-
Estrogens (DES, ethinyl estradiol, mestranol)
Used for hypogonadism/ovarian fail, menstrual abnormalities, men w/androgen-dependent prostate cancer (just like you use testosterone for women w/estrogen-receptor-pos breast cancer!). SE's: endometrial cancer, post-menopausal bleeding, clear cell adenocarcinoma of vagina in female fetuses exposed to DES, inc'd thrombus risk, ER-positive breast cancer.
-
Progestins
OC's, treat endometrial cancer/abnormal bleeding
-
SERMs: Clomiphene
Estrogen partial agonists. Clomiphene = opposite of OC's: inc'd release of FSH & LH from pituitary. Tx: polycystic ovarian syndrome (b/c that condition has high LH, but not FSH, so hirsutism -- you aren't making any estrogen, too much testosterone!). SE's: hot flashes, visual disturbances, multiple simultaneous pregnancies, enlarged ovaries.
-
Finasteride
5-alpha reductase inhibitor --> dec'd DHT. Used for male-pattern baldness & BPH.
-
Flutamide
Testosterone receptor antagonist (competitive). Tx of prostate cancer -- could also give estrogen for androgen-dependent prostate cancer.
-
Tamoxifen
SERM -- antagonizes ER's on breast tissue (for ER-pos breast cancer)
-
Ketoconazole & spironolactone
Ketoconazole inhibits steroid synthesis (i.e. inhibits CYP450 making testosterone & androstenedione). Spironolactone inhibits steroid binding to its receptor, including aldosterone. Used for polycystic ovarian syndrome, so the woman doesn't develop hirsutism (her high LH but lack of FSH is causing her to pump out lots of testosterone). SE's: gynecomastia, amenorrhea.
-
Raloxifene
SERM -- agonist on bone's ER's --> dec'd resorption, to treat osteoporosis. (Because estrogen is good for bone.)
-
Leuprolide
Pulses: GnRH agonist (to treat infertility). Constant: GnRH antagonist (prostate cancer). Also used for uterine fibroids. SE's: nausea, vom, anti-androgen.
-
Sildenafil, vardenafil
Fill the penis (inc cGMP --> vasodilation). Used for ED. SE's: life-threatening hypotension if taken w/nitrates; impaired blue-green color vision; HA.
-
Mifepristone (RU-486)
Abortion drug -- competitively inhibits progestins. SE's: GI (nausea, vom, anorexia), heavy bleeding & pain.
-
OC's
Dec risk of endometrial & ovarian cancer, plus pelvic infections. Bad: Inc triglycerides, HTN, hypercoagulability, depression, weight gain, nausea. Histo: endometrium stroma is decidualized, but glands are inactive.
-
Dinoprostone
Induce labor -- prostaglandin E2 analog. Cervical dilation & uterine contractions.
-
Ritodrine/terbutaline
Inhibit premature labor contractions: B2 agonists that relax uterus.
-
Anastrozole/exemestane
Aromatase inhibitors: for post-menopausal women w/breast cancer (you don't need any more estrogen!)
-
Testosterone
Obv, it's an agonist at androgen receptors. Used for hypogonadism, stimulation of anabolism (rebuilding) after burn/injury; tx of estrogen-receptor-positive breast cancer. SE's: masculinization in females, gonadal atrophy in males (b/c Leydig cells inhibited). Inc'd LDL & dec'd HDL.
-
Leiomyoscarcoma
Aggressive, only 40% 5-year survival. Higher incidence in blacks just like leiomyoma (benign fibroids), but 1 doesn't progress into the other.
-
GYN tumors: most common & most deadly
Common = endometrial; deadly = ovarian.
-
Chlamydia: the bacterial stains that work
It's intracellular, so no Gram stain. Use Giemsa, iodine, or fluorescent Ab's.
-
Placenta accreta
Placenta invades myometrium, so lots of bleeding after delivery. Previous C-section predisposes.
-
Placenta previa
Placenta attaches low in uterus, maybe covering os. Previous C-section predisposes. Painless 3rd-trimester bleed.
-
Abruptio placentae
Painful 3rd-trimester bleed. Smoking, HTN, cocaine. Assoc with DIC. Fetal death.
-
Vaginal clear-cell adenocarcinoma
Young girls; associated with DES exposure in utero
-
Draining of left vs. right ovary/testis
- Right goes right into the IVC: Right gonadal vein --> IVC
- Left side: Left gonadal vein --> left renal vein --> IVC
-
Sarcoma botryoides
Girls <4, grapefruit-like mass protruding through vagina. Desmin-positive tumor cells, spindle-shaped.
-
Ovary & testis drain into which lymph nodes?
Para-aortic
-
Cardinal ligament (transverse cervical)
Connects cervix to side wall of pelvis
-
Round ligament
Connects uterus to labia majora
-
Suspensory ligament
Connects ovaries to lateral pelvic wall
-
Type of epithelium in: Ovary, fallopian tube, uterus, cervix, vagina
- Ovary = simple cuboidal
- fallopian = simple columnar (w/Peg cells to secrete nutrients)
- uterus = simple columnar (pseudostratified)
- cervix = endo is simple columnar, ecto is stratified squamous
- vagina = stratified squamous, non-keratinized
-
Nerves responsible for erection, emission, & ejaculation
- Erection = parasympathetic (pelvic nerve)
- Emission = sympathetic (hypogastric nerve)
- Ejaculation = pudendal nerve
- Point & Shoot.
-
Epididymis
Storage. If dilated duct: spermatocele. Secretes carnitine & acetylcarnitine into seminal fluid.
-
Vas deferens
First place where sperm are motile (they make forward motility factor). Seminal & prostate fluid released into vas deferens.
-
Contents of prostatic fluid
Acidic (citric acid), proteolytic enzymes, zinc (stabilize sperm chromatin)
-
Contents of bulbourethral (Cowper's) glands
Alkaline fluid
-
Contents of seminal vesicles' seminal fluid
Fructose & prostaglandins
-
Kallmann syndrome
Low GnRH --> low FSH & LH --> low testosterone
-
Which cancer genes do HPV 16 & 18 affect?
These viruses produce proteins to inactivate p53 & Rb tumor suppressors
|
|