DRUGS AFFECTING the REPRODUCTIVE SYSTEM
I.
ESTROGENS
Action and Indication
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Hormone replacement therapy
Relieves symptoms of menpause
Treatment of female hypogonadism
Adjunct therapy for osteoporosis
Used in men to decrease progression of prostate carcinoma
Nursing Considerations
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Report symptoms of menopause for dosage adjustment
Given with food to reduce nausea
IV estrogen given slowly by direct IV injection, rapid injection may cause skin flushing
Transdermal estradiol should be applied to clean dry area on the trunk including buttocks and
abdomen
Replace patch according to schedule
Cream medications should be applied deeply into the vagina
Contraindications
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Current diagnosed vaginal bleeding
History of breast cancer
Cautious use in smokers
Cautious use in women with DVT
Drug Interactions
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May need to increase dose of warfarin, oral hypoglycemic and insulin
Increased risk of hepatoxicity when taken with drugs that are hepattoxic
Barbiturates and rifampin may decrease effect of estrogen
Side Effects
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Increase skin pigmentation with sunlight exposure
Weight gain and fluid retention
Nausea for oral forms
Change in libido and increased breast tenderness
Headache, moodiness and hypertension
Increase HDL decrease LDL and cholesterol
Adverse Effect
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Increase risk of breast cancer
Increase risk of endometrial cancer if uterus is intact and no concurrent progestin use
Nursing Responsibilities
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II.
Assess BP periodically
Recommend monthly breast exam and annual mammogram
Administer dose with meals or bedtime to decrease nausea
Inform client that smoking increases risk of thrombus formation
Instruct client to report positive HOMAN’s sign – may be due to clot formation
PROGESTIN
Action and Use
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Cause endometrium to change from prolifertive tosecretory phase in the latter half of the
menstrual cycle in preparation for implantation of embryo
Decrease mid-cycle bleeding in peri and post-menopausal women with dysfunctional uterine
bleeding
For treatment of amenorrhea, breast and renal cancer
Ex: medroxyprogesterone (Provera)
Administration Considerations
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Discontinue if pregnancy is suspected
M injections must be given deeply
Oral form may contain peanut oil; not given to clients with allergy to peanuts
Contraindication
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Pregnancy
Cautious use with current or past history of depression
Food interaction
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increased caffeine levels if caffeine is ingested
Adverse Effects
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Change in menstrual flow, amenorrhea, breast changes
Edema
Cholestatic jaundice
Nursing Considerations
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III.
Plan to deal with worsening or recurring depressive symptoms
Monitoe V/S especially BP
Monitor I/O
Inform client that smoking increases risk of CVA and cardiovascular effects
MEDICATIONS for LABOR and DELIVERY
A. OXYTOCICS
Action:
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Initiate or improve uterine contraction at term
Facilitate involution or prevent post-partum hemorrhage
Stimulate letdown reflex to relieve pain from breast engorgement
Nursing Considerations
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Antepartum and intrapartum monitoring od uterine contraction pattern, FHR and BP
Postpartum monitoring of lochia and BP
Massa
Common Medications
❖ Oxytocin (Pitocin)
❖ Methylergonovine (Methergine)
B.
Ergot Alkaloids
Action
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Used to control postpartum hemorrhage
Common Medication
❖ Ergonovine (Ergotrate)
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Nursing Considerations
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Closely monitor lochia and BP after administration
Perform pad count to monitor bleeding
C. Prostaglandins
Action and Use
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To terminate pregnancy from 12th week to second trimester
Common Medications
Medication
Route
misoprostol
(Cytotec)
PO
dinoprostone
vaginal
supposit
ory, gel,
insert
carboprostrome
thamine
Side Effects
Indication
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Prevention of NSAD
induced gastric ucers
Abortifacient
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Termination of pregnancy
Cervical ripening
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Nausea
Vomiting
Abdominal pain
Flatulence
Cramping
Miscarriage
hypermenorrhea
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Uterine and
vaginal pain
Perforated
uterus
Uterine rupture
hypotension
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IM
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Pregnancy termination in
13-20 wks
Evacuation of uterus in
missed abortion or fetal
death during 2nd trimester
postpartum
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Nursing Considerations
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Prenatal: client must] remain recumbent 20-30 minut]es after administration and have fetal
monitoring during this time
Postpartum: monitor lochia and BP and be prepared for client to develop diarrhea
Ensure adequate client hydration and arrange pre-treatment for N/V
D. Uterine Relaxants (Tocolytics)
Action
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Inhibit contraction thereby arresting labor for at least 48 hours so that corticosteroids
(B-methasone) can be given to facilitate lung maturity
Nursing Considerations
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Medications started at lowest possible dose and increased as indicated until contraction cease
In case of GI symptoms occur, ask client to take medication with food
B-adrenergics contraindicated in pulmonary edema
If client continues on to deliver after receiving uterine relaxant, prepare for oxytocic treatment
for post partum hemorrhage
Monitor V/S and I/O
E. Magnesium sulfate
Action
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Acts as CNS depressant, depresses mooth, skeletal and cardiac muscle function
To arrest preterm labor and treat seizures for pre-eclampsia and eclampsia
Side effects
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Decreased deep tendon reflexesdecreased hand grasp strength
F/E imbalance
N/V
Adverse effect of toxicity
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Loss of DTR
Respiratory depression leading to respiratory arrest
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Antidote: Calcium gluconate is the antidote for Magnesium Sulfate toxicity. If ordered,
administer Calcium Gluconate 10%, IV Push, 10 ml over 3 minute
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