50BFinal Reproductive Drugs

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estrogen

used to tx menopause, dysmenorrhea, atrophic vaginitis (weakening of vaginal wall), turner syndrome (failure of ovary development), cancers of the prostate and breast, suppresses postpartum milk production, acne, prophylaxis for osteoporosis, and oral contraceptives

adverse effects of estrogen

nausea like morning sickness

contraindications for estrogen

avoid in pregnancy and thrombolytic disorders increases risk of embolism if pt smokes, is over 35 and with high doses

conjugated estrogen

clinically used in menopause, cyclic use on 21 day, and 7 days off and has increase risk of endometrial cancer. (can be prevented by cyclic use or use w/progestin

diethylstilbestrol (DES)

nonsteroidal synthetic estrogen. use to be used as post coital contraceptive but not anymore, now used for inoperable prostate cancer

precaution for DES

avoid in pregnancy

progestins

medroxyprogesterone and norethindrone

clinical uses for progestins

used as an oral contraceptive, Tx of dysfunctional uterine bleeding w/estrogens, dymenorrhea w/estrogens, premenstrual tension, endometriosis w/estrogens, endometrial cancers, and suppression of lactation

adverse effects of progestins

congenital defects, hyperglycemia, fluid retention, HA, and visual disturbances

contraindications of progestins

hx of thromboembolism, breast and genital cancer

medroxyprogesterone

injectable progestin, adverse effect is fluid retention (diuretics and low sodium diet used to tx it)

norethindrone

causes loss of bone density

oral contraceptives

four types: combination, mini-pill, morning after and implantable

combination pill

ethyl estradiol, contains estrogen and progestin

adverse effects of ethyl estradiol

thrombophlebitis, thromboembolism (age>35 and smokers), hypertension, possible risk of cancer (endometrial and breast), melasma (freckling when exposed to sun), and depression.

mini pill

contains no estrogen but small amounts of progestin, less effective

Morning after pill

large dose of estrogen (DES), must administer 24 hours but not more than 72 hours after intercourse. adverse effect is nausea and vomiting

selective estrogen receptor modulator (SERMS)

raloxifene, used for prevention of osteoporosis in post menopausal women. decreases LDL cholesterol,

adverse effects of raloxifene

hot flashes and leg cramps

precaution for raloxifene

must discontinue use 72 hours prior to and during prolonged immobilization and avoid in pregnancy

toxemia of pregnancy

preclampsia (hypertensive state) and eclampsia (coma and seizures as sequel to preclampsia)

drug Tx for toxemia of pregnancy

IV infusion of Magnesium sulfate (monitor for signs of toxicity and also contraindicated for heart block or kidney impairment), Hydralyzine (alternative), and valium®/diazepam (for seizures)

oxytocin

used to induce labor, stimulates milk production, and uterus, can also be used to stop hemorrhage

adverse effects of oxytocin

monitor mother and fetus every 10 minutes to prevent uterine tetany, rupture, amniotic fluid embolism, or cervical laceration, can cause decrease in uterine placental placental blood flow and postpartum uterine atony.

contraindications of oxytocin

severe preclampsia, fetal distress, fetal abnormal presentation, and 1st stage of labor.

Androgens

important for growth, reproduction, and masculinization and spermatogenesis.

testosterone

methyltestosterone is drug used to Tx hypogonadism, impotence, suppress lactation in women and inoperable breast tumors in women.

adverse effects of testosterone

masculinization in women, cholestatic hepatitis, salt and fluid retention,

adverse effects of anabolic steroids

roid rage, psychotic reactions, increase risk of CAD, liver toxicity, testicular atrophy, gynecomastia, hair loss, sperm abnormalities, prostate enlargement, and change in libido

sildenafil

use to Tx erectile dysfunction but is not an aphrodisiac. unlabeled used in pulmonary hypertension.

adverse effects of sildenafil

color vision disturbances (blue haze or brightness), HA and hearing problems

DDI of sildenafil

all organic nitrates (NTG, nitroprusside), cimetadine, erythromycin, and ketoconazole

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