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Drew 924 > Vaginal Delivery > Flashcards

Vaginal Delivery Flashcards

1
Q

What part of the vagina is innervated?

A

outer 1/4

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2
Q

How long is the vagina?

A

6 - 8.5 cm

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3
Q

What angle is the vagina relative to the body surface?

A

130 degrees

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4
Q

What are the layers of the stratified squamous epithelium of the vagina?

A

1) basal
2) parabasal
3) transitional
4) intermediate
5) superficial

SITPB

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5
Q

Which layers of the vaginal epithelium are removed during menses?

A

superficial & intermediate

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6
Q

What are the tissue layers of the vagina?

A

1) stratified squamous epithelium
2) lamina propria
3) muscular
4) adventitia

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7
Q

How thick is the stratified squamous epithelium?

A

200 - 300 um with rugae

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8
Q

What is the turnover of the basal layer?

A

33 days

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9
Q

Describe the cells of the basal layer.

A
  • non-cornified columanr germ cells

- microvilli

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10
Q

What layer contains desquamation enzymes for menses?

A

intermediate

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11
Q

What layer metabolizes drugs?

A

superficial (small amount of metabolism, though)

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12
Q

Describe the parabasal layer.

A

– secretion channels, but no goblet cells

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13
Q

Describe the intermediate layer.

A
    • cells flatten
    • desmosomes present to store enzymes
    • enzymes for desquamation
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14
Q

Where do vaginal mucosal secretions originate?

A

1) ultrafiltration (transudation)
2) basal cell layers
3) cervix

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15
Q

What is the function of mucosal secretions?

A

1) lubrication
2) housekeeping
- - IgA’s
- - microbial metabolism –> acidic pH

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16
Q

Describe the components of mucosal secretions.

A

1) mucus
2) exfoliated cells
3) gland secretions
4) IgA
5) small amount of buffer

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17
Q

What is the pH of the vaginal cavity?

A

3.8 - 4.5 (increases after menopause)

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18
Q

What is the pH of semen?

A

7 - 8

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19
Q

What is the major microbe in the vagina?

A

lactobacillus

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20
Q

What is the function of lactobacillus in the vagina?

A

1) glycogen –> lactic acid

2) bactericidal H2O2 release

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21
Q

What enzymes are present in the mucus?

A

proteases & peptidases

22
Q

How does permeability vary along the vaginal cavity?

A

orifice end has larger permeability coefficient

23
Q

What is the effect of menses on absorption?

A

1) changed diffusion path
2) 40% increase in permeability for hydrophilic molecules
3) 3-fold increase for lipophilic molecules

24
Q

What is the mucus diffusion time for negative particles?

A

1.7 h

25
Q

What is the mucus diffusion time for positive particles?

A

7 hours

26
Q

How does mucus affect absorption?

A

significant barrier…negative charge

27
Q

How long does Paragard last?

A

10 years

28
Q

How long does Mirena last?

A

5 years

29
Q

What are the safety features in an IUD?

A

1) string

2) barium for x-ray

30
Q

What are the disadvantages of IUDs?

A

1) bleeding
2) cramping
3) insertion by trained provider

31
Q

What are the 3 types of vaginal rings, referring to drug delivery?

A

1) simple
2) sandwich
3) reservoir

32
Q

Describe the simple vaginal ring.

A

homogenous drug dispersion in a polymeric ring

33
Q

Describe the sandwich vaginal ring.

A

Drug is sandwiched between non-medicated core & the outer band

34
Q

Describe the reservoir vaginal ring.

A

Drug dispersed in central core, encapsulated by polymer

35
Q

What are the coatings for vaginal rings?

A

1) poly(dimethylsiloxane)
2) silicone
also ethylene vinyl acetate butadiene block copolymer in recent testing

36
Q

What are the advantages of vaginal rings?

A

1) good stability
2) good compliance
3) less likely to cause scarring

37
Q

How is the release rate modified in a vaginal ring?

A

1) drug core diameter

2) non-medicated coating thickness

38
Q

What is the only available vaginal film?

A

OTC spermicidal contraceptive (ineffective)

39
Q

Describe the release of a hydrogel for vaginal delivery?

A

1) dessicated polymer with trapped drug

2) hydration –> swelling –> drug escape

40
Q

What is the polymer used in hydrogels?

A

PEO-urethane

41
Q

Describe the 2 structures for pessaries?

A

1) drug-impregnated polyurethane sponge

2) polyurethane sponge covered by drug-polymer

42
Q

What are the 2 types of polyurethane sponges covered in drug/polymer?

A

Type 1: no RCM (poorly permeable drug)

Type 2: with RCM (permeable drug)

43
Q

What is the intended duration for Type 1 pessaries?

A

short-term

44
Q

What is the intended duration for Type 2 pessaries?

A

long-term

45
Q

What are common gelling agents?

A

1) hydrogels
2) polymers
- - starch
- - hydroxyethylcellulose
- - methylcellulose

46
Q

What is a gel?

A

semi-solid polymeric matrix comprising small amounts of solid dispersed in relatively large amount of liquid

47
Q

What are the advantages of a vaginal gel?

A

1) bioadhesive
2) acceptable
3) feasible
4) cheap

48
Q

What are the disadvantages of a vaginal gel?

A

1) messy, leaky

2) uncomfortable

49
Q

What are common bioadhesive agents?

A

1) carbomers
2) carbopols
3) chitosans
4) polycarbophils

50
Q

When are bioadhesives used for vaginal delivery?

A

1) barrier protection
2) Controlled Release
3) vaccines

51
Q

How do bioadhesives bio-adhere?

A

via cross-linking with mucous membrane

Drew 924 (16 decks)

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