CENTRAL LUZON DOCTORS’ HOSPITAL

EDUCATIONAL INSTITUTION, INC

Romulo Highway, San Pablo, Tarlac City
Tel No. (045) 982-5019/ 982-5052/ 982-0264 Fax No. (045) 982-0780/982-2757

DEPARTMENT OF NURSING
NCM 106 PHARMACOLOGY
MODULE 2

INTRODUCTION TO THE REPRODUCTIVE SYSTEM

FEMALE

It consist of:
 Ovaries
 Fallopian tubes
 Uterus
 Accessory structures
o Vagina
o Clitoris
o Labia
o Breast tissue

Estrogen
 Produced by the ovary, placenta and adrenal gland
 Stimulates development of female characteristics
 Prepares the body for pregnancy
 Is responsible for the maturation of the female reproductive organs and for the
appearance of secondary sex characteristics.
 Has numerous metabolic effects on nonreproductive tissues, including the brain,
kidneys, blood vessels, and skin (e.g. it helps maintain low blood cholesterol levels
and facilitates calcium uptake by bones to help maintain proper bone density.
 when women enter menopause at about age 50 to 55, the ovaries stop secreting
estrogen.

Progesterone
 produced by the ovary, placenta and adrenal gland
 promotes maintenance of pregnancy

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Combination of Estrogen and Progesterone
 promotes breast development and regulates the monthly changes of the uterine
cycle

Ovulation
 is the release of a mature egg from one of the ovaries, which happens every month.
A woman is most fertile around the time of ovulation.

Menstrual Cycle
 cyclical nature of the female sex hormones on the body
 MENARCHE – is the onset of menstrual cycle at puberty
 Each cycle starts with release of FSH and LH and stimulation of the ovarian follicles

Pregnancy
 When the ovum is fertilized by a sperm, a new cell is produced that rapidly divides to
produce the embryo
Menopause
 cessation of menses
 depletion of the female ova
 results in lack of estrogen and progesterone

MALE

It consist of:
 testes
 vas deferens
 prostate gland
 penis

 urethra

Testosterone

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  produced by the gonads (by the Leydig cells in the testes in men and by the ovaries
in women).
 Responsible for many sexual and metabolic effects in the male

Andropause
 A.K.A. male climacteric
 Analogues to female menopause
 Occurs with age when the production of testosterone declines, with subsequent loss
of testosterone effects

DRUGS AFFECTING FEMALE REPRODUCTIVE SYSTEM

Drug Classifications
1. Sex hormones
2. Estrogen receptor modulators
3. Fertility drugs
4. Uterine motility drugs

1. Sex Hormones
 Include estrogen and progesterone
o Estrogen – used for PERLL, important for the development of the female
reproductive system and secondary sex characteristics.
 Estradiol
 Conjugated estrogen
 Esterified estrogen
 Contraindications and caution:
o Known allergies
o Idiopathic vaginal bleeding
o Breast cancer
o Estrogen-dependent cancer
o CVA
o Hepatic dysfunction
o Pregnancy
o Lactation
o Bone dse.
o Renal insufficiency

o Progestin – used as contraceptives, maintain pregnancy and development of

secondary sex characteristics, used to treat primary and secondary
amenorrhea and functional uterine bleeding.
 Drospirenone
 Etonogestrel
 Progesterone
 Medroxyprogesterone
 Contraindications and cautions:
o Pelvic inflammatory dse.
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 o STD
o Endometriosis
o Pelvic surgery
o Renal and hepatic disorders
o Epilepsy
o Asthma
o Migraine headache
o Cardiac disfunction
Adverse Effect
 Corneal changes
 Photosensitivity
 Peripheral edema
 Chloasma
 Hepatic adenoma
 Nausea
 Vomiting
 Abdominal cramps
 Bloating
 Breakthrough bleeding
 Changes in menstrual flow
Contraception
 the most widespread pharmacological use of the female sex hormones is to prevent
pregnancy.
o Oral contraceptives
 Referred to as “the pill” mostly are combination of estrogen and
progestins, a few preparations contain only progestin
ESTROGEN AND PROGESTINS ORAL CONTRACEPTIVES
 Daily doses of estrogen in oral contraceptives have declined from 150mcg (40yrs
ago), to about 35mcg in modern formulations. This reduction has resulted in a
decrease in estrogen-related adverse effects.
 Typically, drug administration of an oral contraceptive begins on day 5 of the ovarian
cycle, and continuous for 21days, the other 7days of the month, the client takes
placebo (some contains iron, which replaces iron lost from the menstrual period.
 Act by providing negative feedback to the pituitary to shut down the secretion of LH
and FSH.

