1. Viagra (silenafil) 2. Cialis (Tadalafil) 3. Levitra (Vardenafil HCL)

4. Stendra (Avanafil) 

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What are the names for structures: A, B, C and D

What is B, C, D called?

A. Testosterone

B. Testosterone Enanthate (Delatestryl)

C. Testosterone Cypionate (Depo-testosterone)

D. Testosterone Undecanoate (Andriol)

B, C, & D are all testosterone esters

1. Fundus

2. Body

3. Cervix

1. starts around 8 y/o, the female starts to secrete GnRH in pulsatile manner

2. GnRH acts on anterior pituitary to release LH and FSH.

3. LH and FSH causes growth of ovaries and follicles and menarche.

4. Ovaries secrete more estrogen and progesterone = secondary female characteristics.

Acceleratedgrowthof6-12primordial follicleseachmonth occurs when?

During follicular phase, acceleratedgrowthof ___ occurs eachmonth 

androstenedione or  testosterone; 

aromatase 

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Label: A to G

A - Cholesterol

B Thecal cells

C - Granulosa cells

D. Androstenedione

E. Androstenedione

F. Estradiol

G. Estradiol

___ increasetheactivitiesof aromataseand facilitatethetransport ofcholesterol into thecells (theca and granulosa cells) thatsynthesizeestrogens.

1. Promotes the secretory changes and prepares the uterus for implantation of the fertilized ovum.

2. Decreases frequency and intensity of uterine contractions, preventing expulsion of implanted ovum.

3. Promotes secretion by the mucosal lining of fallopian tubes.

4. Causes aveolar cells of the breast to grow and become secretory.

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What is A, B and C in the endometrial cycle? Give how long they last and which hormones are present.

A. Proliferative phase - high LH and estrogen = 11 days

B. Secretory phase - High progesterone and Inhibin = 12 days

C. Menstrual phase - somewhat high FSH = 5 days

Proliferative phase (pre-ovulation) = Follicular phase

Secretory phase (post ovulation) = Luteal phase

Desquamation of endometrium

Involution of the corpus luteum

FSH & LH actonthe ovaries to causesecretionof _____.

 In the hypothalamic-pituitary-ovarian axis  _____ provide feedback inhibitionof FSH & LH from theanteriorpituitary

In the Hypothalamic-Pituitary-Ovarian Axis, ____ inhibits FSH.

1. Few primordial follicles left

2. Menses stop

3. Ovaries are no longer responsive to gonadotropins (LH and FSH) = LH and FSH are still produced at normal levels.

4. Estrogen and progesterone no longer made secreted by ovaries.

5. No feedback inhibition of FSH and LH, so high levels of FSH and LH

1. PDE-5 inhibitors

2. Synthetic prostaglandin E1 analogs (Alprostadil)

Sildenafil >> Vardenafil

Found in photoreceptors

Tadalafil = PDE-11 selective

- found mostly in skeletal muscle 

1. Sildenafil (Viagra) = PDE-6 = photoreceptors in retina = photosensitivity and blurred vision

2. Tadalafil (Cialis) = PDE-11 = skeletal muscles = myalgia and back pain

3. Priapism (constant erection)

4. Hearing impairment

5. Nonarteric Anterior Ischemic Optic Neuropathy (NAION)

1.  Nitrates→CONTRAINDICATED

–      Producehypotension

–      Suppliesextranitricoxide(NO)

–      24to48-hourseparationrecommended(dependingondrug½-life)

–      Ifemergency,usenon-nitrateagent

2.       CYP3A4inhibitors(strongàdonotcoadminister)

–      Macrolideantibiotics&Azoleantifungals

3.         Antihypertensivemedications(hypotensiverisk)

–      Alpha-1adrenergicblockersàseparatedosesby4hrs

–      OtherBPmedswithsignificanthypotensionrisk

4.         Alcohol(hypotensionrisk)

What are the initial doses and frequency for:

a. Intracavernosal injections (Caverject, Edex)

b. Medicated Urethral System for Erection (MUSE)

a. Caverject/Edex:

- Vasculogenic or psychogenic etiology = 2.5 mcg

- Neurogenic etiology = 1.25 mcg

Frequency: 3 dose/week every 24 hrs

b. MUSE = 125 mcg 

frequency = 2 doses/24 hrs

1. Achieves normal testosterone serum concentrations.

2. Normal circadian rythm: peak in morning and trough in afternoon

3. Normal androgen metabolite concentration

4. Minimal side effects

Buccal - avoids 1st pass metabolism

IM - requires less frequent administration

Absenceofmenstrualperiodinawomanof reproductive age.

PrimaryAmenorrhea–Absenceofmensesbyage16yrsinpresenceof normalsecondarysexualdevelopmentorabsenceofmensesbyage14yrsin absenceofnormalsecondarysexualdevelopment

SecondaryAmenorrhea-Absenceofmensesforthreecyclesorfor6months inpreviouslymenstruatingwoman.

1. Hypothalamic suppression

2. Hyperprolactinemia

3. Ovarian disorder

4. Uterine disorder

Secondary Amenorrhea can result from

Postsurgicaladhesions or

AbnormalUterineDevelopment  (Congenital)

1. Turner syndrome (XO chromosome)

2. Chemotherapy/radiation produce gonadal toxins

3. Gonadal dysgenesis

1. Prolactin-secreting adenoma in the pituitary

2. Breast-feeding

3. Hypothyroidism

4. Pregnancy - most common cause

5. Weight loss/ Eating disorder -affects GnRH

6. Intense exercise - affects GnRH

7. Stress

8. Polycystic ovarian syndrome

9. Hepatic/Renal disease

1. Dopamine antagonist

2. Serotonine enhancers

Polycystic ovarian syndrome affects ___% of women in their reproductive years

1. NSAIDs

2. Oral and intrauterine progesterone

3. Tranexamic acid

DysfunctionalorIrregularUterineBleeding or Bleedingfromuterineendometriumasaresultofdysfunctionalmenstrual

system–excludinganatomiclesionoftheuterus

1. Inabsenceofovulationinthenormal  menstrualcycle,progesteroneisnot producedandtheendometriumcontinues toproliferateunderestrogenproduction.

  2.     Eventually–  endometriumbecomestoo thickthatit cannotcontinuetoexpand underestrogenstimulation

3.       Thisresultsinunorganized,sporadic sloughing  endometrium  characterizedby variableheavybleedingofanovulation

       __ often is recommended treatment for managing acute bleeding episodes of anovulatory bleeding.

Definedas crampylowerabdominaldiscomfortthatbeginswiththe onsetofmenstrualbleedingandgraduallydecreasesoverthenext12–

72h

Primarydysmenorrhea – painwithnormalpelvicanatomy&physiology

 Secondarydysmenorrhea–associatedwithunderlyingpelvicpathology

Most significant mechanism for primary dysmenorrhea is release of ____and other mediators in menstrualfluid–which initiates an inflammatory response and vasopressin-mediated vasoconstriction

1. Metastatic theory = more accepted = endometrial tissue is implanted in abnormal position.

2. Metaplastic theory = endometrial tissue arises directly from mesothelium of pelvic or abdomen.

Give the routes of administration for the GnRH agonists:

-Leuprolide (Lupron) 

- Goserelin 

- Nafarelin

-Leuprolide (Lupron) = IM

- Goserelin = SQ

- Nafarelin = Intranasal