UNIVERSITI PERUBATAN ANTARABANGSA

Bachelor of Pharmacy (Hons) Programme

Reproductive System
BPH3015
(2.0 credits)

Semester 5

2009

Module Guide

TITLE: REPRODUCTIVE SYSTEM

LEVEL: SEMESTER 5

COURSE CODE: BPH3015

PROGRAMME: BPharm (Hons)

CONTENT SYNOPSIS
Most body organ systems function continuously to maintain wellbeing; the reproductive system,
however, appears to be inactive until puberty. Male and female reproductive organs are quite
different but share a common purpose. Gonadal hormones influence the growth and
development of many other organs and tissues, and it is not possible to properly understand the
functioning of reproduction without considering its hormonal regulation. The reproductive and
endocrine systems are in fact closely linked, and both are covered in this Semester. In common
with other Body Systems in the BPharm this Module integrates relevant anatomy, physiology,
pathology, pharmacology, therapeutics and pharmacy practice skills. Teaching-learning activity
includes plenaries, workshops, problem-based learning and pharmacy skills development
sessions
OBJECTIVES
The objectives of this module are to describe1.
factors that affect male fertility;
2.
the ovarian cycle and its hormonal regulation;
3.
the management of reproductive hormonal disorders;
4.
provide practice in counseling on contraception; and
5.
menopause and its related conditions, and their management.
LEARNING OUTCOMES:
On completion of this module, the student should be able to1.
describe the structure and function of the male reproductive system;
2.
describe male and female sexual responses;
3.
describe spermatogenesis and factors which affect it;
4.
describe the etiology, pathogenesis, pathophysiology, diagnosis and treatment of benign
prostatic hyperplasia (BPH)
5.
describe the stages and hormonal profiles of the ovarian and menstrual cycles;
6.
describe the effects of oestrogen and progesterone on endometrial and cervical mucus;
7.
explain the mechanism of action of hormonal contraceptive agents;
8.
describe the onset and hormonal changes of puberty and the development of secondary
sexual characteristics;
9.
describe gamete transport and the process of fertilisation, and mechanisms which block
polyspermy;
10. describe pre-embryonic development, blastocyte formation and implantation;
11. describe hormonal changes in pregnancy and the basis for pregnancy testing;
12. outline the stages of parturition & explain the mechanism of action of drugs that stimulate
or prevent uterine contraction;
13. outline the structure and function of the breast, milk let down reflex and lactation;
14. explain the advantages of breast feeding;
15. describe major problems associated with drugs that appear in breast milk;
16. describe menopausal hormonal changes and the effects of oestrogen deficiency on the
skin, brain, cardiovascular system and bone; and to
17. outline the management of menopausal symptoms using hormone replacement therapy,
its advantages and drawbacks; and counsel subjects undergoing menopause.

LEARNING HOURS:
Lectures
PSD
PBL
Workshops
Guided Reading
Portfolio
TOTAL LEARNING HOURS

10 hours
1.5 hours
3 hours
6 hours
15 hours
5 hours
40.5 hours

TEACHING AND LEARNING METHODS:

Lectures
10 hours
PSD
1.5 hours
PBL
3 hours
Workshops
6 hours
TOTAL CONTACT HOURS

20.5 hours

ASSESSMENTS:
Coursework
PBL
10%
Portfolio
10%
PSD
10%
Written examination: Degree Paper, 2 hours
MEQ: 1 hour, 2 questions
40%
Essay: 1 hour, 1 of 3 questions
30%
MODULE LEADER: Ms Wong Pei Se
ASSOCIATED LECTURERS: Dr. Chen Yu Sui, Assoc Prof Dr. John Paul Evangel Judson, Dr.
Low Bee Yean, Dr. Sheila Rani Kovil George
SYLLABUS:
1. The male reproductive system (Lecture 1hr)
Structure and function of male and female reproductive system
Sexual response
Process of spermatogenesis.
Factors affecting spermatogenesis.
Hypothalamus-pituitary-testes axis.
Biological actions of testosterone.
Blood-testes barrier
2. Benign Prostatic Hyperplasia (Guided Reading - 3 hrs)
Etiology, pathogenesis and pathophysiology
Clinical findings
Treatment: pharmacological and non-pharmacological
3. Infertility (PBL 2 x 1.5 hrs; Guided Reading 3 hrs, Portfolio 5 hrs)
The trigger is normally a scenario or clinical vignette involving infertility. Learning issues
include identification of causes and risk factors, interpretation of the results of laboratory
tests, management and counselling. Following the PBL sessions, a written summary of an
aspect of the topic is written up.

