Meds Affecting Reproduction(General Key Points) ok

N203ATI (Unit 12)

Reproductive System -

Testosterone produced by testes, ovaries, and adrenal cortex. Primary androgen in both genders.

♀: Primary estrogen and progestional are estradiol and progesterone. Both made in ovaries maturation of ♀ reproductive organs & 2º sex characteristics.

Menstruation results from progesterone toward end of cycle

Menopausal symptoms result from estrogen levels.

Clinical uses of hormone preparations: Hormone deficiencies and oppositional treatment of hormone-dependent cancers.

Postmenopausal HRT: Benefits include vasomotor symptom relief and prevention of osteoporosis. Risks include embolic events and cancers.

Oral contraceptives suppress ovulation using ethinyl, estradiol, and norethindrone

OC risks are minimal except in smokers and those with Hx of embolic events.

Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics are used to delay preterm labor.

Oxytocics

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: oxytocin (Pitocin)

Others: methylergonovine (Methergine) strength, frequency, and duration of uterine contractionsTherapeutic Uses: Methergine: Emergency intervention for serious postpartum hemorrhage Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of

postpartum bleeding // Fetal stress testing // Milk letdown (intranasal)Adverse Effects: Methergine: Hypertensive crisis (IV): Headache, nausea, BP Oxytocin: Uterine rupture {Relax myometrium ĉ Mg(SO4)}Contraindications/Precautions: ♀ (?) Methergine: Hypertension

Methergine: Cardiovascular, renal, or hepatic failure.Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs,

cephalopelvic disproportion, prolapsed umbilical cord, fetal distress.Interactions: Vasopressors hypertensionEducation: Use infusion pump and gradually rate contractions longer than 60 sec, freq > q 2-3 min infusion

Tocolytic Medications

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: Terbutaline sulfate (Brethine)Others: magnesium sulfate, ritodrine

Selectively activates β2-adrenergic receptors uterine smooth muscle relaxation

Therapeutic Uses: Delay of preterm labor

Adverse Effects: Tremors, anxiety, headache (β2 skeletal muscle side effects)

Tachycardia, palpitations, chest pain (β1 side effects)

Contraindications/Precautions: ♀ (?) Pregnancy // lactation

Interactions: Concurrent use of β-blockers blunt effects

Concurrent use of adrenergic agonists additive effects

Concurrent use of MAOIs Hypertension

Androgens

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: testosterone (Delatestryl) — Others: fluoxymesterone

(Halotestin), methyl testosterone (Oreton), danazol (Danocrine) Growth and maturation of ♂ sex organs and 2º sex characteristics. Promotes

skeletal muscle growth.Therapeutic Uses: Hypogonadism in androgen-deficient men Delayed puberty Palliative treatment of androgen-responsive breast cancerAdverse Effects: Hypercalcemia (ĉ breast cancer treatment) CV risks: LDL, HDL, edema Hepatotoxicity ♂: Acne, facial hair, gynecomastia, impotence, priapism ♀: Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularitiesContraindications/Precautions: ♀ (X) Pregnancy Prostate cancer

Liver, heart, or renal failureInteractions: Hepatotoxic drugs: risk of liver damage Warfarin, oral hypoglycemics, and glucocorticoids androgen effects on

metabolism can levels of these.Education: Report weight gain > 2 lb/week.

Estrogens

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: conjugated equine estrogens (Premarin)

Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)

Growth and maturation of ♀ reproductive tract and 2º sex characteristics. They bone resorption and LDL. At high levels they suppress release of FSH.

