and coordinated at parturition ( increased estrogen)

33
Q

What increases and decreases gap junction expression in the myometrium?

A

β†’ Increases - estrogen

β†’ Decreases - progesterone

34
Q

Where are estrogen and progesterone receptors also found?

A

β†’ ICCs

35
Q

What prostaglandins do the myometrium and endometrium synthesize?

A

β†’ synthesize PGE2 and PGF2alpha - promoted by estrogens

36
Q

What do prostaglandins induce?

A

β†’ Myometrial contractions
β†’ dysmenorrhoea
β†’ menorrhagia

37
Q

What helps with pain and contraction?

A

β†’ NSAIDs

38
Q

What is the function of prostaglandins?

A

β†’ Coordinate an increase and force of contractions
β†’ increase gap junctions
β†’ soften cervix

39
Q

What are 3 prostaglandin analogues?

A

β†’ Dinoprostone (PGE2)
β†’ Carboprost (PGF2a)
β†’ Misoprostol (PGE1)

40
Q

What is the function of PGE2?

A

β†’ Smooth muscle dilator around the body?

41
Q

What are the 4 uses of prostaglandin analogues?

A

β†’ Induction of labour - before term
β†’ induce abortion
β†’ postpartum bleeding
β†’ softening the cervix

42
Q

What is a side effect of dinoprostone?

A

β†’ Systemic vasodilation
β†’ cardiovascular collapse
β†’ hypertonus and fetal distress

43
Q

How is dinoprostone given to reduce side effects?

A

β†’ Gel

44
Q

What is oxytocin?

A

β†’ A non peptide hormone synthesised in the hypothalamus and released from the posterior pituitary gland

45
Q

When is oxytocin released?

A

β†’ In response to suckling

β†’ cervical dilatation

46
Q

Why is oxytocin not effective in earlier stages?

A

β†’ Receptors are not expressed pre term so they are not effective

47
Q

What does estrogen produce in the later stages of parturition?

A

β†’ Increased oxytocin release
β†’ Increased oxytocin receptors
β†’ increased gap junctions

48
Q

What is the function of oxytocin?

A

β†’ Increases the synthesis of prostaglandins

49
Q

What is ergot?

A

β†’ Fungus that grows on some cereals

50
Q

What happens when you ingest ergot?

A

β†’ Ergotism
β†’ Gangrene
β†’ convulsions
β†’ abortion

51
Q

What is the action of ergot on the myometrium?

A

β†’ Powerful and prolonged uterine contraction when myometrium is relaxed

52
Q

What is the mechanism of action of ergot?

A

β†’Stimulation of alpha adrenoceptors

β†’ 5-HT receptors

53
Q

What are the uses of ergot?

A

β†’ postpartum bleeding

β†’ not induction

54
Q

Why are myometrial relaxants given?

A

β†’ Delay delivery by 48h

β†’ mother can be given antenatal corticosteroids to help fetal lung maturation

55
Q

What is an example of a b2 adrenoceptor stimulant?

A

β†’ Salbutamol

56
Q

How does salbutamol work?

A

β†’ relaxes uterine contractions by direct action on the myometrium
β†’ increases Ca2+ uptake into SR - Ca2+ not available for contraction

57
Q

What is salbutamol used for?

A

β†’ Reduce strength of contractions in premature labour

58
Q

What is an example of a Ca2+ channel antagonist?

A

β†’ Nifedipine

β†’ Mg sulfate

59
Q

What is an example of an oxytocin receptor antagonist?

A

β†’ Retosiban

60
Q

What is an example of a COX inhibitor?

A

β†’ NSAIDs

61
Q

How do NSAIDs work?

A

β†’ Decrease prostaglandins

62
Q

What is a side effect of NSAIDs?

A

β†’ Can cause fetal renal dysfunction

63
Q

What doest stimulation of beta 2 adrenoceptors cause?

A

β†’ Smooth muscle relaxation

64
Q

How does beta 2 adrenoceptor stimulation work?

A

β†’ PKA activity
β†’ Increased Ca2+ activity which increases uptake into SR
β†’ Increases K+ channel activity β†’ hyperpolarisation and decreased Ca2+ entry via VGCC
β†’ Downregulates MLCK

65
Q

What is used for induction of labour?

A

β†’ Oxytocin

66
Q

What is used for induction of labour/termination in early term?

A

β†’ Prostaglandins ( because no oxytocin receptors)

67
Q

What is used for postpartum bleeding?

A

β†’ Prostaglandins
β†’ Oxytocin
β†’ Ergots

68
Q

What is used to prevent premature birth?

A

β†’ Beta 2 adrenoceptor agonists
β†’ Ca2+ channel blockers
β†’ oxytocin inhibitors

69
Q

What are the 2 ways to measure uterine contractions?

A

β†’ Isometric tension recording

β†’ Measure tension generated with diameter of muscle ring remaining constant

πš™πš‘πš’πšœπš’πš˜πš•πš˜πšπš’ 𝟸 : πš›πšŽπš™πš›πš˜πšπšžπšŒπšπš’πš˜πš— (12 decks)

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