4. The female reproductive system (Lecture 1hr)

Structure and function
Sexual response
Hormonal profile in a normal ovarian cycle
Hypothalamic-pituitary-ovarian axis
Follicular development
Biological actions of oestrogen and progesterone
Effect of hormones on endometrial changes
Characteristics of a normal menstrual cycle
5. Puberty (Lecture 1hr)
Onset
Hormonal changes
Secondary sexual characteristics
6. Fertilization and implantation (Lecture 1hr)
A film to show the formation and development of foetus:
Gamete transport
Sperm capacitation
Acrosomal reaction and sperm penetration
Blocks to polyspermy
Completion of meiosis II and fertilization
Pre-embryonic development
Implantation
7. Hormonal contraception (Lecture 1hr)
Types
Adverse effects
Male contraceptives
8. Contraceptive methods and pregnancy and ovulation testing (Guided reading 2 hrs)
Barrier methods
o Prevention of sexually transmitted disease
Intra-uterine devices
Natural methods of family planning
Culture & religious factors
Advantages and drawbacks
Methods & current practice
Ovulation testing
Major sexually transmitted infections are described in Pharmaceutical Microbiology and
Infection BPH2013, Semester 3
9. Common problems associated with the hyper- or hypo-secretion of female sex
hormones and their treatment (Lecture 1hr)
Amenorrhoea
Galactorrhoea
Rationale for treatment.
Mechanisms of action and adverse effects of drugs used.

10. Sexual dysfunction: Erectile dysfunction (Guided Reading 3 hrs)

Definition
Causes
Pharmacological management
1. PDE 5 inhibitors
2. Apomorphine
3. Prostaglandin E
4. Hormonal
11. Pregnancy and lactation (Lecture 1hr)
hCG and tests for pregnancy
Hormonal changes in pregnancy
Stages of parturition
Structure and function of breast
Milk let down reflex
Lactation
Advantages of breast feeding
12. Treatment of common problems in pregnancy and lactation (Lecture 1 hr)
Common problems in pregnancy
Drugs commonly use in pregnancy and labour: uterine relaxants & stimulants
13. Drugs during pregnancy & breast feeding (Workshop 3 hrs, Guided Reading 4 hrs)
Benefits and drawbacks of drug use during pregnancy and breastfeeding:
What are the risks & consequences?
How do we decide? Risk v benefit
Example: uterine relaxants, anticonvulsant, anticoagulant, antibiotic use.
14. Physiology of menopause (Lecture 1hr)
Ovarian failure
Hormonal changes
Effects of oestrogen deficiency
15. Hormone replacement therapy (HRT) (Lecture 1hr)
Benefits and risks
Types of HRT, indications, contraindications, precautions, ADRs
Other clinical use of HRT
16. Contraception and hormone replacement (Workshop 3 hours)
Students are to make recommendations and identify major counseling points on case
scenarios involving choice of contraceptive method, use of contraception or hormone
replacement therapy.
17. Pharmacy Skills Development (PSD 1.5 hrs)
This session highlight issues associated with the use of hormonal contraception. Students
practice counseling on family planning issues, the appropriate use of combined oral
contraceptives and hormone replacement therapy.

