Drugs Used in Men’s and Women’s Health Chapter 41 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2 Chapter 41 Lesson 41.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 3 Objectives Identify common organisms known to cause leukorrhea Cite the generic and brand names of products used to treat Candida albicans, Trichomonas vaginalis, and Gardnerella vaginalis Discuss specific interviewing techniques that can be used to obtain a history of sexual activity Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 4 Objectives (cont’d) Review specific techniques for administering vaginal medications Develop a plan for teaching self-care to women and men with sexually transmitted diseases. Include personal hygiene measures, medication administration, methods of pain relief, and prevention of spread of infection or reinfection Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 5 Vaginitis Leukorrhea is not a disease but symptom of an underlying disorder Most common cause is infection of the lower reproductive tract  Common organisms: Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis Products to treat vaginitis  Miconazole (Monistat)  Metronidazole (Flagyl)  See Table 41-2 for further discussion Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 6 Nursing Assessment Be aware of increasing frequency of sexual activity among adolescents History of current symptoms Medication history Psychosocial considerations Laboratory and diagnostic studies Physical examination Proper approach and use of confidential information will encourage responses during interviews Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 7 Sexually Transmitted Diseases Instructions for adolescents  Rate of STDs is high among those who have unprotected sexual contact with multiple partners  Do thorough assessment of sexual activity and practices  For those sexually active, counsel regarding safe sex practices and voluntary testing  All adolescents should be taught about abstinence and safe sex practices Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 8 Instructions for Women Teaching self-care regarding STDs  Refrain from using irritating vaginal substances  Warm sitz baths may help relieve irritation  Discuss good personal hygiene practices  Hormonal and surgical contraceptive methods do not protect against STDs  Use chemical and physical barriers such as condoms  Properly apply vaginal medications Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 9 Instructions for Men Teaching self-care regarding STDs  Discuss good personal hygiene practices  Discuss appropriate interventions for men with altered sexual function  Latex condoms can be effective in reducing transmission of HIV and some STDs, but are not effective against STDs transmitted by skin- to-skin contact Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 10 Chapter 41 Lesson 41.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 11 Objectives Compare the active ingredients in the two types of oral contraceptive agents Differentiate between the actions and the benefits of the combination pill and the minipill Describe the major adverse effects and contraindications to the use of oral contraceptive agents Develop specific patient education plans to be used to teach a patient to initiate oral contraceptive therapy with the combination pill and the minipill Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 12 Objectives (cont’d) Identify the patient teaching necessary with the administration of the transdermal contraceptive and the intravaginal hormonal contraceptive Describe pharmacologic treatments of benign prostatic hyperplasia Describe the pharmacologic treatment of erectile dysfunction Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Oral Contraceptives Actions  Estrogens block the pituitary release of FSH; progestins inhibit pituitary release of LH Uses  Induce contraception by inhibiting ovulation Common adverse effects  Nausea, weight gain, depression Serious adverse effects  Breakthrough bleeding, yeast infection, blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain Slide 13 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 14 Drug Class: Oral Contraceptives Types  Combination pill – taken for 21 days of the menstrual cycle; contains estrogen and progestin Subdivided into three classes: monophasic, biphasic, triphasic  Minipill – taken every day; contains only progestin  Extended and continuous–cycle – 24-day or 84-day cycles followed by a short placebo period Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 15 Drug Class: Transdermal Contraceptives Drug: norelgestromin–ethinyl estradiol transdermal system (Ortho Evra) Actions  Inhibit ovulation Uses  Estrogen and progestin hormones are in patch form Common adverse effects  Nausea, weight gain, depression Serious adverse effects  Blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 16 Drug Class: Intravaginal Hormonal Contraceptive Drug: etonogestrel–ethinyl estradiol vaginal ring (NuvaRing) Actions  Estrogen and progestin inhibit ovulation Uses  Plastic ring dosage form is inserted into vagina Common adverse effects  Nausea, weight gain, spotting, depression, mood changes, headaches, insomnia, fatigue, lack of energy Serious adverse effects  Leg pain, chest pain, shortness of breath Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 17 Drug Class: Alpha-1 Adrenergic Blocking Agents Actions  Block alpha-1 receptors on the prostate gland, causing muscle relaxation, allowing greater urinary outflow Uses  Reduce mild to moderate urinary obstruction in men with BPH Common adverse effects  Drowsiness, headache, dizziness, weakness, lethargy; tachycardia, fainting Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 18 Drug Class: Antiandrogen Agents Drug: dutasteride (Avodart) Actions  Inhibit enzyme 5-alpha reductase, reduce DHT levels Uses  Treat symptoms of BPH, reduce risks of urinary retention, minimize need for surgery for BPH Common adverse effects  Impotence, decreased libido, decreased volume of ejaculate Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Antiandrogen Agents (cont’d) Drug: finasteride (Proscar) Actions  Inhibit enzyme 5-alpha reductase, reduce DHT levels Uses  Treat symptoms of BPH, reduce risks of urinary retention, minimize need for surgery for BPH, treat male pattern baldness Common adverse effects  Impotence, decreased libido, decreased volume of ejaculate Slide 19 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 20 Drug Class: Phosphodiesterase Inhibitors Actions  Selective inhibitor of PDE-5 enzyme Uses  Treat male erectile dysfunction; pulmonary arterial hypertension Common adverse effects  Headache, flushing of the face and neck, color vision impairment Serious adverse effects  Hypotension, dizziness, angina, loss of vision, sustained erection Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.