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Oral contraceptives
•Treat: prevents pregnancy, reduces fluid retention associated with premenstrual syndrome; also decreases the risk for hormone induced migraine headaches, uterine and ovarian cancers, pelvic inflammatory disease and ovarian cysts
Examples:
-Ethinyl estradiol and drospirenone (Yasmin)
-Ethinyl estradiol and norethindrone (Ortho-novum 10/11+ Necon 1/35)
-Norethindrone (Micronor)
•Mimic properties of natural hormones, suppresses secretion of FSH and LH, thickens cervical mucus to prevent adequate sperm movement, reduces ovum implantation, prevents premenstrual syndrome and decreases risk for hypertension
•Side effects:
-Thromboembolism (monitor for DVT, PE, MI and CVA)
-Uterine bleeding
-Increased growth of breast malignancies (recommend mammograms and breast exams)
-Hypertension (monitor blood pressure)
-Hyperkalemia (caused by drospirenone; monitor EKG)
•Encourage patient to stop smoking
•Make sure patients are NOT pregnant (category X)
•Instruct patient to report pain, leg edema, sudden change in vision, severe headache or shortness of breath
•Stop taking 4 weeks before any surgery that increases the risk for thromboembolic events
•Stop smoking
•Report regular blood pressure checks
•Perform regular self breast exams + regular mammograms/breast exams
•Do not give to patients with these conditions:
-pregnancy category X
-History or other risk for thromboembolic events
-Suspected or confirmed breast cancer
-Altered liver function
-Altered renal function or adrenal function
-Smoker older than 35 years
Drugs for Menopause
•Estrogen therapy
•Estrogen and progesterone [combination therapy]
Estrogen HRT
•Treat: relieve menopausal symptoms (vasomotor), prevents valvular and vaginal atrophy and prevents postmenopausal osteoporosis
•Examples:
-Conjugated equine estrogen (Premarin)
-transdermal estradiol (Estraderm, Climara, FemPatch)
-estradiol intravaginal tablets (Vagifem) or estradiol cream (Estrace vaginal cream)
•Estrogen binds to estrogen receptors in target tissues, hormone replacement therapy (HRT) substitute a smaller, stable amount of estrogen for previous fluctuating amounts
•Side effects
-Nausea
-Hypertension
-Endometrial hyperplasia (increases risk for endometrial + ovarian cancer)
-Thromboembolism
•Monitor and report signs of DVT, PE, MI, & CVA
•Encourage patients to quit smoking
•Monitor blood pressure
•Monitor for vaginal bleeding [instruct patients to report to provider]
•Advice use of HRT for no more than 3 to 4 years
•Exercise regularly and follow a healthy, low fat diet
-History of or other risks for thromboembolic events
-Suspected or confirmed cancer
-liver disease
-Undiagnosed vaginal bleeding
Estrogen and Progesterone HRT
•Treat: relieves severe menopausal symptoms (vasomotor) and vulvar and vaginal atrophy and prevents post menopausal osteoporosis
-Conjugated estrogen and medroxyprogesterone acetate
-estradiol and norethindrone acetate transdermal system
•Estrogen binds to estrogen receptors in target tissues, hormone replacement therapy substitutes a smaller, stable amount of estrogen, progesterone antagonizes estrogen-influenced tissue growth in the uterine endometrium
-Acute cardiac events
-vaginal bleeding and spotting
-Edema + weight gain
-Breast cancer
Do not give to patients with these conditions:
Drug therapy for endometrial hyperplasia and endometriosis
•GnRH agonist
•Progesterone
GnRH agonist
•Treat: endometriosis, uterine fibroids and advanced prostate cancer in males
-Leuprolide (Lupron)
-Nafarelin
•Increases secretion of estrogen + progesterone which decreases LH + FSH, chemically induces menopause, endometrial hyperplasia SHRINKS [In women]. In men with prostate cancer levels of LH + FSH decrease which leads to less testosterone production and less prostate cancer symptoms
-Vasomotor
-Vaginal dryness
-Headache
-Bone loss [perform weight bearing exercises + adequate consumption of calcium & vitamin D]
•Limit drug therapy for up to 6 months to minimize bone loss
•For therapy that lasts longer than 6 months, monitor for bone loss via bone density scan
•Suggest vitamin B6 + vitamin E supplements
•Recommend water soluble lubricants
•Monitor for headache + other CNS effects
•Give IM injections or IM depot form every 3 to 4 months, rotate injection site, EXPECT amenorrhea [no menses] + other menstrual irregularities
•Report headache, dizziness or paresthesia
•Do not use in patients with these conditions:
-pregnancy [category X]
-Allergy to benzyl alcohol
-Abnormal vaginal bleeding
-Metastatic cerebral lesions
Progesterone
•Treats: endometriosis, dysfunctional uterine bleeding and endometrial carcinoma
-Medroxyprogesterone acetate (Provera)
-Megestrol
•Antagonizes estrogen influenced tissue growth in the uterine endometrium, prevents hyperplasia, suppresses growth of endometrial ovum implant, may reduce inflammation in the pelvic cavity
Drug Therapy for Infertility
•LH and FSH stimulants
•Ovulation stimulants
•Hyperprolactinemia inhibitors
LH + FSH stimulant
•Treat: infertility + promotes ovulation
•Example:
-Clomiphene
•Blocks the effects of estrogen receptors on pituitary gland, increases secretion of gonadotropin releasing hormone, stimulates secretion of LH + FSH, stimulates ovary to produce mature follicle and ovulation occurs when follicle ruptures
-vasomotor instability [hot flashes]
-Breast engorgement [wear supportive bra]
-Nausea + abdominal discomfort [take drug with food]
-Blurred vision, flashes of light, dizziness [monitor & report vision alterations + recommend eye exams if this occurs, discontinue therapy if visual symptoms persist)
-Ovarian hyper-stimulation
-Multiple gestation
•Give PO, beginning 5 days after onset of menses + continue therapy for 5 days [repeat 5 day course at 30 day intervals as prescribed]
•Stop taking drug if any suspicion of pregnancy
•Report pelvic pain
-primary ovarian failure
-Undiagnosed uterine bleeding
-Liver disease
-Uncontrolled thyroid disease
-Thrombophlebitis
Ovarian Stimulant
•Treat: promotes ovulation, treats infertility + used in conjunction with a drug that stimulates follicular maturation
-hCG (Pregnyl)
•Stimulates the secretion of LH in patients who do not ovulate, causes ovulation after another fertility drug has stimulated maturation of the ovarian follicle [drugs used in conjunction with hCG: Menotropins + Follitropins]
-Ovarian cyst rupture
-CNS effects: irritability, headache, fatigue and restlessness
•Monitor for indications of ovarian hyper-stimulation [EMERGENCY]
•Monitor for indications of bleeding into the peritoneum [Cullen signs or grey tunner sign]
•Ovulation stimulant + clomiphene [give ovulation stimulant 7 to 9 days after last dose of clomiphene]
•Menotropins or Follitropins + ovulation stimulant [give ovulation stimulant 1 day after the last dose of menotropins or follitropins]
•Monitor and report for pelvic or abdominal pain, pelvic pressure, unusual weight gain or swelling [EMERGENCY call 911]
-pituitary tumor
-Dysfunctional uterine bleeding
-Adrenal insufficiency
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