Reproductive System Drugs

ESTROGENS (oestrogens or œstrogens)

·         A hormone that comprises a group of compounds; it is the main sex hormone in women and is essential to the menstrual cycle.

·         Primarily secreted by the ovary & produced by the cells of the developing graafian follicle.

·         Indications:

o    Menopause symptoms (moderate to severe), “hot flashes”, prevention of postmenopausal osteoporosis, ovarian failure ,breast cancer ,advanced cancer of the prostate, osteoporosis, abnormal bleeding of the uterus, vaginal irritation, female castration,  Tumers syndrome, birth control

·         Contraindications:   

o    Known or suspected pregnancy, breastfeeding mothers, undiagnosed abnormal genital bleeding, patients with breast cancer, endometrial hyperplasia, endometrial cancer,active deep vein thrombosis, pulmonary embolism,liver dysfunction or disease, hypersensitivity to estrogens

Example:

chlorotrianisene  (TACE Capsules®)

dienesterol ( DV Vaginal Cream®)

estradiol (Estrace, Climara, Estraderm, Fempatch, Vivelle®)

estradiol cypionate ( Depo-Estradiol)

estradial valerate ( Delestrogen)

estrogens, conjugated ( Cenestin Tablets ®,Premarin Tablets/Vaginal Cream®)

estrogens, esterified  (Estratab®)

estrone ( Aquest, Estragyn 5®)

estropipate ( Ogen  Ortho-Est®)

ethinyl estradiol ( Estinyl® )

Side Effects:

·         Enlargement or tenderness of breasts (both sexes)

·         Hair loss

·         Loss of appetite

·         Weight changes, retention of water

·         Nausea, vomiting

·         Dizziness

·         Abdominal cramps

·         Feeling of bloatedness

·         Swelling of the ankles & legs

·         Skin rash, irritation

·         Change in sexual desire

Nursing Considerations:

For Oral Estrogen

ü  Take with food or immediately after eating to decrease nausea.

ü  If miss dose, take as soon as remembered, unless it is just before next dose.

ü  Do not take double doses

Transdermal Estrogen

ü  Wash hands before & after applying patch.

ü  Apply to intact, hairless site on abdomen.

ü  Press disc to other site for 10 seconds & check to make sure edges are secure.

ü  Avoid application to waistline or breasts as clothing can loosen the disc.

ü  Rotate sites & do not reuse site for 7 days.

ü  Disc may be reapplied if it falls off.

Vaginal

ü  Stay in a recumbent position at least 30 minutes after inserting.

ü   Do not use tampons, but sanitary napkins may be used to protect clothing.

ü  If dose is missed, do not use missed dose, wait until next regularly scheduled dose.

ü  Use provided applicator to insert vaginal cream or tablet.

ü  Wash applicator with mild soap & water after each use.

Vaginal Ring

ü  To insert, press ring into oval & insert into upper third of the vagina.

ü  No discomfort should be felt, if it occurs ring may not be inserted high enough & can be gently pushed into vagina.

ü  Left in place for 90 days.

ü  If expelled, rinse with lukewarm water & reinsert.

ü  Ring can be expelled by pulling out with a finger.

ü  Take note ring does not interfere with sexual intercourse.

PROGESTINS

·         A synthetic progestogen that has some biological activity similar to progesterone.

·         Progesterone & progestins produce secretion changes in the endometrium for preparation of implantation and nourishment of the embryo.  

