Drugs%20Used%20to%20Treat%20Reproductive%20Conditions

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Drugs Used to Treat Reproductive Conditions
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Figure 26-1 The male reproductive system.
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Table 26-1 Functions of the Male Reproductive
System
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Table 26-1 (continued) Functions of the Male
Reproductive System
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Table 26-2 Male Hormones
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Table 26-2 (continued) Male Hormones
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Synthetic Androgens Uses

• Main indication in men is to supplement low
  levels of testosterone to correct hypogonadism
  or cryptorchidism other uses in men are for
  increasing sperm production
• Used in women to treat postpartum breast
  engorgement, endometriosis, and fibrocystic
  breast disorders

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Synthetic Androgens Adverse Effects

• Common insomnia, excitation, skin flushing,
  anorexia, diarrhea, jaundice, hypercalcemia,
  hypercholesterolemia, sodium retention, edema
• May cause renal calculi, bladder irritability,
  and increased libido

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Synthetic Androgens Contraindications

• Contraindicated in patients with serious cardiac,
  liver, or kidney disease prostatic or breast
  cancer pregnancy and lactation
• Testosterone alters glucose tolerance tests and
  may increase creatinine and creatinine secretion.

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Synthetic Androgens Patient Information

• Advise patients to take oral androgens with meals
  to reduce gastric upset.
• Instruct male patients to report priapism and
  decreased flow of urine.

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Anabolic Steroids and Elderly Men

• The risk of prostate cancer increases in elderly
  men who take androgens.

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Figure 26-2 The female reproductive system.
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Figure 26-2 (continued) The female reproductive
system.
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Table 26-3 Functions of the Female Reproductive
System
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Female Sex Hormones

• Anterior pituitary releases hormones FSH and LH
• Ovaries, adrenal cortex, and placenta (during
  pregnancy) release estrogens and progesterones

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Table 26-4 Major Synthetic Estrogens
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Synthetic Estrogens Uses

• Bind to intracellular receptors that stimulate
  DNA and RNA to synthesize proteins

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Synthetic Estrogens Uses

• Used as hormone replacement therapy in women who
  have had ovaries removed or are postmenopausal
  for prevention and treatment of osteoporosis in
  older women as palliative therapy for breast and
  prostatic carcinoma in men and to treat abnormal
  bleeding and atrophic vaginitis in women

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Synthetic Estrogens Adverse Effects

• Common anorexia, nausea, vomiting, stomach
  cramping, flatulence, headaches, changes in
  libido, edema, breast discomfort or enlargement
• In men, cause feminization, atrophy of sex
  organs, loss of facial or body hair

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Synthetic Estrogens Contraindications

• Contraindicated in breast cancer, pregnancy, and
  lactation
• Use caution in patients with liver disease,
  gallbladder disease, endometriosis, pancreatitis,
  diabetes mellitus, heart failure, and kidney
  dysfunction
• Interactions may cause toxic levels of
  cyclosporine and theophylline

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Synthetic Estrogens Patient Information

• Advise patients to take drug as directed, not
  skipping or increasing or decreasing dose.
• Advise women not to breast feed.

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Testosterone Use During Pregnancy

• Use of testosterone during pregnancy can cause
  masculinization of the fetus, particularly if
  taken during first trimester

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Estrogens During Pregnancy

• Use of estrogens during the first trimester of
  pregnancy may increase the risk of fetal
  malformations, including
• Cleft palate
• Heart defect
• Dislocated hips
• Absent tibiae
• Polydactylia

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Estrogen and Menopause

• Postmenopausal women who are taking estrogens
  should also take progestin to prevent
• Endometrial hyperplasia
• Endometrial carcinoma
• Progestin is not necessary in women who have had
  a hysterectomy.

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Table 26-5 Progestins
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Table 26-5 (continued) Progestins
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Progestins Uses

• Block follicular maturation and ovulation
• Used to treat amenorrhea, functional uterine
  bleeding, endometriosis, and premenstrual syndrome

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Progestins Adverse Effects

• Common vaginal candidiasis, chloasma, cervical
  erosion, breakthrough bleeding, dysmenorrhea,
  amenorrhea, breast tenderness, edema, acne,
  pruritus, mental depression
• Serious thromboembolic disorder, pulmonary
  embolism

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Progestins Contraindications

• Contraindicated with breast or genital cancer in
  patients with impaired liver function,
  undiagnosed vaginal bleeding, miscarriage,
  thrombophlebitis, and thromboembolic disorders
• Use cautiously in anemia, diabetes, history of
  psychotic depression or salpingitis, or abnormal
  Pap smear.

