Introduction to the Reproductive System and Pharmacology

What hormones do both male and female reproductive systems respond to?

Leutinizing hormone (LH) and follicle stimulating hormone (FSH)

What is the role of LH in the male reproductive system?

LH stimulates Leydig cells to produce testosterone.

What is the role of FSH and testosterone in the male reproductive system?

They stimulate seminiferous tubules to produce sperm.

What are the primary functions of the female ovary?

Store ova and produce the sex hormones estrogen and progesterone.

What are the three types of estrogens produced by the ovaries?

Estradiol, Estriol, and Estrone.

What is the role of progesterone in the female reproductive system?

Released into circulation after ovulation, it supports early development of the fetus.

What effects does estrogen have on the body?

Wider hips, increased skin elasticity, development of secondary sex characteristics, breast growth, increased lipids, buildup of uterine lining, and increased uterine motility.

What effects does progesterone have on the body?

Decreased uterine motility, thickened cervical mucus, breast growth, increased temperature, and increased appetite.

What initiates the release of FSH and LH at puberty?

The hypothalamus starts to release GnRH.

What is the significance of the LH surge during the menstrual cycle?

It triggers ovulation.

What happens to the corpus luteum if fertilization does not occur?

It involutes and levels of estrogen and progesterone drop off.

What triggers the start of a new menstrual cycle?

Dropping levels of estrogen and progesterone trigger the release of GnRH, followed by FSH and LH.

What is the role of Human Chorionic Gonadotropin (hCG) during pregnancy?

It causes the corpus luteum to continue to secrete estrogen and progesterone.

What factors can affect the control mechanisms of the female reproductive system?

Stress, starvation, extreme exercise, emotions, and increased light.

How does the menstrual cycle begin?

With the release of FSH and LH and stimulation of ovarian follicles.

What happens to estrogen levels during the first half of the menstrual cycle?

Estrogen levels rise as developing follicles release estrogen.

What is the role of prostaglandins in the uterus?

They cause clamping down (cramps) during menstruation.

What occurs after the ovum is fertilized?

A new cell is produced that divides to form the embryo, which implants on the wall of the uterus.

What is the interface between fetal cells and the uterus called?

The placenta.

What is the effect of increased light on FSH and LH release?

It boosts the release of FSH and LH, contributing to early sexual maturation.

What is the role of the anterior pituitary in the female reproductive system?

It releases FSH and LH under the direction of GnRH from the hypothalamus.

What is the effect of androgens from the adrenal gland in childhood?

They exceed female hormones.

What is the primary function of the placenta during pregnancy?

The placenta acts as an endocrine gland and transport system.

What is the first hormone surge during pregnancy?

Human chorionic gonadotropin (HCG).

Which hormones does the placenta secrete?

Estrogen and progesterone.

What hormones stimulate contractions during labor?

Oxytocin and prostaglandins.

How long does it take for the effects of pregnancy hormones to end after delivery?

6 to 8 weeks.

What physiological changes do estrogen and progesterone cause during pregnancy?

Elevated body temperature, development of the cervical plug, growth of female accessory structures, softening of ligaments, elevated blood glucose and cholesterol levels, and impaired immune responses.

What factors stimulate labor and strong uterine contractions?

Stretch of uterine muscles and cervix, fetal hormonal secretions, and increased release of oxytocin.

What happens to estrogen and progesterone levels after the fetus and placenta are expelled?

They plummet.

What hormone promotes milk secretion postpartum?

Prolactin.

What is the role of oxytocin in lactation?

It allows milk to flow.

What occurs in the ovaries during menopause?

Ovarian follicles stop producing estrogen and progesterone.

What hormones increase in the hypothalamus and pituitary during menopause?

GnRH, FSH, and LH.

What are some effects of testosterone on the male body?

Growth of primary and secondary sex organs, thickening of vocal cords, hair growth, increased muscle mass, and vascular thickening.

How does GnRH affect testosterone production?

GnRH stimulates the release of FSH and LH, which in turn stimulate Leydig cells to produce testosterone.

What is the role of inhibin in male reproductive health?

It provides negative feedback to the pituitary to decrease FSH and sperm production.

What is andropause?

A gradual decrease in testosterone levels and sexual activity with age.

What hormonal changes occur in the body during andropause?

Increased production of GnRH, FSH, and LH in an attempt to stimulate hormone production.

What is the human sexual response cycle?

It includes four phases: excitement, plateau, orgasm, and resolution.

