Drugs affecting reproductive system .ppt

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UNIT 28
Medications That Affect
the Reproductive System

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Key Terms
•Amenorrhea
•Cryptorchidism
•Hirsutism
•Hypogonadism
•Menopause
•Osteoporosis

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Female Hormones
•Onset of puberty: ages 9–16
•FSH and LH released from pituitary
stimulates ovarian activity
•Ovaries produce
–Estrogen and progesterone
–Ova

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Phases of Menstrual Cycle
•Proliferation
•Luteal
•Premenstrual
•Menstruation

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Estrogen: Uses
•Amenorrhea
•DUB
•Hirsutism
•Menopause
•Atrophic vaginitis
•Osteoporosis
•Palliation for breast cancer

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Estrogen: Contraindications
•Pregnancy
•Breast cancer
•Undiagnosed genital bleeding
•Blood clots
•Estrogen-dependent neoplasia
Discussion Question:
How can estrogen be used for palliation in breast
cancer if breast cancer is listed as a
contraindication?

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Estrogen: Adverse Reactions
•Breakthrough bleeding
•Breast tenderness
•Alopecia
•Headache
•Weight gain
(continues)

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Estrogen Adverse Reactions
Warning!
Estrogen use may increase risk of
•Breast cancer
•Gallbladder disease
•Hypertension
•MI in men
•Hypercalcemia (patients with breast cancer and bone metastasis)

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Estrogen: Patient Teaching
•Record weight daily
•Report weight gain of 5 lb or more
•Watch for signs of thrombosis or bleeding
•Perform BSE

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Progesterone
•Produced by ovaries and adrenal cortex
•Prepares uterus for pregnancy
•Suppresses ovulation during pregnancy
•Stimulates milk secretion
(continues)

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Progesterone: Uses

Secondary amenorrhea

DUB

Infertility

Threatened or habitual miscarriage

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Progesterone: Contraindications
•Blood clots
•Cerebral apoplexy
•Liver disease
•Any reproductive cancer
•Missed abortion
•Undiagnosed genital bleeding

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Progesterone:
Adverse Reactions

Breast tenderness

Galactorrhea

Breakthrough bleeding

Weight gain

Depression

Insomnia

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Progesterone:
Patient Teaching
•Record weight daily
•Report weight gain of 5 lb or more
•Watch for signs of thrombosis or bleeding
•Perform BSE
(continues)

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Progesterone:
Patient Teaching
Warning!
Progesterone may cause
•Fluid retention
•Depression
•Increased glucose intolerance
Progesterone should be discontinued if mental depression become severe.

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Menopause
•Decrease in female hormones
•Cessation of menstrual activity
•May be surgically induced
•May be relieved with HRT
•Alternative treatment available
(continues)

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Menopause
•Symptoms
–Hot flashes
–Vaginal dryness
–Insomnia
–Headaches
–Mood swings
–Depression
–Osteoporosis

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Hormone Replacement Therapy:
Benefits
•Most effective treatment for menopausal
symptoms
•Short-term use of hormone therapy for relief
of menopausal symptoms protects against
the following conditions
–Osteoporosis
–Colorectal cancer
–Heart disease

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Hormone Replacement Therapy:
Risks
•Increased risk for blood clots
•Small increase in breast cancer risk
•Greater risk of endometrial cancer
•Increased risk of heart disease in some
women
(continues)

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Hormone Replacement Therapy:
Risks
•DVT and PT are more common in women
taking oral estrogen
•Increased risk for stroke
•Increased risk of developing gallstones

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Alternative Treatments for
Menopause
•Natural biodentical hormones
•Exercise and diet
•Vaginal moisturizers
•Herbal treatments
(continues)

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Alternative Treatments for
Menopause
•Dietary supplements
•Weight reduction
•Smoking cessation

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Methods of Birth Control
•Hormonal
–OCPs
–DEPO-PROVERA
–NuvaRing
–Ortho Evra
–IUD
(continues)