Patient education
1. Backup contraceptive when starting the pill will depend on the type of birth control
and when it was started.
2. Take contraceptives at the same time everyday
3. Use back up contraceptive when taking antibiotics
4. Report symptoms ACHES

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3 Types of estrogen-progestin
1. Monophasic
 Most common
 Delivers a constant amount of estrogen and progestin in every pill

2. Biphasic
 The amount of estrogen in each pill remains constant, but the amount
of progestin is increased toward the end of the menstrual cycle to
better nourish the uterine lining

3. Triphasic
 The amounts of both estrogen and progestin vary in three distinct
phase during the 28-day cycle
Minipills
 the progestin-only oral contraceptive.
 Prevent pregnancy primarily by producing thick, viscous at the entrance to
the uterus that discourages penetration of sperm.
 Also tend to inhibit implantation of fertilized egg.
Several long term formulations of oral contraceptives are as follows:
 Depo-provera – deep IM injection of Medroxyprogesterone acetate that
provides 3 months of contraceptive protection.
 Lunelle – IM injection of Medroxyprogesterone acetate and Estradiol Cypionate
in prefilled syringes that provides one month contraceptive protection.
 Mirena – polyethylene cylinder placed in the uterus that releases
Levonorgestrel. About the size of a quarter and shaped like letter T, Mirena
acts locally to prevent conception for 5 years.

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Nursing considerations:
The role of the nurse in oral contraceptive therapy involves careful
monitoring of a client’s condition and providing education as it relates to the
prescribed drug treatment. Oral contraception is the most effective form of
birth control, and many products are available to prevent pregnancy. Oral
contraceptives are contraindicated for women with a history of stroke,
myocardial infarction, (MI), coronary artery disease, thromboembolic
disorders, or estrogen-dependent tumors because of increases in estrogen
levels and the risk of thrombus formation. Assess for pregnancy before
initiating oral contraceptive therapy. Obtain a complete health history
including personal or familial history of breast of breast cancer, liver tumors,
and hemorrhagic disorders, because these conditions are contraindications
to the use of oral contraceptives. Risks and adverse effects are greater for
women who smoke and are older than age 35. Oral contraceptives should be
used with caution in clients with hypertension, cardiac or renal disease, liver
dysfunction, diabetes, gallbladder disease and a history of depression.

Monitor blood pressure, because these medications can cause mild to

moderate hypertension. Assess vital signs frequently, and monitor for
symptoms of thrombophlebitis, such as pain, redness, and tenderness of the
calves. Oral contraceptives can mimic certain symptoms of pregnancy,
including breast tenderness, nausea, bloating, and chloasma. Reassure the
client that these side effects do not indicate pregnancy. Oral contraceptives
may increase the risk of certain types of breast cancer; therefore, teach
clients how to perform breast self-exams and provide information on routine
scheduling of mammograms appropriate for their age bracket.
Client teaching:
Client education as it relates to oral contraceptives should include the goals of
the therapy, the reasons for assessing baseline data such as vital signs and the
existence of underlying cardiovascular disorders, and possible drug side effects.
Include the following points when teaching client about oral contraceptives:
 Take medications as directed by the healthcare provider.
 Follow instructions carefully for missed doses.
 Immediately report calf pain or redness, dyspnea, and chest pain.
 Monitor blood pressure regularly and report elevations.
 Attend a smoking cessation program if appropriate.
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  Perform monthly self-examination of breasts.
2. Estrogen receptor modulators
 Are used to stimulate specific estrogen receptors to achieve therapeutic effects of
increased bone mass without stimulating the endometrium and causing other less
desirable effects.
o Raloxifene (Evista)
o Toremifene (Fareston)
 Contraindication and cautions:
 Known allergies
 Pregnancy
 Lactation
 Venous thrombosis
 Smoking

 Adverse effects
 Venous thromboembolism
 Hot flashes
 Skin rash
 Nausea
 Vomiting
 Vaginal bleeding
 Depression
 Light headedness

3. Fertility drug
 Stimulate the female reproductive system
 Work either directly stimulate follicles and ovulation or stimulate the hypothalamus
to increase FSH and LH levels.
o Cetrorelix
o Chorionic gonadotropin
o Clomiphene
o Menotropins
 Contraindications and cautions:
 Presence of primary ovarian failure
 Thyroid & adrenal dysfunction
 Ovarian cyst
 Pregnancy
 Idiopathic uterine bleeding
 Known allergies
 Breastfeeding
 Thromboembolic diseases
 Respiratory diseases
 Adverse effects:
 Vasomotor flushing
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  Visual changes
 Abdominal discomfort
 Distention and bloating
 Nausea
 Vomiting
 Ovarian enlargement
 Breast tenderness
 Ovarian overstimulation
 Multiple pregnancy

