Ppt chapter 40

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Drugs Affecting the Female Reproductive System

Drugs Affecting the Female Reproductive System

Chapter 40


Site of Action for Drugs Affecting the Female Reproductive System

Site of Action for Drugs Affecting the Female Reproductive System


Drugs Used to Treat Disorders of the Female Reproductive System

Drugs Used to Treat Disorders of the Female Reproductive System

• Estrogen and Progestins

• Estrogen Receptor Modulators

• Fertility Drugs

• Oxytocics

• Abortifacients

• Ocolytics


EstrogenEstrogen

• Actions

– Protecting the heart from atherosclerosis

– Retaining calcium in the bones

– Maintaining the secondary female sex characteristics

• Indications

– Hormone replacement therapy (HRT)

– Palliative and preventive therapy during menopause


Estrogen (cont.)Estrogen (cont.)

• Pharmacokinetics

– Absorbed through the GI tract and undergoes extensive hepatic metabolism

– Excreted in the urine

• Contraindications

– Allergies and pregnancy

– Idiopathic vaginal bleeding, breast cancer, and estrogen dependent cancer, thromboembolic disorders


Estrogen (cont.)Estrogen (cont.)

• Caution

– Breast feeding, metabolic bone disease, renal insufficiency, hepatic impairment

• Adverse Effects

– GI tract

– Systemic effects of estrogens

• Drug-to-Drug Interactions

– Drugs that enhance hepatic metabolism

– Corticosteroids


Sites of Action of the EstrogensSites of Action of the Estrogens


Estrogen Receptor ModulatorsEstrogen Receptor Modulators• Actions

– Modulating effects on estrogen receptors

– Used to stimulate specific estrogen receptors to increase bone mineral density

• Indications

– Postmenopausal osteoporosis


– Well absorbed in the GI tract, metabolized in the liver

– Excreted in the feces


Estrogen Receptor Modulators (cont.)Estrogen Receptor Modulators (cont.)


– Known allergy, pregnancy, and lactation

– Patients with history of venous thrombosis or smoking

• Adverse Effects

– GI upset

– Changes in fluid balance: headache, dizziness, and visual changes

– Estrogen receptor stimulation: hot flashes, skin rash, edema, and vaginal bleeding


Estrogen Receptor Modulators (cont.)Estrogen Receptor Modulators (cont.)


– Cholestyramine

– Highly protein-bound drugs

– Warfarin


QuestionQuestion

What is an indication for the use of estrogen receptor modulators?

A. Postmenopausal osteoporosis

B. Hereditary angioedema

C. Osteogenesis imperfecta

D. Breast cancer


AnswerAnswer

A. Postmenopausal osteoporosis

Rationale: The indication for estrogen receptor modulators is postmenopausal osteoporosis.


ProgestinsProgestins

• Actions

– Transform the proliferative endometrium into a secretory endometrium

– Inhibit the secretion of FSH and LH

– Prevent follicle maturation and ovulation

– Inhibit uterine contractions

• Indications

– Contraception

– Treatment of primary and secondary amenorrhea

– Fertility protocols


– Well absorbed, undergo hepatic metabolism and are excreted in the urine


Progestins (cont.)Progestins (cont.)


– Allergies, pregnancy, idiopathic vaginal bleeding, breast or genital cancer, history of thromboembolic disorders, PID, sexually transmitted disease, endometriosis, or pelvic surgery

• Adverse Effects

– Varies based on route of administration


– Barbiturates, Carbamazepine, Phenytoin, or Rifampin


Fertility DrugsFertility Drugs

• Actions

– Directly or by stimulating the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova

• Indications

– Infertility in men and women


– Well absorbed, undergo hepatic metabolism and renal excretion


Fertility Drugs (cont.)Fertility Drugs (cont.)


– Primary ovarian failure

– Thyroid or adrenal dysfunction

– Ovarian cysts

– Pregnancy, idiopathic uterine bleeding, and known allergy

• Caution

– Breast feeding, thromboembolic disease, or respiratory disease


Fertility Drugs (cont.)Fertility Drugs (cont.)