What physiological changes occur during the orgasm phase of the sexual response?

Massive sympathetic stimulation leading to increased heart rate and blood pressure.

What happens during the resolution phase of the sexual response?

Relaxation of muscles and reduction of blood flow to the genitals.

How do drugs affecting the sympathetic nervous system influence sexual response?

They may alter the sexual response.

What role do both estrogen and testosterone play in the human reproductive cycle?

They are crucial for the development and regulation of reproductive functions.

What is the significance of sunlight in relation to male hormone levels?

Sunlight influences male hormone levels.

What is the effect of testosterone on protein metabolism?

It increases protein anabolism and decreases protein catabolism.

What are the pharmacologic interventions for female reproductive medications?

Replace missing hormones, act on control mechanisms to decrease release of endogenous hormones, hormone replacement therapy, contraceptives, infertility treatments, induction of labor, and inhibition of labor.

What are the indications for estrogen therapy?

Ovarian failure, hormone replacement therapy (HRT), palliative and preventive therapy during menopause, prevention of postpartum breast engorgement, combination contraception, slowing bone loss from osteoporosis, competing with androgens for receptor sites, and protecting the heart from atherosclerosis.

What are the contraindications for estrogen therapy?

Allergies and pregnancy, undiagnosed vaginal bleeding, breast cancer, thromboembolic disorders, heavy smoking, hepatic-renal disorders, and caution in metabolic bone disease, renal insufficiency, and hepatic impairment.

What are some common adverse effects of estrogen?

Breakthrough bleeding, dysmenorrhea, amenorrhea, fluid retention, weight gain, headache, abdominal cramps, pancreatitis, jaundice, and hepatic adenoma.

What are the indications for progestins?

Contraception, amenorrhea, functional uterine bleeding, fertility treatment, postcoital emergency contraception, inhibiting secretion of FSH and LH, and inhibiting uterine contractions.

What are the contraindications for progestins?

Similar to those for estrogens, endometriosis or pelvic surgery, and drospirenone carries a risk for hyperkalemia.

What are the cautions associated with progestins?

Epilepsy, migraine headaches, asthma, and cardiac or renal dysfunction.

What are some common adverse effects of progestins?

Varies based on route of administration, headache, breast enlargement, and perineal pain.

What are the therapeutic uses of estrogen and progesterone?

Prevention of pregnancy, improvement of acne, treatment of dysfunctional uterine bleeding, primary dysmenorrhea, iron deficiency anemia, alleviation of menopause symptoms, improvement of bone mineral density, treatment of some neoplasms, and decreased risk of colorectal, ovarian, and endometrial cancer.

What is the typical regimen for oral contraceptives?

Begin regimen on day 5 of the cycle, continue for 21 days, then take 7 days of placebo.

What are the different types of oral contraceptives?

Monophasic, biphasic, and triphasic preparations, with some combining estrogen and progestin and others containing only progestin.

What are some uses of oral contraceptives beyond pregnancy prevention?

Treatment for acne, endometriosis, hypermenorrhea, and dysfunctional uterine bleeding.

What are the contraindications for oral contraceptives?

Thromboembolic disorders, stroke, coronary artery disease, hepatic tumors, breast carcinoma, endometrial carcinoma, other estrogen-dependent tumors, and pregnancy.

What drug interactions should be considered with oral contraceptives?

Antibiotics, barbiturates, and anticonvulsants.

What are the different forms of contraception available?

Injectables (e.g., Depo-Provera), intrauterine devices (e.g., Mirena), transdermal patches (e.g., Ortho Evra), vaginal rings (e.g., NuvaRing), and subdermal implants (e.g., Implanon).

What should be done if a dose of oral contraceptive is missed?

If one tablet is missed, take it as soon as possible or take two the next day. If two days are missed, take two tablets daily for two days, then resume. If three days are missed, begin a new cycle of tablets 7 days after the last tablet taken and use alternative contraception.

What is the purpose of post-coital emergency contraception?

To prevent pregnancy after unprotected intercourse, with options like Plan B (available OTC) and Ulipristal (prescription), starting within 72 hours.

What are the signs and symptoms of hormone replacement therapy (HRT) side effects?

Vaginal drying, hot flashes, moodiness, loss of bone density, and increased risk of cardiovascular disease.

What is the role of testosterone in the body?

Results in thickening of cartilage and skin, vascular thickening, and increased hematocrit.

What is the significance of increased hematocrit in relation to testosterone?