4. Uterine motility drugs

 Stimulate uterine contractions to assist labor (oxytocics) or induce abortion
(abortifacients)
 drugs used to slow uterine activity (tocolytics)

a. oxytocics
- stimulate contraction of the uterus
- directly affects neuroreceptors sites to stimulate contraction of the
uterus
- effective in the gravid uterus
- promotes milk ejection (let down) in lactating women,
- does not increase the volume of milk production
- prevention and treatment for uterine atony post delivery
o methylergonovine (Methergine)
o oxytocin (Pitocin)
 contraindication and cautions:
 known allergies
 Cephalopelvic disproportion
 Complete uterine atony
 Early pregnancy
 Coronary dse.
 Hypertension
 Previous cesarean section
 Hepatic and renal impairment
 Adverse effects:
 Cardiac arrhythmias
 Hypertension
 fetal bradycardia
 nausea
 vomiting
 uterine rupture
 pelvic hematoma
 uterine hypertonicity
 severe water intoxication
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  anaphylactic reaction
b. abortifacients
- used to evacuate uterine contents via intense uterine contractions
- stimulate uterine activity, dislodging any implanted trophoblasts and
preventing implantation of any fertilized egg.
o Carboprost
o Dinoprostone
o Mifepristone
 Contraindications and cautions:
 Known allergies
 Active PID
 Acute CV, hepatic, renal or pulmonary dse.
 Lactation
 Scarred uterus
 Acute vaginitis
 Adverse effect:
 Headache
 Paresthesia
 Hypotension
 Vomiting
 Diarrhea
 Nausea
 Uterine rupture
 Uterine or vaginal pain
 Chills
 Diaphoresis
 Backache
 Fever

c. Tocolytics
- Used to inhibit uterine contractions during premature labor
o Ritodrine hydrochloride (Yutopar)
o Terbutaline sulfate (Brethine)
o Magnesium sulfate
o Nifedipine (Procadia)
 Adverse effect
 Tachycardia in both mother and fetus
Nursing considerations:
The role of the nurse in uterine stimulant therapy involves careful monitoring of both
mother’s and child’s conditions and providing education as it relates to the prescribed drug
treatment. Evaluate the client for fetal presentation, especially for the presence of
cephalopelvic disproportion.
For oxytocin to be administered safely, the fetus must be viable, and vaginal delivery
must be possible. Assess the progression of labor. Assess the client for history of invasive
cervical cancer, herpes genitalis, or cord prolapse. Obtain a complete health history
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including gynecological and obstetrics history. gravida. This drug is not used of the client is a
grand multipara, is older than 35 years of age, or has a history of uterine sepsis or traumatic
birth. Previous sensitivity or allergic reaction to an ergot derivative contraindicates in clients
with active cardiac, pulmonary, renal, or hepatic disease. These medications must be used
cautiously with vasoconstrictive drugs.
Frequently assess the client in labor, because oxytocin increases the frequency and
force of uterine contractions. Discontinue the infusion if fetal distress is detected, to
prevent fetal anoxia. Hypertensive crisis may occur if local or regional anesthesia is used in
combination with oxytocin.
Uterine hyperstimulation is characterized by contractions that are less than 2 minutes
apart, have a force greater than 50 mmHg, or last longer than 90 seconds. Discontinue
oxytocin immediately if hyperstimulation occurs. Monitor fluid balance, because prolonged
IV infusion of oxytocin may cause water intoxication. Assess for symptoms of water
intoxication and report immediately. Symptoms include drowsiness, listlessness, headache,
confusion, anuria, and weigh gain. Assess for side effects of oxytocin including anxiety,
maternal dyspnea, hypotension, or hypertension, nausea, vomiting, neonatal jaundice, and
maternal or fetal dysrhythmias.

Client Teaching:
Client education as it relates to oxytocic drugs should include the goals of the therapy;
the reasons for obtaining baseline data such as vital signs, and the existence of underlying
cardiovascular, pulmonary, or renal disorders; and possible drug side effects. Include the
following points when teaching clients about oxytocics:
 be aware that a healthcare provider will continuously monitor for complications of
oxytocin therapy and assess fetal status.
 Immediately report headache, increase vaginal bleeding and prolonged uterine
contractions.