·         Indications:

o    Amenorrhea, dysmenorrhea, endometriosis, infertility, threatened abortion, contraception, premenstrual syndrome (PMS), adjunct or palliative treatment for carcinomas

·         Contraindications:   

o    Known or suspected pregnancy, lactation, unexplained vaginal bleeding, breast cancer, active thrombophlebitis, pulmonary emboli, cardiac disease, cerebrovascular, disease, liver disease, hypersensitivity, anti-seizure & antibiotics medications(rifampin/rifampicine)

Example:

hydroxyprogesterone ( Hylutin®)

levonorgestrel ( Norplant®)

medroxyprogesterone (Cycrin,Provera®)

medroxyprogesterone ( Depo-Provera®)

medroxyprogesterone & conjugated estrogens (Premphase, Prempro®)

megestrol (Megace®)

progesterone ( Prometrium®)

progesterone (Gesterol, Crinone, Progestasert®)

Side Effects:

·         Headache

·         Nausea, vomiting

·         Diarrhea/Constipation

·         Changes in the menstrual flow

·         Breast tenderness

·         Chloasma

·         Rashes

·        

Depo-Provera®

Weight gain

·         Amenorrhea

·         Osteoporosis

Nursing Considerations: (ESTROGENS & PROGESTINS)

ü  Read drug instructions carefully & contact health care provider for questions.

ü  Follow doctor’s orders regarding the

ü  Instruct patient to take as prescribed & not to change the dose or stop the medicine unless advised to do so by the health care provider.

ü  Perform self-breast exams monthly & report lumps to health care provider.

ü  Use sunscreen & protective clothing to prevent photosensitivity reactions.

ü  Inform other heath care providers before surgery or any other treatment.

ü  Diabetics should report increased glucose levels to health care provider as dosage adjustments to oral hypoglycemic or insulin may be necessary.

ü  Report immediately any of the following to the health care provider: headache, blurred vision, chest pain, swelling, tenderness in extremities, shortness of breath, depression, weight gain, jaundice and if bleeding occurs estrogen is withheld.

 For Oral Progestin

ü  Take a tablet every day at the same time each day. Taking it for 3 hours late is the same as missing a dose which can affect the effectivity of the drug.

Subdermal (Norplant)

ü  Six implants are inserted under the skin of the upper arm by a health care professional, which take about 15 minutes. No pain should be felt during the insertion process. Keep the gauze wrap on for 24 hours after the insertion, and then sterile strips of tape should be left over the area for 3 days.

ü  No heavy lifting for 24 hours.

ü  Full protection from pregnancy begins within 24 hours, if the insertion is done within 7 days of the beginning of menstrual period.

ü  Protection last for 5 years.

Parenteral/ Intramuscular

ü  Given every 3 months by heath care professionals.

ü  Full protection from pregnancy begins as soon an the first injection within the first 5 days of menstrual period or within 5 days after delivering a baby if breastfeeding is not done, &  6 weeks  from delivery date for breastfeeding.

ORAL CONTRACEPTIVES

·         Inhibit ovulation by increasing serum estrogen & progestin, which inhibit the secretion of the follicle stimulating hormone (FSH) and lutenizing hormone (LH) from the pituitary gland.

·         Indications:

o    Treatment of hypermenorrhea, oral contraception, postcoital emergency contraception

·         Contraindications:   

o    Pregnancy, lactation, history of thromboembolic disorders, coronary disease, cerebrovascular disease, liver tumors, undiagnosed vaginal bleeding, breast cancer, estrogen-dependent neoplasms

Example:

desogestrel 0.15 mg  (Desogen® )

ethinyl estradiol  30 mcg ( Yasmin®)

ethinyl estradiol 35 mcg (Demulen® 1/35)

ethinyl estradiol 20mcg (Mircette®)

ethinyl estradiol 35 mcg (Ortho Novum®)

ethinyl estradiol 40 mcg ( Triphasil® )

ethinyl estradiol 25mcg (Cyclessa®)

Side Effects:

·         Dizziness, headache, lightheadedness

·         Edema

·         Abdominal pain

·         Nausea, vomiting

·         Diarrhea/constipation

·         Jaundice

·         Weight gain

·         Cramps

·         Amenorrhea

Adverse Effects:

·         Blood clots

·         Hypertension

Nursing Considerations:

·         Monitor BP & report changes throughout the therapy.

·         Take exactly as prescribed at the same time each day & in proper sequence. If pregnancy is suspected stop taking & contact health care provider.

