Pharm Reproduction PP – Flashcards

Sexual maturation Ovulation Development and maintenance of female accessory organs Cell division in breasts and endometrium Maintaining skin and blood vessels Decreasing bone resorption Increased HDL levels, decreased LDL and cholesterol Moving fluid into tissues

Maintaining pregnancy Breast and endometrium development Maturation of endometrium cells Increased body temperature Smooth muscle relaxation

because estrogen stimulated division of the endometrial cells, and dividing cells are more likely to undergo mutation and become malignant. Progesterone stimulates maturation of the endometrial cells into a less rapidly dividing form.

Bartholin's abscess is the build-up of pus that forms a lump in one of the Bartholin's glands. . Fluid in the gland builds up and may become infected. The infection is usually not caused by a sexually transmitted disease (STD). However, many types of bacteria associated with STDs, such as gonorrhea, can lead to infection. Often the abscess appears and become very hot and swollen within 2 or 3 days. Any activity that puts pressure against the vulva, even walking and sitting, may cause excruciating pain.

postmenopausal atrophy and thickening of vulvular tissues

inflammation of the vulva. Most common causes: sensitivity to hormonal changes and allergic responses to feminine hygiene sprays, fabric dyes, soaps & detergents used to wash clothes

in younger women related to HPV; in older women lesions cause itching and repeated injury usually precede carcinomas- healing cells are more likel to mutate

Vaginitis-occurs with disturbance of flora Many different species of bacteria Dominated by species that produce lactic acid Vaginal pH 3.8-4.2 Protect against infections Normal flora can be disrupted by: Abnormal estrogen levels Antibiotics

grade I least severe—uterus bulges into vagina but cervix doesn't protrude through vaginal opening, grade II uterus bulges into vagina and cervix slightly through entrance to vagina, grade III, cervix protrudes through vaginal opening to the extent the vagina is turned inside out.

How did the tissue get there? Up through the fallopian tubes (retrograde menstruation) Activation of dormant cells that were always there The ectopic implants respond to hormones Go through menstrual cycle During menstrual period, tissue dies and bleeds Pain and adhesions result

Pain in sacral area Painful defecation infertility

Most common form of pelvic tumor-found in the smooth muscle of the uterus Exact cause unknown, may suppress tumors with GnRH tx The growth of a fibroid seems to depend on estrogen; many fibroids regress with menopause Risk factors/Predispositions: Age: Increased occurrence with age > 35 Race: more common among in black women than Caucasians Approx. 50% asymptomatic When S/S do occur: Menorrhagia (excessive bleeding) which leads to Anemia Rectal pressure from tumor further leads to Constipation & Urinary frequency & Abdominal distention

Associated with family history of ovarian and breast cancer Causes vague GI symptoms Up to 75% of cases have metastasized by the time they are discovered No specific screening tests available The most common signs & symptoms are are: bloating pelvic or abdominal pain trouble eating or feeling full quickly urinary symptoms, such as urgent or frequent feelings of needing to go Irregular vaginal bleeding

Women who have never given birth or had children late in life Certain genes (breast cancer genes-BRCA1 and BRCA2) are responsible for a small number of ovarian cancer cases. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer. Older women are at highest risk. About two-thirds of the deaths from ovarian cancer occur in women age 55 and older. About 25% of ovarian cancer deaths occur in women between 35 and 54 years of age.

Primary amenorrhea is failure to menstruate by age 16, or age 14 if acompanied by lack of secondary sex characteristics Etiologies-lack of gonadal development, lack of hypothalmic or pituitary or gonadal hormone secretion Secondary amenorrhea is lack of periods for 6 or more months in a woman who has already started menstruation and who is not pregnant, lactating, or in menopause. Etiologies-endometriosis, fibroids, pelvic adhesions, pelvic inflammatory disease

Decreased ovary function Low estrogen Osteoporosis risk Atherosclerosis risk Less inhibition of pituitary Increased FSH and LH Hot flashes negative feedback inhibits FSH release

Occurs between ages of 48-55 Results from gradual cessation of ovarian function including decreased levels of estrogen (review slide 3 for estrogen's functions in body -note non-reproductive role) Estrogen also comes from adrenal cortex but not in sufficient amounts to maintain all of estrogen functions Perimenopause- years surrounding menopause. Begins approximately 4 years prior to menopause. Characterized by menopausal symptoms & menstrual irregularity

