Reproductive Drugs

Front 1

Estradiol (Estrace)

Back 1

Estrogen.
supports development and maintenance of female reproductive tract and 2ndry sex characteristics.
Influences menstrual cycle.
during pregancy placenta produces estrogens to stime. uterine blood flow, growth of uterine muscle, and milk duct proliferations.

SE: nausea, increased headaches, migraines.
used for female hypogonadism, acne, menopausal hormone replacement therapy, contraception.
Oral, transedermal, intravaginal, parenteral (Rare).

Front 2

Metabolic effects of estrogen

Back 2

1)positive effects on bone mass: blocks bone resorption, bone growth during puberty, epiphyseal closure.
2) reduces LDL levels and elevates HDLs.increased cholesterol in bile less bile acids in bile.
3)promotes and suprresses blood coagulation by affecting factors in clotting cascade.

Front 3

Adverse effects of estrogen

Back 3

1) increased risk of endometrial CA in postmenopausal women w/ prolonged solo estrogen use.
2) in elders: estrogen alone can promote growth of pre-existing CA if it is estrogen receptor positive.
3) increased risk for VTE, pulmonary embolism, stroke risk.
4) in postmenopause increases risk for MI.

2)

Front 4

Progestins (Provera)

Back 4

acts like progesterone which is produced by ovaries and placenta.
Prepares uterus for implantation of fertilized ovum.
suppresses contractoin of uterine smooth muscle.
suppresses contractoin of FI smooth muscle, leading to prolonged transit time and constipation.
Promotes growth of milk producing sturctures
suppresses arterial PCO2, alters serum bicarb, elevates serum pH.
May help supress immune system-protects babe,
can suprpress release of LH & FH.
Teratogenic, decreased productio nof cervical mucus, spotting, breakthrough bleeding, irregular menses, increased risk of breast CA.
SE: breast tenderness, bloating, depression.
Therapeutic uses: Contraception, dysfunciotnal uterine bleeding, with amenorrhea & infertility, prevent premature birth, palliation in endometrial CA and hyperplasia.
Routes: oral, IM, SQ, intravaginal, intrauterine, transedermal.
PRovera given orally.

Front 5

Prempro

Back 5

Estrogen and progesterone compined: used for menopausal hormone replacement therapy. (For this either just estrogen is used, or the combo)
Risks: Estrogen + progestin in postmenopause can decrease CA risk, however, it can actually CAUSE breast CA. in post menopause. Premenopause: estrogen and progestin oral contraceptives increase rise of VTEs.
can cause cardiovascular and cancer risks...
HRT approved uses: rx of vasomotor symptoms, rx for vulvar & vaginal atrophy, osteoporosis prevention.

Front 6

Uterine stimulants

Back 6

Oxytocin
Ergot alkaloids
Prostaglandins

Front 7

Oxytocin (Pitocin)

Back 7

promotes uterine contraction- induces labor & stimulates milk ejection reflex.
Increases force, frequency & Duration of contractions. can also promote renal retention of water.
Use postpartum to control bleeding & increase uterine tone.
Routes: IM, IV. 1/2 life: 12-17 mins.
Precaut/Adv FX: can cause uterine rupture: higher risk for multiparity.
contraindicated in cased of cephaolopelvic disproportion (Head bigger than pelvis passageway), fetal malpresentation, placental abnormalities, umbilical prolapse, previous uterine (CS) surgery, fetal distress, women with active genital herpes.
Reate water intoxication if toomany IV fluis.
COnstant pt. monitoring during infusion : BP, P, uterine contractility, fetal heart rate monitoring.

Front 8

Methylergonovine (Methergine)

Back 8

Ergot aldaloid:
not used to induce labor as contractions may be to prolonged and intense: used after labor to help return uterus to original size, tone and decrease bleeding.
High risk for HTN.
Used postpartum /post abortion toreturn uterus back down to size and reduce bleeding. also causes arteriole and venous constriction (good for migraines)-can decrease headaches.
Routes: oral, IM (Usual route) , IV-avoid as can cause HTN this route. RAPID ACTION> lasts several hours. reassess uterus.
Adv FX, etc.: monitor BP constantly! , as well as P & uterine contractility. causes cramping. not for use in labor, not for pts. with HTN, caution for those with renal, CV and hepatic disorders. Contraidicated in pregancy, HTN, hypersensistive to drug, labor induction and threatened or spontaneous abortion.

