1. Chapter 24 Reproductive System Drugs

2. 2 Reproductive Hormones Gonadotropic Androgens Estrogens Progestins

3. 3 Gonadotropic Hormones Follicle-stimulating hormone (FSH) –stimulate development of ovarian follicles and sperm production Luteinizing hormone (LH) –Stimulate secretion of estrogen; ovulation Luteotropic hormone (LTH) –Stimulate secretion of progesterone

4. 4 Androgens Aka: Male hormones Stimulate development of male characteristics Examples –Testosterone –Andosterone

5. 5 Androgens Uses –Replacement (andropause), Congenital hypogonadism or delayed puberty, Aquired hypogonadism (trauma, surgery) Side effects –Acne, increased oiliness of skin and hair, alopecia –Premature closure of bone ends in adolescents Dangers of illegal use of anabolic steroids –Risk of developing psychosis, delusions, paranoia, depression, mania, aggression/violence

6. 6 Ex: Depo-testosterone, Androgel

7. 7 Impotence Agents Classification: Phosphodiesterase (PDE) inhibitors Treatment for male erectile dysfunction (ED) aka “impotence” Side effects –Headache, flushing, abnormal vision, dizziness, nasal congestions –CV: angina, tachycardia, hypotension, palpatiations Ex: Viagra, Cialia, Levitra

8. 8 Interactions: –NITRATES!! Patient Education –Erection >4hours, seek medical advice

9. 9 Estrogens Female sex hormone Development of female secondary sexual characteristics

10. 10 Estrogen Therapy Uses Contraceptives Meonopausal symptom relief Female Hypogonadism Post Menopausal estrogen replacement may reduce CV dz and elevated HDLs in females Postcoital use after rape or incest (within 24-48 hours) of a single large dose to prevent, not terminate, pregnancy

11. 11 Estrogen Therapy Side effects –Increased risk of thromboembolic disorder, MI, Stroke

12. 12 Progestins Synthetic drugs that exert progesterone-like activities Progesterone –Secreted by corpus luteum and adrenal glands –Changes in uterine endometrium in second half of the menstrual cycle –Prepares for implantation of fertilized ovum

13. 13 Progestins –Development of maternal placenta after implantation –Development of mammary glands

14. 14 Progestins Ex: Provera, Depo-Provera, Megace Uses –Tx of amenorrhea, abnormal uterine bleeding caused by hormonal imbalance –Contraceptive –Postmenopausal –Sexual Deviancy in males (Depo IM) Side effects –Menstrual irregularites, spotting, Thromboembolic disorders

15. 15 Contraceptive Agents Estrogen-progestin combination –Suppression of FSH and LH –Prevents ovulation Progestin-only contraceptives –Prevents ovulation –Thickens cervical mucus –Creates endometrium that is not condusive to sustaining fertilized ovum –Indicated for those who do not tolerate Estrogen Tx.

16. 16 Contraceptive Agents Uses –Prevent Birth Side effects –Fluid retention, bleeding between periods, break through bleeding, changes in mood and libido Absolute contraindications –Thromboemboic disorder, suspected breast/cervicatl CA,Women over 35 and currently smoking 15 cigarettes a day

17. 17 Interactions –Antibiotics Patient education –Alternative contraceptive for the first 1-2 weeks of initiation –Take same time of day, everyday –If missed, pill should be doubled up until the patient has caught up. –If 3 pills or more are missed, pt is instructed to throw away the pack until she starts period again, THEN begin a new pack of pill –Stop oral contraceptive if pregnancy is suspected –Stop smoking

18. 18 Choices of Contraceptives Monophasic –Same proportions of estrogen and progestin Biphasic –2 sequences of progestin and less than 50 mcg estrogen Triphasic –3 sequences of progestin and less than 50 mcg estrogen Use smallest dose possible for results

19. 19 Progestin-containing intrauterine device (IUD) Reservior of synthetic progestin Releases small amounts of progesterone daily, providing 5 years of continuous contraceptive protection.

20. 20 Postcoital Contraceptives Unintentional risk of pregnancy Must be administered within 72 hours Emergency contraceptive kit –Pregnancy test –4 tablets of estrogen/progesterone combination

21. 21 Mifepristone (Mifeprex) Antiprogesterone drug Terminate unwanted pregnancy Requires three physician visits Side effects Contraindications Patient education

22. 22 Drugs for Labor and Delivery Oxytocin –Secreted by posterior pituitary lobe Stimulates uterine contraction Stimulates release of milk Synthetic drugs are called oxytocics

23. 23 Labor and Delivery Oxytocin Magnesium sulfate –Tx of severe preeclampsia or eclampsia Prevents Seizures during L&D

24. 24 Infertility Drugs Clomiphene citrate (Clomid) –Induce ovulation Chorionic gonadotropin (Profasi) –Induces ovulation

25. 25 Drug List 1.Andro Gel 2.Viagra 3.Cialis 4.Levitra 5.Estrace 6.Premarin 7.Provera 8.Depo-Provera 9.Megace 10. Ortho-Cyclen 11. Loestrin 12. Ortho-Noveum 7/7/7 13. (oxytocin) Pitocin 14. (magnesium sulfate 15. Clomid 16. (chorionic gonadotropin)