Reproductive Agents

Drugs Affecting The Female Reproductive System

A. Sex Hormones
B. Estrogen Receptor Modulators
C. Fertility Drugs
D. Uterine Motility Drugs
A. Sex Estrogens
Hormones
Therapeutic -important for the development of the female
Actions and reproductive system and secondary sex
Indications characteristics
-used for hormone replacement therapy
-Also used as palliation for the discomforts of
menopause ,hypogonadism, ovarian failure, to
prevent postpartum engorgement, osteoporosis ,
and for palliation in certain cancers
Pharmacokinetic -oralestrogen are well-absorbed through GI and
s undergo extensive hepatic metabolism
-excreted through urine
-cross the placenta and enter breastmilk
Contraindication -any known allergies to estrogen
s and Cautions -patient with idiopathic vaginal bleeding,breast
cancer or any estrogen-dependent cancer
-history of thromboembolic disorders
-pregnancy and lactation
-caustiously in patient with metabolic bone
disease
Progestins
-used as contraceptives, most effectively in
combination with estrogens
-used to treat primary and secondary amenorrhea and
uterine bleeding
-Progestins transform the proliferative endometrium
into a secretory endometrium, inhibit the secretion of
FSH and LH,prevent follicle maturation and ovulation,
inhibit uterine contractions and may have some
anabolic and estrogenic effects.
-like estrogen as to the
absorption ,metabolism,and excretion
-Etonogestrel, avsilsble as a vaginal ring
-Nuvaring,is available as a subdermal implant
that may place for up to 3 years and then
removed
-similar to estrogen
-in addition, it also contraindicated in the
presence of pelvic inflammatory disease,
endometriosis or pelvic surgery
-Drospirenone, is contraindicated in patients
who are at risk for hyperkalemia
-caution in patient with epilepsy, migraine
headached,asthma ,cardiac or renal
 Estrogens
Adverse Effects -commonly on involve the genitourinary tract
-include bleeding,menstrual
irregularities,dysmenorrhea,amenorrhea,
and changes in libido
-systemic effect of estrogen,including fluifd
retention, electrolyte disturbances,
headache,dizziness,mental changes,weight
changesand edema
-GI effects include: vomoting,abdominal
cramps,bloating,colitis
Progestins
-vary with the administration
route used
-systemic effects are very similar
to adverse effects of estrogen
-Vaginal gel use is associated
with headache,nervousness,
constipation,breast enlargement,
and perineal pain
B. Estrogen Receptor Modulators