·         During the beginning use of oral contraceptives, use an additional form of birth control for the first cycle.

·         If one dose is missed, take as soon as remembered. But then if 2 consecutive days are missed, take 2 tablets a day for the next 2 days, continue with regular dosing schedule and use an additional method of contraception for the rest of the cycle.

·         If 3 consecutive days are missed, discontinue and use another form of contraception until menses begins or pregnancy is ruled out.

·         Encourage patient to perform monthly self-breast exam & notify physician if lumps are noted.

·         Stress the importance of regular follow-up gynecological exams with health care provider, including pap smears.

·         Report immediately any of the following to the health care provider: headache, blurred vision, chest pain, swelling, tenderness in extremities, shortness of breath, depression, weight gain, jaundice and if bleeding occurs estrogen is withheld.

UTERINE STIMULANTS

·         Used to induce, or augment labor, facilitate uterine contractions following a miscarriage, induce abortion, or reduce hemorrhage following childbirth or abortion.

·         Oxytocics, ergot alkaloids and prostaglandins stimulate uterine contractions.

·         Indications:

o    Oxytocics  - induction of labor, control postpartum or postabortion hemorrhage, intranasal: stimulation of lactation

o    Ergot Alkaloids – prevention & treatment of postpartum or postabortion hemorrhage caused by uterine atony or subinvolution

o    Prostaglandins – induce abortion from 12 to 20 weeks gestation, management of nonmetastatic gestational trophoblastic disease, treatment of incomplete abortion, fetal death within the uterus

·         Contraindications:   

o    Spontaneous threatened abortion , before the  delivery of the placenta it could cause placental entrapment, hypersensitivity, pelvic inflammatory disease, cervical stenosis, uterine fibrosis

Example:

oxytocin (Pitocin, Syntocinon®)

dinoprostone ( Prepidil® Gel, Prostine E®)

ergonovine (Ergotrate®)

methylergonovine (Methergine®)

carboprost thromethamine (Hemabate®)

Side Effects:

Oxytocics

·         Tachycardia, hypertension, dysrhythmias

·         Seizures

·         Nause, vomiting

·         Uterine rupture

Ergot Alkaloids

·         Dizziness, headache

·         Hypertension, hypotension, dysrthythmias

·         Tinnitus

·         Nausea, vomiting

·         Cramps

·         Dyspnea

·         Diaphoresis

·         Pruritus

Prostaglandins

·         Hypertension, hypotension

·         Headache, drowsiness

·         Nausea, vomiting

·         Diarreha

·         Dyspnea

  Nursing Considerations:

Oxytocics

ü  Monitor maternal vital signs frequently throughout the administration.

ü  Use fetal monitoring & assess fetal heart rate continuously throughout the administration.

ü  Assess character, frequency, and duration of contractions.

ü  Patients receiving parenteral oxytocin should be under medical supervision and should be hospitalized.

ü  When administering nasal spray to clear nasal passage, allow the patient to sit upright, hold container upright, insert into nostril, and squeeze solution into nostril on inspiration.

ü  Use an infusion pump when administering IV and should be connected via a Y-site so that oxyctocin can be disconnected while maintaining vein access.

Ergot Alkaloids

ü   Can be given through PO, IM, or IV(PO & IM are preferred, IV is use only for emergency).

ü  Monitor vital signs, fundus (location, tone) , and vaginal drainage frequently throughout the administration.

ü  Monitor calcium levels; effectiveness is decreased with hypocalcemia.

ü  Avoid smoking as nicotine increases the effects of ergot derivatives.

ü  Avoid double dosing on missed dose. Omit and resume normal dosage schedule.

ü  Seek medical attention if uterine relaxation is prolonged or if there are changes in vaginal bleeding.

ü  Report to the physician if the following symptoms are noted: paresthesias, chest pain, and peripheral ischemia.

Prostaglandins

ü  Assess the respiratory status of the patient and report chest tightness, wheezing which could be a sign of anaphylaxis.

