ReproDrugs and More

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.

OC's, treat endometrial cancer/abnormal bleeding

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.

5-alpha reductase inhibitor --> dec'd DHT. Used for male-pattern baldness & BPH.

Testosterone receptor antagonist (competitive). Tx of prostate cancer -- could also give estrogen for androgen-dependent prostate cancer.

SERM -- antagonizes ER's on breast tissue (for ER-pos breast cancer)

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.

SERM -- agonist on bone's ER's --> dec'd resorption, to treat osteoporosis. (Because estrogen is good for bone.)

Pulses: GnRH agonist (to treat infertility). Constant: GnRH antagonist (prostate cancer). Also used for uterine fibroids. SE's: nausea, vom, anti-androgen.

Fill the penis (inc cGMP --> vasodilation). Used for ED. SE's: life-threatening hypotension if taken w/nitrates; impaired blue-green color vision; HA.

Abortion drug -- competitively inhibits progestins. SE's: GI (nausea, vom, anorexia), heavy bleeding & pain.

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.

Induce labor -- prostaglandin E2 analog. Cervical dilation & uterine contractions.

Inhibit premature labor contractions: B2 agonists that relax uterus.

Aromatase inhibitors: for post-menopausal women w/breast cancer (you don't need any more estrogen!)

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.

Aggressive, only 40% 5-year survival. Higher incidence in blacks just like leiomyoma (benign fibroids), but 1 doesn't progress into the other.

Common = endometrial; deadly = ovarian.

It's intracellular, so no Gram stain. Use Giemsa, iodine, or fluorescent Ab's.

Placenta invades myometrium, so lots of bleeding after delivery. Previous C-section predisposes.

Placenta attaches low in uterus, maybe covering os. Previous C-section predisposes. Painless 3rd-trimester bleed.

Painful 3rd-trimester bleed. Smoking, HTN, cocaine. Assoc with DIC. Fetal death.

Young girls; associated with DES exposure in utero

• Right goes right into the IVC: Right gonadal vein --> IVC
• Left side: Left gonadal vein --> left renal vein --> IVC

Girls <4, grapefruit-like mass protruding through vagina. Desmin-positive tumor cells, spindle-shaped.

Para-aortic

Connects cervix to side wall of pelvis

Connects uterus to labia majora

Connects ovaries to lateral pelvic wall

• 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

• Erection = parasympathetic (pelvic nerve)
• Emission = sympathetic (hypogastric nerve)
• Ejaculation = pudendal nerve
• Point & Shoot.

Storage. If dilated duct: spermatocele. Secretes carnitine & acetylcarnitine into seminal fluid.

First place where sperm are motile (they make forward motility factor). Seminal & prostate fluid released into vas deferens.

Acidic (citric acid), proteolytic enzymes, zinc (stabilize sperm chromatin)

Alkaline fluid

Fructose & prostaglandins

Low GnRH --> low FSH & LH --> low testosterone

These viruses produce proteins to inactivate p53 & Rb tumor suppressors