Tackett 11-06-07 Estrogens (Sex Hormones)

Front 1

What inhibits FSH and LH (gonadotropin) release in a woman?

Back 1

Estrogens

Front 2

_____ cells of ovary release estrogen

Back 2

granulosa

Front 3

surge of what stimulates ovulation

a) LH
c) FSH
c) estrogen

Back 3

a) LH

Front 4

Why does ant pit stop making gonadotropins during cycle?

Back 4

corpus luteum makes estrogen and progesterone

Front 5

What are phyto-estrogens?

Back 5

plant estrogen
(used as dietary supplement or cream used to enlarge breasts)

Front 6

What is conjugation?

Back 6

conversion of compound to large bulky compoiund that is more water soluble and more easily excreted.

Front 7

Three Natural Human Estrogens

Back 7

17b estradiol (principal ovarian estrogen)
Estriol (principal placental estrogen)
Estrone (metabolite of 17b estradiol and major ovarian and postmenopausal estrogen)

Front 8

How are hormones transported to target tissues?

Back 8

complexed with proteins

Front 9

Estrogens are carried by ____

Back 9

sex hormone-binding globulin

Front 10

Progesterone is carried by _____

Back 10

corticosteroid-binding globulin

Front 11

Actions of Estrogens

Back 11

Reg of repro tract, pit and breasts during cycle

role in some tumor growth

Incr water and Na retention

Decr bowel motility

Front 12

Effects of Estrogen

Back 12

Incr fat depo in breasts, butt and thighs

Initiate breast development

Acc growth at puberty

Stims closure of epiphyses in the shafts of long bones

Stim synth and secretion of prolactin from pit

Incr cellular prolif of uterus in the absence of progesterone

Incr protein synth

Thickens vaginal mucosa and thinning of cervical mucus

Aids in maint of bone mass

Stims hepatic production of sex hormone-binding globulin, thyroid binding globulin, blood clotting factors

Front 13

Estrogen's effect on LDL formation

a) inhibits
b) stimulates
c) no effect

Back 13

a) inhibits

Front 14

Estrogen's effect on HDL production

a) inhibits
b) stimulates
c) no effect

Back 14

b) stimulates

Front 15

Estrogen's effect on blood clotting factors production

a) inhibits
b) stimulates
c) no effect

Back 15

b) stimulates

Front 16

What progestins have weak progestational activity?

Back 16

17a-, 20a-, and 20b-hydroxypro-gesterone

Front 17

Progesterone concentrations rise rapidly in ______ phase of menstrual cycle

Back 17

luteal

Front 18

Progesterone's effect on temperature during luteal phase of cycle

a) increases
b) decreases
c) no effect

Back 18

a) increases

Front 19

Progesterone's effect on HDL production

a) increases
b) decreases
c) no effect

Back 19

b) decreases

Front 20

Progesterone's effect on LDL production

a) increases
b) decreases
c) no effect

Back 20

a) increases

Front 21

Progesterone'e effect on Na and H2O retention?

a) increases
b) decreases
c) no effect

Back 21

b) decreases

Front 22

Progesterone's effect on endometrial lining?

a) maintains it
b) sloughs it
c) no effect

Back 22

a) maintains it

Front 23

Conditions calling for HRT with Estrogens and progesterone

Back 23

Menopause (estrogens, progestins)
Osteoporosis (estrogens, progestins)
Ovarian failure (estrogens, progestins)
Dysfunctional uterine bleeding (progestins,estrogens)
Luteal phase dysfunction (progestins)

Breast cancer (estrogens, progestins, antiestrogens, steroidogenesis inhibitors)
Endometrial cancer (progestins, antiestrogens
Prostate cancer (estrogens)

Endometriosis (danazol, progestins, GnRH)
Diagnostic (progestins)

Front 24

What is clomiphene citrate used for?

Back 24

Ovulation induction
Infertility

Front 25

Natural estrogens (3)

Back 25

Estradiol (most potent)
Estrone
Estriol

Front 26

Problems with administering natural estrogens

Back 26

Low oral potency
Poorly absorbed and rapidly inactivated by liver

Front 27

Conjugated Estrogens Prepared from pregnant mare’s urine (3)

Back 27

Estrogen
Equilin (found in horses but not humans)
Estrone

Front 28

Pluses to conjugated estrogens

Back 28

Water soluble with virtually no estrogenic activity until activated by hydrolyzation

Front 29

Synthetic Steroidal Estrogens

Back 29

Ethinyl estradiol
Mestranol (converted to ethnyl estradiol by liver)
Estropipate
Quinestrol

