Chapter 58 Drugs for Disorders in Women’s Health, Infertility, and Sexually Transmitted Infections Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Irregular or Abnormal Uterine Bleeding Irregular uterine bleeding: Many different medical conditions or pathologies related to the menstrual cycle Abnormal uterine bleeding (AUB): Wide range of variable bleeding patterns in women Amenorrhea Menorrhagia Metrorrhagia Menometrorrhagia Intramenstrual bleeding Dysfunctional uterine bleeding (DUB) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Amenorrhea Primary amenorrhea: No menses by age 14 years without secondary sex characteristics or no menses by age 16 years with secondary sex characteristics Secondary amenorrhea: Absence of a spontaneous menstrual period for 6 consecutive months in women who have experienced menstrual cycles in the past Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Progestational Challenge Test Test uses an oral progestin administered for a limited period of time to confirm that the hypothalamus-pituitary-ovarian (HPO) responses (the hormonal system mediating the menstrual cycle) are intact. Micronized progesterone (Prometrium) Medroxyprogesterone acetate (Provera) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Metabolic Syndrome Polycystic ovarian syndrome (PCOS): Form of metabolic syndrome caused by the oversecretion of luteinizing hormone (LH) Insulin resistance: Hallmark of PCOS Metformin (Glucophage) Clomiphene citrate (Clomid or Serophene) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Abnormal Uterine Bleeding Patterns Menorrhagia: Regular uterine bleeding greater than 80 mL or lasting more than 7 days Metrorrhagia: Irregular uterine bleeding greater than 80 mL or lasting more than 7 days Menometrorrhagia: Combination of these two Intramenstrual bleeding: Episode of bleeding, usually light, that occurs between menstrual periods Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Dysfunctional Uterine Bleeding Most common classification of irregular bleeding Extraneous estrogen drug product usually effective in stopping prolonged DUB Estrogen-progestin combination products Depot-medroxyprogesterone acetate (Depo-Provera) IUS/LNG (Mirena) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Pharmacologic Management: Irregular Bleeding Nonsteroidal antiinflammatory drugs (NSAIDs): mefanamic acid (Ponstel), ibuprofen, and naproxen sodium CHC products Progestins: medroxyprogesterone acetate, norethindrone, and micronized progesterone Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Dysmenorrhea Pelvic pain associated with the menstrual cycle, also called cyclic pelvic pain (CPP) Primary dysmenorrhea Secondary dysmenorrhea Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Pharmacologic Treatment: Dysmenorrhea Herbal, botanical, and vitamin/mineral therapy NSAIDs Hormonal contraception Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Endometriosis Abnormal location of endometrial tissue outside the uterus Common cause of dysmenorrhea, chronic pelvic pain, and infertility Most common symptoms of endometriosis are dysmenorrhea and pelvic pain, sometimes including chronic pelvic pain, which lasts more than 6 months and is not associated specifically with menstruation. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Pharmacologic Management of Endometriosis CHC products Progestational products Gonadotropin inhibitors and Gn-RH agonists Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Premenstrual Syndrome Collection of cyclic physical symptoms and perimenopausal mood alterations. Symptoms increase in the 2 weeks before menstruation and subside after menses begins. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Pharmacologic and Complementary and Alternative Treatment of PMS Herbal, botanical, or vitamin/mineral therapy Antidepressant and anti-anxiety medications Hormonal therapy Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Common Vulvovaginal Infections Vulvovaginal candidiasis (VVC): yeast infection of the vulva or vaginal area treated with antifungal medications Bacterial vaginosis: treated with metronidazole (Flagyl) or tinidazole (Tindamax) Trichomoniasis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Infertility Inability to conceive a child after 12 months of unprotected sexual intercourse Assessment of woman: alterations in ovarian function and anatomic disorders Assessment of man: any disease process that prevents sperm production or blocks sperm transport Refer to Table 58-2, Causes of Infertility. Refer to Table 58-3, Common Tests for Infertility. Refer to Table 58-4, Ovulatory Stimulants and Ovulation Control. Refer to Prototype Drug Chart 58-1, Clomiphene Citrate. Refer to Nursing Process: Infertility. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Induction of Ovulation Clomiphene citrate (CC) Side effects: breast discomfort, fatigue, dizziness, depression, nausea, increased appetite, dermatitis, urticaria, anxiety, weakness, heavier menses, vasomotor flushing, and abdominal bloating or pain Recombinant FSH, LH, and human chorionic gonadotropin (hCG) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Luteal Phase Deficits Decreased progesterone levels in the luteal phase of the menstrual cycle (the phase after ovulation) Decreased luteal-phase progesterone output: luteal-phase deficiency (LPD) Treatment with progesterone in vaginal, oral, or IM dosing (called luteal-phase support) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Other Drug Treatments Hyperprolactinemia Elevated level of prolactin is the causative factor of infertility. Cause: Use of certain drugs, pituitary adenoma Treatment: Ergot derivative bromocriptine (Parlodel) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Infertility Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Drug Therapy for Male Infertility Oligospermia: Semen with a low concentration of sperm Asthenospermia: Low sperm motility Testosterone Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Sexually Transmitted Infections Transmission and risk Bacterial pathogens Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID. Treponema pallidum is a spirochete that causes syphilis. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Sexually Transmitted Infections Viral pathogens Human papllioma virus: Gardasil Herpes simplex virus: antiviral medications HIV Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Other Pathogens Pediculosis humanus capitus: head lice Pediculosis humanus corporus: body lice Phthirus pubis: pubic lice Trichomonas vaginalis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Sexually Transmitted Infections Assessment Nursing diagnosis Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 Use of which substance has been associated with changes in sperm production and viability? Echinacea Valerian St. John’s wort Green tea Answer: C Rationale: St. John’s wort affects sperm cells and causes decreased sperm motility and decreased viability. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 Nonsteroidal antiinflammatory agents decrease pain associated with dysmenorrhea by altering the patient’s perception of pain. blocking the transmission of pain impulse. preventing the synthesis of prostaglandins. thinning the blood to allow for better flow. Answer: C Rationale: NSAIDs block pain by preventing synthesis of prostaglandins. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 Which information will the nurse include when teaching a patient about premenstrual syndrome (PMS)? “Avoid aerobic exercise when experiencing PMS.” “Increase salt intake when experiencing PMS.” “Increased calcium intake may help with PMS.” “Progesterone is effective in the treatment of PMS.” Answer: C Rationale: Aerobic exercise and decreased salt intake have the potential to decrease symptoms associated with PMS. Progesterone has not been approved for treatment of PMS by the U.S. Food and Drug Administration. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Which of the following is the term for a yeast infection of the vulva or vaginal area? Vulvovaginal candidiasis Gonorrhea Bacterial vaginosis Trichomoniasis Answer: A Rationale: Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva or vaginal area. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.