Urogenital Disorders resulting from estrogen loss: Vaginal dryness &/or Vaginitis Urinary stress incontinence &/or tract infections (UTIs) s/s resulting from loss of ovarian estrogen: Decreased body hair, breast tissue, skin elasticity, SQ fat Ovaries and uterus decrease in size Vaginal tissues become pale and more fragile Weakening of pelvic organ support tissue Osteoporosis Increased risk of cardiovascular disease

Cancer develops when cells mutate and are not repaired BRCA1 and BRCA2 genes code for proteins that help repair DNA after it has mutated Mutation of BRCA1 or BRCA2 make cancer more likely In a cancer, cells continue dividing too fast Estrogen and other growth factors make breast cells divide Breast cells with too many estrogen or growth factor receptors are more likely to become cancerous

Estrogen Receptors (ER) — Studies have shown that estrogen often regulates the growth of breast cancer. Knowledge of whether a tumor is positive or negative for the presence of estrogen receptors is used for prognosis and patient selection for anti-hormonal therapy. Progesterone Receptors (PR) — To help predict the response to hormonal therapy, the presence of the estrogen-regulated progesterone receptor is now determined routinely. HER2 — Detects overproduction of HER2 protein and/or gene amplification, both of which contribute to aggressive growth of the cancer and its spread to other parts of the body. BRCA1 and BRCA2 (short for breast cancer 1 and breast cancer 2) genes code for proteins that help repair DNA after it has mutated

BRCA1 and BRCA2--Inherited alterations in these genes are indicated in hereditary cases of breast and ovarian cancer estimates of lifetime risk show about 13.2 percent of women in the general population will develop breast cancer, compared with estimates of 36 to 85 percent of women with an altered BRCA1 or BRCA2 gene. estimates of lifetime risk for ovarian cancer for women in the general population indicate that 1.7 percent will get ovarian cancer, compared with 16 to 60 percent of women with altered BRCA1 or BRCA2 genes The likelihood that breast and/or ovarian cancer is associated with BRCA1 or BRCA2 is highest in families with a history of multiple cases of breast cancer, cases of both breast and ovarian cancer, one or more family members with two primary cancers or an Ashkenazi (Eastern European) Jewish background. Men with an altered BRCA1 or BRCA2 gene also have an increased risk of breast cancer (primarily if the alteration is in BRCA2), and possibly prostate cancer

Surveillance- mammograms and breast exam (self and health care providers) ; For ovarian cancer, surveillance methods may include transvaginal ultrasound, CA-125 blood testing, and clinical exams Risk Avoidance—exercising regularly and limiting alcohol consumption (Research results on the benefits in the general population; the effects of these actions in people with BRCA1 or BRCA2 alterations are not yet known.) Chemoprevention-Few studies have been performed to test the effectiveness of tamoxifen in women with a BRCA1 or BRCA2 alteration. One study found that tamoxifen reduced incidence of breast cancer by 62 percent in women w/BRCA2 alterations Results showed no reduction in breast cancer incidence with tamoxifen use among women with BRCA1 alterations. Prophylactic surgery -remove tissue at risk

Studies show that approximately 25% of breast cancer patients have tumors that are HER2+. HER2 stands for Human Epidermal growth factor Receptor 2 In normal cells, HER2 proteins help send growth signals from outside the cell to the inside of the cell. These signals tell the cell to grow and divide. (see next slide) In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression.

Actions Protects the heart from atherosclerosis Retains calcium in the bones Maintains the secondary female sex characteristics Indications Hormone replacement therapy (HRT) Palliative and preventive therapy during menopause-controversial Contraindications Allergies and pregnancy Idiopathic vaginal bleeding, breast cancer, estrogen-dependent cancer, and thromboembolic disorders Caution: no smoking with estrogen use. Estrogen and nicotine increase risk for development of thrombi & emboli Adverse effects GU tract-breakthrough bleeding, dysmenorrhea, anemorrhea, libido changes Systemic effects of estrogens-fluid retention Drug-to-drug/drug-to-food interactions Drugs increasing hepatic metabolism decrease estrogens effect (ex: tetracyline) Corticosteroids-increased effect of these drugs with estrogen Grapefruit juice inhibits metabolism of estradiols CNS drugs-phenytoin & barbituates antibiotics such as tetracyclines, rifampin

