TIME SPECIFIC CONTENTS TEACHING, LEARNING ACTIVITIES EVALUATION

OBJECTIVES
INTRODUCTION:
Medroxyprogesterone injection is a hormone
medication that’s available as three brand names:
 Depo-Provera which is used to treat kidney
cancer or cancer of the endometrium.
 Depo-Provera Contraceptive injection, which
Is used as birth control.
 Depo-subQ Provera 104 ,which is used as
birth control or as a treatment for
endometriosis pain.

Medroxyprogesterone is a form of progesterone

, a hormone our body makes. Medroxyprogesterone can help
regulate other hormones in our body. This body works in
different ways, depending on doctor’s prescription.

ANNOUNCEMENT OF THE TOPIC:

“MEDROXYPROGESTERONE INJECTION I.P”
TIME SPECIFIC CONTENTS TEACHING, LEARNING EVALUATION
OBJECTIVES ACTIVITIES
After the discussion, NAME OF THE MEDICINAL PRODUCT: Student teacher explains about What is
the group will be able the description of Medroxyprogesterone
Medroxyprogesterone injection I.P.
to know about medroxyprogesterone injection. injection?
medroxyprogesterone
Injection.
QUANTITATIVE AND QUALITATIVE
INFORMATION:
Each ml contains medroxyprogesterone acetate I.P
150 mg
Water for injection
q.s

PHARMACEUTICAL FORMS
Sterile aqueous suspension.

THERAPEUTIC INDICATIONS
Depot-medroxyprogesterone acetate(MPA)
injectable suspension is indicated for :
- Contraception
- Treatment of endometriosis

LONG TERM USE:

Since loss of bone mineral density may occur in pre-
menopausal women who use MPA injection long term , a
risk/benefit assessment , which also takes into
consideration the decrease in bone marrow density that
occurs during pregnancy and/or lactation , should be
considered.
USE IN CHILDREN:
 MPA IM is not indicated before menarche. Data are
available in adolescent. Other than concerns about loss of
bone marrow density, the safety and effectiveness of MPA
IM are expected to be the same for post-menarcheal
adolescent and adult females.

POSOLOGY AND METHOD OF ADMINISTRATION:

Injectable suspension should be shaken well before
use.

CONTRACEPTION:
MPA intramuscular (IM) should be vigorously shaken just
before use to ensure that the dose being administered
represents a uniform suspension. The recommended dose is 150
mg of MPA injectable suspension every 3 months (12-13) weeks
administered by intramuscular injection in the gluteal or deltoid
muscle. The IM suspension is not formulated for subcutaneous
injection.
The initial IM injection should be given during the first five
days after the onset of a normal menstrual period; within 5 days
postpartum if not breastfeeding of if exclusively breast feeding,
at or after 6 weeks postpartum.
For the second and susbsequent injections, if the time
interval between IM injections is greater than 13 weeks,
pregnancy should be ruled out before administering the next IM
injection.

SWITCHING FROM OTHER METHODS OF

CONTRACEPTION:
When switching from other contraceptive methods ,
(MPA IM) should be given in a manner that ensures continuous
contraceptive coverage based upon the mechanism of action of
both methods, (e.g., patients switching from oral contraceptives
should have their first injection of MPA within 7 days after
taking their last active pill.)

ENDOMETRIOSIS:
Injectable MPA should be given intramuscularly 100 mg
every 2 weeks for at least 6 months and MPA can also be given
intramuscularly 150 mg every 3 months in endometriosis.

HEPATIC INSUFFICIENCY:
No studies have evaluated the effect of hepatic diseases
on the pharmacokinetics of MPA. However , MPA is almost
exclusively eliminated by hepatic metabolism and steroid
hormones may be poorly metabolized in patients with severe
liver insufficiency.

RENAL INSUFFICIENCY:
No clinical studies have evaluated the effect of renal
diseases on the pharmacokinetics of MPA. However, since MPA
is almost exclusively eliminated be hepatic metabolism, no
dosage adjustment should be necessary in women with renal
insufficiency.

PHARMACOKINETICS PROPERTIES
ABSORPTION:
Following intramuscular administration, MPA is slowly
released ,resulting in low, but persistent levels in the circulation.
Immediately after intramuscular injection of 150 mg/ml MPA,
plasma levels were 1.7 +or – 0.3nmol/L. Two weeks later, levels
were 6.8+or – 0.8 nmol/L. Mean time to peak is approximately 4
to 20 days following anintramuscular dose. Serum
medroxyprogesterone acetate levels gradually decline and
remain relatively constant at about 1ng/ml for 2-3 months.
Circulating levels can be detected for as long as 7 to 9 months
following an intramuscular injection.

DISTRIBUTION:
MPA is approximately 90 percentage to 95 percentage protein
bound. Volume of distribution is reported as 20+3 litres.
Medroxyprogesterone acetate crosses the blood brain barrier,
and the placental barrier. Low levels of medroxyprogesterone
acetate have been detected in breast milk of lactating women.
METABOLISM:
MPA is metabolized in the liver.

ELIMINATION:
The elimination half life following single intramuscular injection
is about 6 weeks. Medroxyprogesterone acetate is primarily
excreted in the feces, via biliary secretion. Approximately 30
percentage of an intramuscular dose is secreted in the urine
after 4 days.

PHARMACODYNAMIC PROPERTIES
Medroxyprogesterone acetate is a derivative of
progesterone.