DRUGS AFFECTING MALE REPRODUCTIVE SYSTEM

Drug Classifications
1. Androgens
2. Anabolic steroids
3. Drugs for treating penile erectile dysfunction

1. Androgens
 Male sex hormones
 Responsible for the growth and development of male sex organs and
maintenance of secondary male sex characteristics
 Increase protein anabolism and decrease protein catabolism
 Includes:
o Testosterone – produced in the testes; responsible for male characteristics
before puberty
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 o Androgens – produced in the adrenal glands; sustains male characteristics
after puberty
 Testosterone
 Danazol
 Fluoxymesterone
 Methyltestosterone
 Contraindication and cautions:
o Known allergies
o Pregnancy
o Lactation
o Presence of prostate/breast cancer
o Liver dysfunction
o CVD
 Adverse effect:
o Dizziness
o Headache
o Sleep disorders
o Fatigue
o Rash
o Androgenic effects (acne,deepening of voice, oily
skin)
o Hypoestrogenic effects
o Polycythemia
o Nausea
o Hepatocellular carcinoma
2. Anabolic steroids
 Analogues of testosterone that have been developed to produce the
tissue-building effects of testosterone with less androgenic effect
 Promotes body tissue-building processes, reverse catabolic or tissue-destroying
process and increase hemoglobin and red blood cell mass. (anemias, cancer,
angioedema, weight gain, tissue repair)
o Oxandrolone
o Oxymetholone
 Contraindication and cautions:
 Known allergies
 Pregnancy
 Lactation
 Liver dysfunction
 coronary dse.
 Prostate / breast cancer
 Adverse effects:
 Excitation
 Insomnia
 Virilization (male secondary sex characteristic)
 Hepatitis
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  Liver cell tumors
 Blood lipid changes
 Acne
 Musculinization of females
 Priampism
 Baldness
 Loss of libido
Nursing considerations:
The role of the nurse on androgen therapy for hypogonadism involves careful
monitoring of a clients condition and providing education as it relates to the prescribed drug
treatment. Obtain a history that includes questions regarding the possibility of impaired
sexual functioning and diminished libido. Conduct a physical assessment for evidence of
decreased hormone production, such as decreased or absent body hair, small testes, or
delayed signs of puberty. This assessment should also include the client’s emotional status
because depression and mood swings may be symptoms of decreased hormone secretion.
Monitor lab results, especially liver enzymes, if the client has a history of anabolic steroid
use. Also, monitor serum cholesterol, especially in clients with a history of myocardial
infarction or angina, as the drug can increase this lab value. Contraindications to androgen
therapy include prostatic or male breast cancer, renal disease, cardiac and liver dysfunction,
hypercalcemia, benign prostatic hyperplasia (BPH), and hypertension. Androgens must ne
used cautiously in prepubertal men, adults, older adults, and in men with acute intermittent
porphyria.
Monitor for side effects of clients taking androgens, including skin reactions such as
pruritus or blistering with topical formulations. Some adverse reactions found to occur in
women as a result of androgen use include deepening of the voice, facial hair growth,
enlarged clitoris, and irregular menses.

Client teaching:
Client education as it relates to androgen therapy should include the goals of therapy
the reasons for obtaining baseline data such as vital signs and the existence of underlying
cardiac or renal disorders, and possible drug side effects. Include the following points when
teaching clients about androgen therapy:
 Keep all scheduled laboratory visits for periodic serum cholesterol, serum
electrolyte, and liver function tests.
 Check weight twice a week and report significant increases.
 Report any soreness at injection sites.
 Immediately report prolonged or painful erections (priapism).
 If diabetic, be alert for signs and symptoms of hypoglycemia (shaking, sweating,
hunger, anxiety, and dizziness).
 Notify the healthcare provider immediately if pregnancy is planned or suspected.
 Be aware of proper technique in using medication (transdermal patch, oral
medication, gel, or injection).

3. Drugs for Penile erectile dysfunction

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  Acts locally to relax the vascular smooth muscle and allow filling of the corpus
cavernosum.

 Penile erectile dysfunction

- Inability to achieve or
maintain an erection
sufficient for intercouse
- a condition in which the
corpus cavernosum does not
fill with blood to allow for
penile erection
- results from aging process
and in vascular and
neurological conditions
- PDE inhibitors – work by relaxing smooth muscle increasing blood flow to area
causing an erection.
o Prostaglandin alprostadil
o Sildenafil (Viagra)
o Tadalafil (Cialis)
o Vardenafil (Levitra)
 Contraindication and cautions:
 Priampism
 Penile implants
 Bleeding disorders
 CAD
 Active peptic ulcer
 Hypotension
 Severe hypertension
 Severe hepatic and renal disorders
 Adverse effects:
 Headache
 Abnormal vision
 Flushing
 Dyspepsia
 Urinary tract infection
 Rash

NOTE: Nitrate medications should not be prescribed with PDE inhibitors

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