Drugs Used in Men’s and Women’s Health Chapter 29 Drugs Used in Men’s and Women’s Health

drug therapy for men’s and women’s health drug therapy for men’s and women’s health involves treating genital infections and STDs many women use contraceptives for birth control drugs are also used in obstetrics some men require treatment of prostatic hyperplasia or erectile dysfunction

STDS: description table 29-1 pg. 358-359 Drug Therapy for Leukorrhea and Genital Infections: having vaginal secretions is normal, excessive discharge is not normal leukorrhea is an abnormal whitish vaginal discharge can occur at any age symptom of an underlying disorder most common cause is an infection STDS: description table 29-1 pg. 358-359 drugs used to treat genital infections: table 29-2 pg. 359 (also see ch. 34)

Drugs Used for Contraception: contraception: process or methods used to prevent pregnancy oral contraceptives are most common form of birth control in the United States goal is to prevent pregnancy oral contraceptives prevent ovulation 2 types of oral contraceptives: combination pill and mini-pills combination pill: contains both estrogen and progestin pills packed with 28 tablets 3 types of combination pills mono-phasic: contain a fixed amount of estrogen and progestin, given daily for 21 days bi-phasic: contain fixed dose estrogen and a progestin dose on days 1-10 that is lower than days 11-21 tri-phasic: have varying amounts of hormones to provide the lowest dose necessary to prevent conception mini-pill: contains only progestin, all 28 tabs contain active hormones

Drugs Used for Contraception cont…. new combination contraceptive contains levonorgestrel/ehtinyl estradiol (Seasonale) woman has only 4 periods a year, one each season contains estrogen and progestin in lower doses than other combination ontraceptives pack contains 84 active tablets, and 7 that contain no hormones, one tablet taken daily

Assisting With the Nursing Process oral contraceptives: ASSESSMENT: measure weight and BP (standing/supine) PLANNING: see box 29-2 pg.361 IMPLEMENTATION: combination pills: first pill is taken on 1st Sunday after period begins, one pill taken per day at same time til pack is gone (21 day pack, wait a week and start a new pack. 28 day pack, start a new pack after finishing a pack) mini-pills: first pill is taken on first day of period, use other birth control the first month, take 1 pill daily at same time til pack is gone. Follow nurses direction for missed doses. EVALUATION: report and record: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, headaches, brown pigmentation on forehead, cheeks and nose: common side effects, RX change is needed if not resolved in 3 months vaginal discharge, break-through bleeding, yeast infection: prescription change and other drugs may be needed blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain: signals serious complications

Transdermal Contraceptive: example: norelgestromin-ethinyl estradiol transdermal system: Ortho Evra contains estrogen and progestin to inhibit ovulation cervical mucous becomes thick, inhibits sperm from traveling up cervix to the uterus and fallopian tubes hormones also change endometrial wall, this impairs implantation of a fertilized ovum

Assisting With the Nursing Process transdermal contraceptive: ASSESSMENT: measure BP (standing/supine) PLANNING: dose form is the patch IMPLEMENTATION: apply a new patch on the same day of the week “patch change day”, apply patch to clean, dry, intact, healthy skin, patch sites: buttock, abdomen, upper outer arm or upper torso, do NOT apply to breast. Do not apply make up, powder, lotion or cream to the skin or patch area (see info pg. 363 on first day start vs Sunday start) Follow nurses instructions if a patch becomes loose and falls off another form of birth control is needed the first 7 days of menstrual cycle EVALUATION: report and record: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, headaches, brown pigmentation on forehead, cheeks and nose: common side effects, RX change is needed if not resolved in 3 months vaginal discharge, break-through bleeding, yeast infection: prescription change and other drugs may be needed blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain: signals serious complications

Drugs Used in Obstetrics Obstetric medicine deals with pregnant women, labor and childbirth, and first 6-8 weeks after birth Drugs used in obstetrics for : inducing labor controlling breathing maintain uterine firmness after delivery induce therapeutic abortion prevent premature labor prevent seizure activity promote ovulation prevent mother-child blood incompatibilities in future pregnancies **** drugs used in obstetrics listed in table 29-3 p. 362****

