Reproductive Flashcards
Components of Ectoderm
Surface ectoderm, neuroectoderm, neural crest
What are the components of surface ectoderm?
Epidermis Lens of the eye Nasal and oral epithelium Ear sensory organ Tooth enamel Adenohypopysis (Rathke's pouch) Parotid, sweat, and mamillary glands Anal canal below pectinate line (stratified squamous)
What is a craniopharyngioma?
benign tumor of Rathke pouch (surface ectoderm) that has cholesterol crystals, calcifications
What are the components/derivatives of neuroectoderm?
CNS
- Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
- Retina
- Optic nerve
- Spinal cord
What are the components derived from neural crest cells?
PNS
- DRG, cranial nerves, schwann cells, ANS)
- melanocytes
- chromaffin cells adrenal medulla
- parafollicular (C) cells of thyroid
- pai and arachnoid
- skull bones
- odontoblasts
- aorticopulmonary septum
What are the components derived from mesoderm?
Muscle (skeletal, cardiac), bone, connective tissue, blood, lymphatics Serous lining of the body cavities Spleen wall of the gut tube Kidneys, testes, ovaries, vagina Adrenal cortex Dermis
What is the notocord derived from?
Mesoderm
What is its function?
uses SHH signaling to induce formation of neural plate
What is the post-natal derivative of the notocord?
nucleus pulposus of the spinal cord
What are mesodermal defects?
VATER CL Vertebral defects Anal atresia Tracheo-esophageal fistula Renal defects
Cardio defeects Limb defects (bone and muscle)
What is the derivative(s) of endoderm?
Epithelial lining of gut tube above pectinate line
Most of urethra
Luminal epithelial derivatives (lung, liver, pancreas, gallbladder, eustacian tube, thymus, parathyroid, thyroid follicular glands)
Branchial cleft 1 structures
external auditory meatus
Branchial cleft 2-4 structures
Cervical sinuses
Filled in by 2nd arch mesenchyme
Can persist as branchial cleft cyst (lateral neck mass in child that does not move when swallowing)
Branchial arch 1 structures
Cartilage: Meckels: mandible, malleous, incus, and sphenomandibular ligament
Muscle: mastication (temporal, masseter, medial and lateral ptyerogoid), tensor tympani, tensor veli palitini, mylohyoid, anterior belly digastric
Nerves: V2 and V3 (maxillary and mandibular)
Branchial pouch structure 1
middle ear, eustacian tube, mastoid air cells (endoderm lined structures of the ear)
What is the mechanism of clomiphene?
ER anatogonist in hypothalamus
Decreases negative feedback and increase LH and FSH secretion from pituitary to stimulate ovulation
What are the side effects of clomiphene?
Hot flashes, ovarian enlargement, multiple simutaneous pregnancies, visual disturbances
What is clomiphene used to treat?
PCOS, infertility due to anovulation
What are ketoconazole and spirnolactone used to treat in PCOs?
Androgen symptoms
What is the first line treatment of PCOS?
weight reduction
What would you give a woman with PCOS who doesn’t want to get pregnant?
OCPs, control symptoms and preg
What is the mechanism of leuprolide
GnRH analog that acts as an agonist when given as a pulsitile dose and an antagonist when given continuously(down regs GnRH receptor on pituitary)
When can you use leuprolide?
Pulsitile: infertility
Continuous: prostate cancer after flutamide; leiomyomas; precocious puberty, endometriosis
What are the side effects of leuprolide?
Antiandrogen, nausea, vomiting
What is the mechanism of danazol?
synthetic androgen that acts as a partial agonist at androgen receptors
What is danazol used to treat?
Hereditary angioedema, endometriosis
What are the side effects of danazol?
Weight gain, edema, acne, hirsuitism, maculinization, lower HDL, hepatotoxicity
What is the treatment for endometriosis?
NSAIDS, OCPs, progestins, GnRH agonists, danazol, laproscopic removal
What is the mechanism of progestins?
Binds to PR and decrease growth and increase vascularization of endometrium
When are progestins used?
In OCPs and to treat endometrial cancer, abnormal uterine bleeding
What are the causes of gynacomastia in men?
Hyperestrogenic states (old age, cirrhosis, testicular tumor, puberty)
Klienfelters
Drugs (Some Drugs Create Awesome Knockers): Spironlactone, Digoxin, Cimentidine, AlcoholKetaconazole
What is the mechanism of tamoxifen?
