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Pharmacology in Nursing Women s Health Drugs b/c the have a

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Title: Pharmacology in Nursing Women s Health Drugs b/c the have a


1
Pharmacology in NursingWomens Health Drugs
2
Female Reproductive Functions
  • Female sex steroid hormones
  • Estrogens
  • Progestins
  • Pituitary gonadotropin hormones
  • Follicle stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Development of primary and secondary sex
    characteristics
  • Menstrual Cycle

3
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4
Estrogens
  • Three major endogenous estrogens
  • Estradiol (principal most active)
  • Estrone
  • Estriol
  • Synthesized from cholesterol in ovarian follicles
  • Basic chemical structure of a steroid

5
Exogenous Estrogenic DrugsSynthetic
  • Steroidal
  • Conjugated estrogens, estradiol transdermal, many
    others
  • Nonsteroidal
  • Chlorotrianisene, diethylstilbestrol diphosphate,
    others
  • These drugs no longer available in the United
    States

6
Estrogens Required For
  • The development and maintenance of the female
    reproductive system
  • The development of female secondary sex
    characteristics

7
Estrogens Indications
  • Treatment of or prevention of disorders that
    result from estrogen deficiency
  • Atrophic vaginitis
  • Hypogonadism
  • Oral contraception (given with a progestin)
  • Dysmenorrhea
  • Hot flashes of menopause

8
Estrogens Indications (contd)
  • Treatment of or prevention of disorders that
    result from estrogen deficiency (contd)
  • Uterine bleeding
  • Palliative treatment of advanced breast and
    prostate cancer
  • Osteoporosis treatment and prophylaxis
  • Many other indications

9
Estrogens Indications (contd)
  • Continuous-combined hormone replacement therapy
    (CCHRT)
  • Fixed estrogen/progestin combination products
  • Reduce complications, such as endometrial
    hyperplasia, that occur from using estrogen alone

10
EstrogensContraindications
  • Allergy to the medication
  • Any estrogen dependent cancer
  • Undiagnosed abnormal vaginal bleeding
  • Pregnancy
  • Active thromboembolic disorder or history

11
EstrogensAdverse Effects
  • Thrombolytic eventsmost serious
  • Nauseamost common
  • Hypertension, thrombophlebitis, edema
  • Vomiting, diarrhea, constipation, abdominal pain
  • May cause photosensitivity, chloasma
  • Amenorrhea, breakthrough uterine bleeding
  • Tender breasts, fluid retention, headaches

12
Progestins
  • Synthetic derivatives of progesterone
  • medroxyprogesterone (Provera)
  • hydroxyprogesterone
  • megestrol (Megace)
  • Many others

13
Progestins Indications
  • Treatment of functional uterine bleeding caused
    by
  • Hormonal imbalance, fibroids, or uterine cancer
  • Treatment of primary and secondary amenorrhea

14
Progestins Indications (contd)
  • Palliative treatment of some cancers and
    endometriosis
  • Prevention of threatened miscarriage
  • Alleviation of symptoms of PMS

15
Progestins Indications (contd)
  • megestrol
  • Adjunct therapy for treatment of breast and
    endometrial cancers
  • Also used for management of anorexia, cachexia,
    or unexplained weight loss in AIDS patients
  • Used to stimulate appetite and promote weight
    gain in patients with cancer
  • Used with estrogen replacement therapy after
    menopause

16
ProgestinsAdverse Effects
  • Liver dysfunctioncholestatic jaundice
  • Thrombophlebitis, thromboembolic disorders, such
    as PE
  • Nausea, vomiting
  • Amenorrhea, breakthrough uterine bleeding,
    spotting
  • Edema, weight gain or loss

17
Contraceptive Drugs
  • Medications used to prevent pregnancy
  • Oral medications
  • Monophasic, biphasic, and
  • triphasic forms
  • Most contain estrogen-progestin combinations

18
Contraceptive Drugs (contd)
  • Other contraceptive forms available
  • Long-acting injectable form of medroxyprogesterone
    (Depo-Provera)
  • Transdermal contraceptive patch
  • Intravaginal contraceptive ring

19
Contraceptive Drugs Mechanism of Action
  • Prevent ovulation by inhibiting the release of
    gonadotropins and increasing uterine mucous
    viscosity, resulting in
  • Decreased sperm movement and fertilization of the
    ovum
  • Possible inhibition of implantation of a
    fertilized egg (zygote)

20
Contraceptive Drugs Other Drug Effects
  • Improve menstrual cycle regularity
  • Decrease blood loss during menstruation
  • Decreased incidence of functional ovarian cysts
    and ectopic pregnancies

21
Contraceptive Drugs Indications
  • Primarily used to prevent pregnancy
  • Other uses
  • Treatment of endometriosis and hypermenorrhea
  • To produce cyclic withdrawal bleeding
  • Postcoital emergency contraception

