Chapter 24 Reproductive System Drugs. 2 Reproductive Hormones Gonadotropic Androgens Estrogens...

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Chapter 24 Reproductive System Drugs

Transcript of Chapter 24 Reproductive System Drugs. 2 Reproductive Hormones Gonadotropic Androgens Estrogens...

Chapter 24

Reproductive System Drugs

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Reproductive Hormones

• Gonadotropic

• Androgens

• Estrogens

• Progestins

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Gonadotropic Hormones

• Follicle-stimulating hormone (FSH)– stimulate development of ovarian

follicles and sperm production

• Luteinizing hormone (LH)– Stimulate secretion of estrogen;

ovulation

• Luteotropic hormone (LTH)– Stimulate secretion of progesterone

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Androgens

• Aka: Male hormones

• Stimulate development of male characteristics

• Examples– Testosterone– Andosterone

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Androgens

• Uses– Replacement (andropause), Congenital

hypogonadism or delayed puberty, Aquired hypogonadism (trauma, surgery)

• Side effects– Acne, increased oiliness of skin and hair,

alopecia– Premature closure of bone ends in adolescents

• Dangers of illegal use of anabolic steroids– Risk of developing psychosis, delusions,

paranoia, depression, mania, aggression/violence

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• Ex: Depo-testosterone, Androgel

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Impotence Agents

• Classification: Phosphodiesterase (PDE) inhibitors

• Treatment for male erectile dysfunction (ED) aka “impotence”

• Side effects– Headache, flushing, abnormal vision, dizziness,

nasal congestions – CV: angina, tachycardia, hypotension,

palpatiations

• Ex: Viagra, Cialia, Levitra

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• Interactions:– NITRATES!!

• Patient Education– Erection >4hours, seek medical advice

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Estrogens

• Female sex hormone

• Development of female secondary sexual characteristics

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Estrogen Therapy

•Uses

•Contraceptives

•Meonopausal symptom relief

•Female Hypogonadism

•Post Menopausal estrogen replacement may reduce CV dz and elevated HDLs in females

•Postcoital use after rape or incest (within 24-48 hours) of a single large dose to prevent, not terminate, pregnancy

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Estrogen Therapy

• Side effects– Increased risk of thromboembolic

disorder, MI, Stroke

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Progestins

• Synthetic drugs that exert progesterone-like activities

• Progesterone– Secreted by corpus luteum and adrenal

glands– Changes in uterine endometrium in

second half of the menstrual cycle – Prepares for implantation of fertilized

ovum

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Progestins

– Development of maternal placenta after implantation

– Development of mammary glands

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Progestins

• Ex: Provera, Depo-Provera, Megace• Uses

– Tx of amenorrhea, abnormal uterine bleeding caused by hormonal imbalance

– Contraceptive– Postmenopausal– Sexual Deviancy in males (Depo IM)

• Side effects– Menstrual irregularites, spotting,

Thromboembolic disorders

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Contraceptive Agents

• Estrogen-progestin combination– Suppression of FSH and LH– Prevents ovulation

• Progestin-only contraceptives– Prevents ovulation– Thickens cervical mucus– Creates endometrium that is not condusive to

sustaining fertilized ovum– Indicated for those who do not tolerate

Estrogen Tx.

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Contraceptive Agents

• Uses– Prevent Birth

• Side effects– Fluid retention, bleeding between periods,

break through bleeding, changes in mood and libido

• Absolute contraindications– Thromboemboic disorder, suspected

breast/cervicatl CA,Women over 35 and currently smoking 15 cigarettes a day

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• Interactions– Antibiotics

• Patient education– Alternative contraceptive for the first 1-2 weeks of

initiation– Take same time of day, everyday– If missed, pill should be doubled up until the patient has

caught up.– If 3 pills or more are missed, pt is instructed to throw

away the pack until she starts period again, THEN begin a new pack of pill

– Stop oral contraceptive if pregnancy is suspected– Stop smoking

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Choices of Contraceptives

• Monophasic– Same proportions of estrogen and progestin

• Biphasic – 2 sequences of progestin and less than 50 mcg

estrogen

• Triphasic– 3 sequences of progestin and less than 50 mcg

estrogen

• Use smallest dose possible for results

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Progestin-containing intrauterine device (IUD)

• Reservior of synthetic progestin

• Releases small amounts of progesterone daily, providing 5 years of continuous contraceptive protection.

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Postcoital Contraceptives

• Unintentional risk of pregnancy• Must be administered within 72 hours• Emergency contraceptive kit

– Pregnancy test– 4 tablets of estrogen/progesterone

combination

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Mifepristone (Mifeprex)

• Antiprogesterone drug

• Terminate unwanted pregnancy

• Requires three physician visits

• Side effects

• Contraindications

• Patient education

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Drugs for Labor and Delivery

• Oxytocin– Secreted by posterior pituitary lobe

• Stimulates uterine contraction

• Stimulates release of milk

• Synthetic drugs are called oxytocics

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Labor and Delivery

• Oxytocin

• Magnesium sulfate– Tx of severe preeclampsia or eclampsia

• Prevents Seizures during L&D

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Infertility Drugs

• Clomiphene citrate (Clomid)– Induce ovulation

• Chorionic gonadotropin (Profasi)– Induces ovulation

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Drug List

1. Andro Gel2. Viagra3. Cialis4. Levitra5. Estrace6. Premarin7. Provera8. Depo-Provera9. Megace

10. Ortho-Cyclen11. Loestrin12. Ortho-Noveum

7/7/713. (oxytocin) Pitocin14. (magnesium sulfate15. Clomid16. (chorionic

gonadotropin)