Drugs for Disorders and Conditions of the Female Reproductive System

Hypothalamus and Pituitary Regulation of Female Reproductive System Gonadotropin-releasing hormone (GnRH) Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) Act on ovary and cause immature ovarian follicles to begin developing

Endocrine System Various glands that secrete hormones, chemical messengers released in response to a change in the body’s internal environment The role of hormones is to maintain the body’s homeostasis “Negative Feedback”

Negative Feedback

Estrogens and Progestins (Ovarian): PROGESTINS (Uterine): Responsible for maturation of sex organs and secondary sex characteristics of female Prepare endometrium for implantation High progesterone and estrogen levels in final third of uterine cycle provide negative feedback to shut off GnRH, FSH, and LH secretion

Used to prevent pregnancy Oral Contraceptives Used to prevent pregnancy Most are combination of estrogens and progestins Small doses prevent conception by blocking ovulation (negative feedback)

Estrogen-Progestin Contraceptives Act by providing negative feedback to pituitary Shuts down secretion of LH and FSH Ovarian cycle cannot mature, ovulation is prevented.

Estrogen-Progestin Contraceptives Progestin-only oral contraceptives (minipills) Produce thick, viscous mucus at entrance to uterus Discourages penetration by sperm Estrogen-Progestin Contraceptives Advantages? Disadvantages? Alternatives?

Thromboembolic Disorders Hypertension Migraines High Blood Sugar Cancer Increases appetite, weight gain, fatigue, nausea, breast tenderness Oral Contraceptives Serious Adverse Effects Common Side Effects

Emergency Contraception May be administered within 72 hours after unprotected sex Prevents implantation of fertilized egg Plan B: levonorgestrel in two doses, 12 hours apart Preven: combination of ethinyl estradiol and levonorgestrel Other agents may be given to abort implanted embryo Mifepristone (Mifeprex, RU-486) Misoprostol (Cytotec) Emergency Contraception Emergency Contraception vs. Pharmacologic Abortion

Menopause Progressive decrease in estrogen secretion by ovaries, resulting in permanent cessation of menses Unpleasant symptoms: hot flashes, night sweats, irregular menstrual cycles, vaginal dryness, bone mass loss

Hormone Replacement Therapy (HRT) Estrogen or Estrogen-progestin combinations Commonly used to treat unpleasant symptoms of menopause Hormone Replacement Therapy (HRT)

Dysfunctional Uterine Bleeding Hemorrhaging that occurs on noncyclic basis or in abnormal amounts Progestins are drugs of choice for treating uterine abnormalities Menorrhagia Amenorrhea Endometriosis Examples: Early abortion Pelvic neoplasms Benign growths

Uterine Stimulants and Relaxants Oxytocics: Natural hormones secreted by posterior pituitary Stimulate uterine contractions to induce labor Suckling stimulates release of oxytocin Tocolytics: Slow uterine contractions to delay labor Used in clients with premature labor

Treatment of Female Infertility Can occur at level of hypothalamus, pituitary, or ovary Pharmacotherapy targeted to specific cause of dysfunction Stimulates release of LH Results in maturation of increased number of ovarian follicles Rise in LH level sufficient to induce ovulation in 90% of treated women

Estradiol and Norethindrone (Ortho-Novun) Protoype Drugs Estradiol and Norethindrone (Ortho-Novun) Conjugated Estrogens (Cenestin, Enjuvia, Premarin) Medroxyprogesterone Acetate (Provera) Oxytocin (Pitocin)

Estradiol and Norethindrone (Ortho-Novun) Therapeutic class: combination oral contraceptive Pharmacologic class: Estrogen/progetin Prevent ovulation by negative feedback control targeted at hypothalamus and pituitary gland. Off label indications: acne, endometriosos, dysfunctional uterine bleeding. Improve regular menstrual cycle, decrease incidence of painful menstrual cycle. Frequent side effects: nausea, breast tenderness, weight gain, breakthrough bleeding. Most serious cardiovascular adverse effect: htn, thromboembolic disorders. Interactions: some abx, anticonvulsants decrease effectiveness of ocp

Conjugated Estrogens (Cenestin, Enjuvia, Premarin) Therapeutic class: Hormone Pharmacologic class: estrogen/hormone replacement therapy Used to treat moderate to severe symptoms of menopause caused by diminished estrogen secretion by ovaries. Side effects: nausea, fluid retention, edema, breast tenderness, abdominal cramping, bloating. Estrogens when used alone have high risk of uterine, breast cancer.

Medroxyprogesterone Acetate (Provera) Therapeutic class: Hormone (agent for dysfucntioanl uterine bleeding) Pharmacologic class: Progestin Primary target is endometrium of uterus. Inhibits effect of estrogen on uterus, restoring hormonal balance. Used for dysfucntional uterine bleeding Side effects: breast tenderness, break through bleeding, menstrual irregularities. Weight gain, depression, n/v, htn. Most serious side effect: increased risk for thromboembolic disease. Black box warning: may cause loss of bone mineral density.

Oxytocin (Pitocin) Therapeutic class: Drug to induce labor; uterine stimulant Pharmacologic class: Hormone; oxytocic Drug of choice for inducing labor by increasing frequency & force of uterine contractions. May also be given postpartum to reduce hemorrhage after expulsion of placenta, and to aid in return of normal muscular tone to uterus. Adverse side effects: rapid, painful uterine contractions and fetal tachycardia. Complications to mother: uterine rupture

Monitor client’s condition Provide client education Role of Nurse Monitor client’s condition Provide client education Obtain medical, surgical, drug history Assess lifestyle and dietary habits Obtain description of symptomology and current therapies

Oral Contraceptive Therapy Monitor for symptoms of thrombophlebitis Oral contraceptives can mimic certain symptoms of pregnancy Breast tenderness, nausea, bloating, chloasma Missing a dose Antiseizure/antibiotics –reduce effectivenses Self-Breast Examinations

Hormone Replacement Therapy Monitor client closely for signs and symptoms of thrombus or embolus Encourage client to report signs of depression, decreased libido Also headache, fatigue, weight gain

Progestin Therapy Common side effects Breakthrough bleeding, nausea Abdominal cramps, dizziness Edema, weight gain Monitor for amenorrhea; sudden, severe headache Also for signs of pulmonary embolism: sudden severe chest pain, dyspnea Report symptoms to health-care provider immediately

Can cause photosensitivity and phototoxicity Progestin Therapy Can cause photosensitivity and phototoxicity Monitor for pruritus, sensitivity to light, acne, rash, alopecia Phototoxic reactions cause serious sunburn within 5 to 18 hours

Uterine Stimulant Therapy Frequently assess client in labor Oxytocin increases frequency and force of uterine contractions Discontinue infusion if fetal distress detected

Uterine Stimulant Therapy Assess for symptoms of water intoxication Drowsiness, listlessness, headache Confusion, anuria, weight gain Side effects of oxytocin Anxiety, maternal dyspnea, hypotension or hypertension Nausea, vomiting, neonatal jaundice Maternal or fetal dysrhythmias