Reproductive System

Question 1

What are the two main types of female contraceptives?

Answer 1

Combined pill (estrogen and progestogen)
Progestogen-only pill

Question 2

How does the combined pill work for contraception?

Answer 2

Estrogen inhibits FSH secretion through negative feedback, thereby suppressing ovarian follicular development

Progestogen inhibits LH secretion, preventing ovulation

Question 3

What are the adverse effects of the combined pill contraception?

Answer 3

Mild nausea
Breast tenderness
Flushing
Breakthrough bleeding
Dizziness
Depression or irritability
Skin changes (acne caused by progestogen)
Weight gain
Thromboembolism* (when combined with other factors such as smoking or HTN, especially in 3rd generation progestogens)
Some women experience increased blood pressure (switched to progestogen-only)

Question 4

What are the 3rd generation progestogens?

Answer 4

Desogestrel and gestodene

Question 5

How does the progestogen-only pill work as a contraceptive?

Answer 5

Acting on the cervical mucus, making it inhospitable to sperm

Inhibits implantation due to actions on the endometrium

Alters mobility and secretions of the fallopian tubes

Question 6

What adverse effects are associated with the progestogen-only pill?

Answer 6

Disturbances of menstruation
Less reliable than the combined
Less overall safety data due to being less widely used

Question 7

What kind of contraception is levonorgestrel used for?

Answer 7

Postcoital (emergency) contraception

Question 8

What kind of contraception is medroxyprogestogen used for?

Answer 8

Long-acting progestogen-only contraception, given as a depot injection

Question 9

How does oxytocin work to induce labor?

Answer 9

Agonism of the oxytocin receptor, increasing intracellular calcium and inducing uterine contractions

Question 10

What are the adverse effects of oxytocin?

Answer 10

Hypotension* (rapid administration)
High doses can cause sustained contractions reducing blood flow and oxygen delivery to the placenta that lead to fetal distress and potentially death*
Uterine rupture
Antidiuretic effect

Question 11

How does ergometrine induce labor?

Answer 11

Not completely understood, may act on alpha-adrenoceptors and 5-HT receptors

Question 12

When is ergometrine used?

Answer 12

When the uterus is inappropriately relaxed, minimal effect on a contracted uterus

Question 13

What are the adverse effects of ergometrine?

Answer 13

Vomiting (stimulation of D2 receptors)*
Vasoconstriction
Increased blood pressure
Nausea
Blurred vision
Headache
Angina

Question 14

What are mifepristone and misoprostol used for?

Answer 14

Medically-induced abortion

Question 15

How do mifepristone and misoprostol work?

Answer 15

Mifepristone is an antiprogestogen that acts as a competitive inhibitor, allowing for lower doses of the prostaglandin

Misoprostol is an E1 analog that induces myometrial contraction, leading to expulsion of tissue (gemeprost can also be used)

Question 16

What effect do atosiban and salbutamol have on parturition?

Answer 16

They delay it

Question 17

How does atosiban work?

Answer 17

Competitive oxytocin receptor, preventing increase of IP3 and intracellular calcium and release of prostaglandins

Question 18

How does salbutamol work in relation to birth?

Answer 18

A beta-2-adrenoceptor agonist that can inhibit spontaneous oxytocin-induced contractions of the pregnant uterus

Question 19

What is the maximum time limit that birth should be delayed by?

Answer 19

48 hours

Question 20

What do clomiphene, gonadorelin, follitropin, lutropin, and GnRH analogues treat?

Answer 20

Infertility

Question 21

What are the side effects of infertility treatments?

Answer 21

Flushing
Vaginal dryness
Bone loss
Reversible ovarian enlargement (clomiphene)

Question 22

What do sildenafil, tadalafil, and vardenafil treat?

Answer 22

Erectile dysfunction

Question 23

How do phosphodiesterase type V inhibitors work?

Answer 23

Inhibition of phosphodiesterase type V precents inactivation of cGMP, which causes vasodilation during sexual stimulation

Question 24

What are the adverse effects of phosphodiesterase type V inhibitors?

Answer 24

Hypotension*
Flushing
Headache
Visual disturbances* (inhibition of PDE VI – more common in tadalafil and sildenafil)