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

2. 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

3. 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
drugs used to treat genital infections: table 29-2 pg. 359 (also see ch. 34)

4. 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

5. 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

6. 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 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

7. 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

8. 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

9. 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****

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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