Reproductive Flashcards
DES babies
birth defects
estrogen - reasons to take
Atrophic vaginitis- thinning, drying & inflammation of
vaginal walls
Hypogonadism
🞑 Oral contraception (given with a progestin)
🞑 Dysmenorrhea
🞑 “Hot flashes” of menopause (vasomotor symptoms) 🞑
🞑 Breast & Prostate Cancer
🞑 Osteoporosis
estrogen contraindications
Any estrogen-dependent cancer
Undiagnosed abnormal vaginal bleeding
Pregnancy - can cause a miscarriage
Active thromboembolic
disorder or history of stroke,
venous blood clot
Thrombolytic events—most serious
estrogen adverse
Amenorrhea, breakthrough uterine bleeding
Tender breasts, fluid retention, headaches (increased fluid)
Premarin (Enjuvia®, Premarin®)
replace estrogen deficit
leg cramps
DVTs usually start in the back of the leg so ask about back of leg when sitting for long periods. will hurt when they cross their legs.
Progestins - produced by…
Produced by corpus luteum, then pregnant placenta
Synthetic derivatives of progesterone
Progestins: Indications
Treatment of functional uterine bleeding caused by: after birth
🞑 Hormonal imbalance, fibroids, or uterine cancer
Treatment of primary and secondary amenorrhea,
palliative cancer & endometriosis
Prevent conception
Progestins: Indications - palliative treatment
of some cancers and
endometriosis
Prevention of threatened miscarriage relaxing uterine smooth muscles
Alleviation of PMS symptoms
Progestogens : Indications - Megestrol (Megace) **
synthetic progestin
🞑 Adjunct therapy for treatment of breast and
endometrial cancers
****Management of anorexia, cachexia, or unexplained
weight loss in AIDSpatients
🞑 To stimulate appetite and promote weight gain in
cancer patients
🞑 Female infertility
Progestins: Adverse Effects
Liver dysfunction- cholestatic jaundice- (flow of bile from
liver slows/stops)
Thrombophlebitis, thromboembolic disorders,
such as PE
Nausea, vomiting
Amenorrhea, breakthrough uterine bleeding,
“spotting”
Edema, weight gain or loss & depression
Medroxy-progesterone***
Action: has effects similar to those of progesterone;
inhibits secretion of Pituitary Gonadotropins thus prevents
ovulation
Class: synthetic progestogens
Use: treat absent or irregular menstrual periods,
abnormal uterine bleeding. Also used to decrease
the risk of endometrial hyperplasia & renal cancer
How supplied: tablets, injections\
Dont give to anyone under 25 - leaches calcium out of bones
*****Depo-Provera = 1 shot coverage for 3 months, caution for
under 25 years of age due to bone density issues.
Medroxyprogesterone (Provera®) - Precautions: Nursing Considerations:
🞑 May causemelasma.Not for usein pregnancy
🞑 Teachwomento do BSE (breast self exam)
🞑 Teachwomen:take Provera by mouthwith or without food.
Takeat the sametime every day, with doses not more than
24 hours a part.
🞑 Teachwomen: If a dose ismissed,take it assoon as
possible. If it is almost time for the next dose, skip the
missed dose and go back to the regular dosing schedule.
Do not take 2 dosesat once
🞑 If miss 2 active pill in 3 weeks or miss 3 or more in a
row. Instruct pt to throw out rest of pack and Start a new
pack that day.
