PHARMACOLOGY

Father Saturnino Urios University

Prepared by: REANNE MAE C. ABRERA SN
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REPRODUCTION: FUNCTIONAL ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM
CHARACTERISTICS OF THE FEMALE REPRODUCTIVE SYSTEM
❖ Cyclic changes in activity → Menstrual cycle and menstruation
❖ Restricted periods of fertility → Ovulation
❖ Limited gamete product → Pool established at birth; Oogonia = female gametes
FUNCTIONS OF THE GRANULOSA CELLS
➢ The wall of the uterus contains:
■ The outer layer is the perimetrium. It contains epithelial cells and
connective tissue.
■ The middle layer is the myometrium. It contains smooth muscles and is
the thickest layer of the wall of the uterus.
■ The inner layer is the endometrium. It contains a layer of epithelial cells
as well as connective tissue. It also has numerous glands.
❖ Vagina

❖ Secretes antral fluid ➢ It is the female organ of copulation. Its’ walls contains smooth muscle and the

❖ Provide nutrients for developing oocyte inner surface is bathed in acid fluid secreted from the uterus or glands in the

❖ Secrete paracrines that support follicle development cervix which protects itself against bacterial infections.

❖ Secrete inhibin ❖ Uterine tubes

❖ Secrete estrogens ➢ It is also called the fallopian tubes or oviducts. The mature ovum gets

❖ Secrete substance that forms zone pellucide transported into the uterine tube and into the uterus. This is where fertilization
takes place.
THE FEMALE REPRODUCTIVE TRACT
❖ Fimbriae
❖ Uterus
➢ They are finger-like projections. The infendibulum is located right above the
➢ It is the site of fetal development The cervix is the canal leading to the vagina.
fimbriae. They both help pick up the ovum released from the ovary. They help
Both the cervix and vagina is called the birth canal.
move the ovum into the uterine tube by peristalsis and then turns into ciliary
action. It takes about four (4) days for a mature ovum to reach the uterus.
REPRODUCTION: FUNCTIONAL ANATOMY OF THE MALE REPRODUCTIVE SYSTEM ➢ They secrete an alkaline fluid that contains fructose, enzymes, and
prostaglandins. The purpose of the alkaline fluid is to neutralize the acid in the
CHARACTERISTICS OF THE MALE REPRODUCTIVE SYSTEM
female reproductive tract. Fructose is used for energy in order for the sperms to
❖ Vas deferens propel themselves. The enzymes facilitate enzyme clotting. Prostaglandins
❖ Penis provide motility and viability for the sperms.
❖ Testis
➢ It is the male’s gonads. The majority of the testicle is composed of seminiferous
tubules which produce sperm via spermatogenesis. DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM
➢ The seminiferous tubules’s lumen is lined by cells called Sertoli cells (which
A. Sex Hormones
support sperm development) which are connected via tight junctions. The lining
B. Estrogen Receptor Modulators
outside of these cells are a layer of smooth muscles (allows peristalsis by
C. Fertility Drugs
propelling sperm through the seminiferous tubules). Leydig cells are found
D. Uterine Motility Drugs
outside of the Sertoli cells, they secrete testosterone.
➢ There are two compartments: Basal compartment and Lumenal compartment.
The basal compartment is the area that goes between the tight junctions
towards the smooth muscles. The lumenal compartment is the area that goes
from the tight junctions towards the lumen.
❖ Scrotum
❖ Bulbourethral gland
➢ It secretes a viscous fluid that contains mucus as it serves as a lubricant.
❖ Prostate gland
➢ It secretes citrate, an energy source for sperm motility. It also secretes enzymes
which break down the semen clot once it is inside the female reproductive tract.
❖ Seminal vesicles
 SEX HORMONES Pharmacokinetics Oral estrogen are It is like estrogen as to the

bleeding. well-absorbed through GI and absorption, metabolism, and

undergo extensive hepatic excretion. Etonogestrel is
SEX HORMONES ESTROGENS PROGESTINS
metabolism. It is excreted available as a vaginal ring.

Therapeutic Actions and It is important for the It is used for contraceptives, through the urine. It can cross Nuvaring is available as a

Indications development of the female most effectively in the placenta and enter subdermal implant that may

reproductive system and combination with estrogens. breastmilk. place for up to 3 years and

secondary sex characteristics. It is used to treat primary and then removed.

