Ppt chapter 52

Chapter 52
Drugs Affecting Women’s Health
and Sexuality
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiology
• The female sex hormones are responsible for producing
female sexual characteristics, developing the female
reproductive system, and maintaining pregnancy.
• The two types of female sex hormones are estrogen and
progestin.
• Both are steroidal compounds that the ovaries begin to
secrete at puberty and that the placenta secretes during
pregnancy.
• The adrenal cortex also secretes estrogen and progestin,
but in much smaller amounts.

Menstrual Cycle

Pathophysiology
• If a woman is deficient in endogenous sex hormones, she
does not experience normal sexual development.
• When a woman’s estrogen levels drop during
menopause, the ending of the monthly ovarian cycles,
she experiences several changes.
• In postmenopausal women, the loss of estrogen
contribute to the development of osteoporosis.
• Osteoporosis is characterized by low bone mineral
density.
• Deficiency of sex hormones is the leading cause of
osteoporosis.

Estrogens
• Many different types of exogenous estrogen differ
somewhat in terms of indications, route of
administration, and pharmacokinetics.
• Routes of administration may be oral, intramuscular (IM),
transdermal, or topical (as vaginal creams).
• Most of these estrogens are used for correction of low
endogenous estrogen or in birth control products
combined with progestins.
• Prototype drug: conjugated estrogen (Premarin)

Conjugated Estrogen: Core Drug
Knowledge
• Pharmacotherapeutics
– Used primarily in hormone replacement therapy
• Pharmacokinetics
– Metabolism: liver. Excreted: kidneys.
• Pharmacodynamics
– Stimulates the development of the female sex organs
and secondary female sexual characteristics

Conjugated Estrogen: Core Drug
Knowledge (cont.)
• Contraindications and precautions
– Black Box warning in the labels indicates that the
drug increases the risk of cardiovascular events.
• Adverse effects
– Increases the risk of stroke and coronary heart
disease, breakthrough bleeding, headache, nausea,
vomiting, bloating, abdominal cramps, and chloasma
• Drug interactions
– No important drug interactions are associated with
conjugated estrogen.

Conjugated Estrogen: Core Patient
Variables
• Health status
– Assess blood pressure and breast for any masses.
• Life span and gender
– Check the patient’s age.
• Environment
– Causes photosensitivity

Conjugated Estrogen: Nursing Diagnoses
and Outcomes
• Ineffective Sexuality Patterns related to therapy for
female hypogonadism or lack of intrinsic estrogen
– Desired outcome: The patient will develop normal
sex organs and secondary sexual characteristics
while using estrogen drug therapy.
• Risk for Delayed Growth and Development related to
intrinsic estrogen deficiency and early hypophysis closing
from estrogen replacement therapy
– Desired outcome: The patient will achieve normal
growth and development while using drug therapy.

Conjugated Estrogen: Nursing Diagnoses
and Outcomes (cont.)
• Decisional Conflict related to comparison of risks and
benefits of postmenopausal estrogen replacement
therapy
– Desired outcome: The patient will make an
informed decision about estrogen replacement
therapy after comparing personal risks and benefits.

Conjugated Estrogen: Planning and
Interventions
• Maximizing therapeutic effects
– Administer conjugated estrogen cyclically.
• Minimizing adverse effects
– Monitor for signs of thrombophlebitis and
thromboembolus.
– In women with a uterus, the combination of estrogen
and progestin should always be used to minimize the
risk of endometrial cancer.

Conjugated Estrogen: Teaching,
Assessment, and Evaluation
• Patient and family education
– Teach patients and their families about the
therapeutic purpose of estrogen.
– Provide instruction on how to take the estrogen.
• Ongoing assessment and evaluation
– If the patient is a prepubescent girl, evaluate for
normal sexual development with estrogen therapy,
and monitor the patient’s growth as appropriate.

Question
• The Women’s Health Initiative (WHI) found that
menopausal women who had moderate-to-severe
vasomotor symptoms had benefit from estrogen therapy.
– A. True
– B. False

Answer
• A. True
• Rationale: The Women’s Health Initiative (WHI) found
that menopausal women who had moderate-to-severe
vasomotor symptoms at the start of the study
experienced a small benefit in their sleep quality with 3
years of estrogen-progestin therapy.
• However, therapy provided no benefit for other health-related
quality-of-life measures, such as general health,
vitality, mental health, relief from depressive symptoms,
or sexual satisfaction.

Progestins
• Progestins consist of progesterone and its derivatives.
• Through stimulation or inhibition, they regulate secretion
of pituitary gonadotropins.
• Progestins also inhibit spontaneous uterine contractions.
• Prototype drug: progesterone (Prometrium, Crinone)

Progesterone: Core Drug Knowledge
– Helps produce normal menstrual cycles
– Administered: oral or IM. Metabolism: liver.
Excreted: kidneys.
– Exogenous progesterone affects the body in ways
similar to those of endogenous progesterone.