22
Contraceptive DrugsAdverse Effects
  • Drawbacks to the use of these drugs include
    (effects due to estrogen component)
  • Hypertension
  • Thromboembolism, possible PE, MI, stroke
  • Alterations in lipid and carbohydrate metabolism
  • Increases in serum hormone concentrations
  • Edema, dizziness, headache, depression, nausea,
    vomiting, diarrhea, increased appetite, increased
    weight, breast changes, many others

23
Contraceptive DrugsInteractions
  • Drugs that decrease effectiveness of oral
    contraceptive drugs
  • Antibiotics, barbiturates, isoniazid, rifampin,
    griseofulvin

24
Contraceptive DrugsInteractions (contd)
  • Drugs that may have reduced effectiveness if
    given with oral contraceptive drugs
  • Anticonvulsants, beta-blockers, hypoglycemic
    drugs, oral anticoagulants, theophylline,
    vitamins, hypnotics

25
Osteoporosis
  • Low bone mass
  • Increased risk of fractures
  • Primarily affects women
  • 20 of those with this condition are men

26
Osteoporosis
27
Osteoporosis Risk Factors
  • Caucasian/Asian descent
  • Slender body build
  • Early estrogen deficiency
  • Smoking
  • Alcohol consumption
  • Low-calcium diet
  • Sedentary lifestyle
  • Family history

28
Drug Therapy for Osteoporosis
  • Calcium supplements and vitamin D may be
    recommended for women at high risk for
    osteoporosis

29
Drug Therapy for Osteoporosis (contd)
  • Bisphosphonates
  • alendronate (Fosamax), ibandronate (Boniva),
    risedronate (Actonel)
  • Selective estrogen receptor modifier (SERM)
  • raloxifene (Evista)
  • Hormone
  • calcitonin
  • teriparatide (Forteo)

30
Drug Therapy for Osteoporosis (contd)
  • Biphosphonates
  • Work by inhibiting osteoclast-mediated bone
    resorption, thus preventing bone loss
  • SERMs
  • Stimulate estrogen receptors on bone and
    increasing bone density

31
Drug Therapy for Osteoporosis (contd)
  • calcitonin
  • Directly inhibits osteoclastic bone resorption
  • teriparatide
  • Only drug that stimulates bone formation
  • Derivative of parathyroid hormone
  • Action similar to natural parathyroid hormone

32
Drug Therapy for OsteoporosisIndications
  • Bisphosphonates and calcitonin
  • Both prevention and treatment of osteoporosis
  • Biphosphanates also used for glucocorticoid-induce
    d osteoporosis and Pagets disease

33
Drug Therapy for OsteoporosisIndications
(contd)
  • raloxifene
  • Prevention of postmenopausal osteoporosis
  • teriparatide
  • Used for those with highest risk of fracture
    (prior history of fractures)

34
Drug Therapy for OsteoporosisAdverse Effects
  • SERMs
  • Hot flashes, leg cramps
  • Can increase risk of venous thromboembolism
  • Not used if patient is near age of menopause due
    to possible hot flashes
  • Leukopenia

35
Drug Therapy for OsteoporosisAdverse Effects
(contd)
  • Bisphosphonates
  • Headache, GI upset, joint pain
  • Risk of esophageal burns if medication lodges in
    esophagus before reaching the stomach

36
Fertility Drugs
  • Various medical techniques used to treat
    infertility
  • Include
  • in vitro fertilization
  • Medication therapy ovulation stimulation

37
Fertility Drugs (contd)
  • clomiphene (Clomid
  • Nonsteroidal ovulation stimulant
  • Blocks estrogen receptors in the uterus and
    brain, resulting in a false signal of low
    estrogen levels
  • Causes increased production of Gn-RH, FSH, and LH
  • As a result, maturation of ovarian follicles is
    stimulated, leading to ovulation and increased
    chance of conception

38
Fertility Drugs (contd)
  • Mentropins (Pergonal)
  • Standardized mixture of FSH and LH
  • Stimulates development of ovarian follicles,
    leading to ovulation
  • May also be given to men to stimulate
    spermatogenesis

39
Fertility Drugs (contd)
  • chorionic gonadotropin (Ovidrel)
  • Recombinant form of human chorionic gonadotropin
  • Causes rupture and ovulation of mature ovarian
    follicles, and maintenance of corpus luteum
  • Used to stimulate ovulation

40
Fertility DrugsIndications
  • Used primarily to induce ovulation in anovulatory
    patients
  • Also may be used to promote spermatogenesis in
    infertile men

41
Fertility DrugsAdverse Effects
  • Tachycardia, phlebitis, DVT
  • Dizziness, headache, flushing, depression,
    anxiety, nervousness, fatigue
  • Nausea, bloating, constipation, others
  • Ovarian hyperstimulation, multiple pregnancies,
    blurred vision, breast pain, others

42
Uterine-Active Medications
  • Medications used to alter uterine contractions
  • Used to
  • Promote labor
  • Prevent the start or progression of labor
  • Postpartum use to reduce the risk of postpartum
    hemorrhage

