pharmacology in nursing women’s health drugs karen ruffin rn, msn ed
DESCRIPTION
Pharmacology in Nursing Women’s Health Drugs Karen Ruffin RN, MSN Ed. Female Reproductive Functions. Female sex steroid hormones Estrogens Progestins Pituitary gonadotropin hormones Follicle stimulating hormone (FSH) Luteinizing hormone (LH). Female Reproductive Functions (cont’d). - PowerPoint PPT PresentationTRANSCRIPT
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Pharmacology in Nursing
Women’s Health Drugs
Karen Ruffin RN, MSN Ed.
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Female Reproductive Functions
• Female sex steroid hormones– Estrogens– Progestins
• Pituitary gonadotropin hormones– Follicle stimulating hormone (FSH)– Luteinizing hormone (LH)
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Female Reproductive Functions (cont’d)
• Development of primary and secondary sex characteristics
• Menstrual cycle
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Estrogens
• Three major endogenous estrogens– Estradiol (principal & most active)– Estrone– Estriol
• Synthesized from cholesterol in ovarian follicles
• Basic chemical structure of a steroid
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Exogenous Estrogenic Drugs–Synthetic
• Steroidal– Conjugated estrogens, estradiol
transdermal, many others
• Nonsteroidal– Chlorotrianisene, diethylstilbestrol
diphosphate, others– These drugs no longer available in the
United States
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Estrogens Required For
• The development and maintenance of the female reproductive system
• The development of female secondary sex characteristics
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Estrogens: Indications
• Treatment of or prevention of disorders that result from estrogen deficiency– Atrophic vaginitis– Hypogonadism– Oral contraception (given with a
progestin)– Dysmenorrhea– “Hot flashes” of menopause
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Estrogens: Indications (cont’d)
• Treatment of or prevention of disorders that result from estrogen deficiency (cont’d)– Uterine bleeding– Palliative treatment of advanced breast
and prostate cancer– Osteoporosis treatment and prophylaxis– Many other indications
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Estrogens: Indications (cont’d)
• Continuous-combined hormone replacement therapy (CCHRT) – Fixed estrogen/progestin combination
products– Reduce complications, such as
endometrial hyperplasia, that occur from using estrogen alone
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Estrogens:Contraindications
• Allergy to the medication
• Any estrogen dependent cancer
• Undiagnosed abnormal vaginal bleeding
• Pregnancy
• Active thromboembolic disorder or history
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Estrogens:Adverse Effects
• Thrombolytic events—most serious
• Nausea—most common
• Hypertension, thrombophlebitis, edema
• Vomiting, diarrhea, constipation, abdominal pain
• May cause photosensitivity, chloasma
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Estrogens:Adverse Effects (cont’d)
• Amenorrhea, breakthrough uterine bleeding
• Tender breasts, fluid retention, headaches
• Others
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Progestins
• Synthetic derivatives of progesterone
– medroxyprogesterone (Provera)– hydroxyprogesterone– megestrol (Megace)– Many others
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Progestins: Indications
• Treatment of functional uterine bleeding caused by:– Hormonal imbalance, fibroids, or uterine
cancer
• Treatment of primary and secondary amenorrhea
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Progestins: Indications (cont’d)
• Palliative treatment of some cancers and endometriosis
• Prevention of threatened miscarriage
• Alleviation of symptoms of PMS
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Progestins: Indications (cont’d)
• megestrol– Adjunct therapy for treatment of breast and endometrial
cancers– Also used for management of anorexia, cachexia, or
unexplained weight loss in AIDS patients– Used to stimulate appetite and promote weight gain in
patients with cancer
• Used with estrogen replacement therapy after menopause
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Progestins:Adverse Effects
• Liver dysfunction—cholestatic jaundice• Thrombophlebitis, thromboembolic
disorders, such as PE• Nausea, vomiting• Amenorrhea, breakthrough uterine
bleeding, spotting• Edema, weight gain or loss• Others
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Contraceptive Drugs
• Medications used to prevent pregnancy
• Oral medications– Monophasic, biphasic, and
triphasic forms– Most contain estrogen-progestin
combinations
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Contraceptive Drugs (cont’d)
• Other contraceptive forms available– Long-acting injectable form of
medroxyprogesterone (Depo-Provera)– Transdermal contraceptive patch– Intravaginal contraceptive ring
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Contraceptive Drugs: Mechanism of Action
• Prevent ovulation by inhibiting the release of gonadotropins and increasing uterine mucous viscosity, resulting in:– Decreased sperm movement and
fertilization of the ovum– Possible inhibition of implantation of a
fertilized egg (zygote)
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Contraceptive Drugs: Other Drug Effects
• Improve menstrual cycle regularity
• Decrease blood loss during menstruation
• Decreased incidence of functional ovarian cysts and ectopic pregnancies
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Contraceptive Drugs: Indications
• Primarily used to prevent pregnancy
