medication therapy for women's health and infertility Flashcards
Required for: •Development and maintenance of female reproductive system Indications: •Premature ovarian failure •Atrophic vaginitis •Hypogonadism •Oral contraception •Dysmenorrhea •Hot flashes of menopause •Osteoporosis treatment •Dysfunctional uterine bleeding
Premarin, estrace, Estraderm
estrogens
Adverse Effects: •Thrombolytic events –most serious •Nausea & Vomiting •Hypertension, Edema, Thrombophlebitis •Constipation, Abdominal Pain •May cause photosensitivity, choloasma •Breast tenderness •Headaches •Fluid retention •Breast, Endometrial and Ovarian Cancer
Premarin, estrace, Estraderm
estrogens 2
Contraindications:
•Any estrogen dependent cancer
•Undiagnosed abnormal vaginal bleeding
•Active thromboembolic disorder or history
Premarin, estrace, Estraderm
estrogens 3
Patient Teaching:
•Do not take if pregnant
• Grapefruit and grapefruit juice may interact with
estradiol and lead to unwanted side effects
•Notify HCP if signs of heart disease, blot clots,
abnormal vaginal bleeding or other s/s of cancer
especially breast, endometrial or ovarian.
Premarin, estrace, Estraderm
estrogens 4
mportant for the regulation of ovulation and menstruation.
• Indications:
• Functional uterine bleeding
• Primary and secondary amenorrhea
• Leiomyoma (fibroids)
• Palliative treatment of some cancers and endometriosis
• Used with estrogen replacement after menopause
• Used for weight gain for patients with cancer or AIDS
Depot-Medroxyprogesterone (Depo-Provera) and
Megace
Progesterone
Benefits:
• No effect on lactation
• No increased risk of venous thromboembolism
• Mild anticonvulsant – consider as contraception in seizure disorder
Depot-Medroxyprogesterone (Depo-Provera) and
Megace
Progesterone 2
Adverse Effects: • Blood clots • Edema • Liver Dysfunction • Nausea and Vomiting • Weight Gain or Loss • Amenorrhea • Increase Breast Cancer
Depot-Medroxyprogesterone (Depo-Provera) and
Megace
Progesterone 3
Patient Teaching:
• Do not take if pregnant or peanut allergy
• May develop break through bleeding
• Do not take if there is a history of heart disease or bleeding disorders
Depot-Medroxyprogesterone (Depo-Provera) and
Megace
Progesterone 4
Actions: • Prevents ovulation by inhibiting release of gonadotropins • Increase uterine mucous viscosity Metabolism: Renally Indications: • Treatment of acne • Relieve the symptoms of premenstrual dysphoric disorder • Treatment of abnormal uterine bleeding • Family planning
Contraceptives
Forms of Medications:
• Oral –most estrogen-progestin combinations
• Injection: Medroxyprogesterone acetate (Depro-Provera)
• Transdermal Patch
• Vaginal Ring (NuvaRing)
• Progestin IUD (Mirena, Skyla)
contraceptives 2
Adverse effects: • Hypertension • Thromboembolism • Alterations in lipid and carb metabolism • Increases in serum hormone concentrations • Edema • Headache • Weight gain • Breast changes • Nausea and vomiting
contraceptives 3
Patient teaching:
• Take medications at same time daily
• Do not skip a dose
• Follow instructions if missed dose
• Avoid smoking
• Notify HCP if any s/s of adverse effects appear
• Antibiotics can cause decrease in effectiveness
contraceptives 4
Stimulates Ovulation Adverse Effects • Common • Decreased cervical mucus • Hot flashes • Less common • Pelvic Pain • Nausea • Mastalgia • May exacerbate premenstrual symptoms
Clominphene citrate (clomid) infertility medications
Complications: • Multiple pregnancy (twins most common) • Mild ovarian hyper-stimulation • Venous Thromboembolism • Increased ovarian cancer risk Patient Teaching: • Important to report visual changes, ascites abdominal pain, weight gain, shortness of breath • Common side effects include: • Flushing, GI distress, mastalgia, headache, abnormal vaginal bleeding
Clominphene citrate (clomid) infertility medications 2
Indicated for luteal phase deficiency (LPD)
• Fertilization takes place and fertilized egg is released but does not implant into the
lining of the uterus.
• Ovarian follicle that released the egg does not turn into a corpus luteum.
Progesterone oral or injections
Treatment: IVF patients prescribed progesterone (oral or injection) during the
second half of the menstrual cycle up to first/second trimester
• No scientific studies have found definitive evidence that progesterone
supplements prevent miscarriage in women who are not using artificial
reproduction methods
Progesterone oral or injections 2
GnRH antagonists (Leuprolide & Gonadorelin)
• Binds to gonadotropin-releasing hormone
receptors and decrease the effect of gonadotropinreleasing
hormone.
Indications:
• uterine fibroids
• endometriosis
GnRH antagonists (Leuprolide & Gonadorelin) Gonadotropin-Releasing Hormone Antagonists
Adverse Effects: • Hot flashes • Headaches • N&V • Constipation • Emotional lability • Vaginititis & Decreased libido • Severe Reactions: cardiac complications including heart failure and arrhythmias Patient Teaching: • Do not use if pregnant or lactating • Monitor for dehydration closely due to N&V
GnRH antagonists (Leuprolide & Gonadorelin) Gonadotropin-Releasing Hormone Antagonists 2
Initially causes synthesis and release of luteinizing hormone (LH) and
follicle-stimulating hormone (FSH). With continued use (more than 4
wk) suppresses secretion of LH and FSH
Indications:
• Endometriosis symptoms such as pelvic pain, menstrual cramps and
dyspareunia
• Central precocious puberty in male and females
Nafarelin acetate (synarel) Gonadotropin-Releasing Hormone Antagonists
Adverse Effects:
• Headaches; insomnia; depression.