Front 30

Which estrogens are Used predominantly as oral contraceptives

Back 30

Synthetic Steroidal Estrogens

Front 31

Parenteral Synthetic Steroidal Estrogens

Back 31

Estradiol cypionate
Estradiol valerate
Polyestradiol phosphate

Front 32

Synthetic Non-Steroidal Estrogens

Back 32

Diethylstilbesterol
Chlorotrianisene
Dienestrol

Front 33

Progestins

(maybe disregard this card)

Back 33

Progesterone
17a-hydroxyprogesterone
Medroxyprogesterone acetate
Megestrol acetate
Hydroxyprogesterone caproate
Levonorgestrel
Norgestrel
Norethindrone
Norethindrone acetate
Norethynodrel
Ethynodiol diacetate

Front 34

Most effective reversible method

Back 34

Combination Oral Contraceptives

Front 35

Failure rate of combination oral contraceptives

Back 35

is less than 0.7 per 100 women

Front 36

Combination Oral Contraceptives

What is the estrogen and what is the progestin?

Back 36

Estrogen component is either ethinyl estradiol or mestranol (less potent)

Progestins include norethidrone, norethidrone acetate, ethynodiol diacetate, norgestrel or levonorgestrel

Front 37

What decreases the incidence of adverse side effects of combination oral contraceptives

Back 37

low dose estrogen

Front 38

Most common formulations consist of 21 days of combination with how many days off for withdrawal bleeding?

Back 38

7

Front 39

Oral Contraceptives: MOA

Progestin primarily suppresses a) LH
b) FSH
c) estrogen

Back 39

a) LH

(prevents menstruation)

Front 40

Oral Contraceptives: MOA

Estrogen suppreses
a) LH
b) FSH
c) progestin

Back 40

b) FSH

(prevents emergence of dominant follicle)

Front 41

Oral Contraceptives: MOA

What is estrogen's effect on endometrium?

Back 41

stabilizes

Front 42

Oral Contraceptives: MOA

What is estrogen's effect on progestin?

Back 42

postentiates the progestin action

Front 43

Oral Contraceptives: MOA

Progestin's effect on endometrium?

Back 43

makes endometrium not receptive to ovum implantation

Front 44

Oral Contraceptives: MOA

Which is the dominant hormone?

Back 44

progestin

(endomeetrial effect is profoudly "progestational")

Front 45

Combination Oral Contraceptives Prevent pregnancy by ___

Back 45

inhibiting ovulation

Front 46

Combination Oral Contraceptives

Early follicular phase FSH concentrations and midcycle peaks of FSH and LH are

a) observed
b) not observed

Back 46

b) not observed

Front 47

Combination Oral Contraceptives

The lower concentration of FSH results in

a) decreased ovarian function
b) increased ovarian function
c) decreased pituitary function
d) increased pituitary function

Back 47

a) decreased ovarian function

Front 48

Combination Oral Contraceptives

Missing how many doses during a cycle substantially increases risk of pregnancy?

Back 48

two or more

Front 49

Seems to me that
Combination Oral contraceptives prevent pregnancy in 3 general ways. What are they?

Back 49

1) inhibit follicle maturation
2) inhibits ovum implantation in endometrium
3) inhibits sperm penetration by making cervix thicker and more mucus-y

Front 50

Combination Oral Contraceptives:

They protect against ovarian cancer , but may cause what cancer?

Back 50

endometrial

(Controversial.. later slide says it reduces endometerial cancer)

Front 51

Combination Oral Contraceptives:

50% decrease in _____ breast disease

Back 51

fibrocystic

Front 52

21 active pills, 2 days placebo, 5 days of 10 mg ethinyl estradiol alone

a) Mircette
b) Seasonale
c) Ovcon
d) Yasmin

Back 52

a) Mircette

Front 53

a) Mircette
b) Seasonale
c) Ovcon
d) Yasmin

Back 53

d) Yasmin

Front 54

84 consecutive hormonal pills followed by 7 days placebo

a) Mircette
b) Seasonale
c) Ovcon
d) Yasmin

Back 54

b) Seasonale

Front 55

chewable pills (COC)

a) Mircette
b) Seasonale
c) Ovcon
d) Yasmin

Back 55

c) Ovcon

Front 56

Combination Oral Contraceptives - Side Effects

Risk of idiopathic venous thrombosis (2-6 fold greater)
is related to

a) combination
b) dose

Back 56

b) dose

Front 57

Combination Oral Contraceptives - Side Effects


Increased BP is related more to

a) progestin
b) estrogen
c) LH
d) FSH

Back 57

b) estrogen

Front 58

Combination Oral Contraceptives - Side Effects

Cervical cancer risk in some users (use greater than how many yrs?)

