26 Drugs Used to Treat Reproductive Conditions

Figure 26-1 The male reproductive system.

Table 26-1 Functions of the Male Reproductive System

Table 26-1 (continued) Functions of the Male Reproductive System

Table 26-2 Male Hormones

Table 26-2 (continued) Male Hormones

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

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

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.

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.

Anabolic Steroids and Elderly Men The risk of prostate cancer increases in elderly men who take androgens.

Figure 26-2 The female reproductive system.

Figure 26-2 (continued) The female reproductive system.

Table 26-3 Functions of the Female Reproductive System

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

Table 26-4 Major Synthetic Estrogens

Synthetic Estrogens: Uses Bind to intracellular receptors that stimulate DNA and RNA to synthesize proteins

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

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

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

Synthetic Estrogens: Patient Information Advise patients to take drug as directed, not skipping or increasing or decreasing dose. Advise women not to breast feed.

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

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

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.

Table 26-5 Progestins

Table 26-5 (continued) Progestins

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

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

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.

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.

Estrogen–Progestin Combinations in Postmenopause The use of such combination drugs in postmenopausal women is controversial. The benefits of use are protection against: Osteoporosis Colon cancer

Estrogen–Progestin Combinations in Postmenopause The risks of using such combination drugs include: Cardiovascular disease Breast cancer Thromboembolism

Table 26-6 Types of Oral Contraceptives

Table 26-6 (continued) Types of Oral Contraceptives

Table 26-6 (continued) Types of Oral Contraceptives

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

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

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

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.

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

Smoking and Oral Contraceptives Smoking while taking oral contraceptives can cause serious adverse effects to the cardiovascular system.

Table 26-7 Effects of Drugs on Labor and Delivery

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

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

Oxytocics: Adverse Effects Common: nausea, vomiting, dizziness, headache Serious: maternal cardiac arrhythmias, hypertensive episodes, intracranial hemorrhage

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

Oxytocics: Patient Information Instruct patients to report: Cold or numb fingers or toes Severe cramping Chest pain Sudden or severe headache

Uterine Relaxants: Uses They are beta2-adrenergic agonists. Used in management of preterm labor.

Uterine Relaxants: Adverse Effects Common: headache, nausea, vomiting, nervousness, restlessness, sweating, emotional upset Serious: chest pain, arrhythmias, pulmonary edema

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

Uterine Relaxants: Patient Information Advise patients about potential adverse effects and drug interactions.