Therapeutic Uses: Dysfunctional uterine bleeding & endometriosis Postmenopausal symptoms & osteoporosis Prostate cancer Contraception

Adverse Effects: Risk for estrogen-dependent breast cancer Prolonged estrogen endometrial / ovarian cancers (Give progestins, too) Emboli ( risk from smoking) Feminization, impotence, libido in ♂

Contraindications/Precautions: ♀ (X) Pregnancy Breast cancerRisk of thromboembolic disease Pt. or family Hx of heart disease

Interactions: Estrogens η of warfarin Phenytoin toxicity

Education: IM deep into large muscle mass Apply patches to trunk

Progesterones

N203ATI (Unit 12)

Reproductive System -

Expected Action:

Proto: medroxyprogesterone (Provera)Others: norethindrone (Micronor), megestrol acetate (Megace)

Induce favorable conditions for fetal development and maintain pregnancy. in progesterone levels menstruation.

Therapeutic Uses: Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine

bleeding, amenorrhea, endometriosis, and endometrial cancer.Adverse Effects: Breast cancer Edema Thromboembolic events Breakthrough bleeding, amenorrhea, breast tendernessContraindications/Precautions: ♀ (X) Breast cancer

Hx of thromboembolic, cardiovascular, cerebrovascular disease.Undiagnosed vaginal bleeding

Interactions: Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,

tetracycline, penicillin all η of oral contraceptives.Education: Anticipate withdrawal bleeding for 3-7 days

Oral Contraceptives

N203ATI (Unit 12)

Reproductive System -

Expected Action: Proto: Ovcon 35 — Others: Necon, ortho-novum fertility by inhibiting ovulation, thickening cervical mucous, and making

lining of endometrium less favorable to implantation.Therapeutic Uses: Prevent pregnancyAdverse Effects: Hypertension Thromboembolic events Breakthrough or abnormal uterine bleeding Cervical cancerContraindications/Precautions: ♀ (X) Pregnancy

Hx of thrombophlebitis and cardiovascular events Smoker > 35Family history or risk factors for breast cancer

Interactions: OC η of warfarin and oral hypoglycemics Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,

tetracycline, penicillin all η of oral contraceptives.Education: Take for 21 days followed by 7 days with no drug 1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days

Antineoplastic Agent(1 of 2)

N203ATI (Unit 12)

Reproductive System -

Expected Action: Proto: leuprolide (Lupron)

Synthetic luteinizing hormone testosterone levels and uterine fibroid growth

Therapeutic Uses: Palliative treatment of advanced prostate cancer

Uterine fibroids and endometriosis

Adverse Effects: Hot flashes Bone pain

Thromboembolic events ( risk with smoking)

Contraindications/Precautions: ♀ (X) Pregnancy and lactation

Education: Administer leuprolide immediately upon reconstitution

Administer leuprolide depot preparations deep IM

Antineoplastic Agents(2 of 2)

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: tamoxifen (Nolvadex), Selective Estrogen

Receptor Modulators (SERMs) Tamoxifen competes ĉ estrogen estrogen effectsTherapeutic Uses: Breast cancer Breast cancer preventionAdverse Effects: Hot flashes Bone pain Hyperlipidemia Hypercalcemia: Patients with bone metastases risk for hypercalcemiaContraindications/Precautions: ♀ (X) Pregnancy and lactation

History of DVTInteractions: Warfarin: anticoagulant effect Antineoplastic agents: antineoplastic effects (nausea, vomiting, neutropenia)Education: Give with food or fluid if gastric upset occurs Omit missed doses Monitor for weight gain and peripheral edema

Erectile Dysfunction

N203ATI (Unit 12)

Reproductive System -

Expected Action:Proto: sildenafil (Viagra) — Others: tadalafil (Cialis),

vardenafil (Levitra)

Augments effects of nitric oxide released during stimulation blood to corpus cavernosum penile erection.

Therapeutic Uses: Erectile dysfunction

Adverse Effects: Priapism: if longer than 4 hours MI, sudden death: Evaluate and monitor cardiovascular history and health

Contraindications/Precautions: ♀ (?) Cardiovascular disease

Taking medications in nitrate family including nitroglycerin

Interactions: Organic nitrates (nitroglycerin) fatal hypotension Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil

metabolism plasma level of sildenafil.

Education: Take 1 hour before sex; limit to 1x/day.