READING LIST:
1.
Marieb, E.N. & Hahn, J. (2006) Human Anatomy and Physiology, 7th Edition, The
Benjamin/Cummings Publishing Company.
2.
Widmaier E.P., Raff, H., & Strang, K.T. (2007) Vanders Human Physiology, The
Mechanisms of Body Function with ARIS, 11th Edition, McGraw Hill.
3.
Martini, F.H. (2004) Fundamentals of Anatomy & Physiology 6th edition, Pearson,
Benjamin Cummings Publishing Company, San Francisco.
4.
Rang, H.P., Dale M.M. & Ritter, J., & Flower, R. (2007) Pharmacology 6th Edition, Churchill
Livingstone
5.
Katzung, B.G. Basic & Clinical Pharmacology, (2007) 10th edition, Appleton and Lange
6.
Brunton, L., Lazo, J. & Parker, K. (2006). Goodman and Gilmans The Pharmacological
Basis of Therapeutics, 11th edition, McGraw-Hill
7.
Kumar, V., Cottran, R.S. & Robbines, S.L. (2004) Basic Pathology 7th Edition, WB
Saunders Company
8.
Chandrasoma, P., & Taylor, C.R. (2000) Concise Pathology 6th. Edition, Appleton & Lange
9.
Rubin, E. (2008) Essentials of Rubin's Pathology 5th Edition, Lippincott Williams & Wilkins.
10. Underwood, J.C.E. (2000) General and Systemic Pathology 3rd Edition, Churchill
Livingstone
11. DiPiro, J.T., Talbert, R.L., Yee, G.C., et al (2007) Pharmacotherapy: A Pathophysiologic
Approach 6th Edition, McGraw Hill
12. Koda-Kimble, M.A., Young, L.Y., Kradjan W.A., et al (2008) Applied Therapeutics: The
Clinical Use of Drugs 9th Edition, Applied Therapeutics Inc.
13. Walke, R., & Edwards, C.R.W. (2004). Clinical Pharmacy and Therapeutics, 3rd edition,
Churchill Livingstone.
14. Gaw, A., Cowan, R.A., OReilly, D. St.J. et al (2008) Clinical Biochemistry An Illustrated
Colour Text, 3rd Edition, Churchill Livingstone
GUIDED READING [AVAILABLE IN I:\PHARMACY Lecturer Folders\Ms Wong Pei Se\S5
2009\REPRO 2009]:
1.
Dull P., Reagan R. W. AND Bahnson R.R. Managing Benign Prostatic Hyperplasia
.American Family Physician 2002; 66:77-84, 87-8
2.
Ministry of Health, Malaysia, Academy of Medicine of Malaysia, Malaysian Urological
Association. Consensus on Management of Benign Prostatic Hyperplasia. 1998
Available at http://www.acadmed.org.my/html/cpg.htm
3.
McElhatton P. R. General Principles of Drug Use in Pregnancy. Pharmaceutical Journal.
270: 232-234
4.
McElhatton P. R. Drug use in pregnancy: Part 1 Pharmaceutical Journal 2003; 270: 270272
5.
McElhatton P.R. Drug use in pregnancy: Part 2. Pharmaceutical Journal. 2003; 270: 305307
6.
Nathan A. General care of pregnant women. Pharmaceutical Journal. 2003; 270: 338-340
7.
Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ 2000;
321:499-503.
8.
Fazio, L., Brock, G. (2004). Erectile dysfunction: management update. CMAJ 170: 14291437

BPharm(Hons) Semester 5
Reproductive System: Workshop I - Drug use during Pregnancy & Breastfeeding
Students are expected to read below reference materials and attempt the following
assignments before workshop.
All available at www.pharmj.com
[Also available in I-DRIVE - Lecturer Folders\Ms Wong Pei Se\S5 2009\REPRO 2009]
Patricia R. General Principles of drug use in pregnany. Pharm J. 2003;270: 232-234
Patricia R. Drug Use in pregnany: Part 1. Pharm J. 2003; 270:270-272
Patricia R. Drug Use in pregnancy: Part 2. Pharm J 2003;270:305-307
Alan N. General care of pregnant women. Pharm J 2003; 270:338-340

1. A woman calls the medicines information unit and says that about 2 hours ago she took
sumatriptan for a severe migraine headache. She asks if it is now safe to breastfeed her 3
month-old baby. What would you recommend?
2. A 42-year old mother-to-be (first pregnancy; 4 weeks pregnant) has been taking sertraline
for six months, for depression. Her depression has only recently got better & she does not
wish to stop her medication. Comment.
3. A 32-year old woman who is 10 weeks pregnant is found to have a fasting blood glucose of
7.2mmol/l. She weighs 72kg and is 155cm tall, with a family history of diabetes. An oral
glucose tolerance test (100g oral glucose load) gave blood glucose concentrations of
12mmol.l and 9.2mmol/l after 1 and 2 hours respectively. Gestational diabetes mellitus is
diagnosed.
How should this woman be managed? Could oral hypoglycaemic agents be used?
What are the consequences of hyperglycaemia during pregnancy?
Is she at risk of developing diabetes mellitus after delivery?
Can she continue her anti-diabetic medication if she is breastfeeding?
Diagnosis of GDM with a 100-g oral glucose load

Fasting
1-h
2-h
3-h

mg/dl
95
180
155
140

mmol/l
5.3
10.0
8.6
7.8

Two or more of the venous plasma concentrations must be met or exceeded for a positive
diagnosis. The test should be done in the morning after an overnight fast of between 8 and 14 h
and after at least 3 days of unrestricted diet ( 150 g carbohydrate per day) and unlimited
physical activity. The subject should remain seated and should not smoke throughout the test.
4. A 35-year old female with hypertension is currently well controlled on hydrochlorothiazide.
She has discovered that she is one month pregnant. She wants to know whether the drug
is safe for her and her baby.