Delegation Guidelines Drugs Used in Obstetrics: Drugs used in obstetrics must be given carefully to protect the health of the mother and fetus. If allowed to give such drugs, you need to learn more about them. Ask for the necessary education and supervision. Some drugs are given parenterally- by intramuscular or intravenous injection. Because you do NOT give parenteral dose forms, they are NOT included in this chapter. Should a nurse delegate the administration of such to you, you must: - remember that parenteral dosages are often very different from dosages other routes -Refuse the delegation. Make sure to explain why. Do NOT just ignore the request. Make sure the nurse knows that you cannot give drug and why

Drug Therapy for Benign Prostatic Hyperplasia prostate gland lies in front of rectum and below bladder in males, it also surround the urethra in young males it’s the size of a walnut, it grows and enlarges as the man gets older, this is BPH (benign prostatic hyperplasia) usually BPH is not problematic til after age 50, most older men have symptoms BPH causes urinary problems, these include: weak urine stream frequent voidings of small amounts of urine urgency and leaking or dribbling of urine frequent urination at night urinary retention treament depends on extent of problem TURP (trans-urethral resection of prostate, common surgical procedure

Alpha-1 Adrenergic Blocking Agents block alpha-1 receptors on the prostate gland and certain areas of the bladder neck, muscles relax allowing greater urine flow used to treat mild-moderate urinary obstruction with BPH examples: alfuzosin (Uroxatral) and tamsulosin (Flomax) goals of therapy: reduce symptoms of BPH improve urine flow

Assisting With the Nursing Process alpha-1 adrenergic blocking agents: ASSESSMENT: measure BP (standing/supine) PLANNING: alfuzosin (Uroxatral) dose from is 10mg extended-release tabs tamsulosin (Flomax) dose form is 0.4mg capsules IMPLEMENTATION: alfuzosin (Uroxatral) given at once after same meal each day, tablets should not be chewed/crushed tamsulosin (Flomax):caspule is given about 30minutes after same meal each day, dosage may be increased to 0.8mg after 2-4 weeks of therapy if needed to control symptoms EVALUATION: report and record: drowsiness, headache, dizziness, weakness, lethargy: tend to be self-limiting, provide for safety dizziness, tachycardia, fainting: may develop 15-90minutes after the first dose, give drug with food to avoid these symptoms, provide for safety

Anti-Androgen Agents: the following are used to treat BPH: dutasteride (Avodart) finasteride (Proscar) these drugs reduce the cell growth associated with BPH goals of therapy: reduce BPH symptoms improve urine flow reduce need for surgery

Assisting With the Nursing Process anti-androgen agents: ASSESSMENT: ask nurse what to observe/report PLANNING: dutasteride (Avodart): dose form is 0.5mg capsules finasteride (Proscar): dose form is 5mg tablets IMPLEMENTATION: -(Avodart): a 0.5mg capsules is given once/day, with or without food -finasteride (Proscar): a 5mg tablet is given once a day with or without food EVALUATION: report and record: complaints of impotence, decreased sexual drive, decreased volume of ejaculate: tend to be self-limiting

Drug Therapy for Erectile Dysfunction (ED): ED or impotence: inability for male to have erection Causes: diabetes spinal cord injury multiple sclerosis prostate problems alcoholism heart/circulatory disorders drug abuse psychological factors high blood pressure meds

Phospho-Diesterase Inhibitors: Drugs result in smooth muscle relaxation, allows blood to fill the erectile tissue in penis during sexual stimulation An erection that results can last an hour or so Goals of therapy: improved erectile function sexual satisfaction in men with ED

Assisting With the Nursing Process Drugs that treat ED: ASSESSMENT: measure vital signs PLANNING: see table 29-4 (p. 365) for “Oral Dose Forms” IMPLEMENTATION: see table 29-4 (p. 365) for “Adult Dosage Range”, a dose is taken 30 minutes to 4 hours before sexual activity EVALUATION: report and record: headache, flushing of the face and neck: tend to be self- limiting color (blue or green) vision impairment: dosage may need to be reduced hypotension, dizziness, angina: person should lie down and stop sexual activity, person should NOT take nitroglycerin for angina priapism: prolonged or constant erection, medical attention is needed if it lasts longer than 4 hours