Meds Affecting Reproduction –(General Key Points)
- Testosterone produced by testes, ovaries, and adrenal cortex. Primary androgen in both genders.
- Female: Primary estrogen and progestional are estradiol and progesterone. Both made in ovaries leads to maturation of Female reproductive organs & 2º sex characteristics.
- Menstruation results from decreased progesterone toward end of cycle
- Menopausal symptoms result from decreased estrogen levels.
- Clinical uses of hormone preparations: Hormone deficiencies and oppositional treatment of hormone-dependent cancers.
- Postmenopausal HRT: Benefits include vasomotor symptom relief and prevention of osteoporosis. Risks include embolic events and cancers.
- Oral contraceptives suppress ovulation using ethinyl, estradiol, and norethindrone
- OC risks are minimal except in smokers and those with Hx of embolic events.
- Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics are used to delay preterm labor.
Oxytocics
Drug: oxytocin (Pitocin)
Others: methylergonovine (Methergine
Expected Action: increase strength, frequency, and duration of uterine contractions
Therapeutic Uses: Methergine: Emergency intervention for serious postpartum hemorrhage, Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of postpartum bleeding // Fetal stress testing // Milk letdown (intranasal)
Adverse Effects:
Methergine: Hypertensive crisis (IV): Headache, nausea, ñBP
Oxytocin: Uterine rupture {Relax myometrium ĉ Mg(SO4)}
Contraindications/Precautions: Pregnancy (?)
Methergine: Caution with Cardiovascular, renal, or hepatic failure.
Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs, cephalopelvic disproportion, prolapsed umbilical cord, fetal distress
Interactions: Vasopressors leads to hypertension
Education:
Use infusion pump and gradually increase rate,
Call for contractions longer than 60 sec, freq > q 2-3 min and stop infusion
Tocolytic Medications
Drug: Terbutaline sulfate (Brethine)
Others: magnesium sulfate, ritodrine
Expected Action:
Selectively activates β2-adrenergic receptors leads to uterine smooth muscle relaxation
Therapeutic Uses: Delay of preterm labor
Adverse Effects: Tremors, anxiety, headache (β2 skeletal muscle side effects), Tachycardia, palpitations, chest pain (β1 side effects)
Contraindications/Precautions: Pregnancy // lactation
Interactions:
Concurrent use of β-blockers leads to blunt effects
Concurrent use of adrenergic agonists leads to additive effects
Concurrent use of MAOIs leads to Hypertension
Androgens
Drug: testosterone (Delatestryl)
Others: fluoxymesterone (Halotestin), methyl testosterone (Oreton), danazol (Danocrine)
Expected Action: Growth and maturation of ♂ sex organs and 2º sex, characteristics. Promotes skeletal muscle growth
Therapeutic Uses:
Hypogonadism in androgen-deficient men
Delayed puberty
Palliative treatment of androgen-responsive breast cancer
Adverse Effects:
Hypercalcemia (ĉ breast cancer treatment)
CV risks: Increased LDL, Decreased HDL, edema
Hepatotoxicity
Male: Acne, facial hair, gynecomastia, impotence, priapism
Female: Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities
Contraindications/Precautions: Pregnancy, Prostate cancer, Liver, heart, or renal failure
Interactions:
Hepatotoxic drugs: increases risk of liver damage
Warfarin, oral hypoglycemics, and glucocorticoids leads to androgen effects on metabolism can increase levels of these.
Education: Report weight gain > 2 lb/week.
Estrogens
Drug: conjugated equine estrogens (Premarin)
Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)
Expected Action: Growth and maturation of female reproductive tract and 2º sex characteristics. They stop bone resorption and decrease LDL. At high levels they suppress release of FSH.
Therapeutic Uses:
Dysfunctional uterine bleeding & endometriosis
Postmenopausal symptoms & osteoporosis
Prostate cancer
Contraception
Adverse Effects:
Risk for estrogen-dependent breast cancer
Prolonged estrogen leads to endometrial / ovarian cancers (Give progestins, too)
Emboli (increased risk from smoking), Feminization, impotence, decreased libido in men
Progesterones
Drug: medroxyprogesterone (Provera)
Others: norethindrone (Micronor), megestrol acetate (Megace)
Expected Action:
Induce favorable conditions for fetal development and maintain pregnancy. decreases in progesterone levels leads to menstruation.
Therapeutic Uses:
Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine bleeding, amenorrhea, endometriosis, and endometrial cancer.
Adverse Effects: Breast cancer, Edema, Thromboembolic events, Breakthrough bleeding, amenorrhea, breast tenderness
Contraindications/Precautions:
Pregnancy (X), Breast cancer, Hx of thromboembolic, cardiovascular, cerebrovascular disease, Undiagnosed vaginal bleeding
Interactions:
Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all decrease absorbtion of oral contraceptives.
Education: Anticipate withdrawal bleeding for 3-7 days
Oral Contraceptives
Drug: Ovcon 35 —
Others: Necon, ortho-novum
Expected Action: decreases fertility by inhibiting ovulation, thickening cervical mucous, and making lining of endometrium less favorable to implantation.
Therapeutic Uses: Prevent pregnancy
Adverse Effects: Hypertension, Thromboembolic events
Contraindications/Precautions: Pregnancy, Hx of thrombophlebitis and cardiovascular events, Smoker > 35, Family history or risk factors for breast cancer
Interactions: OC decreased absorbtion of warfarin and oral hypoglycemic, Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all decrease effectiveness of oral contraceptives.
Education:
Take for 21 days followed by 7 days with no drug
1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days
Antineoplastic Agent (1 of 2)
Drug: leuprolide (Lupron)
Expected Action: Synthetic luteinizing hormone ò testosterone levels and decreases uterine fibroid growth
Therapeutic Uses: Palliative treatment of advanced prostate cancer, Uterine fibroids and endometriosis
Adverse Effects: Hot flashes, Bone pain, Thromboembolic events (increased risk with smoking)
Contraindications/Precautions: Pregnancy and lactation
Education: Administer leuprolide immediately upon reconstitution, Administer leuprolide depot preparations deep IM
Antineoplastic Agents (2 of 2)
Drug: tamoxifen (Nolvadex), Selective Estrogen Receptor Modulators (SERMs)
Expected Action: Tamoxifen competes ĉ estrogen leads to decreased estrogen effects
Therapeutic Uses: Breast cancer, Breast cancer prevention
Adverse Effects: Hot flashes, Bone pain, Hyperlipidemia, Hypercalcemia: Patients with bone metastases ñ risk for hypercalcemia
Contraindications/Precautions Pregnancy and lactation, History of DVT
Interactions: Warfarin: increases anticoagulant effect, Antineoplastic agents: ñ antineoplastic effects (nausea, vomiting, neutropenia)
Education: Give with food or fluid if gastric upset occurs, Omit missed doses, Monitor for weight gain and peripheral edema
Erectile Dysfunction
Drug: sildenafil (Viagra)
Others: tadalafil (Cialis), vardenafil (Levitra)
Expected Action: Augments effects of nitric oxide released during stimulation leads to blood to corpus cavernosum leads to penile erection.
Therapeutic Uses: Erectile dysfunction
Adverse Effects: Priapism: Call if longer than 4 hours, MI, sudden death: Evaluate and monitor cardiovascular history and health
Contraindications/Precautions: Pregnancy (?), Caution with Cardiovascular disease, Taking medications in nitrate family including nitroglycerin
Interactions:
Organic nitrates (nitroglycerin) leads to fatal hypotension
Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil metabolism leads to increased plasma level of sildenafil.
Education: Take 1 hour before sex; limit to 1x/day.
