Reproductive Flashcards
1
Q
Hypothalamic/Anterior Pituitary Hormones
A
- Growth Hormone Releasing Hormone (GHRH) – stimulates
release of growth hormone (GH) - Gonadotropin Releasing Hormone (GnRH) – stimulates Follicle-Stimulating (FSH) and Luteinizing (LH) Hormones that affect release of reproductive hormones in male and females
2
Q
Female Reproductive Steroid Hormones
A
Estrogens and Progestins
- Produced in Ovaries
3
Q
Male Reproductive Steroid Hormones
A
Androgens
- Produced in Testes
4
Q
Patient use of reproductive steroids hormones
A
- Legal – Contraceptives, Hormone Replacement
- Illegal – Performance Enhancement
5
Q
Males - Testosterone stimulates:
A
- Spermatogenesis
- muscle anabolism
- production of RBC
- stimulates secondary sexual characteristics & maturation
6
Q
Females - Estrogen
A
Responsible for sexual differentiation: promotes primary & secondary sexual characteristics in females
7
Q
Females - Estrogen and Progesterone
A
Primarily Responsible for Female Reproductive Cycle
8
Q
Follicle Stimulating Hormone
A
- Men: stimulates testosterone production
- Women: FSH stimulates maturation of follicles in ovary and consequently increased estrogen
9
Q
Luteinizing Hormone
A
- men: LH stimulates Leydig cell differentiation & fx
- women: LH surge triggers ovulation & development of corpus luteum
10
Q
Estrogen and Progesterone in Reproductive Cycle
A
- FSH stimulates the maturation of the follicle
- As the follicle develops, increasing amounts of estrogen are released
- The LH surge stimulates ovulation
- Ovum is Released from Follicle
- Corpus Luteum formed from ruptured follicle
- Combined effect of estrogen & progesterone from corpus luteum cause uterine lining to thicken 7. Corpus Luteum regresses –> menstruation
11
Q
Female Sec hormones and contraceptive drugs
A
Estrogen
Progesterone
Luteinizing Hormone (LH)
Follicle Stimulating Hormone (FSH)
12
Q
Use of Estrogen
A
- used for replacement of endogenous hormone after menopause or after ovariectomy:
- Treat atrophy of secondary sexual organs
- vasomotor effects & improve blood lipids (increase HDL, decrease LDL)
- increase bone mineralization
- decrease risk of coronary heart disease
- ER modulators (SERMS) used to Treat endometriosis, metastatic breast and prostate CA
13
Q
Use of progesterone
A
negative feedback on pituitary prevents FSH/LH release
14
Q
Estrogen Preparations
A
- Premarin: conjugated estrogen
- used as estrogen replacement, antineoplastic, prevention of osteoporosis
15
Q
Adverse Effects of Estrogen Preparations
A
- Na+ and H2O retention (edema of feet and ankles) * GI - N&V
- very high levels may cause cardiomyopathy/MI, clotting disorders, embolism, thrombosis
- CA - may increase risk of endometrial & breast CA (especially if given w/o progesterone)
16
Q
Selective Estrogen Receptor Modulators (SERMs)
A
- Produce estrogen agonist effect in some tissues, antagonist effect in other
- Tamoxifen: decreases risk of breast cancer
- Raloxifene: decreases risk of breast and uterine cancer
17
Q
2 Types of Contraceptive Pills
A
- Progestin Pill
- Combination Pills
18
Q
Progestin Pill (minipill)
A
- Through negative feedback blocks LH surge preventing egg release
- prevents buildup of uterine lining & decreases sperm’s ability to fertilize an egg
- Must be taken every day (21-24 days out of 27 day cycle)
- Can cause irregular and unpredictable Cycles
19
Q
Combination Pills
A
- Contain Estrogen and Progestin
- Prevents FSH and LH surge preventing egg release
- Supports uterine lining preventing bleeding.
