Ppt chapter 40

Drugs Affecting the Female
Reproductive System
Chapter 40
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Site of Action for Drugs Affecting the
Female Reproductive System

Drugs Used to Treat Disorders of the
Female Reproductive System
• Estrogen and Progestins
• Estrogen Receptor Modulators
• Fertility Drugs
• Oxytocics
• Abortifacients
• Ocolytics

Estrogen
• Actions
– Protecting the heart from atherosclerosis
– Retaining calcium in the bones
– Maintaining the secondary female sex characteristics
• Indications
– Hormone replacement therapy (HRT)
– Palliative and preventive therapy during menopause

Estrogen (cont.)
• Pharmacokinetics
– Absorbed through the GI tract and undergoes
extensive hepatic metabolism
– Excreted in the urine
• Contraindications
– Allergies and pregnancy
– Idiopathic vaginal bleeding, breast cancer, and
estrogen dependent cancer, thromboembolic
disorders

Estrogen (cont.)
• Caution
– Breast feeding, metabolic bone disease, renal
insufficiency, hepatic impairment
• Adverse Effects
– GI tract
– Systemic effects of estrogens
• Drug-to-Drug Interactions
– Drugs that enhance hepatic metabolism
– Corticosteroids

Sites of Action of the Estrogens

Estrogen Receptor Modulators
• Actions
– Modulating effects on estrogen receptors
– Used to stimulate specific estrogen receptors to increase
bone mineral density
• Indications
– Postmenopausal osteoporosis
– Well absorbed in the GI tract, metabolized in the liver
– Excreted in the feces

Estrogen Receptor Modulators (cont.)
– Known allergy, pregnancy, and lactation
– Patients with history of venous thrombosis or smoking
• Adverse Effects
– GI upset
– Changes in fluid balance: headache, dizziness, and visual
changes
– Estrogen receptor stimulation: hot flashes, skin rash,
edema, and vaginal bleeding

Estrogen Receptor Modulators (cont.)
– Cholestyramine
– Highly protein-bound drugs
– Warfarin

Question
What is an indication for the use of estrogen receptor
modulators?
A. Postmenopausal osteoporosis
B. Hereditary angioedema
C. Osteogenesis imperfecta
D. Breast cancer

Answer
A. Postmenopausal osteoporosis
Rationale: The indication for estrogen receptor modulators
is postmenopausal osteoporosis.

Progestins
• Actions
– Transform the proliferative endometrium into a secretory endometrium
– Inhibit the secretion of FSH and LH
– Prevent follicle maturation and ovulation
– Inhibit uterine contractions
• Indications
– Contraception
– Treatment of primary and secondary amenorrhea
– Fertility protocols
– Well absorbed, undergo hepatic metabolism and are excreted in the urine

Progestins (cont.)
– Allergies, pregnancy, idiopathic vaginal bleeding,
breast or genital cancer, history of thromboembolic
disorders, PID, sexually transmitted disease,
endometriosis, or pelvic surgery
• Adverse Effects
– Varies based on route of administration
– Barbiturates, Carbamazepine, Phenytoin, or Rifampin

Fertility Drugs
• Actions
– Directly or by stimulating the hypothalamus to
increase FSH and LH levels, leading to ovarian
follicular development and maturation of ova
• Indications
– Infertility in men and women
– Well absorbed, undergo hepatic metabolism and
renal excretion

Fertility Drugs (cont.)
– Primary ovarian failure
– Thyroid or adrenal dysfunction
– Ovarian cysts
– Pregnancy, idiopathic uterine bleeding, and known
allergy
• Caution
– Breast feeding, thromboembolic disease, or
respiratory disease

Fertility Drugs (cont.)
• Adverse Effects
– Increase risk of multiple births and birth defects
– Ovarian overstimulation
– Headache, fluid retention, nausea, bloating
– Uterine bleeding, ovarian enlargement
– Gynecomastia

Oxytocics
• Actions
– Affect neuroreceptors sites to stimulate contractions
of the uterus
• Indications
– Prevention and treatment of uterine atony after
delivery
– Rapidly absorbed, metabolized in the liver, and
excreted in urine and feces

Oxytocics (cont.)
– Allergy and early pregnancy
– Cephalopelvic disproportion
• Caution
– Coronary artery disease, hypertension, lactation, and
previous Cesarean section

Oxytocics (cont.)
• Adverse Effects
– Excessive effects: uterine hypertonicity and spasm
– GI upset (nausea)
– Headache
– Blood pressure changes
– Water intoxication

Question
Tell whether the following statement is true or false.
Fertility drugs act by stimulating the pituitary to increase
FSH and LH levels, leading to ovarian follicular
development and maturation of ova.

Answer
False
Rationale: Fertility drugs either act directly or by
stimulating the hypothalamus to increase FSH and LH
levels, leading to ovarian follicular development and
maturation of ova.

Abortifacients
• Actions
– Stimulate uterine activity
– Dislodge any implanted trophoblast and preventing
implantation of fertilized egg
• Indications
– Termination of pregnancy at 12-20 weeks
– Well absorbed, metabolized in the live and excreted
in the urine

Abortifacients (cont.)
• Caution
– Asthma, hypertension, or adrenal disease
– Acute vaginitis or scarred uterus
• Adverse Effects
– Abdominal cramping
– Heavy uterine bleeding
– Perforated uterus or uterine rupture
– Headache, nausea, vomiting, diarrhea, diaphoresis,
backache, and rash

Tocolytics
• Uses
– Relax the uterine smooth muscle and prevent
contractions leading to premature labor and delivery
– Usually reserved for use after 20 weeks of gestation;
neonate has a chance of survival outside the uterus
• Prototype
– Only one in US: Ritodrine (Yutopar); withdrawn
because of serious side effects

Use of Drugs Affecting the Female
Reproductive System Across the Lifespan

Prototype Estrogen

Prototype Estrogen Receptor Modulators

Prototype Progestins

Prototype Fertility Drugs

Prototype Fertility Drugs (Continued)

Prototype Oxytocics

Prototype Oxytocics (Continued)

Prototype Abortifacients

Nursing Considerations for Estrogen or
Estrogen Receptor Modulators
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Progestins
• Implementation
• Evaluation

Nursing Considerations for Fertility Drugs
• Implementation
• Evaluation

Nursing Considerations for Oxytocics
• Implementation
• Evaluation

Nursing Considerations for Abortifacients
• Implementation
• Evaluation

Question
What would be an appropriate nursing diagnosis for a
patient who is taking oxytocics ?
A. Constipation related to dopaminergic effects
B. Excess fluid volume related to ergotism or water
intoxication
C. Risk for injury related to CNS effects and incidence of
orthostatic hypotension
D. Constipation related to decreased fluid intake

Answer
B. Excess fluid volume related to ergotism or water
intoxication
Rationale: Nursing diagnoses related to drug therapy might
include: excess fluid volume related to ergotism or water
intoxication

Ppt chapter 40

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