It is used for hormone secondary amenorrhea and

Contraindications and Any known allergies to It is similar to estrogen. In
replacement therapy and also uterine bleeding. Progestin
Cautions estrogen, patients with addition, it is also
used as palliation for the transforms the proliferative
idiopathic vaginal bleeding, contraindicated in the
discomforts of menopause, endometrium into a secretory
breast cancer or any presence of pelvic
hypogonadism, ovarian endometrium, inhibit the
estrogen-dependent cancer, inflammatory disease,
failure to prevent postpartum secretion of FSH and LH,
history of thromboembolitic endometriosis or pelvic
engorgement, osteoporosis, prevent follicle maturation
disorders, pregnancy and surgery. Drospirenone is
and for palliation in certain and ovulation, inhibit uterine
lactation, cautiously in contraindicated in patients
cancers. contractions and may have
patient with metabolic bone who are at risk for
some anabolic and estrogenic
disease. hyperkalemia. Caution in
effects.
patients with epilepsy,
migraine, headaches, asthma,
and cardiac or renal
dysfunction.
Adverse Effects It is commonly involved in the They vary with the ESTROGEN RECEPTOR MODULATORS
genitourinary tract. It includes administration route used.
❖ Therapeutic Actions and Indications
bleeding, menstrual Its’ systemic effects are very
➢ It’s not hormones but it affects specific estrogen receptor sites, stimulating some
irregularities, dysmenorrhea, similar to adverse effects of
and blocking others.
amenorrhea, and changes in estrogen. Vaginal gel use is
❖ Pharmacokinetics
libido. It has a systemsic associated with headache,
➢ It is administered orally. Raloxifene is well absorbed at the GI and metabolized at
effect of estrogen, including nervousness, constipation,
the liver. Excretion occurs through the feces. It is known to enter at the placenta
fluid retention, electrolyte breast enlargement, and
and breastmilk.
disturbances, headache, perineal pain.
❖ Contraindications and Cautions
dizziness, mental changes,
➢ Raloxifene is contraindicated to any known allergy. During pregnancy and
weight changes and edema.
lactation. Caution is used with patients with history of venous thrombosis or
GI effects include vomiting,
smoking.
abdominal cramps, bloating,
❖ Adverse Effects
and colitis.
➢ Raloxifene is associated with GI upset, nausea and vomiting, headache,
dizziness, visual changes and mental changes. Venous thromboembolism is
potentially dangerous side effects. blood clot in a vein

❖ Nursing Considerations
➢ Assess for contraindication, adverse effects, and side effects. Assess for any
known allergy. Encourage the use of small frequent meals. Monitor visual
changes. Assess for potential changes in perfusion or liver function.

FERTILITY DRUGS
❖ Therapeutic Actions and Indications
➢ They 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 developent and maturation of ova. The drugs
used to treat infertile women with functioning ovaries whose partner is fertile.
➢ Fertility drugs include:
■ Menotropins which inihibits premature LH surges in women undergoing
controlled ovarian stimulation by acting like GnRH antagonist.
■ Cetrorelix which is used to stimulate spermatogenesis.
■ Urofollitropin which is 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
breastfeeding with thromboembolic diseases and respiratory diseases.
❖ 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 contraindications,
adverse reactions, and laboratory tests. Assess the cause of the dysfunction
before beginning of the therapy. Check urine, estrogen, and estradiol levels
before beginning of the therapy. Discontinue the drug at any sign of ovarian
stimulation. Provide warnings about the risk and hazards of multiple births.
UTERINE MOTILITY DRUGS: 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 hormon and also stimulate the lacteal glands in the breast to
contract, promoting milk production in lactating women. It is indicated for the
prevention and treatment of uterine atony after delivery.
❖ Pharmacokinetics
➢ It is rapidly absorbed after parenteral or oral administration, metabolized in the
liver, and excreted in the urine or feces. They cross the placenta and enter breast
milk. Methylergonovine promote uterine involution.
❖ Contraindications and Cautions
➢ Presence of any known allergy to oxytocics and patients with cephalopelvic
disproportion, unfavorable fetal position, complete uterine atony or early
pregnancy.
❖ Adverse Effects
➢ Excessive effects like uterine hypertonicity and spasm, uterine rupture,
postpartum hemmorhage, decreased fetal heart rate, GI upset, and causes
 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. Perform
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 any sign of
uterine hypertonicity.
UTERINE MOTILITY DRUGS: ABORTIFACIENTS
❖ Therapeutic Actions and Indications
➢ It is used to evacuate uterine contents via intense uterine contractions. It
stimulates uterine activity, dislodging any implanted trophoblast and preventing
implantation of any fertilized egg.
❖ Pharmacokinetics
➢ These drugs are well absorbed when administered. They are metabolized in the
liver and excreted in the urine. Mifepristone is administerd 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, patients with active pelvic
inflammatory disease, hepatic, renal, or pulmonary disease, lactating women,
and any history of asthma, hypertension, adrenal disease, acute vaginitis, and
scarred uterus.
❖ Adverse Effects
➢ Abdominal cramping, heavy uterine bleeding, perforated uterus, uterine rupture,
and others include headache, nausea and vomiting, diarrhea, diaphoresis,
backache, and rash.
❖ Nursing Considerations
➢ Assess for contraindications, adverse reactions, and laboratory tests. Perform
complete physical and psychological assessment. Confirm date of last
menstruation period. Evaluate uterine tone and invollution and the amount of
bleeding. Administered via route is 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
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 therapy in cases of
hypogonadism (underdeveloped testes) and to treat certain breast cancers.
 ❖ Pharmacokinetics
ANABOLIC STEROIDS
➢ They are metabolized in the liver and excreted in the urine. It is not known
❖ Therapeutic Actiosn and Indications
whether androgens enter breastmilk. Drugs include Danazol,
➢ They are analogues of testosterone that have been developed to produce the
Methyltestosterone, and Fluoxymesterone.
tissue-building effects of testosterone with less androgenic effect. Indicated for
❖ Contraindications and Cautions
particular anabolic steroids. It can be used to treat anemias, certain cancers and
swelling of the area
➢ Presence of any known allergy to the drug. During lactation, presence of prostate beneath the skin