Progesterone: Core Drug Knowledge
(cont.)
– Hypersensitivity
• Adverse effects
– Progesterone may increase the risk of breast and
ovarian cancer when given in combination with
estrogen to postmenopausal women
– No known drug interactions are associated with
progesterone

Progesterone: Core Patient Variables
• Health status
– Assess for contraindications to therapy.
– Pregnancy Category B
• Environment
– Caution patients about exposure to ultraviolet light

Progesterone: Nursing Diagnoses and
Outcomes
• Disturbed Body Image related to potential breakthrough
bleeding, spotting, changes in menstrual flow, weight
gain, or breast tenderness secondary to adverse effects
of drug therapy
– Desired outcome: The patient will not experience
substantial adverse effects from drug therapy to alter
body image.
• Risk for Injury related to loss of vision, onset of
thrombotic disorders, and depression secondary to
adverse effects of drug therapy
– Desired outcome: The patient will not suffer an
injury related to adverse effects of drug therapy.

Progesterone: Planning and Interventions
– The dosing schedule varies depending on the clinical
indication for using progesterone.
– Take steps to minimize the adverse effects of
progesterone therapy.
– Do not give drug to patients with contraindications to
therapy.

Progesterone: Teaching, Assessment, and
Evaluation
– Instruct patients and their families on the therapeutic
and adverse effects of progesterone.
– Teach patients how to perform breast self-examination.
– Monitor premenopausal women taking progesterone
for return of normal menstrual flow and cessation of
abnormal bleeding.

Question
• Progesterone is also added to postmenopausal HRT
therapy
– A. To decrease the risk of endometrial cancer
– B. To prevent ovarian cancer
– C. To decrease the risk of coronary artery disease
– D. To prevent breast cancer

Answer
• A. To decrease the risk of endometrial cancer
• Rationale: Progesterone is added to postmenopausal
HRT to decrease the risk of endometrial cancer from
estrogen therapy.

Oral Contraceptives
• Contain estrogen and progesterone or just progesterone
• Oral contraceptives are given to prevent pregnancy.
• Inhibit ovulation by suppressing the gonadotropins FSH
and LH
• Oral contraceptives should be prescribed with the
smallest effective dose of estrogen possible.
• Oral contraceptives are known to interact with penicillins
and tetracyclines.

Bisphosphonates
• The bisphosphonate drug class affects normal and
abnormal bone resorption.
• Prototype drug: alendronate (Fosamax)

Alendronate: Core Drug Knowledge
– Used to treat and prevent osteoporosis
– Administered: oral. Excreted: kidneys.
– Inhibits both normal and abnormal bone resorption

Alendronate: Core Drug Knowledge
(cont.)
– Hypocalcemic or hypersensitive
• Adverse effects
– Musculoskeletal pain, flatulence, acid regurgitation,
esophageal ulcer, gastritis, headache, and erythema
– Due to drug interaction, it is recommended to wait at
least 30 minutes after taking alendronate before
taking any other drug.

Alendronate: Core Patient Variables
• Health status
– Assess past medical history and contraindications to
drug.
– Pregnancy Category C
• Lifestyle, diet, and habits
– Review dietary eating habits
• Environment
– Assess environment where drug will be given.
• Culture and inherited traits
– Asian and white women are at increased risk for
osteoporosis.

Alendronate: Nursing Diagnoses and
Outcomes
• Risk for Injury related to fractures from osteoporosis or
Paget disease
– Desired outcome: The patient using drug therapy
will have no fractures.
• Potential Complication: Electrolyte Imbalance related to
drug therapy with alendronate
– Desired outcome: The patient will not experience
electrolyte imbalance.
• Potential Complication: Altered GI Function related to
adverse effects of drug therapy with alendronate
– Desired outcome: The patient will experience either
no or minimal adverse effects.

Alendronate: Planning and Interventions
– Provide patient education
– Take measures to correct preexisting hypocalcemia
before treatment.
– Monitor electrolytes during therapy.

Alendronate: Teaching, Assessment, and
Evaluation
– Teach patients to take alendronate at least 30
minutes before eating.
– Patients should swallow the medicine with 6 to 8
ounces (180 to 240 mL) of plain water.
– Verify throughout therapy that the patient is not
experiencing hypocalcemia or other adverse effects
from alendronate therapy.

Question
• Patient teaching regarding proper administration of
alendronate should include which of the following?
– A. Medication can be taken before bedtime.
– B. Medication can be taken with other medications.
– C. Medication should be taken on an empty stomach
with 8 oz of water.
– D. Both A and D
– E. All of the above

Answer
• C. Medication should be taken on an empty stomach with
8 oz of water.
• Rationale: Alendronate should be taken first thing in the
AM on an empty stomach with a full glass of water; the
patient needs to remain upright for 1 hour after
administration. Alendronate should not be given within
30 minutes of other medications.

Ppt chapter 52

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