ü  Remind the patient that fever may occur in 15 to 45 minutes after insertion of vaginal suppository but temperature returns to normal 2 to 6 hours after discontinuation of therapy.

ü  Monitor for nausea, vomiting, & diarrhea. Administer antiemetic & antidiarrheal medications to provide comfort.

ü  Monitor for hemorrhage & assess vaginal discharge.

UTERINE RELAXANTS (tocolytics)

·          Relax the smooth muscles of the uterus and prevent contraction and labor induction which increases the chances of fetal survival.

·         Indications:

o     B_2-  adrenergic Agonists, Nifedipine (Ca⁺ Channel Blockers), COX inhibitors, Magnesium Sulfate  – inhibition of labor, reversal of uterotonic hyperstimulation, ease intrauterine surgery, relief of dysmenorrheal

·         Contraindications:   

o     Renal insufficiency, hypersensitivity, cardiovascular disorders, pulmonary hypertension, hypokalemia

Example:

ritodrine ( Yutopar®)

terbutaline ( Bricanyl®) Magnesium Sulfate Terbutaline

Side Effects:

·         Hypotension

·         Blurred vision

·         Dizziness, lightheadedness

·         Dry mouth

·         Chest pain or tightness

·         Reflex tachycardia

·         Nausea, vomiting

·         Loss of appetite

·         Pulmonary edema

·         Cardio respiratory arrest – Magnesium sulfate

Nursing Considerations:

ü  Monitor vital signs especially respiratory rate, breath sounds, uterine contractions, and FHR every 5 minutes when initiating the therapy, every 15-30 minutes when the patient is stable.

ü  If administering Mg SO₄ frequently check deep tendon reflexes for signs of toxicity.

ü  Use an infusion monitoring device during administration of the drug.

ü  Monitor potassium & glucose levels.

ü  Stress the importance of following treatment including bed rest.

ü  Notify health care provider if membranes rupture or if contractions resume, or if there is loss of fetal activity.

ANDROGENS

·         Stimulate RNA synthesis, resulting in increased protein production and in natural hormone in males. Stimulate primary sex characteristics and maintenance of secondary sex characteristics, may cause weight gain & increased musculature and strength, and stimulate the production of red blood cells.

·         Indications:

o    Testosterone - hypogonadism, delayed puberty, palliative treatment of androgen- responsive breast cancer, endometriosis, fibrocystic, breast disease, prostate, hereditary angioedema

o    Androgen Inhibitors ( 5 Alpha- Reductase Inhibitors) – treatment of BPH, male androgenic alopecia

o    Phosphodiesterase Inhibitors – erectile dysfunction

·         Contraindications:   

o    Pregnancy, lactation, hypercalcemia, male patients with breast or prostate cancer, patients with severe cardiac, renal, or hepatic disease, hypersensitivity, concurrent use with organic nitrates & alpha blockers

Example:

testosterone ( Testoderm®, Depo-Testosterone®, Androderm®)

testosterone cypionate (Andro-Cyp®, Andronate®, depAndro®)

testosterone enanthate ( Andro®, Andropository®, Delatest®)

danazol ( Danocrine®)

Side Effects:

·         Headache, depression

·         Insomnia

·         Nausea, vomiting

·         Deepening of the voice

·         Gynecomastia

·         Menstrual irregularities

·         Edema

  Nursing Considerations:

ü  Monitor I & O, weight and report changes that indicate fluid retention.

ü  Monitor liver function studies, cholesterol, calcium levels throughout the therapy.

ü  Monitor for symptoms of virilism in women & precocious puberty in men. Bone age determination should be done every 6 months to assess rate of bone maturation.

ü  Administer as prescribed, dose is tapered before being discontinued & do not discontinue without consulting with the health care provider.

ü  Diabetic patients need to monitor blood sugar it may cause hypoglycemia if insulin or oral hypoglycemic are taken.