43
Uterine Stimulants
  • Also called oxytocics
  • Ergot derivatives
  • Prostaglandins
  • Progesterone antagonist
  • oxytocin (hormonal drug)

44
Uterine Stimulants (contd)
  • Ergot alkaloids
  • Increase force and frequency of uterine
    contractions
  • Used after delivery of the infant and placenta to
    prevent postpartum uterine atony and hemorrhage
  • methylergonovine (Methergine)

45
Uterine Stimulants (contd)
  • Prostaglandins
  • Natural hormones
  • Cause potent contraction of myometrium, smooth
    muscle fibers of the uterus
  • Used to induce labor by softening the cervix and
    enhancing uterine muscle tone
  • dinoprostone (Prostin E2) and misoprostol
    (Cytotec)

46
Uterine Stimulants (contd)
  • Progesterone antagonist
  • mifepristone (Mifeprex)
  • RU-486, the abortion pill
  • Stimulates uterine contractions to induce
    abortion
  • Given with a prostaglandin drug for elective
    abortions

47
Uterine Stimulants oxytocin (Pitocin)Synthetic
Form
  • Used to induce labor at or near full-term
    gestation, and to enhance labor when contractions
    are weak and ineffective
  • Prevent or control postpartum uterine bleeding
  • Complete an incomplete abortion (after
    miscarriage)
  • Promote milk ejection during lactation

48
Uterine StimulantsAdverse Effects
  • Hypotension or hypertension, chest pain
  • Headache, dizziness, fainting
  • Nausea, vomiting, diarrhea
  • Vaginal pain, cramping
  • Leg cramps, joint swelling, chills, fever,
    weakness, blurred vision

49
Uterine RelaxantsTocolytics
  • Used to stop labor that begins before term to
    prevent premature birth
  • Generally used after the 20th week of gestation
    to stop uterine contractions that occur between
    the 20th and 37th weeks of gestation (considered
    premature labor)
  • Nonpharmacologic measures
  • Bedrest, sedation,
  • hydration

50
Uterine RelaxantsTocolytics (contd)
  • Uterine contractions that occur between the 20th
    and 37th weeks of gestation are considered
    premature labor
  • Nonpharmacologic measures
  • Bedrest, sedation, hydration

51
Uterine Relaxants
  • ritodrine (Yutopar) and terbutaline (Brethine)
  • Beta-adrenergic drugs
  • Stimulation of beta2-adrenergic receptors on the
    uterine smooth muscle
  • Results in relaxation of the uterus, thus
    stopping premature contractions
  • Off-label use
  • Magnesium sulfate IV also used to stop labor

52
Uterine RelaxantsAdverse Effects
  • Palpitations, tachycardia, hypertension
  • Tremors, anxiety, insomnia, headache, dizziness
  • Nausea, vomiting, anorexia, bloating, diarrhea,
    constipation
  • Hyperglycemia, hypokalemia
  • Dyspnea, hyperventilation

53
Nursing Implications
  • Assess baseline VS, weight, blood glucose levels,
    renal and liver function studies
  • Assess whether the patient smokes
  • Assess history and medication history
  • Assess contraindications, including potential
    pregnancy

54
Nursing Implications (contd)
  • Before giving any uterine stimulants, assess the
    mothers vital signs and fetal heart rate
  • Uterine relaxants are used when premature labor
    occurs between the 20th and 37th weeks of
    gestation

55
Nursing Implications (contd)
  • For bisphosphonate, ensure that the patient has
    no esophageal abnormalities and can remain
    upright or in a sitting position for 30 minutes
    after the dose

56
Nursing Implications (contd)
  • Estrogens and progestins
  • Take the smallest dose needed
  • Give IM doses deep in large muscle masses, and
    rotate sites
  • Give oral doses with meals to reduce GI problems
  • Teach patient about correct self-administration
    and what to do if a dose is missed

57
Nursing Implications (contd)
  • Estrogens and progestins (cont'd)
  • Increased susceptibility to sunburn may
    occuradvise patient to wear sunscreen or avoid
    sunlight
  • Patients should report weight gain
  • Annual follow-up exams should be completed,
    including PAP smear and breast exam

58
Nursing Implications (contd)
  • Follow specific administration guidelines
    carefully for IV administration of uterine
    relaxants or stimulants
  • Monitor the patients vital signs and fetal
    condition during therapy
  • Instruct patient taking fertility drugs to take
    the medication as ordered
  • Recommend the patient keep a journal while on
    fertility drugs

59
Nursing Implications (contd)
  • Biphosphonates
  • Instruct patient to take medication upon rising
    in the morning, with a full glass of water, and
    30 minutes before eating
  • Emphasize that the patient should sit upright for
    at least 30 minutes after taking the medication

60
Nursing Implications (contd)
  • SERMs
  • Instruct patient that the medication will need to
    be discontinued 72 hours before and during any
    prolonged immobility (such as surgery or a long
    trip)

61
Nursing Implications (contd)
  • Monitor for therapeutic responses
  • Monitor for adverse effects
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