Genitourinary and Reproductive Flashcards
Why is progesterone included with estrogen for treating menopause?
It protects from increased risk of endometrial cancer
(estrogen only is fine if prior hysterectomy)
Estrogen hormone replacement therapy
Prototype
conjugated equine estrogen (Premarin)
transdermal Estradiol (FemPatch, Estraderm, Climara)
estradiol cream (Estrace)
estradiol intravaginal tabs (Vagifem)
Estrogen hormone replacement therapy
MOA
Binds to estrogen receptors in breasts, genitals, hypothalamus and pituitary gland
Provides small, stable amount of estrogen to prevent menopause symptoms
Estrogen hormone replacement therapy
Adverse Effects
Nausea
HTN (increased angiotensin and aldosterone)
Water retention
Endometrial hyperplasia (increased risk of endometrial and ovarian cancers)
Thromboembolic events
Estrogen hormone replacement therapy
Teaching
- Quit smoking
- Monitor for pain, redness, and swelling in leg, dypsnea, chest pain
- Stop 4 weeks before surgery due to thromboembolic event risk
- Monitor vaginal bleeding (may indicate cancer)
- Nausea goes away with time
Estrogen hormone replacement therapy
Admin
Continuous use and at same time daily to avoid bleeding
Cream or intravag tabs at bedtime
Estrogen hormone replacement therapy
Contraindications
- hx of thromboembolic events
- Breast, ovarian, endometrial, or vaginal cancer
- Undiagnosed vag bleeding
- Liver disease
Estrogen hormone replacement therapy
Common interactions
Decreased effect with St. John’s Wort, anticonvulsants, some antibiotics
Reduces effectiveness of warfarin and diabetes meds
Increase levels of diazepam, chlordiazepoxide, TCAs, and theophylline
Estrogen and progesterone hormone replacement therapy
Indication
Severe menopause symptoms: hot flashes and vaginal atrophy
Prevents menopausal osteoporosis
Estrogen and progesterone hormone replacement therapy
Prototype
conjugated estrogen and medroxyprogestrone acetate (Prempro)
transdermal estradiol and norethindrone (CombiPatch)
Estrogen and progesterone hormone replacement therapy
MOA
Estrogen binds to target tissues to prevent menopause symptoms.
Progesterone antagonizes tissue growth in endometrium caused by estrogen
Estrogen and progesterone hormone replacement therapy
Adverse effects
Even greater risk of thromboembolic event
Increased risk for vaginal bleeding, weight gain, breast cancer
GrH agonist
Prototype
Leuprolide (Lupron)
Nafarelin (Synarel)
GrH agonist
classification
Gonadotropin releasing hormone antineoplastic
GrH agonists
MOA
Stimualates secretion of FSH and LH from pituitary gland, which increases estrogen and progesterone.
After several weeks, FSH and LH drop drastically to the point of monopausal hormone levels
This allows endometrium to shrink
GrH agonists
Indication
Endometrial hyperplasia
Endometriosis
GrH agonists
Adverse effects
Hot flashes
Headache
Vaginal dryness
Bone loss
GnRH agonists
Interventions
- Therapy limited to 6 mo to prevent osteoporosis
- Bone density scanning if must last longer
GnRH agonists
Admin
Intramuscular injection
GnRH agonists
Instructions
- Perform weight bearing exercises daily and take calcium and vit D
- Lube for vaginal dryness
GnRH agonists
Contraindications
Pregnancy
Abnormal vag bleeding
Metastatic brain cancer
Allergy to benzoyl alcohol
Progesterone
Prototype
medroxyprogesterone acetate (Provera)
norethindrone (Micronor)
Progesterone
Indication
Endometriosis
Abnormal bleeding
Palliative tx for advanced uterine cancer
Progesterone
MOA
Antagonizes estrogen from causing endometrial growth
LH and FSH stimulants
Prototype
clomiphene (Clomid)
LH and FSH stimulants
Class
Ovulatory stimulants
LH and FSH stimulants
MOA
Inhibits estrogen receptors on pituitary and increases GnRH release from the hypothalamus
GnRH stimulates LH and FSH release, causing more follicle maturation and ovulation
LH and FSH stimulants
Adverse effects
Vasomotor effect (hot flashes)
Breast engorgement
GI upset
Visual disturbance
Ovarian enlargement
Multiple gestation
LH and FSH stimulants
Instructions
- cold compresses for hot flashes
- report pelvic pain
- report vision changes
LH and FSH stimulants