- More effective than progestin only - 99% effective
- Must be taken every day (21-24 days out of 27 day cycle)
- Close to 100 brands available in USA (Ex: Yaz)
- Many forms of administration: pill, vaginal ring, injection
20
Q
How do oral contraceptives work
A
- Fixed amount of estrogen & progesterone
- ~ 3 weeks on: 1 week off to simulate normal cycle
- Inhibits ovulation by suppressing gonadotropins, follicle-stimulating hormone, and luteinizing hormone
21
Q
Adverse Effects
A
- Thrombotic events, liver damage, HTN, hyperglycemia, bleeding irregularities
- Cigs smoking increases the risk of serious CV side effects from combination oral contraceptive use
22
Q
Anti-Progestins
A
- Antagonize progesterone receptors
- Used to terminate pregnanc
23
Q
Mifepristone
A
- Abortion pill administered in first 7 weeks of pregnancy
- Used to Rx uterine bleeding and dysmenorrhea
- Also Used for “Morning After Pill”
- Only Morning after pill without Prescription in US is Levonorgestrel (Plan B)
24
Q
See male sex hormones little image thing on slide 14
A
25
Adrenal Androgens
- synthesized adrenal cortex
* Precursor for more potent steroids:
* DHEA: 1° precursor of natural estrogens
26
Androstenedione
- androgenic steroid produced by testes, adrenal cortex, and ovaries.
* highly correlated with muscular physique and may be taken as a supplement
* banned by IOC & sporting organization
27
Dihydrotestosterone (DHT)
a metabolite of testosterone and even more potent than testosterone
28
Nandrolone Decanoate clinical uses vs abuse
* administered in a dosing cycle by IM injection
* Clinical uses: Rx of breast CA, anemia or “wasting ” disorders
* Abuse: used by athletes to increase muscle bulk, increase recovery time, improve endurance
29
Adverse effects of androgen abuse
- liver damage (tumor & peliosis hepatitis)
* decrease blood HDL / increase LDL
* altered glucose metabolism (DM-II)
* avascular necrosis of femoral head
* aggression, mood swing, psychosis
* testicular atrophy
* Infertility
* masculinizing effects in females
* early hip degeneration
30
Rehab Relevance
- Cardiovascular adverse effects associated with estrogens and progestins
- Estrogens, hormonal contraceptives and SERMs as associated with increased risk of thromboembolic events
- Hot flashes and difficulty with thermoregulation can occur with use of SERMs
- Be aware of signs of athletes using GH or androgens to enhance performance and be able to discuss with patient adverse effects
31
What is complementary medicine
* derived from natural products or sources
* Herbal products
* Components of natural products (bovine cartilage, fish oils, etc…)
* Homeopathic remedies
* Dietary supplements (vitamins, minerals, etc…)
32
Why are those meds classified as "complementary"
* Because they may only be effective when used with a traditional medicine
* Not considered drugs since they are not pure and exact composition may be unknown
* Not under FDA regulation
33
Problem with ACM:
1. Public makes the assumption that just because a
product is “natural” or plant derived, it is safe --> Heroin, Cocaine, Cyanide, etc…are “all natural” and plant derived products
* Active ingredients are OFTEN unknown: May be the same active compound found in prescription
drugs; May Be formulated with other compounds that are unknown and have other adverse effects
* Many of these Rx have not been studied: Exact effect and side effects are unknown
34
How ACMs can interact with both other meds and PT
* ACMs can stimulate the liver to enhance drug metabolism (enzyme induction): liver more quickly inactivated conventional drugs
* ACMs may exert a direct toxic effect
* ACMs can produce side effects/adverse effects similar to other medications
35
St. John's wort and Ginseng
increase warfarin breakdown, decreasing its effectiveness
36
Kava Kava
toxic to liver
37
Ginkgo Biloba
anticoagulant effect, increased risk of hemorrhage
38
Lipid soluble vitamins
A, D, E
* These can accumulate in adipose tissue and have the greatest potential for adverse effects
39
Vitamin A
Over-dose can cause liver toxicity & birth defects to the uterus in pregnant moms taking high doses
40
Vitamin D
Hypercalcemia
41
Vitamin E
Hemorrhagic Toxicity
42
Water Soluble Vitamins
B and C
Generally well tolerated
43
Vitamin C
GI disturbance, kidney stones, excess iron absorption
- may decrease availability of other drugs by acidifying the urine
44
Minerals
Both Macro-nutrient minerals (major minerals) and trace minerals have the potential to produce adverse effects when taken in excess
45
Major Minerals
Ca, Cl, Mg, Phosphate, K and Na
* Over-dose associated with electrolyte disturbance, water imbalance and CV and neurological side effects
46
Minor Minerals
Chromium, Cu, Fluoride, Iodine, Iron, Manganese, Selenium and Zn
* Over-dose associated with wide variety of toxic effects depending on the organ where the mineral accumulates
* Ex: iron: toxic to heart and liver