MECHANISM OF ACTION
MPA is a synthetic progestin which has been demonstrated
to possess several pharmacologic actions on the endocrine
system:
- Inhibition of pituitary gonadotropins
- Decrease of ACTH and hydrocortisone blood levels
- Decrease of circulating estrogen levels(as a result of
both FSH inhibition and enzymatic induction of hepatic
 reductase , resulting in increased clearance of
testosterone and consequent decreased conversion of
androgens to estrogens).

CONTRAINDICATIONS:
MPA is contraindicated in patients with the following
conditions:
- Known or suspected pregnancy
- Undiagnosed vaginal bleeding
- Severe liver dysfunction
- Known hypersensitivity to MPA or any other
component of the drugs.

SPECIAL WARNINGS AND PRECAUTIONS FOR USE:

- Unexpected vaginal bleeding during therapy with MPA
should be investigated
- MPA may cause some degree of fluid retention,
therefore , caution should be exercised in treating any
patient with a pre existing medical condition that
might be adversely affected by fluid retention.
- Patients with a history of treatment for clinical
depression should be carefully monitored while
receiving MPA therapy.
- Some patients receiving MPA may exhibit a decreased
glucose tolerance. Diabetic patients should be
carefully observed while receiving such therapy.
- The pathologist should be informed of the patient’s
use of MPA if endometrial or endocervical tissue is
submittedfor examination.
- The physician should be informed that use of of MPA
may decrease the levels of the following endocrine
biomarkers;
 Urinary steroids, urinary gonadotropins, sex
hormone binding globulin.
- Medication should not be administered f there is a
sudden partial or complete loss of vision or if there is a
sudden onset of proptosis, diplopia, or migraine.
- Discontinuation of MPA is recommended in patients
who develop VTE while undergoing therapy with MPA.

NURSES RESPNSIBILITIES:
- Be aware that medroxyprogesterone theraoy should
not be used to prevent cardiovascular disease or
dementia.
- Medroxyprogestin should be used cautiously in
patients with risk factors for vascular diseases.
- Be aware that the drug causes significant loss of bone
mineral density in adolescence and early adulthood.
- Notify prescriber immediatey if patient develops
sudden vision loss, abnormal protrusion of eyeball,
diplopia, papilledema, migraine or other signs of
thrombotic events.
- Except to stop medroxyprogesterone therapy in any
woman who develops evidence of cancer,
cardiovascular disease such as CVA ,MI, pulmonary
embolism, or venous thrombosis, or dementia.

PATIENT TEACHING:
- Encourage the patient to take adequate vitamin D and
calcium.
- Educate the women that they might experience
irregular bleeding and more experience amenorrhoea.
- Educate the women to maintain a balanced diet
during the therapy as there is a chance to gain weight
during the therapy.
- Direct patients to alert the prescriber if there is some
 alteration in the blood tests.
- Caution post menopausal women about increased risk
of dementia associated with progestin therapy.
- Explain the risk of medroxyprogesterone therapy
including breast, endometrial, or ovarian cancer,
cardiovascular disease, dementia, and gallbladder
especially in postmenopausal women.
Time Specific objectives Contents Teaching ,learning activities Evaluation

SUMMARY:
So today we have discussed about
medroxyprogesterone injection, available forms,
indications, dosage, contraindications, pharmacokinetics,
pharmacodynamics, warning and special precautions,
nursing considerations and patient teaching.

CONCLUSION:
Injectable contraceptive is an effective method of
contraception that can be injected subcutaneously or in
the muscles. It prevents pregnancy from taking place by
releasing progesterone in the body. Each dose of
injectable contraceptive prevents pregnancy for three
months. Currently intramuscular variety of injectable
contraceptive is available at government facilities, free of
BIBLIOGRAPHY: cost.
- JONES AND
BARLETT 2011,
NURSES DRUG
HANDBOOK,
PUBLISHED BY
KEVIN SULLIVAN,
10TH EDITION,PAGE
NO:700-704
- www.webMD.
 IDENTIFICATION DATA:
NAME: ALICE MOIRANGTHEM

CLASS: M.Sc NURSING 1ST YEAR

SUBJECT: OBSTETRICS AND GYNAECOLOGIACL NURSING

TOPIC: MEDROXYPROGESTERONE INJECTION

GROUP: MSC NURSING 1ST YEAR

VENUE:

DURATION OF TEACHING: 30 MIN

AV AIDS:

DATE AND TIME OF TEACHING:

PREVIOUS KNOWLEDGE OF THE GROUP: THE STUDENTS MIGHT HAVE PREVIOUS KNOWLEDGE ABOUT
MEDROXYPROGESTERONE INJECETION FROM THEIR B.Sc NURSING PROGRAMME
GENERAL OBJECTIVES:
For students point of view:
- to acquire knowledge on the topic “medroxyprogesterone injection” and apply the knowledge in their profession.

For student teacher’s point of view:

- to acquire skills in effective teaching
- to gain confidence in facing the group.
- To refine the skills of classroom teaching.
- To learn effective use of A.V aids in class.
 RUFAIDA COLLEGE OF NURSING, JAMIA HAMDARD
DRUG PRESENTATION ON: MEDROXYPROGESTERONE INJECTION

SUBMITTED TO SUBMITTED BY
SUBMITTED TO SUBMITTED BY

SUBMITTED ON