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Progestins Patient Information

• Advise patients to avoid exposure to prolonged UV
  light.
• Tell patients to immediately report sudden severe
  headache or vomiting, dizziness or fainting,
  numbness in an extremity, acute chest pain,
  sudden vision loss.

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EstrogenProgestin Combinations in Postmenopause

• The use of such combination drugs in
  postmenopausal women is controversial. The
  benefits of use are protection against
• Osteoporosis
• Colon cancer

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EstrogenProgestin Combinations in Postmenopause

• The risks of using such combination drugs
  include
• Cardiovascular disease
• Breast cancer
• Thromboembolism

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Table 26-6 Types of Oral Contraceptives
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Table 26-6 (continued) Types of Oral
Contraceptives
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Table 26-6 (continued) Types of Oral
Contraceptives
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Contraceptive Hormones Uses

• Provide negative feedback to hypothalamus
• This inhibits gonadotropin-releasing hormone
• The pituitary therefore ceases secretion of FSH,
  which would normally stimulate ovulation

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Oral Contraceptives Adverse Effects

• Common nausea, abdominal pain, gallbladder
  disease, hepatic adenomas, breast tenderness or
  pain, weight gain, dysmenorrhea, amenorrhea,
  menorrhagia, metrorrhagia
• Serious thromboembolism, stroke, myocardial
  infarction

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Oral Contraceptives Contraindications

• Pregnancy and lactation
• Genital bleeding of unknown cause
• Thrombophlebitis
• Coronary artery disease
• Liver dysfunction
• Endometrial or breast cancer
• Severe hypertension
• Diabetes with vascular involvement

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Oral Contraceptives Patient Information

• Instruct patients to follow the dosing schedule
  carefully and to use barrier contraception when
  taking antibiotics.
• Instruct patients to report calf pain or
  tenderness, shortness of breath, chest pain,
  visual disturbances, drooping eyelids, or double
  vision.

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Oral Contraceptives and Surgery

• Oral contraceptives should be discontinued 4
  weeks before surgery because of the risk of
  postoperative thromboembolism.

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Smoking and Oral Contraceptives

• Smoking while taking oral contraceptives can
  cause serious adverse effects to the
  cardiovascular system.

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Table 26-7 Effects of Drugs on Labor and
Delivery
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Table 26-7 (continued) Effects of Drugs on
Labor and Delivery
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Oxytocics Uses

• Directly act on uterine muscle to produce phasic
  contractions
• Used to initiate or improve uterine contractions
  during delivery (only after cervix is dilated)
  also used to stimulate milk letdown following
  delivery

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Oxytocics Adverse Effects

• Common nausea, vomiting, dizziness, headache
• Serious maternal cardiac arrhythmias,
  hypertensive episodes, intracranial hemorrhage

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Oxytocics Contraindications

• Must not be used to induce labor prior to
  delivery of the placenta
• Contraindicated in unfavorable fetal position or
  presentation, cephalopelvic disproportion,
  obstetric emergencies, fetal distress
• May interact with vasoconstrictor drugs to cause
  severe hypertension

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Oxytocics Patient Information

• Instruct patients to report
• Cold or numb fingers or toes
• Severe cramping
• Chest pain
• Sudden or severe headache

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Uterine Relaxants Uses

• They are beta2-adrenergic agonists.
• Used in management of preterm labor.

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Uterine Relaxants Adverse Effects

• Common headache, nausea, vomiting, nervousness,
  restlessness, sweating, emotional upset
• Serious chest pain, arrhythmias, pulmonary edema

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Uterine Relaxants Contraindications

• Uterine relaxants are contraindicated in patients
  with
• Antepartum hemorrhage
• Eclampsia
• Uncontrolled diabetes
• Bronchial asthma
• Pulmonary hypertension
• Cardiac disease

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Uterine Relaxants Patient Information

• Advise patients about potential adverse effects
  and drug interactions.