Estrogen antagonist at breast, agonist at bone, uterus
What are the side effects of tamoxifen?
thromboembolism and endometrial cancer
What is tamoxifen used for?
Treat and prevent recurrence of ER/PR breast cancer
What is the mechanism of raloxifene?
Antagonist of ER at breast, uterus
Agonist at bone
What are the side effects of raloxifene?
Increased risk of thromboembolism
What is raloxifene used for?
Treatment of osteoporosis
What is the mechanism of sildenafil (vardenafil, tadalafil)?
Inhibits PDE-5 –> increases cGMP –> NO –> smooth muscle relaxation of the corpus caveronsum–> increase blood flow –> erection
What are the clinical uses of sildenafil et al?
erectile dysfunction
What are the toxicities associated with sildenafil?
Hot and sweaty, but then Headache, Heartburn, Hypotension
- headache, flushing, dyspepsia, cyanopsia (blue tinted vision), risk of life threatening hypotension in people taking nitrates)
When is sildenafil contraindicated?
People taking nitrates (hypotension)
What other medication can cause priapism?
trazadone (anti depressant, anti-anxiety)
What is the mechanism of ehtynyl estradiol, DES, and mestranol?
Estrogens
Binds estrogen receptors
What are the clinical uses of estrogens?
hypoganodism or ovarian failure
menstrual abnormalities
hormone replacement therapy in post menopausal women
Use in men with androgen dependent prostate cancer
What are the side effects of estrogens?
risk of endometrial cancer
bleeding in post menopausal women
clear cell adenocarcinoma of the vaginal in those exposed to DES in utero
increased risk of thrombosis
What are contradidications to estrogens?
ER+ breast cancer
History of DVT
What can you do to decrease risk of endometrial cancer during hormone replacement for post menopausal women?
Add progesterone
What are the risks of hormone replacement therapy in post menopausal women?
increased risk of endometrial carcinoma with unopposed estrogen, possible increased cardiovascular risk
What are anastrozole/exemestane?
Aromotase inhibitors for post menopausal women with ER+ breast cancer
What is the mechanism off mifepristone?
RU-486
competitive inhibitor of progestins at PR
What is mifepristone used for?
Termination of pregnancy with misoprostil (PGE1)
What are the side effects of mifepristone?
Heavy bleeding, GI effects (nausea, vomiting, anorexia), and abdominal pain
What are contraindications in OPCs?
heavy smokers >35 y/o (risk of cardiovascular event)
patients with history of thromboembolism or stroke
history of an estrogen dependent tumor
What are the roles of estrogen and progesterone specifically in OPCs?
Estrogen: block ovulation by preventing LH surge
Progesterone: cause mucous thickening to prevent sperm entry, inhibit endometrial proliferation so make it less suitable for embryo implantation
What is the use of terbutaline/ritodrine?
b2 agonist that relax the uterus to decrease contraction frequency in labor
What is the mechanism of testosterone or methyltestosterone?
agonist at androgen receptors
What are the clinical uses of testosterones?
treat hypogonadism and promote development of secondary sex characteristics
Anabolism to promote recovery after a burn or injury
What are the side effects of testosterone?
Masculization in females
Decrease in testicular testosterone in males by inhibiting LH release –> gonadal atropy and azoospermia
Premature closer of epiphyseal plates
High LDL, low HDL
What is the action of finasteride?
5a reductase inhibitor used in BPH and male pattern baldness
What is the action of flutamide?
nonsteriodal competitive inhibitor at androgen receptors, used for prostate carcinoma
What is the action of ketoconazole ?
inhibits 17,20 desmolase and used to treat PCOS to reduce androgen symptoms, side effects are gynacomastia and ammenorhea
What is the action of spiranolactone?
inhibits steriod binding and 17aOH and 17,20 desmolase which decrease androgen effect and can be used to treat androgen symptoms in POS but with side effect of gynacomastia and ammenorhea
What is the action of tamulosin?
a1 antagonist that inhibits SM contraction and works specificially at the a1a,d receptors so treats BPH exclusively
What is the action of minoxidil?
direct arteriolar dilator that is used to treat androgeneitc allopecia, and severe refractory HT