• Adverse Effects

– Increase risk of multiple births and birth defects

– Ovarian overstimulation

– Headache, fluid retention, nausea, bloating

– Uterine bleeding, ovarian enlargement

– Gynecomastia


Oxytocics Oxytocics

• Actions

– Affect neuroreceptors sites to stimulate contractions of the uterus

• Indications

– Prevention and treatment of uterine atony after delivery


– Rapidly absorbed, metabolized in the liver, and excreted in urine and feces


Oxytocics (cont.) Oxytocics (cont.)


– Allergy and early pregnancy

– Cephalopelvic disproportion

• Caution

– Coronary artery disease, hypertension, lactation, and previous Cesarean section


Oxytocics (cont.) Oxytocics (cont.)

• Adverse Effects

– Excessive effects: uterine hypertonicity and spasm

– GI upset (nausea)

– Headache

– Blood pressure changes

– Water intoxication


QuestionQuestion

Tell whether the following statement is true or false.

Fertility drugs act by stimulating the pituitary to increase FSH and LH levels, leading to ovarian follicular

development and maturation of ova.


AnswerAnswer

False

Rationale: Fertility drugs either act directly or by stimulating the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and

maturation of ova.


AbortifacientsAbortifacients

• Actions

– Stimulate uterine activity

– Dislodge any implanted trophoblast and preventing implantation of fertilized egg

• Indications

– Termination of pregnancy at 12-20 weeks


– Well absorbed, metabolized in the live and excreted in the urine


Abortifacients (cont.)Abortifacients (cont.)

• Caution

– Asthma, hypertension, or adrenal disease

– Acute vaginitis or scarred uterus

• Adverse Effects

– Abdominal cramping

– Heavy uterine bleeding

– Perforated uterus or uterine rupture

– Headache, nausea, vomiting, diarrhea, diaphoresis, backache, and rash


TocolyticsTocolytics

• Uses

– Relax the uterine smooth muscle and prevent contractions leading to premature labor and delivery

– Usually reserved for use after 20 weeks of gestation; neonate has a chance of survival outside the uterus

• Prototype

– Only one in US: Ritodrine (Yutopar); withdrawn because of serious side effects


Use of Drugs Affecting the Female Reproductive System Across the Lifespan

Use of Drugs Affecting the Female Reproductive System Across the Lifespan


Prototype EstrogenPrototype Estrogen


Prototype Estrogen Receptor Modulators Prototype Estrogen Receptor Modulators


Prototype ProgestinsPrototype Progestins


Prototype Fertility DrugsPrototype Fertility Drugs


Prototype Fertility Drugs (Continued)Prototype Fertility Drugs (Continued)


Prototype Oxytocics Prototype Oxytocics


Prototype Oxytocics (Continued) Prototype Oxytocics (Continued)


Prototype AbortifacientsPrototype Abortifacients


Nursing Considerations for Estrogen or Estrogen Receptor Modulators

Nursing Considerations for Estrogen or Estrogen Receptor Modulators

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


Nursing Considerations for ProgestinsNursing Considerations for Progestins



• Implementation

• Evaluation


Nursing Considerations for Fertility DrugsNursing Considerations for Fertility Drugs



• Implementation

• Evaluation


Nursing Considerations for Oxytocics Nursing Considerations for Oxytocics



• Implementation

• Evaluation


Nursing Considerations for AbortifacientsNursing Considerations for Abortifacients



• Implementation

• Evaluation


QuestionQuestion

What would be an appropriate nursing diagnosis for a patient who is taking oxytocics ?

A. Constipation related to dopaminergic effects

B. Excess fluid volume related to ergotism or water intoxication

C. Risk for injury related to CNS effects and incidence of orthostatic hypotension

D. Constipation related to decreased fluid intake


AnswerAnswer

B. Excess fluid volume related to ergotism or water intoxication

Rationale: Nursing diagnoses related to drug therapy might include: excess fluid volume related to ergotism or water intoxication

Ppt chapter 40

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