• Acne; seborrhea.
• Nasal irritation.
• Vaginal dryness.
• Hot flushes; decreased libido; emotional lability; myalgia; reduced breast
size; edema; weight gain; hirsutism; decreased bone density
Patient Teaching: Do not use if pregnant or lactating
Nafarelin acetate (synarel) Gonadotropin-Releasing Hormone Antagonists 2
Indications:
• Anaerobic bacterial infection (BV, C-diff, bacteroides fragilis)
• Protozoal infections (Trichomoniasis, amebiasis & giardiasis)
• An antibiotic. Covalently binds to DNA resulting in disruption of its helical
structure, inhibiting bacterial nucleic acid synthesis and resulting in bacterial
cell death
• Metabolism: Hepatic
Metronidazole (Flagyl) (first line medication)
Bacterial vaginosis
Adverse Effects:
• Antabuse like effects (Never use with alcohol)
• GI intolerance
• Neurotoxicity (stop immediately with s/s of seizures, encephalopathy,
cerebellar dysfunction or peripheral neuropathy)
Patient Teaching: Do not use in first trimester
Metronidazole (Flagyl) (first line medication)
Bacterial vaginosis 2
Indications:
• Anaerobic bacterial infection (BV, C-diff, bacteroides fragilis)
• topically to treat acne
• intra-abdominal or pelvic infections, osteomyelitis, diabetic foot ulcers,
aspiration pneumonia and dental infections
An antibiotic. Inhibits bacterial protein synthesis by binding to bacterial
ribosomal subunits
• Metabolism: Hepatic
Clindamycin (Cleocin HCl)
Bacterial vaginosis
Adverse Effects:
• Pseudomembranous colitis (severe diarrhea)
• GI distress
Patient Teaching: Take entire dose to prevent development of antibiotic
resistance.
Clindamycin (Cleocin HCl)
Bacterial vaginosis 2
Indications:
-Treats vaginal yeast infections
-relieves external itching and irritation
• Anti-fungal medication.
• Prevents fungal organisms from producing vital substances required for growth
and function
Miconazole (Gyn-Lotrimin, Mycelex G, Monistat)
yeast - candida albicans
Adverse Effects: • Headache • Vaginal/urethral burning/itching/pain may occur Patient Teaching: • Vaginal use only
Miconazole (Gyn-Lotrimin, Mycelex G, Monistat)
yeast - candida albicans 2
an antioxidant
• Plays a role in the immune system and metabolic
processes
• Fat soluble
• GYN indication: Fibrocystic breast
• Patient teaching: good sources of vitamin E include vegetable oils,
margarine, nuts and seeds, leafy greens. Also added to certain foods
like cereal.
• May be harmful if taking blood thinners
Vitamin E
Aids the body with utilization of energy from foods
•Water soluble
• GYN indication: Premenstrual Dysphoric Disorder
• Patient teaching: good sources of vitamin B6 include fish, poultry,
meat, eggs and dairy products. Leafy green vegetable, beans and
peas. Many cereals and breads have added B vitamins
Vitamin B6 (pyridoxine)
Key role in bone health, maintains heart rhythm and
muscle function
• GYN indication: Premenstrual Dysphoric Disorder
• Patient teaching:
• Constipation and GI upset is common side effect
• Foods rich calcium include dairy products, dark-green
leafy vegetables and calcium-fortified foods (e.g., orange
juice)
• Vitamin D helps with absorption of calcium
calcium
Immunostimulant for preventing and treating infection
• Adverse Effects: Opportunistic infections, Impaired Wound Healing &
Hepatotoxicity with prolonged use
• No Evidence Based Research (EBR) it improves cold symptoms
Echinacea
moderate lipid lowering & antihypertensive effect,
improves milk production with breastfeeding
Adverse Effects:
-Halitosis & altered body odor, GI upset & Flatulence
Garlic
psychological benefit & improved immune function
• Adverse Effects: Hypoglycemia, HTN, GI distress, Insomnia &
Headaches
Ginseng
a remedy for skin conditions including burns, sunburn, frostbite,
psoriasis, and cold sores, used on areola and nipples after
breastfeeding
• Adverse Effects: aloe gel contains latex
• Wash off prior to breastfeeding to minimize diarrhea in infant
aloe
improves insomnia
• Adverse Effects: Sleepiness on awakening, Headache, GI distress,
Withdrawal symptoms when stopped (similar to benzodiazepine
withdrawal)
valerian
- Avoid Vitamin A in excess of 3000 IU per day
* Avoid Vitamin D in excess of 400 IU per day
vitamins
- Devil’s claw root - decrease inflammation , swelling & resulting pain.
- Barberry – improves heart rate and decrease inflammation
- Dong Quai - menstrual cramps, PMS and menopausal symptoms
- High concentrations of Oregano - helps reduce cough and spasms
herbals associated with miscarriage
Ginkgo - improves blood circulation
• Ephedra – stimulates the heart but is banned in the USA
• Ginseng - used for stress, to boost the immune system & stimulant.
• Goldenseal- treatment of urinary tract infections, upset stomach irregular,
menstrual periods, chronic fatigue syndrome
Other herbal teratogens