Therapeutic Actions and Indications

• -its not a hormones but affect specific estrogen receptor
sites, stimulating some and blocking others.
Pharmacokinetics
• administer orally
• Raloxifene, well absorbed at GI and metabolize at the
liver
• Excretion occur through feces
• it is known to enter at the placenta and breastmilk
Contraindications and Cautions
• Raloxifene, contraindicated to any known allergy
• during pregnancy and lactation
• caution in used with patient with history of venous thrombosis or smoking
Adverse Effects
• Raloxifene, associated with GI upset,nausea and vomiting,headache,dizziness,visual changes and
mental changes
• Venous thromboembolism is potentially dangerous side effects
Nursing Consideration
• Assess for contraindication,adverse effects , and side effects
• assess for any known allergy
• encourage the use of small frequent meals
• monitor visual chnges
• asses for potential changes in perfusion , liver function
 C. Fertility Drugs
Therapeutic Actions and Indications
• -stimulate the female reproductive system by either directly to stimulate
follicles and ovulation or stimulate the hypothalamus to increase FSH and
LH levels leading to ovarian follicular development and maturation of ova.
• drugs used to treat infertility woman with functioning ovaries whose
partner is fertile.
• Fertility drugs include:
– Menotropins -inhihbits premature LH surges in women undergoing controlled
ovarian stimulation by acting like GnRH antagonist
– Cetrorelix - used to stimulate spermatogenesis
– Urofollitropin -used to stimulate follicle development and induce ovulation
Pharmacokinetics
• these drugs are well absorbed and are treated like endogenous hormones
within the body, undergoing hepatic metabolism and renal excretion
Contraindications and Cautions
• in the presence of primary ovarian failure , thyroid or adrenal dysfunction
• known allergy to any fertility drugs
• caution should be used in women who are breasfeeding , with thromboembolic
diseases, and respiratory disease
Adverse Effects
• greatly increased risk of multiple births and birth defects, ovarian
stimulation,headache,fluid retention,nausea,bloating,uterine bleeding,ovarian
enlargement,gynecomastia and febrile reactions
Nursing Considerations
• assessment on pelvic and breast examination
• assess for contraindication,adverse reactions, and laboratory tests
• assess the cause of the dysfunction before beginning of the therapy
• check urine estrogen and estradiol levels before beginning ogf the therapy
• discontinue the drug at any sign of ovarian stimulation
• Provide warnings about the risk and hazards of multiple births
D. Uterine Motility Drugs
1. Oxytocics
Therapeutic Actions and Indications
• the oxytocics directly affect neuroreceptor sites to stimulate contraction of the uterus,
they are especially effective in the gravid uterus
• it is a synthetic form of the hypothalamic hormone,also stimulate the lacteal glands
in the breast to contract promoting milk production in lactating women
• indicated for the prevention and treatment of uterine atony after delivery
Pharmacokinetics
• rapidly absorbed after parenteral or oral administration,metabolized in the liver and
excreted in the urine and feces.
• they cross the placcenta and enter breast milk.
• Methylergonovine, promote uterine involution
Contraindications and Cautions
• presence of any known allergy to oxytocics
• with cephalopelvic disproportion,unfavorable fetal position, complete uterine atony
or early pregnancy
Adverse Effects
• excessive effects like uterine hypertonicity and spasm, uterine rupture, postpartum
hemorrhage, decrease fetal heart rate
• GI upset
• casue severe water intoxication with coma and even maternal death when used for
a prolonged period
Nursing Considerations
• assess for contraindication,adverse reactions, and laboratory tests
• performe complete assessment
• assess labor pattern
• evaluate uterine tone, noting any indication of atony
• regulate oxytoxin delivery using infusion pump
• monitor blood pressure and fetal heart rate frequently
• discontinue drugs for for any sign of uterine hypertonicity
2. Abortifacients
Therapeutic Actions and Indications
• used to evacuate uterine contents via intense uterine contractions
• stimulate uterine activity, dislodging any implanted trophoblast and preventing implantation of any fertilized egg.
Pharmacokinetics
• these drugs are well absorbed when administered
• they metabolized in the liver and excreted in the urine
• Mifepristone , is administered orally and takes 5 to 7 days to produce the desired effects
• Carboprost,is available as an IM injection with an onset of 15 minutes and a duration of 2 hours
• Dinoprostone, is given by intravaginal suppository with an onset of effects in 10 minutes and a duration of
effects of 2 hours
Contraindications
• presence of any known allergy to the drug
• with active pelvic inflammatory disease, hepatic, renal or pulmonary disease
• lactation women
• caution should be used with any history of asthma,hypertension, adrenal disease,acute vaginitis,scarred uterus
Adverse Effects
• abdominal cramping, heavy uterine bleeding, perforated uterus,
uterine rupture
• others include headache, nausea and vomiting,diarrhea,
diaphoresis,backache ,and rash
Nursing Considerations
• assess for contraindication,adverse reactions, and laboratory tests
• performe complete physical and psychological assessment
• confirm date of last menstruation period
• evaluate uterine tone and involution and the amount of bleeding
• administere via route indicated
• monitor patient response to the drug, effectiveness measures and
teaching plan
Drugs Affecting The Male Reproductive System

