NCLEX Medications Review – Meds Affecting Reproduction

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.



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


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

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


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
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

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.



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

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



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


Pregnancy (X), Breast cancer, Hx of thromboembolic, cardiovascular, cerebrovascular disease, Undiagnosed vaginal bleeding


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.


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

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.

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