1. Focus on Pharmacology Essentials for Health Professionals
Jahangir Moini, MD, MPH
Chapter 23 Effects of Drugs on the Reproductive System

2. Synthetic Androgens: Uses
Main indication in men is to supplement low levels of testosterone to correct hypogonadism or cryptorchidism(absence of one or both testes from the scrotum) ; other uses in men are for increasing sperm production
Used in women to treat postpartum breast engorgement, endometriosis (the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the ovaries), and fibrocystic breast disorders

3. 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

4. Synthetic Androgens: Contraindications
Contraindicated in patients with serious cardiac, liver, or kidney disease; prostate or breast cancer; pregnancy and lactation
Testosterone alters glucose tolerance tests and may increase creatinine and creatinine secretion

5. 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.

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

7. 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 prostate carcinoma in men; and to treat abnormal bleeding

8. 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

9. 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

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

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

12. Estrogens During Pregnancy
Use of estrogens during the first trimester of pregnancy may increase the risk of fetal malformations

13. 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

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

15. Progestins: Adverse Effects
Common: vaginal candidiasis, breakthrough bleeding, dysmenorrhea, amenorrhea, breast tenderness, edema, acne, pruritus, mental depression
Serious: thromboembolic disorder, pulmonary embolism

16. 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, or abnormal Pap smear

17. 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.

18. 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
The risks of using such combination drugs include:
cardiovascular disease
breast cancer
thromboembolism

19. Contraceptive Hormones: Uses
Provide negative feedback to hypothalamus
This inhibits gonadotropin-releasing hormone
The pituitary therefore cease secretion of FSH, which would normally stimulate ovulation

20. Oral Contraceptives: Adverse Effects
Common: nausea, abdominal pain, gallbladder disease, breast tenderness or pain, weight gain, dysmenorrhea, amenorrhea,
Serious: thromboembolism, stroke, myocardial infarction

21. Oral Contraceptives: Contraindications
Pregnancy and lactation
Genital bleeding of unknown cause
Coronary artery disease
Liver dysfunction
Endometrial or breast cancer
Severe hypertension
Diabetes with vascular involvement

22. 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.

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

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

25. Oxytocics: Uses
Used to initiate or improve uterine contractions during delivery (only after cervix is dilated); also used to stimulate milk letdown following delivery

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

27. Oxytocics: Contraindications
Must not be used to induce labor prior to delivery of the placenta
Contraindicated in unfavorable fetal position or presentation, obstetric emergencies, fetal distress
May interact with vasoconstrictor drugs to cause severe hypertension

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

29. Uterine Relaxants: Uses
Used in management of preterm labor

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

31. Uterine Relaxants: Contraindications
Uterine relaxants are contraindicated in patients with:
Antepartum hemorrhage (before birth)
Eclampsia (seizures)
Uncontrolled diabetes
Bronchial asthma
Pulmonary hypertension
Cardiac disease

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