26 Drugs Used to Treat Reproductive Conditions
Table 26-1 (continued) Functions of the Male Reproductive System
Synthetic Androgens: Uses • Main indication in men is to supplement low levels of testosterone to correct hypogonadism or cryptorchidism; other uses in men are for increasing sperm production • Used in women to treat postpartum breast engorgement, endometriosis, and fibrocystic breast disorders
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
Synthetic Androgens: Contraindications • Contraindicated in patients with serious cardiac, liver, or kidney disease; prostatic or breast cancer; pregnancy and lactation • Testosterone alters glucose tolerance tests and may increase creatinine and creatinine secretion.
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.
Anabolic Steroids and Elderly Men • The risk of prostate cancer increases in elderly men who take androgens.
Female Sex Hormones • Anterior pituitary releases hormones FSH and LH • Ovaries, adrenal cortex, and placenta (during pregnancy) release estrogens and progesterones
Synthetic Estrogens: Uses • Bind to intracellular receptors that stimulate DNA and RNA to synthesize proteins
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 prostatic carcinoma in men; and to treat abnormal bleeding and atrophic vaginitis in women
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
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 and theophylline
Synthetic Estrogens: Patient Information • Advise patients to take drug as directed, not skipping or increasing or decreasing dose. • Advise women not to breast feed.
Testosterone Use During Pregnancy • Use of testosterone during pregnancy can cause masculinization of the fetus, particularly if taken during first trimester
Estrogens During Pregnancy • Use of estrogens during the first trimester of pregnancy may increase the risk of fetal malformations, including: • Cleft palate • Heart defect • Dislocated hips • Absent tibiae • Polydactylia
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.
Progestins: Uses • Block follicular maturation and ovulation • Used to treat amenorrhea, functional uterine bleeding, endometriosis, and premenstrual syndrome
Progestins: Adverse Effects • Common: vaginal candidiasis, chloasma, cervical erosion, breakthrough bleeding, dysmenorrhea, amenorrhea, breast tenderness, edema, acne, pruritus, mental depression • Serious: thromboembolic disorder, pulmonary embolism
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, history of psychotic depression or salpingitis, or abnormal Pap smear.
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.
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
Estrogen–Progestin Combinations in Postmenopause • The risks of using such combination drugs include: • Cardiovascular disease • Breast cancer • Thromboembolism
Contraceptive Hormones: Uses • Provide negative feedback to hypothalamus • This inhibits gonadotropin-releasing hormone • The pituitary therefore ceases secretion of FSH, which would normally stimulate ovulation
Oral Contraceptives: Adverse Effects • Common: nausea, abdominal pain, gallbladder disease, hepatic adenomas, breast tenderness or pain, weight gain, dysmenorrhea, amenorrhea, menorrhagia, metrorrhagia • Serious: thromboembolism, stroke, myocardial infarction
Oral Contraceptives: Contraindications • Pregnancy and lactation • Genital bleeding of unknown cause • Thrombophlebitis • Coronary artery disease • Liver dysfunction • Endometrial or breast cancer • Severe hypertension • Diabetes with vascular involvement
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.
Oral Contraceptives and Surgery • Oral contraceptives should be discontinued 4 weeks before surgery because of the risk of postoperative thromboembolism.
Smoking and Oral Contraceptives • Smoking while taking oral contraceptives can cause serious adverse effects to the cardiovascular system.
Table 26-7 (continued) Effects of Drugs on Labor and Delivery
Oxytocics: Uses • Directly act on uterine muscle to produce phasic contractions • Used to initiate or improve uterine contractions during delivery (only after cervix is dilated); also used to stimulate milk letdown following delivery
Oxytocics: Adverse Effects • Common: nausea, vomiting, dizziness, headache • Serious: maternal cardiac arrhythmias, hypertensive episodes, intracranial hemorrhage
Oxytocics: Contraindications • Must not be used to induce labor prior to delivery of the placenta • Contraindicated in unfavorable fetal position or presentation, cephalopelvic disproportion, obstetric emergencies, fetal distress • May interact with vasoconstrictor drugs to cause severe hypertension
Oxytocics: Patient Information • Instruct patients to report: • Cold or numb fingers or toes • Severe cramping • Chest pain • Sudden or severe headache
Uterine Relaxants: Uses • They are beta2-adrenergic agonists. • Used in management of preterm labor.
Uterine Relaxants: Adverse Effects • Common: headache, nausea, vomiting, nervousness, restlessness, sweating, emotional upset • Serious: chest pain, arrhythmias, pulmonary edema
Uterine Relaxants: Contraindications • Uterine relaxants are contraindicated in patients with: • Antepartum hemorrhage • Eclampsia • Uncontrolled diabetes • Bronchial asthma • Pulmonary hypertension • Cardiac disease