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