Actions Modulating effects on estrogen receptors Used to stimulate specific estrogen receptors to increase bone mineral density Indication Postmenopausal osteoporosis Contraindications Patients with history of venous thrombosis and smoking Adverse effects GI upset Changes in fluid balance: headache, dizziness, and visual changes Estrogen receptor stimulation: hot flashes, skin rash, edema, and vaginal bleeding Drug-to-drug interactions Cholestyramine-reduces absorption of ERM Highly protein-bound drugs-(valium, ibuprofen, naproxen to name a few) interfere with binding sites Warfarin-reduced effectiveness of warfarin

Administer with food to decrease GI upset Monitor liver function tests Monitor PT if warfarin therapy used with ERM Monitor for bleeding & menstrual irregularities Provide thorough client education on HRT! HRT is also known at menopausal hormone therapy (MHT)

Early research in Women's Health Initiative showed replacement of estrogen slightly increased risk of breast and cervical cancer HRT 5 years increased: CV disease, stroke, blood clot formation, gallstones and ovarian Ca. Current recommendation: careful consideration of risks vs benefits. Some women may benefit from HRT if used < 5 yrs

Herbal therapy used to ease menopausal symptoms. Studies often conflict in findings regarding efficacy. Karch outlines potential complications in Box 40.4 pg 635: Herbs used for sleep disturbances & mood symptoms ginseng Herbals used to relieve hot flashes and night sweats Black cohosh red clover Flaxseed dong quai Soy

Actions Transform the proliferative endometrium into a secretory endometrium-pregnancy will not occur Inhibit the secretion of FSH and LH Prevent follicle maturation and ovulation Inhibit uterine contractions Indications Contraception Treatment of primary and secondary amenorrhea Fertility protocols Contraindications idiopathic vaginal bleeding, breast or genital cancer, history of thromboembolic disorders, PID, sexually transmitted disease, endometriosis, and pelvic surgery Adverse effects Vary based on route of administration-generally include CV risks for all routes Drug-to-drug interactions Barbiturates, phenytoin, and rifampin decrease effect of progestins

Action Directly increase—or by stimulating the hypothalamus increase—FSH and LH levels which leads to ovarian follicular development and maturation of ova Indication Infertility in men and women Contraindications Primary ovarian failure Thyroid or adrenal dysfunction Ovarian cysts Pregnancy, idiopathic uterine bleeding, known allergy Caution Breast feeding, thromboembolic disease, and respiratory disease Adverse effects Increased risk of multiple births and birth defects Ovarian overstimulation Headache, fluid retention, nausea, and bloating Uterine bleeding and ovarian enlargement Gynecomastia

high fat diet; family hx-both autosomal chromosomes and the X chromosome have genes that have been linked to possible inheritance risk; race: Africaln americans > caucasions > asians; red meat consumption Japanese American men >native Japanese men; heavy metal exposure, STDs, vasectomy

normal is 4ng/mL Elevations & digital rectal exam for screening and diagnosis; BPH can increase PSA slightly; PSA levels slightly higher in older males

tumors spread to the bladder neck; arise from the urothelial lining of the prostatic urethra

asymptomatic in early stages; overdistended bladder due to outlet obstruction; urgency; nocturia; frequency (may resemble BPH symptoms); hematuria; metastasis: bone pain, fractures, lower extremity lymphedema, supraclavicular adenopathy, lower extremity deep vein thrombosis, cancer cachexia

monitor liver tests and skin for jaundice; monitor for s/s HF, LDL, HDL; illegal use anabolic steroids-cardiomyopathy, hepatic cancer, personality changes and sexual dysfunction

warfarin, glucocorticoids and oral hypoglycemics- androgens increase the medication levels: monitor for bleeding, hypoglycemia and s/s infection

oxandrolone: promotes weight gain in debilitated patients, increases protein anabolism, treats certain cancers. Oxymetholone: treats various anemias. Stanozolol: treats hereditary angioedema

testosterone: hypogonadism-breast cancer. Danazol: blocks the release of FSH and LH in women. Fluoxymesterone: hypogonadism-breast cancer. Testolactone: breast cancers

erectile dysfunction: nitroglycerin can lead to fatal hypotension. CV cautions: coronary artery disease, hypotension. Main bleeding cautions: active peptic ulcer and other chronic bleeding tendencies