Back 58

5

Front 59

Combination Oral Contraceptives - Side Effects

Effect on milk production

a) increases
b) decreases

Back 59

b) decreases

Front 60

Combination Oral Contraceptives - Side Effects

Contraindicated in what conditions?

Back 60

History of thrombophlebitis
Coronary artery or cerebrovascular disease
Suspected pregnancy
Undiagnosed abnormal genital bleeding
Carcinoma of breast, cervix, uterus, vagina

Front 61

Problems with Progestin-Only Contraception

Back 61

Slightly higher failure rate (2-3 per 100 women-yrs)
Higher incidence of irregular bleeding
Suppresses FSH and LH to variable degrees

Front 62

Progestin-Only Contraception produces endometrial

a) hypertrophy
b) hypotrophy
c) atrophy

Back 62

c) atrophy

Front 63

Medroxyprogesterone is not approved in the USA b/c why?

Back 63

breast tumors in beagles

Front 64

Progestin-Only Contraception can be used in the USA for what conditions?

Back 64

treatment of advanced endometrial and renal carcinoma and endometriosis

Front 65

Side effects of Progestin-Only Contraception

Back 65

Breakthrough bleeding, spotting
Amenorrhea
Edema
Weight gain
Bloating
Mood changes
Decreased HDL and increased LDL

Front 66

Which Oral Contraceptive?

Endometriosis-

Back 66

need strong progestin to create a pseudo-pregnancy state

Front 67

Which Oral Contraceptive?

Functional ovarian cysts

Back 67

high dose monophasic pill may be more effective

Front 68

Which Oral Contraceptive?

Androgen excess

Back 68

high estrogen/progestin ratio to reduce free testosterone and inhibit 5 alpha reductase activity

Front 69

Which Oral Contraceptive?

Breastfeeding

Back 69

progestin only pill

Front 70

Transdermal: what's it called?

Back 70

Ortho Evra

Front 71

What's in Ortho Evra?

Back 71

Delivers 20 mcg ethinyl estradiol and 150 mcg on norelgestromin daily

Front 72

What's NuvaRing?

Back 72

Vaginal contraceptive ring

Front 73

What's in NuvaRing?

Back 73

15 mcg ethinyl estradiol and 120 mcg of desogestrel

Front 74

What's the failure rate of Nuva Ring?

Back 74

Failure rate of typical use: 8%

Front 75

What's Depo Provera?

Back 75

150 mg IM q 3 months

Front 76

how long does Depo Provera last?

Back 76

Contraceptive level maintained for 14 weeks

Front 77

What is mechanism of DepoProvera?

Back 77

Thickens cervical mucous
Blocks LH surge
Initiate treatment during first week of menses

Front 78

Advantages of Depo Provera

Back 78

Long acting
Estrogen-free
Safe during breast feeding
Increases milk quality

Front 79

Disadvantages of Depo Provera

Back 79

Irregular bleeding (70% in first year)
Breast tenderness
Weight gain
Depression
Slow return of menses after stopping use
Decreases HDL

Front 80

Postcoital Contraception must be given in what time frame?

Back 80

72 hours

Front 81

How does pstcoital contraception work

Back 81

Endometrium is made nonreceptive to implantation by high dose of hormone

Front 82

Contragestation:

Give example,
How does it work,
what are side effects?

Back 82

Mifepristone (RU 486)
Synthetic potent antiprogestin
Binds to progesterone receptor
Well tolerated
Occasional prolonged uterine bleeding

Front 83

________ acts as an antiestrogen at the hypothalamus to increase pulse frequency of LH

Back 83

Clomiphene

Front 84

Endometriosis results from what?

Back 84

ectopic endometrial cell implants outside the uterus

Front 85

Goal of therapy for endoetriosis

Back 85

to induce a hormone-poor environment (especially low estrogen) to inhibit growth of implants

Front 86

Agents used to treat endometriosis include

Back 86

Danazol
Progestins
Gonadotropin-releasing hormone or analogs

Front 87

What does Danazol do?

Back 87

Inhibits either LH/FSH surge

Produces amenorrhea and relief of pain without decreasing basal concentrations of gonadotropins or estrogen

Front 88

What's Tamoxifen?

Back 88

therapy that reduces estrogen


Antiestrogen