Contraceptive Drugs - contraindications
Oral medications
🞑 Monophasic, biphasic, and triphasic forms
Triphasic form most closely duplicates the normal hormonal
levels of the female cycle*
Depo- Provera- 3 month in 1 shot
🞑 Newer extended cycle products
🞑 Most contain estrogen-progestin combinations
plan B
Levon-orgestrel = Plan B, w/in 72 hrs of unprotected sex &
f/up dose 12 hrs after first dose. ($40-50.00)
Seasonale
( extended cycle), both estrogen & progestin,
women will only have 1 menstrual cycle every 3 months
Contraceptive Drugs:
Adverse Effects
Drawbacks to the use of these drugs include:
🞑 Hypertension
🞑 Thromboembolism, possible PE, MI, stroke
🞑 Alterations in lipid and carbohydrate metabolism
🞑 Increases in serum hormone concentrations
These effects are caused by the estrogen
component
contraceptive adverse
May alsocause:
🞑 Edema,dizziness, headache, Depression,
nausea, vomiting,diarrhea, increased
appetite, increased weight, breast &
changes, many others
contraceptive interactions***
penicillin and Cephalosporins
Contraceptive
Drugs: Interactions - Drugs that may have reduced
effectiveness
Anticonvulsants, beta-blockers, hypoglycemic drugs,
oral anticoagulants, theophylline, hypnotics,
tricyclic antidepressants
fertility drugs - Clomiphene (Clomid®, others)
Nonsteroidal ovulation stimulant
🞑 Blocks estrogen receptors in the uterus and brain,
resulting in a false signal of low estrogen levels - this will produce twins sometimes bc more than one egg
fertility - mentropins (Pergonal®)
Standardized mixture of FSH and LH
🞑 Stimulates development of ovarian follicles,
leading to ovulation
🞑 May also be given to
men t to stimulate
spermatogenesis
🞑 From urine of post
menopausal women
Chorionic gonadotropin alfa (Ovidrel®)
Recombinant form of human chorionic gonadotropin
🞑 Causesrupture and ovulation of mature ovarian
follicles, and maintenance of corpus luteum
Fertility Drugs: Indications
Used primarily to induce ovulation in anovulatory
patients
Fertility Drugs: Adverse Effects
Tachycardia, phlebitis, DVT, multiple pregnancies**pregnancies,
blurred vision (can indicate a clot - serious-stroke), breast pain, others
Uterine- Active Medications
Promote labor (stimulants) ie oxytocin or Prevent the start or progression of labor (relaxants)
Uterine Stimulants - also called
oxytocics -oxytocin hormone secreted from
Posterior lobe of Pituitary gland
1. Oxytocin (hormonal drug)
2. Prostaglandins
3. Ergot derivatives
4. Progesterone antagonist *
Oxytocin (Pitocin®) - synthetic form
🞑 Used to induce labor at or near full-term gestation,
and to enhance labor when contractions are weak and
ineffectivef
oxytocin other uses
🞑 Prevent or control postpartum uterine bleeding
🞑 Complete an incomplete abortion (after miscarriage)
🞑 Promote milk ejection during lactation
Prostaglandins - uterine stimulants
Natural hormones
🞑 Causepotent contraction of myometrium, smoothmuscle
fibers of the uterus
🞑 Used to induce labor by softening the cervix and
enhancing uterine muscle tone
🞑 dinoprostone (Prostin E2,Cervidil®, Prepidil ) and
misoprostol (Cytotec®)( termination of pregnancy
12 wk-20wk)
Ergot alkaloids (alk = toxic)
Increase force and frequency of uterine contractions
🞑 Used after delivery of the infant and placenta to
prevent postpartum uterine atony and hemorrhage
🞑 methylergonovine (Methergine®)
Progesterone antagonist*- Politically charged
“ Abortion Pill”
mi-fe-pristone (Mifeprex®)
🞑 Stimulates uterine contractions to induce abortion
🞑 Given with a prostaglandin drug for elective abortions
Uterine Stimulants: Adverse Effects
Hypotension or hypertension, chest pain
Headache, dizziness, fainting
Nausea, vomiting, diarrhea
Vaginal pain, cramping
Leg cramps, joint swelling, chills, fever,
weakness, blurred vision
Uterine Relaxants: Tocolytics
Stop Labor “To-cease-labor”
Used to stop labor that begins before term to prevent
premature birth
Generally used after 20th week of gestation(5 mon)
: Tocolytics - INMT (it’s not my time)
= Indomethacin-anti/inflammatory
N= Nifedipine-CCB
M= Mag Sulfate-relax smooth uterine muscle
T= Terbutaline –BB, dec uterine contractions
oxy - increase t - it’s not my time
Uterine Relaxants: Tocolytics
Uterine contractions that occur between the 20th
and 37th weeks of gestation are considered
premature labor
Nonpharmacologic measures
🞑 Bed rest (be on left side - to keep flow of blood going), sedation, hydration
Magnesium sulfate IV***(don’t need to know anything else on this slide)
Magnesium sulfate IV also used to stop labor**must have Ca-Glucanate to tx Mag toxic
Uterine Relaxants: Adverse Effects
Palpitations, tachycardia, Hypertension, others
Tremors, anxiety, insomnia, headache, dizziness,
others
Nausea, vomiting, anorexia, bloating, diarrhea,
constipation
Hyperglycemia, hypokalemia
Dyspnea, hyperventilation
Uterine Relaxants: nursing implications
Assess baseline vital signs, weight, blood
glucose levels, renal and liver function studies
Assess whether the patient smokes
Assess history and medication history
Assess contraindications, including potential
pregnancy
relaxants cont*****
Before giving any uterine stimulants, assess the
mother’s vital signs and fetal heart rate, Q 15 min
Uterine relaxants are used when premature labor
occurs between the *****20th and 37th weeks of
gestation
Estrogens and progestins - nursing implications
Give IM doses deep in large muscle masses, & rotate sites - very viscous so do it deep - won’t leak
infertility - Advise patients to
Advise patients to keep a journal while on
fertility drugs
A woman has not taken her oral contraceptive since
Monday morning. It is now Thursday morning. What
should she do now to prevent pregnancy?