• Other uses– Treatment of endometriosis and
hypermenorrhea– To produce cyclic withdrawal bleeding– Postcoital emergency contraception
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Contraceptive Drugs:Adverse Effects
• Drawbacks to the use of these drugs include:– Hypertension– Thromboembolism, possible PE, MI, stroke– Alterations in lipid and carbohydrate metabolism– Increases in serum hormone concentrations
• These effects are due to the estrogen component
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Contraceptive Drugs:Adverse Effects (cont’d)
• May also cause:
– Edema, dizziness, headache, depression, nausea, vomiting, diarrhea, increased appetite, increased weight, breast changes, many others
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Contraceptive Drugs:Interactions
• Drugs that decrease effectiveness of oral contraceptive drugs
– Antibiotics, barbiturates, isoniazid, rifampin, griseofulvin
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Contraceptive Drugs:Interactions (cont’d)
• Drugs that may have reduced effectiveness if given with oral contraceptive drugs– Anticonvulsants, beta-blockers,
hypoglycemic drugs, oral anticoagulants, theophylline, TCAs, vitamins, hypnotics
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Osteoporosis
• Low bone mass
• Increased risk of fractures
• Primarily affects women
• 20% of those with this condition are men
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Osteoporosis
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Osteoporosis: Risk Factors
– Caucasian/Asian descent– Slender body build– Early estrogen deficiency– Smoking– Alcohol consumption– Low-calcium diet– Sedentary lifestyle– Family history
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Drug Therapy for Osteoporosis
• Calcium supplements and vitamin D may be recommended for women at high risk for osteoporosis
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Drug Therapy for Osteoporosis (cont’d)
– Bisphosphonates• alendronate (Fosamax), ibandronate (Boniva), risedronate
(Actonel)
– Selective estrogen receptor modifier (SERM)
• raloxifene (Evista)
– Hormone• calcitonin
• teriparatide (Forteo)
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Drug Therapy for Osteoporosis (cont’d)
Biphosphonates
• Work by inhibiting osteoclast-mediated bone resorption, thus preventing bone loss
SERMs
• Stimulate estrogen receptors on bone and increasing bone density
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Drug Therapy for Osteoporosis (cont’d)
calcitonin– Directly inhibits osteoclastic bone
resorption
teriparatide– Only drug that stimulates bone formation– Derivative of parathyroid hormone– Action similar to natural parathyroid
hormone
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Drug Therapy for Osteoporosis:
Indications
• Bisphosphonates and calcitonin– Both prevention and treatment of
osteoporosis– Biphosphanates also used for
glucocorticoid-induced osteoporosis and Paget’s disease
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Drug Therapy for Osteoporosis:
Indications (cont’d)• raloxifene
– Prevention of postmenopausal osteoporosis
• teriparatide– Used for those with highest risk of fracture
(prior history of fractures)
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Drug Therapy for OsteoporosisAdverse Effects
• SERMs– Hot flashes, leg cramps– Can increase risk of venous thromboembolism– Not used if patient is near age of menopause
due to possible hot flashes– Leukopenia
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Drug Therapy for OsteoporosisAdverse Effects (cont’d)
• Bisphosphonates– Headache, GI upset, joint pain
– Risk of esophageal burns if medication lodges in esophagus before reaching the stomach
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Fertility Drugs
• Various medical techniques used to treat infertility
• Include:– in vitro fertilization– Medication therapy: ovulation
stimulation
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Fertility Drugs (cont’d)
• clomiphene (Clomid, others)– Nonsteroidal ovulation stimulant– Blocks estrogen receptors in the uterus
and brain, resulting in a false signal of low estrogen levels
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Fertility Drugs (cont’d)
• Clomiphene (Clomid, others) (cont’d)– Causes increased production of Gn-RH,
FSH, and LH– As a result, maturation of ovarian follicles
is stimulated, leading to ovulation and increased chance of conception
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Fertility Drugs (cont’d)
• Mentropins (Pergonal)– Standardized mixture of FSH and LH– Stimulates development of ovarian follicles,
leading to ovulation– May also be given to men to stimulate
spermatogenesis
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Fertility Drugs (cont’d)
• chorionic gonadotropin alfa (Ovidrel)– Recombinant form of human chorionic
gonadotropin– Causes rupture and ovulation of mature
ovarian follicles, and maintenance of corpus luteum
– Used to stimulate ovulation
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Fertility Drugs:Indications
• Used primarily to induce ovulation in anovulatory patients
• Also may be used to promote spermatogenesis in infertile men
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Fertility Drugs:Adverse Effects
• Tachycardia, phlebitis, DVT • Dizziness, headache, flushing,
depression, anxiety, nervousness, fatigue• Nausea, bloating, constipation, others• Ovarian hyperstimulation, multiple
pregnancies, blurred vision, breast pain, others
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Uterine-Active Medications• Medications used to alter uterine
contractions
• Used to:– Promote labor– Prevent the start or progression of
