Ati Reproduction System Meds (Reproductive Tract Meds)

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Estrogens

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proto: Premarin
other: estridol (Estrace, Vagifem), estradiol hemihydrate

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estrogen MOA

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needed for growth and maturation of the female reproductive system and secondary sex characteristics
support release of FSH needed for contraception

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estrogen use

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contraception
postmenopausal osteoporosis
dysfunctional uterine bleeding
treatment of prostate cancer
moderate to severe vulvar atrophy

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estrogen adverse

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endometrial and ovarian cancers when prolonged estrogen is the only postmenopausal therapy
potential risk for estrogen dependent breast cancer
embolic events such as MI, pulmonary embolism, DVT, stroke
women over 60 have increased risk of MI and CAD

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estrogen interventions

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adminster progestins along with estrogen
endometrial biopsy every 2 years and yearly pelvic exam
rule out estrogen-dependent breast cancer prior to starting therapy
avoid nicotine products
pain, swelling, warmth, erythema of lower legs

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estrogen contraindications

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client or family history of heart disease
abnormal vaginal bleeding that is undiagnosed
breast or estrogen-dependent cancer
history or risk of thromboembolitic disease
breastfeeding
caution to pubescent girls- if administered monitor bone growth and check periodically for early epiphyseal plate closure

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estrogen interactions

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estrogens can reduce the effectiveness of warfarin (Coumadin)
phenytoin (Dilantin) can decrease the effectiveness of estrogens
corticosteroids may increase effects of estrogen
smoking increases risk for thrombosis

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estrogen interventions

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warfarin doses may need to be adjusted
monitor for decreased or increased estrogen effects
advise clients not to smoke

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estrogen admin

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take med same time each day
report menstrual and breast changes

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estrogen effectiveness

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no conception
relief of postmenopausal symptoms (hot flashes, mood swings)
reduction in dysfunctional bleeding
decrease in spread of prostate cancer

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progesterones

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medroxyprogesterone (Provera)
noethindrone (Micronor), megesterol acetate (Megace)

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progesterone MOA

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induce favorable conditions for fetal growth and development and maintain pregnancy
drop in progesterone levels results in menstruation

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progesterone use

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counter adverse effects of estrogen in hormone therapy for treatment of:
dysfunctional uterine bleeding due to hormonal imbalance
amenorrhea due to hormonal imbalance
endometriosis
advanced cancer of the endometrium, breast and kidney
can also be sued in women who are undergoing in vitro and in some clients to prevent preerm birth

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progesterone adverse

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breast cancer
thromboembolic events- do not smoke, monitor for pain, swelling, warmth, or erythema of lower legs, chest pain, SOB
breakthrough bleeding
amenorrhea
edema
jaundice
migraine

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progesterone contraindications

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undiagnosed vaginal bleeding
thromboemolic disease, cardiovascular, cerebrovascular disease
breast or genital cancers
caution: DM, seizures, and migraine headaches

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progesterone interactions

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carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), and rifampin may decrease contraceptive effectiveness
concurrent use with bromocriptine

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progesterone admin

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anticipate withdrawal bleeding 3-7 days after stopping meds
stop taking meds if pregnancy is suspected
Conception should be delayed 3 months following use

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progesterone effectiveness

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restoration of hormonal balance with control of uterine bleeding
restoration of menses
decrease in endometrial hyperplasia
control spread of endometrial cancer

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hormonal contraceptives

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Proto: estrogen and progesterone combinations:
ethinyl estridiol and norehtindrone (Ovcon 35, Necon 1/35)
ethinyl estradiol and drospirenone (Yasmine)
progesterone only:
norethindrone (Micronor)

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hormonal contraceptives MOA

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stop conception by preventing ovulation
thicken cervical mucus and alter endometrial lining to reduce chance of fertilization

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hormonal contraceptive USE

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used to prevent pregnancy

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hormonal contraceptives adverse

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thrombolytic events (MI, pulmonary embolism, thrombophlebitis, stroke) unlikely with progestin-only OCs
hypertension
breakthrough or abnormal uterine bleeding
breast cancer

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hormonal contraceptives contraindications

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smokers and over age of 35
history of thrombophlebitis and cardivascular events
risk factor or family history of breast cancer
abnormal vaginal bleeding
caution: hypertension, diabetes mellitus, gall bladder disease, uterine leiomoma, seizures, and migraine headaches

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hormonal contraceptive interactions

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oral contraceptive effectiveness decreases with use of carbamzepine, phenobarbital, antibiotics, especially penicillins and cephalosporins, phenytoin (Dilantin), and rifampin
decrease effects of warfarin