angioedema. It is also known to be used illegally for the enhancement of muscle

the development of male cancer among men. Patients with liver dysfunction or cardiovascular disease.
mass, increased hematocrit, and theoretically increase in strength and
physical characteristics
(such as muscle bulk,
body hair, and deep Topical forms of testosterone having a black box warning alerting the user to the
endurance.
risk of viralization in children who come in contact with the drug from touching
voice) in a female or
precociously in a boy,
typically as a result of ❖ Pharmacokinetics
excess androgen the clothes and skin of the man using the drug. Not for long term use and to take
production
➢ It is well absorbed and widely distributed throughout the body. It is metabolized
appropriate precautions.
in the liver and excreted in the urine.
❖ Adverse Effects excessive hair growth in women
❖ Contraindications and Cautions
➢ Androgenic effects include: acne, edema, hirsutism, deeping of the voice, oily skin
➢ Presence of any known allergy to the drug. Presence of liver dysfunction,
and hair, weight gain, decrease in breast size, and testicular atrophy.
coronary disease, and prostate cancer.
Antiestrogen effects include: flushing, sweating, vaginitis, nervousness, and
❖ Adverse Effects
emotional liability. A potentially life threatening effect that has been documented
➢ In prepubertal males, adverse effects include viralization like phallic enlargement,
is hepatocellular cancer.
hirsutism, and increase skin pigmentation. On postpubertal males, may
❖ Nursing Considerations
experience inhibition of testicular function, gynecomastia, testicular atrophy,
➢ Assess for contraindications, adverse reactions, and laboratory tests. Perform
priapism, baldness, and change in libido. These drugs all have a black box
complete physical assessment. Arrange for radiograph of the long bones in
warning as alerts to potentially serious effects of liver tumors, hepatitis, and
children. Remove an old dermal system before applying a new system to clean,
blood lipid level changes that might be associated with increased risk of coronary
dry, and intact skin. Monitor the response of the therapy. Monitor liver function
heart disesase.
periodically.
❖ Nursing Considerations
 ➢ Assess for contraindications, adverse reactions, and laboratory tests. Perform retinitis pigmentosa, severe hypertension, severe hepatic or renal disorders,
physical assessment. Arrange for radiograph of the long bones in children. congenital prolonged QT interval, and optic neuropathy.
Administer with food if GI effects are severe. Monitor endocrine function, hepatic ❖ Adverse effects
function, and serum electrolytes. Monitor the response of the therapy. Monitor ➢ Local effects such as pain at the injection sites, infection, priapism, fibrosis, and
liver function periodically. rash. Systemic effects including headache, flushing, dyspepsia, UTI, diarrhea,
dizzines, optic neuropathy, loss of hearing, increased risk of melanoma and rash.
DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION
❖ Nursing Considerations
❖ Therapeutic Actions and INdications
➢ Assess for contraindication, adverse reactions, and laboratory tests. Perform
➢ Penile erectile dysfunction is a condition in which the corpus cavernosum does
complete physical assessment. Assess the cause of dysfunction. Monitor
not fill with blood to allow for penile erection. This can result from the aging
vascular disease for any sign of exacerbation.
process and in vascular and neurological conditions. When injected directly into
the cavernosum, alprostadil acts locally to relax the vascular smooth muscles
and allow filling of the corpus cavernosum causing penile erection. Prostaglandin
alprodastil and the PDE5 inhibitors are indicated for the treatment of penile
erectile dysfunction.
❖ Pharmacokinetics
➢ After injection, it metabolizes 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 and Cautions
➢ In the presence of any anatomical obstruction or conditions that might
predispose to priapism. They cannot be used with penile implants and are not
prolonged
and
unwanted
erection indicated for use to improve sexual performance in women. Caution should be
used in patients with bleeding disorders, coronary diseases, active peptic ulcer,