Reproductive + Post Reproductive Health

Question 1

What are the sex steroids derived from?

Answer 1

Cholesterol

Question 2

What type of receptors do steroid hormones act on?
How do they exert their effects?

Answer 2

Nuclear receptors
Through gene transcription

Question 3

What are the COCP and progesterone only pill metabolised by?

Answer 3

In liver by CYP 450 enzymes

Question 4

What is oral contraceptive efficacy reduced by?
Examples
Why?

Answer 4

• CYP450 enzyme inducing drugs
  e.g carbamazepine, phenytoin, rifampicin ,smoking
• All increase production of hepatic CYP450

Question 5

Difference in the role of high + low levels of progesterone

Answer 5

high: inhibits ovulation
low: thickens cervical mucus (does NOT inhibit ovulation)

Question 6

What steroids are used in hormone replacement?

Answer 6

Natural oestrogen
Synthetic progesterone

Question 7

Uses of bisphosphonates

Answer 7

Osteoporosis
Bone diseases e.g. Paget’s disease of bone + malignancy

Question 8

Outline the absorption, metabolism + excretion of oestrogen in the body

Answer 8

• readily absorbed from skin + mucous membranes
• metabolised by hepatic CYP450
• excreted in urine as glucuronides + sulphates

Question 9

Outline the absorption, metabolism + excretion of progesterone in the body

Answer 9

• injected progesterone is bound to albumin
• some stored in adipose tissue
• metabolised by hepatic CYP450
• excreted in urine conjugated to glucuronic acid

Question 10

Pharmacokinetics of bisphosphonates

Answer 10

• long half life
• poor gut absorption which is affected by food > taken on empty stomach

Question 11

What are the adverse drug effects of bisphosphonates?
What needs to be done about them?

Answer 11

• Oesophagitis (remain seated or standing for 30mins after taking)
• Hypocalcaemia (check Ca2+ + vit D levels before)

Question 12

What is the mechanism of action of bisphosphonates

Answer 12

Reduce bone turnover by controlling osteoclast activity

Question 13

What is the mechanism of action of mifepristone?

Answer 13

Progesterone receptor antagonist
- act as an anti-progesterone
- sensitising myometrium to prostaglandin induced contractions

Question 14

What are the uses of mifepristone?

Answer 14

Termination of pregnancy
Medical management of miscarriage

Question 15

What is the mechanism of action as ulipristal acetate (Ella one) as an emergency contraceptive?

Answer 15

• Selective progesterone receptor modulator
• Inhibition of ovulation via suppressing LH surge

Question 16

What is the mechanism of action of clomiphene?

Answer 16

• selective oestrogen receptor modulator
• competes with oestrogen for ER binding
• causes ovulation induction through LH surge

Question 17

What advice should be given when taking bisphosphonates?

Answer 17

Taken on empty stomach
Remain seated/standing for 30 mins after taking

Question 18

Action of tamoxifen at the breast tissue

Answer 18

• used in treatment of breast cancer
• Oestrogen receptor antagonist
• causes antiestrogenic + antitumor effects
• slows cell cycling

Question 19

Action of tamoxifen at bone

Answer 19

Oestrogen agonist > prevents osteoporosis in post menopausal women

Question 20

Action of tamoxifen at hypothalamus

Answer 20

• Acts as oestrogen agonist in premenopausal women
• increases gonadotropin levels > induce ovulation

Question 21

Action of tamoxifen at endometrium

Answer 21

Acts as oestrogen receptor agonist > endometrial hyperplasia (bad thing)

Question 22

Actions of oestrogen

Answer 22

• endometrial proliferation
• Na+ H2O retention
• raises HDL + lowers LDL
• decreases bone resorption
• impaired glucose tolerance
• increased blood coagulability

Question 23

What are side effects of oestrogen?

Answer 23

• breast tenderness
• N+V
• water retention
• thromboembolism
• increased blood coagulability
• impaired glucose tolerance
• increased risk of endometrial, ovarian + breast cancer

Question 24

Actions of progesterone

Answer 24

• secretory endometrium
• maintains pregnancy
• mood changes
• increases bone mineral density
• fluid retention

Question 25

Side effects of progesterone

Answer 25

Weight gain
Fluid rented on
Acne
N + V
Irritability
Lack of concentration

Question 26

Actions of testosterone

Answer 26

Male secondary sex characteristics
Increased muscle mass

Question 27

Side effects of testosterone

Answer 27

Aggression
Acne
Voice changes
Increase body hair/male pattern baldness
Increased risk of atherosclerotic disease

Question 28

Uses of raloxifene

Answer 28

Prevention of osteoporosis in menopause and breast cancer