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Methods of Birth Control
•Nonhormonal
–Condoms
–Sterilization
–Spermicides
–IUD
–Diaphragm
–Natural planning

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NuvaRing
•Inserted vaginally
•Left in place for 3 weeks
•98–99% effective
•Side effects and contraindications are same
as with OCPs

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Ortho Evra
•Birth control patch
•Replaced weekly
•99% effective
•Same adverse effects and contraindications
as OCPs

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DEPO-PROVERA
•Given every 3 months
•May take some time for effects to wear off
after discontinued
•99% effective

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Oral Contraceptives
•Monophasic
•Biphasic
•Triphasic
•Progesterone only
(minipill)

Nearly 100% effective

Most contain mixture of
estrogen and progestins

21 active pills per cycle
for most OCPs

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Oral Contraceptives:
Contraindications
•Blood clots
•Angina pectoris
•Reproductive cancer
•Undiagnosed genital bleeding
•CVA or MI
•Pregnancy
(continues)

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Oral Contraceptives:
Contraindications
Warning!
Cigarette smoking increases risk of serious adverse effects from OCP use.
Women older than 35 who smoke more than 15 cigarettes per day should
find alternative contraception.

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Testosterone
•Onset of puberty: ages 13–15
•Gradual decline in production after age 40
•Maintains male sex characteristics, libido,
sexual potency, and sperm production
•Rapidly inactivated by liver

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Testosterone: Uses
•Hypogonadism
•Stimulate puberty
•Impotence
•Select breast cancer patients
(continues)

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Testosterone: Uses
Did you know?
Testosterone is frequently abused by
individuals who wish to increase
muscle mass and athletic skill.
Be aware of signs of abuse.

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Testosterone: Contraindications
•Pregnancy or lactation
•Male breast or prostate cancer
•Pituitary insufficiency
•History of MI
•Hypercalcemia
(continues)

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Testosterone: Contraindications

BPH

Impaired liver or kidney function

Infants

Young children

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Testosterone: Adverse Reactions,
Male
•Gynecomastia
•Oligospermia
•Excess penile erection
•Fluid and electrolyte imbalance
•Suppression of clotting factors

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Testosterone: Adverse Reactions,
Male

Altered liver function

Peliosis hepatitis

Headache

Baldness

Libido changes

Increased cholesterol

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Testosterone: Adverse Reactions,
Female
•Amenorrhea
•Menstrual irregularities
•Inhibition of gonadotropin secretion
•Virilization

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Testosterone:
Patient Teaching
•Record weight daily
•Report weight gain of 5 lb or more
•Monitor BP
•Watch for signs of bleeding
(continues)

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Testosterone:
Patient Teaching
Discussion Question:
Testosterone transdermal systems are listed as
schedule III controlled substances. Why do you
think this is, when other forms are not?

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Erectile Dysfunction
•Affects up to 20 million U.S. men
•80% have a physical cause:
–Vascular disease– Neurologic diseases
–Diabetes – Surgery
–Prescription drugs– Spinal injury
–Substance abuse– Hormonal imbalance,
reduced testosterone
(continues)

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Erectile Dysfunction
•May be treated with
–Viagra
–Cialis
–Levitra
Warning!
Medications for erectile dysfunction (ED) are not recommended for use in
men with preexisting cardiovascular disease, due to increased cardiac risk.

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Labor and Delivery Drugs
•Uterine relaxants
–Delay preterm labor
•Uterine stimulants (oxytocic agents)
–Induce labor
–Induce abortion
–Control bleeding

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Sexuality and the Older Adult
•Sexual interest remains into 70s and beyond
•At all ages, more men than women say sex is
important
•Nine in ten say that companionship is most
important in a relationship
•Medications and health problems cause
decline in sexual activity

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Sexuality and Children
•STDs seen beginning as early as age 10
•STDs may be contracted with first
intercourse
•Most are treatable
•Risk of teen pregnancy
(continues)

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Sexuality and Children
Discussion Questions:
What are the consequences of untreated STDs?
What are some ways to prevent STDs and teen
pregnancy?