Admin
PO once daily for 5 days after start of menses
Take at same time every day
LH and FSH stimulants
Contraindications
Pregnancy (teratogenic)
Primary ovarian failure
Uterine bleeding
Liver disease
Uncontrolled thyroid disease
Thrombophlebitis
Ovulation Stimulant
Prototype
human chorionic gonadotropin (Pregnyl)
Ovulation Stimulant
Indication
Infertility
Ovulation Stimulant
MOA
Causes ovulation by stimulating secretion of LH
Ovulation Stimulant
Adverse effects
Ovarian rupture from hyperstimulation
CNS symptoms: irritable, headache, fatigue
Ovulation Stimulant
Interventions
- Monitor for hyperstimulation: abdominal pain and swelling
- Monitor for ovarian rupture: sudden, sharp pelvic pain, nausea, vomiting, weakness
Ovulation Stimulant
Admin
- Confirm maturation of the follicle via intravaginal sonography
- Reconstitute and admin via IM
- Give 7-9 days after last dose of clomiphene if taking
Ovulation Stimulant
Contraindications
Pituitary tumor
Dysfunctional uterine bleeding
Adrenal insufficiency
Uncontrolled thyroid disease
Antihyperprolactinemia
Prototype
cabergoline
bromocriptine (Parlodel)
Antihyperprolactinemia
Indication
Infertility
Antihyperprolactinemia
MOA
Increases available dopamine, which causes the pituitary gland to secrete less prolactin
Less prolactin increases secretion of HcG, which stimulates LH and FSH to produce ovulation
Antihyperprolactinemia
Adverse effects
Pulmonary fibrosis
Pericardial fibrosis
Valvular disorders
Retroperitoneal fibrosis
Nausea, dizziness, headache
Antihyperprolactinemia
Interventions
Monitor serum prolactin levels monthly until reach a normal level
Antihyperprolactinemia
Contraindications
Uncontrolled hypertension
Oxytocin
Class
uterine stimulants
Oxytocin
prototype
oxytocin (Pitocin)
Oxytocin
MOA
Mimics natural oxytocin released by the pituitary
Causes uterine contraction and milk ejection
Oxytocin
adverse effects
Uterine hyperstimulation = uterine rupture and death
Hypertensive crisis
Water intoxication (ADH effect)
Oxytocin
Interventions
- Monitor length, strength, and frequency of contractions
- Monitor FHR
- Monitor BP
- Monitor I&Os for water intoxication
- Monitor for nausea, headache
- If contractions longer than 1 minute or are more frequent than every 2 min, or resting uterine pressure is greater than 15-20 mmHg = turn on side, stop infusion, administer oxygen, prepare uterine relaxant
Oxytocin
Admin
- IV infusion
- Increase by 1-2 mL/min every 30-60 min until contractions last up to 1 min and occur every 2-3 min.
- Cervic should be dilated 2-3 cm and effaced before admin
Oxytocin
Contraindications
- Unripe cervix
- Placental abnormalities
- Herpes
- Fetal distress
- Fetal lung immaturity
- Breech or transverse
- Umbilical cord prolapse
- Cephalopelvic disproportion
Ergot alkaloids
Prototype
methylergonovine (Methergine)
Ergot alkaloids
Indication
Prevent and treat postpartum hemorrhage
Ergot alkaloids
MOA
Stimulate smooth muscle in uterus
Ergot alkaloids
Adverse effects
rare: hypertension, stroke, nausea, cramps, arrhythmias, seizures
Ergot alkaloids
Interventions
Monitor BP, HR, and seizures
Ergot alkaloids
Admin
- Check BP prior to admin
- IM every 2 hours or orally for 2-7 days
- IV over 1 min
- Assess slowing of vaginal bleeding
Ergot alkaloids
Contraindications
Induced labor
Threatened miscarriage
Hypertension
Synthetic prostaglandins
Indication
Promotes softening, dilating, and effacement of the cervix
Synthetic prostaglandins
Prototype
dinoprostone (Cervidil)
misoprostol (Cytotec)
Synthetic prostaglandins
MOA
Activates collagenase, which breaks down collegan complex that keeps cervix firm and closed
Softens the cervix and allows contractions to start
Synthetic prostaglandins
Adverse effects
Amniotic fluid embolism
Uterine rupture
Chills
Hypotension
Nausea
Synthetic prostaglandins
Admin
- Gel in prefilled syringe administered through cervix with endocervical catheter with pt lying supine (pillow under hip) for 30 min. Start oxytocin 6-12 hours after last dose
- Pouch contained drug placed at cervix while pt lies supine for 2 hours. Pouch removed with attached tape when active labor begins