Start over witha newmonthlypack of oral
contraceptives. use a second form of contraceptions
Testosterone
Responsible for normal development and maintenance of
primary and secondary male sex characteristics
🞑 Development of bone and muscle tissue
🞑 Inhibition of protein catabolism (metabolic breakdown)
🞑 Retention of various electrolytes - Nitrogen, phosphorus Na & K
adrogen
Several synthetic derivatives of testosterone
Long-term dosage forms can last from 2 to 3 days to
2 to 4 weeks
Oral forms have a high first-pass effect - usually not given orally
Transdermal forms available
🞑 Patches and gel
testosterone precautions
Precautions: not for use in prostate cancer, male
breast cancer, heart, liver and kidney disease
testosterone teaching considerations
keep clean oil buildup can cause acne. May experience mild fluid retention.
🞑 Possible stimulation of prostate tissue growth (hypertrophy), with
perhaps some increased urination symptoms such as a
decreased stream or frequency.
🞑 Pt is at risk for increased risk of developing
prostate cancer
Anabolic steroid
Schedule III. may give to men who aren’t growing
Androgens: Mechanism of Action
Stimulation of normal growth and development of the
male sex organs
🞑 Development and maintenance of male secondary sex
characteristics
🞑 Stimulate increased synthesis of body proteins, aiding
in the formation of muscular and skeletal proteins
Androgen Inhibitors
5-Alpha-reductase inhibitors
Alpha1-adrenergic blockers
Androgen receptor blockers
Gonadotropin-releasing hormone (Gn-RH)
Analogs
Finasteride (Proscar, Propecia®) and Dutasteride (Avodart®)**
unsafe. Inhibits enzyme converting testosterone to DHT more potent
form of testosterone stimulates prostate growth.
Alpha1
-Adrenergic Blockers**
1mg= Alopecia
- 5mg= BPH
Drugs to Treat Erectile Dysfunction
sildenafil - board will usually use this name, not viagra. (Viagra®)
🞑 First oral drug for tx of ED
Longer Duration
vardenafil (Levitra®)
tadalafil (Cialis®)
Drugs to Treat Erectile Dysfunction
Prolonged erection >4 hrs= medical emergency - priatism - NO NITRATES - causes severe hypotension and we can’t get it back up and then have heart attack.
Men’s Health Drugs: Adverse Effects
5-alpha-reductase inhibitors
Finasteride
🞑 Loss of libido, loss of erection,
ejaculatory dysfunction, other effects
🞑 May cause PSA concentrations to decrease
🞑 PSA- Serum “Prostate Specific Antigen” Inc S/sx
of prostate CA
🞑 Normal 2.5 – 3 ng/mL (just know these value)
general list of
what nitrates look like - patch, pill, etc.
Nursing Implications - Men’sHealth Drugs: -
get baseline psa and digital rectal exam - it’s hasn’t been evidenced based yet. GI upset
🞑 Headache
🞑 Back pain
🞑 Dysuria
weight, renal functions,
do IM deep it hurts when it leaks out
Transdermal Androderm® patches / gel are
applied to the skin on the body, never to scrotal
skin
Transdermal Androderm® patches / gel are
applied to the skin on the body, never to scrotal
skin
Pregnant women should not handle crushed or
broken finasteride tablets,
can cause
teratogenesis
Finasteride can be used to treat baldness in both
men and women.
false