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androgens

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testosterone (Androderm-50, Testopel)

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androgen MOA

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acts on cellular DNA to promote specific mRNA molecules and production of proteins, resulting in:
development of sex traits in men and the production and maturation of sperm
increase in muscle
increase in synthesis of erythropoeitin

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androgen use

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hypogonadism in males
delayed puberty in boys
androgen replacement in testicular failure
anemia not responsive to traditional therapy
postmenopausal breast cancer
muscle wasting in male clients who have AIDS

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androgen adverse

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women- cessasion of menses and other hormonal related issues
men- acne, priapism, increased facial and body hair, and penile enlargement
epiphyseal closure
hypercholesterolemia
increase in prostate cancer
polycythemia
edema from salt and water retention
high abuse potential

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androgen interventions

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monitor epiphyses with serial x-rays
monitor for indications of jaundice
cholesterol levels
monitor hemoglobin, hematocrit
monitor for weight gain and swelling of extremities and report to provider

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androgen contraindications

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men with prostate or breast cancer
hypercalcemia
older adult clients
HF, hypertension, cardiac, renal, liver disease

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androgen interactions

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alters effects of oral anticoagulants
may alter effects of insulins and antidiabetic agents
concurrent use of androgens and hepatotoxic meds may increase risk for hepatotoxicity

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androgen admin

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inject IM formulations into large muscle and rotate injection sites
monitor women for signs of masculinization
reduce cholesterol
use barrier for birth control

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androgen effectiveness

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puberty will be induced in boys and testosterone will be increased in men
decrease in progression of breast cancer in women

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5-alpha reductase inhibitors

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proto: finasteride (Proscar, Propecia)
other: dutasteride (Avodart)

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5-alpha reductase inhibitors MOA

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decreases usable testosterone by inhibiting the converting enzyme, and causes a reduction of the prostate size and increases hair growth

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5-alpha reductase inhibitors use

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benign prostatic hyperplasia
male pattern baldness

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5-alpha reductase adverse

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decreased libido, ejactulate volume
gynecomastia
orthostatic hypotension

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5-alpha reductase contraindications

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hypersensitivity
liver disease

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5-alpha reductase admin

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therapeutic effects may take 6 months or longer
pregnant women should not handle crushed or broken meds
do not donate blood unless this med has been discontinued for at least one month

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5-alpha reductase effectiveness

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prostate size is decreased
PSA levels have decreased
increased hair growth

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alpha adrenergic agonists

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proto: tamsulosin (Flomax)
silodosin (Rapaflo)
alfuzosin (Uroxatral), terazosin , doxazosin (Cardura)

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alpha adrenergic agonist MOA

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decrease mechanical obstruction of urethra by relaxing smooth muscle of bladder neck and prostate
non-selective agents also affect blood vessels, resulting in lowered BP
may be used for BPH and hypertension

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alpha adrenergic agonist use

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benign prostatic hyperplasia, thus increasing urine flow

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alpha adrenergic adverse

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hypotension, dizziness, nasal congestion, sleepiness, fatigue, problems with ejaculation

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alpha adrenergic contraindications

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medication sensitivity
women
renal impairment (silodosin)

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alpha adrenergic interactions

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cimetidine- decrease clearance of tamsulosin
anithypertensives, PDE5 inhibitors, and nitroglycerin used concurrently with nonselective agents may cause severe hypotension
erythromycin and HIV protease inhibitors (Ritonavir will increase levels of alfuzosin and silodosin when used concurrently

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alpha adrenergic admin

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tamsulosin - 30 min after a meal
silodosin- with meal
alfuzosin- right after meal each day
terazosin: bedtime
doxazosin- same time each day

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alpha adrenergic effectiveness

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improved urinary flow with minimal adverse effects

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phosphodiesterase 5 inhibitors

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proto: sildenafil (Viagra)
other: tadalafil (Cialis), vardenafil (Levitra)

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phosphodiesterase PDE5 inhibitors

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augments the effects of nitric oxide released during sexual stimulation resulting in enhanced blood flow to the corpus cavernosum and penile erection

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phosphodiesterase PDE5 use

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erectile dysfunction

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phosphodiesterase PDE5 adverse

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MI, sudden death
priapism

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phosphodiesterase contraindications

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nitrates (nitroglycerin)
cardiovascular disease
grapefruit juice

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phosphodiesterase interactions

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nitroglycerin- hypotension
ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit juice inhibit metabolism otherby increasing plasma levels of meds

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phosphodiesterase admin

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tadalafil is approved to be taken daily or prior to sexual activity

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phosphodiesterase effectiveness

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evidenced by erection sufficient for sexual intercourse