Will it be safer if she stopped taking medication?

Is hydrochlorothiazide safe in pregnancy?
What can be used instead?
Can she choose not to take any antihypertensive agent during pregnancy?
Can she breastfeed whilst on antihypertensive drugs? Which might be suitable?

5. A 22-year old woman who is 12 weeks pregnant describes symptoms of epigastric pain &
discomfort, especially after food. She had a similar problem a year ago and found ranitidine,
recommended by a community pharmacist, to be effective. She wants to know whether she
can use ranitidine again.
Is ranitidine safe during pregnancy?
What could you recommend?
6. A 32-year old who is 21 weeks pregnant reports finding blood on the toil paper after
defaecation.. She has had difficulty in passing motion because of hard stools. Her neighbour
has recommended senna and she wants to know whether senna is safe for her and the
baby. Comment.
7. Part I: KK (aged 30 years old) is admitted to Labour and Delivery suite for labour induction.
KK is at 43 weeks gestation by dates and her obstetric examination is normal (shown by
ultrasound). Her bishop score is 3. Her cervical examination reveals an unfavorable cervix
for labour induction.
What are the indications for labour induction in KK?
Part II: KKs bishop score has turned to 9 twelve hours after the administration of dinoprostone
vaginal insert. However, KK has not developed a consistent pattern of uterine
contractions.
Briefly explain the dosage regimen for dinoprostone gel and dinoprostone vaginal
insert. State any relevant monitoring parameters.
Name an agent that has an unlicensed indication for cervical ripening and briefly
explain its advantages over dinoprostone when used.
What would be the management for KK at this point?

8. AB (aged 18 years old), G2P1, 30 weeks gestation, is complaining of vaginal bleeding,

cramps and uterine contraction and was later admitted to O&G unit. ABs contractions that
last about 30 seconds, varying in intensity and at around 9 minutes interval. AB delivered
her first baby at 32 weeks gestation. Cervical examination performed on AB revealed a 2
cm cervical dilation (1 cm increment from her prenatal visit 2 weeks ago) and without signs
of premature rupture of membrane (PROM). IV magnesium sulfate 6 g for 30 minutes
(loading dose) followed by continuous IV infusion of 2 g/hr has been ordered for AB.
Comment on the use of tocolytic drugs for AB.

BPharm(Hons) Semester 5
Reproductive System: Workshop II - Hormone Replacement Therapy & COC
Students are expected to attempt the following assignments before workshop.
1. A female in her mid 20s, looking for pill to prevent pregnancy. She has no significant
medical and drug history.
2. A female in her mid 20s, looking for pill to prevent pregnancy. She has past medical history
of diabetes mellitus and varicose veins.
3. A female in her mid 30s, would like you to recommend a COC. She has tuberculosis and
currently on therapy.
4. A female customer with complaint of weight gain with her current COC- Marvelon. She
wants to know whether she should change to other types of COC.
5. A female customer came in for supply of COC, Minulet and painkiller for migraine.
6. A young 18 year old female comes to buy tablets which can her in delaying her menstrual.
7. A female has called you that told you that she has missed her COC pill. She is not sure what
she should be doing now.
8. A female customer wants to buy morning after pill.
9. A male customer, requesting for 3 boxes of morning after pill.
10. A female who is 2 weeks post-partum wants to know whether she can start her COC
Trinordiol.
11. A 55-year-old post-menopausal female requesting for advice on HRT. She had
hysterectomy 3 years ago.
12. A 52-year-old post-menopausal female requesting for advice on HRT. She has no
significant medical and drug history.
13. A female in peri-menopausal complained of irregular menstruation and hot flushes even
after 3 months on taking Livial.
14. A 43-year old female who has not had her menstrual for the past 6 months. She has also
experienced menopausal symptoms.