A. Androgens
B. Anabolic Steroids
C. Drugs for Treating Penile Erectile Dysfunction
A. Androgens

Therapeutic Actions and Indications

• they act to increase the retention of nitrogen,sodium,potassium, and phosphorus and to decrease the
urinary excretion of calcium
• they also increase the production of red blood cells
• it is used for replacement therepy in cases of hypogonadism (underdeveloped testes) and to treat certain
breast cancers.
Pharmacokinetics
• they metabolized in the liver and excretd in the urine
• it is not known whether androgens enter breastmilk
• drugs include:Danazol ,Methyltestosterone,Fluoxymesterone
Contraindications
• presence of any known allergy to the drug
• during lactation, presence of prostate cancer among men
• with liver dysfunction or cardiovascular disease
• topical forms of testerone have a black box warning alerting the user to the risk of virilization in children
who come in contact with the drug from touching the clothes and skin of the man using the drug
• not for long term use and to take appropriate precautions
Adverse Effects
• Androgenic effects include: acne, edema, hirsutism, deeping of the voice, oily skin
and hair, weight gain, decrease in breast size and testicular atrophy
• Antiestrogen effects include: flushing, sweating,vaginitis,nervousness, and
emotional lability
• a potentially - life threatening effect that has been documented is hepatocellular
cancer
Nursing Considerations
• assess for contraindication,adverse reactions, and laboratory tests
• performe complete physical
• assess for contraindication,adverse reactions, and laboratory tests
• arrange for radiograph of the long bones in children
• remove an old dermal system before applying a new system to clean , dry and
intact skin
• Monitor the response of the therapy
• monitor liver function periodically
B. Anabolic Steroids
Therapeutic Actions and Indications
• are analogues of testosterone that have been developed to produce
the tissue-building effects of testosterone with less androgenic effect.
• indicated for for particular anabolic steroids
• can be used to treat anemias, certain cancers and angioedema
• also known to be used illegally for the enhancement of muscle
mass,increased hematocrit and theoretically increase in strenght and
endurance
Pharmacokinetics
• well absorbed and widely distributed throughout the body
• metabolized in the liver and excreted in the urine
Contraindications
• presence of any known allergy to the drug
• presence of liver dysfunction,coronary disease, prostate cancer
Adverse Effects
• in prepubertal males adverse effect include virilization like phallic enlargement, hirsutism,
increased skin pigmentation
• on postpubertal male may experience inhibition of testicular
function,gynecomastia,testicular atrophy,priapism,baldness and change in libido
• These drugs all have a black box warnings as alerts to potentially serious effects of liver
tumors , hepatitis and blood lipids level changes that might associated with increased risk
of coronary artery disease
Nursing Considerations
• assess for contraindication,adverse reactions, and laboratory tests
• performe complete physical
• assess for contraindication,adverse reactions, and laboratory tests
• arrange for radiograph of the long bones in children
• administer with food if GI effects are severe
• Monitor endocrine function,hepatic function and serum electrolytes
• Monitor the response of the therapy
• monitor liver function periodically
 C. Drugs for Treating Penile Erectile Dysfunction
Therapeutic Actions and Indications
• Penile Erectile dysfunction is a condition in which the corpus cavernosum does not fill with blood to allow for
penile erection.This can result from the aging process and in vascular and neurological conditions
• when injected directly into the cavernosum, alprostadil acts locally to relax the vascular smooth muscle and
allow filling of the corpus cavernosum causing penile erection
• Prostaglandin alprostadil andthe PDE5 inhibitors are indicated for the treatment of penile erectile dysfunction
Pharmacokinetics
• after injection, it metabolized to inactive compounds in the lungs and excreted in the urine
• the PDE5 inhibitors are well absorbed from the GI tract, undergo metabolism in the liver and excreted in the
feces
Contraindications
• in the presence of any anatomical obstruction or condition that might predispose to priapism
• they cannot be used with penile implants, and they are not indicated for use to improve sexual performance in
women.
• caution should be used in patient with bleeding disorders, coronary diseas,active peptic ulcer, retinitis
pigmentosa,severe hypertension,severe hepatic or renal disorders,congenital prolonged QT interval,optic
neuropathy
Adverse effect
local effects such as pain at the injection sites,
infection,priapism,fibrosis, and rash
systemic effects including
headache,flushing,dyspepsia,UTI,diarrhea,dizziness,optic
neuropathy,loss of hearing increased risk of melanoma and rash
Nursing Considerations
• assess for contraindication,adverse reactions, and laboratory tests
• performe complete physical
• assess for contraindication,adverse reactions, and laboratory tests
• assess the cause of dysfunction
• monitor vascular disease for any sign of exacerbation
References:

• Karch, A. M., & Karch. (2011). Focus on nursing

pharmacology. Wolters Kluwer Health/Lippincott Williams
& Wilkins.

• Katzung, B. G. (2017). Basic and clinical pharmacology.

McGraw-Hill Education.

• Gersch,C.(2017).Pharmacology Made Incredibly

Easy.Wolters Kluwer Health/Lippincott Williams & Wilkins.