labor– Postpartum use: to reduce the risk of
postpartum hemorrhage
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Uterine Stimulants
Also called oxytocics
• Ergot derivatives
• Prostaglandins
• Progesterone antagonist
• oxytocin (hormonal drug)
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Uterine Stimulants (cont’d)Ergot alkaloids
• Increase force and frequency of uterine contractions
• Used after delivery of the infant and placenta to prevent postpartum uterine atony and hemorrhage
• methylergonovine (Methergine)
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Uterine Stimulants (cont’d)
Prostaglandins• Natural hormones• Cause potent contraction of myometrium,
smooth muscle fibers of the uterus• Used to induce labor by softening the
cervix and enhancing uterine muscle tone
• dinoprostone (Prostin E2) and misoprostol (Cytotec)
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Uterine Stimulants (cont’d)
Progesterone antagonist
• mifepristone (Mifeprex)
• RU-486, the “abortion pill”
• Stimulates uterine contractions to induce abortion
• Given with a prostaglandin drug for elective abortions
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Uterine Stimulants: oxytocin (Pitocin)—Synthetic Form
• Used to induce labor at or near full-term gestation, and to enhance labor when contractions are weak and ineffective
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Uterine Stimulants: oxytocin (Pitocin)—Synthetic Form
(cont’d)• Other uses
– Prevent or control postpartum uterine bleeding
– Complete an incomplete abortion (after miscarriage)
– Promote milk ejection during lactation
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Uterine Stimulants:Adverse Effects
• Hypotension or hypertension, chest pain
• Headache, dizziness, fainting
• Nausea, vomiting, diarrhea
• Vaginal pain, cramping
• Leg cramps, joint swelling, chills, fever, weakness, blurred vision
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Uterine Relaxants:Tocolytics
• Used to stop labor that begins before term to prevent premature birth
• Generally used after the 20th week of gestation
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Uterine Relaxants:Tocolytics (cont’d)
• Uterine contractions that occur between the 20th and 37th weeks of gestation are considered premature labor
• Nonpharmacologic measures– Bedrest, sedation, hydration
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Uterine Relaxants
• ritodrine (Yutopar) and terbutaline (Brethine)– Beta-adrenergic drugs
– Stimulation of beta2-adrenergic receptors on the uterine smooth muscle
– Results in relaxation of the uterus, thus stopping premature contractions
– “Off-label” use
• Magnesium sulfate IV also used to stop labor
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Uterine Relaxants:Adverse Effects
• Palpitations, tachycardia, hypertension, others
• Tremors, anxiety, insomnia, headache, dizziness, others
• Nausea, vomiting, anorexia, bloating, diarrhea, constipation
• Hyperglycemia, hypokalemia• Dyspnea, hyperventilation, others
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Nursing Implications
• Assess baseline VS, weight, blood glucose levels, renal and liver function studies
• Assess whether the patient smokes
• Assess history and medication history
• Assess contraindications, including potential pregnancy
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Nursing Implications (cont’d)
• Before giving any uterine stimulants, assess the mother’s vital signs and fetal heart rate
• Uterine relaxants are used when premature labor occurs between the 20th and 37th weeks of gestation
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Nursing Implications (cont’d)
• For biphosphonates, ensure that the patient has no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose
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Nursing Implications (cont’d)
• Estrogens and progestins
– Take the smallest dose needed– Give IM doses deep in large muscle
masses, and rotate sites– Give oral doses with meals to reduce GI
problems– Teach patient about correct self-
administration and what to do if a dose is missed
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Nursing Implications (cont’d)
• Estrogens and progestins (cont'd)
– Increased susceptibility to sunburn may occur—advise patient to wear sunscreen or avoid sunlight
– Patients should report weight gain– Annual follow-up exams should be
completed, including PAP smear and breast exam
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Nursing Implications (cont’d)
• Follow specific administration guidelines carefully for IV administration of uterine relaxants or stimulants
• Monitor the patient’s vital signs and fetal condition during therapy
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Nursing Implications (cont’d)
• Instruct patient taking fertility drugs to take the medication as ordered
• Recommend the patient keep a journal while on fertility drugs
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Nursing Implications (cont’d)
• Biphosphonates
– Instruct patient to take medication upon rising in the morning, with a full glass of water, and 30 minutes before eating
– Emphasize that the patient should sit upright for at least 30 minutes after taking the medication
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Nursing Implications (cont’d)
• SERMs
– Instruct patient that the medication will need to be discontinued 72 hours before and during any prolonged immobility (such as surgery or a long trip)
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Nursing Implications (cont’d)
• Monitor for therapeutic responses
• Monitor for adverse effects