Meds Affecting Reproduction

(General Key Points)

N203 ATI (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 & 2 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

N203 ATI (Unit 12) Reproductive System -

Expected Action: Therapeutic Uses:

Proto: oxytocin (Pitocin) Others: methylergonovine (Methergine)

strength, frequency, and duration of uterine contractions 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 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 hypertension Education: Use infusion pump and gradually rate contractions longer than 60 sec, freq > q 2-3 min infusion

Tocolytic Medications

N203 ATI (Unit 12) Reproductive System -

Expected Action:

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

Selectively activates 2-adrenergic receptors uterine smooth muscle relaxation

Therapeutic Uses: Adverse Effects:

Delay of preterm labor Tremors, anxiety, headache (2 skeletal muscle side effects)

Tachycardia, palpitations, chest pain (1 side effects)

Contraindications/Precautions: Interactions:

(?) Pregnancy // lactation

Concurrent use of -blockers blunt effects

Concurrent use of adrenergic agonists additive effects Concurrent use of MAOIs Hypertension

Androgens

N203 ATI (Unit 12) Reproductive System -

Proto: testosterone (Delatestryl) Others: fluoxymesterone (Halotestin), methyl testosterone (Oreton), danazol (Danocrine) Growth and maturation of sex organs and 2 sex characteristics. Promotes skeletal muscle growth. Therapeutic Uses: Hypogonadism in androgen-deficient men Delayed puberty Palliative treatment of androgen-responsive breast cancer Adverse Effects: Hypercalcemia ( breast cancer treatment) CV risks: LDL, HDL, edema Hepatotoxicity : Acne, facial hair, gynecomastia, impotence, priapism : Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities Contraindications/Precautions: (X) Pregnancy Prostate cancer Liver, heart, or renal failure Interactions: 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. Expected Action:

Estrogens

N203 ATI (Unit 12) Reproductive System -

Expected Action:

Proto: conjugated equine estrogens (Premarin) Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)

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

Dysfunctional uterine bleeding & endometriosis Prostate cancer Contraception Risk for estrogen-dependent breast cancer Feminization, impotence, libido in Breast cancer Pt. or family Hx of heart disease Phenytoin toxicity Apply patches to trunk

Postmenopausal symptoms & osteoporosis

Adverse Effects:

Prolonged estrogen endometrial / ovarian cancers (Give progestins, too) Emboli ( risk from smoking)
Contraindications/Precautions:

(X) Pregnancy

Risk of thromboembolic disease

Interactions: Education:

Estrogens of warfarin IM deep into large muscle mass

Progesterones

N203 ATI (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 tenderness Contraindications/Precautions: (X) Breast cancer Hx of thromboembolic, cardiovascular, cerebrovascular disease. Undiagnosed vaginal bleeding Interactions: Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all of oral contraceptives. Education: Anticipate withdrawal bleeding for 3-7 days

Oral Contraceptives

N203 ATI (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: Adverse Effects:

Prevent pregnancy Hypertension Thromboembolic events Cervical cancer Smoker > 35

Breakthrough or abnormal uterine bleeding

Contraindications/Precautions:

(X) Pregnancy

Hx of thrombophlebitis and cardiovascular events Family history or risk factors for breast cancer
Interactions:

OC of warfarin and oral hypoglycemics Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all of oral contraceptives. 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

Education:

Antineoplastic Agent
(1 of 2)

N203 ATI (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: Education:

(X) Pregnancy and lactation

Administer leuprolide immediately upon reconstitution

Administer leuprolide depot preparations deep IM

Antineoplastic Agents
(2 of 2)

N203 ATI (Unit 12) Reproductive System -

Proto: tamoxifen (Nolvadex), Selective Estrogen

Receptor Modulators (SERMs) Tamoxifen competes estrogen estrogen effects Therapeutic Uses: Breast cancer Breast cancer prevention Adverse Effects: Hot flashes Bone pain Hyperlipidemia Hypercalcemia: Patients with bone metastases risk for hypercalcemia Contraindications/Precautions: (X) Pregnancy and lactation History of DVT Interactions: 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
Expected Action:

Erectile Dysfunction

N203 ATI (Unit 12) Reproductive System -

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

vardenafil (Levitra)

Augments effects of nitric oxide released during stimulation blood to corpus cavernosum penile erection.
Therapeutic Uses: Adverse Effects:

Erectile dysfunction 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.