focus on pharmacology essentials for health professionals

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

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Focus on Pharmacology, First EditionBy Jahangir Moini

Focus on PharmacologyEssentials for Health

Professionals

Chapter 23Effects of Drugs on the Reproductive System

Jahangir Moini, MD, MPH




Synthetic Androgens: Uses• Main indication in men is to supplement low

levels of testosterone to correct hypogonadism or cryptorchidism(absence of one or both testes from the

scrotum) ; other uses in men are for increasing sperm production

• Used in women to treat postpartum breast engorgement, endometriosis (the lining of the uterus (endometrium) appear and flourish outside the uterine cavity,

most commonly on the ovaries), and fibrocystic breast disorders




Synthetic Androgens: Adverse Effects

• Common: insomnia, excitation, skin flushing, anorexia, diarrhea, jaundice, hypercalcemia, hypercholesterolemia, sodium retention, edema

• May cause renal calculi, bladder irritability, and increased libido




Synthetic Androgens: Contraindications

• Contraindicated in patients with serious cardiac, liver, or kidney disease; prostate or breast cancer; pregnancy and lactation

• Testosterone alters glucose tolerance tests and may increase creatinine and creatinine secretion




Synthetic Androgens: Patient Information

• Advise patients to take oral androgens with meals to reduce gastric upset.

• Instruct male patients to report priapism and decreased flow of urine.




Female Sex Hormones

• Anterior pituitary releases hormones FSH and LH

• Ovaries, adrenal cortex, and placenta (during pregnancy) release estrogens and progesterones




Synthetic Estrogens: Uses

• Used as hormone replacement therapy in women who have had ovaries removed or are postmenopausal; for prevention and treatment of osteoporosis in older women; as palliative therapy for breast and prostate carcinoma in men; and to treat abnormal bleeding




Synthetic Estrogens: Adverse Effects

• Common: anorexia, nausea, vomiting, stomach cramping, flatulence, headaches, changes in libido, edema, breast discomfort or enlargement

• In men, cause feminization, atrophy of sex organs, loss of facial or body hair




Synthetic Estrogens: Contraindications

• Contraindicated in breast cancer, pregnancy, and lactation

• Use caution in patients with liver disease, gallbladder disease, endometriosis, pancreatitis, diabetes mellitus, heart failure, and kidney dysfunction

• Interactions may cause toxic levels of cyclosporine




Synthetic Estrogens: Patient Information

• Advise patients to take drug as directed, not skipping or increasing or decreasing dose.

• Advise women not to breast feed.




Testosterone Use During Pregnancy

Use of testosterone during pregnancy can cause masculinization of the fetus, particularly if taken during first trimester.




Estrogens During Pregnancy

• Use of estrogens during the first trimester of pregnancy may increase the risk of fetal malformations




Estrogen and Menopause

• Postmenopausal women who are taking estrogens should also take progestin to prevent:– Endometrial hyperplasia – Endometrial carcinoma

• Progestin is not necessary in women who have had a hysterectomy




Progestins: Uses

• Block follicular maturation and ovulation

• Used to treat amenorrhea, functional uterine bleeding, endometriosis, and premenstrual syndrome




Progestins: Adverse Effects

• Common: vaginal candidiasis, breakthrough bleeding, dysmenorrhea, amenorrhea, breast tenderness, edema, acne, pruritus, mental depression

• Serious: thromboembolic disorder, pulmonary embolism




Progestins: Contraindications

• Contraindicated with breast or genital cancer; in patients with impaired liver function, undiagnosed vaginal bleeding, miscarriage, thrombophlebitis, and thromboembolic disorders

• Use cautiously in anemia, diabetes, or abnormal Pap smear




Progestins: Patient Information

• Advise patients to avoid exposure to prolonged UV light.

• Tell patients to immediately report sudden severe headache or vomiting, dizziness or fainting, numbness in an extremity, acute chest pain, sudden vision loss.




• The use of such combination drugs in postmenopausal women is controversial. The benefits of use are protection against:– osteoporosis – colon cancer

• The risks of using such combination drugs include:– cardiovascular disease– breast cancer– thromboembolism

Estrogen–Progestin Combinations in Postmenopause




Contraceptive Hormones: Uses

• Provide negative feedback to hypothalamus

• This inhibits gonadotropin-releasing hormone

• The pituitary therefore cease secretion of FSH, which would normally stimulate ovulation




Oral Contraceptives: Adverse Effects

• Common: nausea, abdominal pain, gallbladder disease, breast tenderness or pain, weight gain, dysmenorrhea, amenorrhea,

• Serious: thromboembolism, stroke, myocardial infarction




Oral Contraceptives: Contraindications

• Pregnancy and lactation• Genital bleeding of unknown cause• Coronary artery disease• Liver dysfunction• Endometrial or breast cancer• Severe hypertension• Diabetes with vascular involvement




Oral Contraceptives: Patient Information

• Instruct patients to follow the dosing schedule carefully and to use barrier contraception when taking antibiotics.

• Instruct patients to report calf pain or tenderness, shortness of breath, chest pain, visual disturbances, drooping eyelids, or double vision.




Oral Contraceptives and Surgery

Oral contraceptives should be discontinued 4 weeks before surgery because of the risk of postoperative thromboembolism.




Smoking and Oral Contraceptives

Smoking while taking oral contraceptives can cause serious adverse effects to the cardiovascular system.




Oxytocics: Uses

• Used to initiate or improve uterine contractions during delivery (only after cervix is dilated); also used to stimulate milk letdown following delivery




Oxytocics: Adverse Effects

• Common: nausea, vomiting, dizziness, headache

• Serious: maternal cardiac arrhythmias, hypertensive episodes, intracranial hemorrhage




Oxytocics: Contraindications

• Must not be used to induce labor prior to delivery of the placenta

• Contraindicated in unfavorable fetal position or presentation, obstetric emergencies, fetal distress

• May interact with vasoconstrictor drugs to cause severe hypertension




• Instruct patients to report:– Cold or numb fingers or toes– Severe cramping– Chest pain– Sudden or severe headache.

Oxytocics: Patient Information




• Used in management of preterm labor

Uterine Relaxants: Uses




• Common: headache, nausea, vomiting, nervousness, restlessness, sweating, emotional upset

• Serious: Chest pain, arrhythmias, pulmonary edema

Uterine Relaxants: Adverse Effects




• Uterine relaxants are contraindicated in patients with:– Antepartum hemorrhage (before birth)– Eclampsia (seizures)– Uncontrolled diabetes– Bronchial asthma– Pulmonary hypertension– Cardiac disease

Uterine Relaxants: Contraindications




Advise patients about potential adverse effects and drug interactions.

Uterine Relaxants: Patient Information

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