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:

Proto: oxytocin (Pitocin)

Others: methylergonovine (Methergine)

strength, frequency, and duration of uterine contractions

Therapeutic 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 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
Use infusion pump and gradually rate
Education:
contractions longer than 60 sec, freq > q 2-3 min infusion

Tocolytic Medications

N203
ATI (Unit 12)
Reproductive System -

Proto: Terbutaline sulfate (Brethine)

Others: magnesium sulfate, ritodrine

Expected Action:

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.
Hypogonadism in androgen-deficient men
Therapeutic Uses:
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.
Report weight gain > 2 lb/week.
Education:
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

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)
Contraindications/Precautions:

(X)

Risk of thromboembolic disease

Interactions:
Education:

Feminization, impotence, libido in

Pregnancy

Breast cancer

Pt. or family Hx of heart disease

Estrogens of warfarin

Phenytoin toxicity

IM deep into large muscle mass Apply patches to trunk

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.
Anticipate withdrawal bleeding for 3-7 days
Education:

Oral Contraceptives

N203
ATI (Unit 12)
Reproductive System -

Proto: Ovcon 35 Others: Necon, ortho-novum

Expected Action:

fertility by inhibiting ovulation, thickening cervical mucous, and making

lining of endometrium less favorable to implantation.
Prevent pregnancy
Therapeutic Uses:
Adverse Effects:

Hypertension Thromboembolic events

Breakthrough or abnormal uterine bleeding

Cervical cancer

Pregnancy
(X)
Hx of thrombophlebitis and cardiovascular events
Smoker > 35
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.
Contraindications/Precautions:

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 -

Proto: leuprolide (Lupron)

Expected Action:

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
Breast cancer
Breast cancer prevention
Therapeutic Uses:

Hot
flashes

Bone
pain
Hyperlipidemia
Adverse Effects:
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)
Give with food or fluid if gastric upset occurs
Education:
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),

vardenafil (Levitra)

Expected Action:

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.