Reproductive Flashcards by Elizabeth Ludwig

Components of Ectoderm

Surface ectoderm, neuroectoderm, neural crest

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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)

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What is a craniopharyngioma?

benign tumor of Rathke pouch (surface ectoderm) that has cholesterol crystals, calcifications

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What are the components/derivatives of neuroectoderm?

CNS

Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
Retina
Optic nerve
Spinal cord

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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

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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

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What is the notocord derived from?

Mesoderm

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What is its function?

uses SHH signaling to induce formation of neural plate

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What is the post-natal derivative of the notocord?

nucleus pulposus of the spinal cord

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What are mesodermal defects?

VATER CL
Vertebral defects
Anal atresia
Tracheo-esophageal fistula
Renal defects

Cardio defeects
Limb defects (bone and muscle)

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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)

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Branchial cleft 1 structures

external auditory meatus

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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)

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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)

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Branchial pouch structure 1

middle ear, eustacian tube, mastoid air cells (endoderm lined structures of the ear)

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What is the mechanism of clomiphene?

ER anatogonist in hypothalamus

Decreases negative feedback and increase LH and FSH secretion from pituitary to stimulate ovulation

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What are the side effects of clomiphene?

Hot flashes, ovarian enlargement, multiple simutaneous pregnancies, visual disturbances

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What is clomiphene used to treat?

PCOS, infertility due to anovulation

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What are ketoconazole and spirnolactone used to treat in PCOs?

Androgen symptoms

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What is the first line treatment of PCOS?

weight reduction

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What would you give a woman with PCOS who doesn’t want to get pregnant?

OCPs, control symptoms and preg

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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)

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When can you use leuprolide?

Pulsitile: infertility
Continuous: prostate cancer after flutamide; leiomyomas; precocious puberty, endometriosis

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What are the side effects of leuprolide?

Antiandrogen, nausea, vomiting

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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