It indicates a potential increase in red blood cell production, which can affect blood viscosity and cardiovascular health.

What are the potential systemic effects of estrogens?

Fluid retention, weight gain, headache, abdominal cramps, pancreatitis, jaundice, and hepatic adenoma.

What are the prototype drugs for estrogens and progestins?

Estrogens include norethindrone, drospirenone (Yasmin), etonogestrel (Implanon), levonorgestrel (Mirena), medroxyprogesterone (Provera), and ulipristal (Ella).

What are some associated risks of estrogen receptor modulators?

Increased risk of breast and cervical cancer, heart disease, and stroke.

What is the effect of newer drugs on breast and cervical cancer risk?

They only increase the risk in short-term use.

What are the therapeutic actions of estrogen receptor modulators?

They affect specific estrogen receptor sites, stimulating some and blocking others.

How does Raloxifene function as an estrogen receptor modulator?

Acts as an estrogen agonist in the bone and as an antagonist in uterine and breast tissue.

What is an indication for the use of Raloxifene (Evista)?

Treatment and prevention of postmenopausal osteoporosis and reduction of risk of breast cancer.

What precautions should be taken when using estrogen receptor modulators?

Caution for those with previous thromboembolism and those who smoke.

What are some adverse effects of estrogen receptor modulators?

Venous thromboembolism, vaginal bleeding, changes in fluid balance, ophthalmic changes, hot flashes, skin rash, edema.

What should be monitored in patients receiving estrogen receptor modulators?

Monitor for swelling, changes in vision, venous thromboembolism (VTE), liver function, and conduct annual pelvic exams, Pap smears, and breast exams.

What is a potential serious risk associated with estrogen receptor modulators in postmenopausal individuals?

Possible increased risk of death due to stroke in those with coronary heart disease or risk factors for coronary events.

What is a nursing consideration for patients receiving estrogen receptor modulators?

Strongly urge patients to stop smoking to reduce the risk of VTE.

What changes may occur in vision due to estrogen receptor modulators?

Fluid in the eye and curvature of the corneas, which may change the fit of contact lenses.

What symptoms may indicate estrogen receptor stimulation?

Hot flashes, skin rash, edema, and vaginal bleeding.

What should patients be taught regarding missed doses of estrogen receptor modulators?

Teach steps to take if a dose is missed.

What is the rationale for using estrogen receptor modulators in postmenopausal women?

To treat and prevent postmenopausal osteoporosis and reduce breast cancer risk.

What is the primary indication for estrogen receptor modulators?

Postmenopausal osteoporosis.

What are the changes in fluid balance associated with estrogen receptor modulators?

Headache, dizziness, and mental changes.

What is the role of estrogen receptor modulators in breast cancer risk?

They have antiestrogen effects on breast tissue, which decreases cancer risk.

What is the relationship between estrogen receptor modulators and cardiovascular disease?

If used for more than 5 years, there is an increased risk of cardiovascular disease and stroke.

What should be monitored annually for patients on estrogen receptor modulators?

Annual pelvic exam, Pap smear, and breast exam.

What is the effect of estrogen receptor modulators on thromboembolism?

They can increase the risk of venous thromboembolism.

What is defined as the inability to become pregnant after 1 year of frequent, unprotected intercourse?

Female infertility.

What percentage of couples are affected by female infertility?

25%.

What percentage of infertility cases are related to female factors?

60%.

Name two causes of female infertility related to physical conditions.

Pelvic infections and physical obstruction of fallopian tubes.

What are some hormonal origins of female infertility?

Hypothalamus, pituitary, and ovarian origin.

What is the primary fertility drug used to treat lack of leutinizing hormone?

Clomiphene (Clomid).

What is the function of Cetrorelix (Cetrotide) in fertility treatment?

Suppresses ovulation until follicles mature.

How does Chorionic gonadotropin (HCG) assist in fertility treatments?

It mimics the leutinizing surge causing ovulation.

What is Menotropin (Pergonal) used for in fertility treatments?

To stimulate ovulation and spermatogenesis.

What are the contraindications for using fertility drugs?

Primary ovarian failure, ovarian cysts, pregnancy, idiopathic uterine bleeding, and known allergy.

What caution should be taken when administering fertility drugs?

Caution in patients with thromboembolic disease, breast or chest feeding, and respiratory disease.

What are some adverse effects of fertility drugs?

Increased risk of multiple births and birth defects, ovarian overstimulation, headache, fluid retention, nausea, bloating, uterine bleeding, and gynecomastia.