Front 9

Carboprost (Hemabate)

Back 9

Prostaglandin... next step up: stronger than Methergine.
Suppresses postpartum bleeding via intesne uterine contractions and vasoconstriction. also can be used to induce abortion.
ADv FX: vomiting and diarrhea in 60% of pts. Nausea & fever common. Brochoconstriction, vasoconstriction (HTN),
contraindicationed with acute PID, active disease of lungs, heart, kidneys, liver. caustin with asthma, diabetes, uterine scarring and HTN.

Front 10

Misoprostol (cytotec)

Back 10

for cervical ripening... also a prostaglandin.
softens/effaces and dilates cervix (Originally used for ulcers).
Used to ripen cervix before giving pitocin. more effective, convenient and less expensinve than similar drugs. higher incidence of uterine hyperstimulation. needs constant monitoring FHT and uterine activity.

Front 11

Systemic analgesia.

Back 11

Opiod agonist antagonists:
Butophanol (Stadol) & Nalbuphine (nubain).
mixed opiod to provide analgesia w/o significant respiratory depression in mother or baby. baby is less alert, has less sucking action and is slower...
teh meds cross teh bbb to provide analgesic effects. tehy also cross placenta and fetal bbb more readily than mother's bbb!
longer half life in babe than in mother. also crosses into breastmilk!
Used for moderate to severe abor pain and post op after c section.
IM, IV(Preferred).
Have narcan ready... cautions: respiratory depressoin, decreased alertness, delayed sucking in newborn. assess maternal VS, pain level, FHR & Pattern. Don't give to an opioid dependent mother- may cause w/d symptoms in mom an dbaby.
Adv. FX: N/V, sedation, confusion, tachy or bradycardia, hypotension, dry mouth, pruritus (Itching), urinary retention, decreased FHR variability, decreased uterine activity if given in early labor.

Front 12

Naloxone (Narcan)

Back 12

use with filter neede. give slowly.
Opioid antidote.
reverses CNS depressent, esp. respiratory depression, but brings pain back with a vengence.
IM, SQ, IV (Preferred).
Infants with neonatal narcosis may also show hypotonia, lethargy, delay in temp regulation, increased risk for hypoxia, hypercarbia acidosis (treat with ventilation, O2, gentle stimulation + narcan if needed).

Front 13

Epidural catheters

Back 13

Spinal anesthesia-block:
anesthetic solution made of anestehtic alone or with fentanyl injected into L3, L4 or L5 interspace into subarachnoid space. Mixes with CSF, effects begin w/in 1-2 mins, and lasts 3 hours. peri area last area to have sensation return.

Front 14

Fentanyl citrate

Back 14

also sufentanil citrate, preservative free morphine.
actions: opriods, short acting (1.5-3.5 hours for Fent and sufentanil, 4-7 hours for morphine)
Uses: labor, birth, posteoperative pain.
routes:Intrathecal or epidural
supposedly doesn't cause mathernal hypotension or affect VS. mom feels contractions but not pain, so she can bear down in 2nd stage of labor.
S FX: N/V, pruritis, urinary retention , delayed resp. depression, keep narcan and O2 available.

Front 15

Bupivacaine

Back 15

local anesthetic.
Blocks sodium channels in axon membrane: stopes electrical conduction, blocks pain.
onset: 5 mins: lsts 2-4 hours.
Adv FX: possible CNS excitation, tehn cns depression. CV FX: bradycardia, slowed conduction, AV block, vasodilation causes hypotension. allergic dermatitis, rare anaphylaxis. can prolong labor.
crosses placenta-can cause bradycardia and cns depression in neonate.
person must be able to hold still for this..also can't have it if they have active antepartum bleeding, anticoagulant therapy or bleeding disorder, infection at injection site or allergy to anesthetic drug or opioid.

Front 16

Methyltestosterone
(Android, testred)

Back 16

androgens produced by testes, ovaries, adrenal cortex. promotes expression ofmale sex characteristics.
Anabolic Fx promotes growth of skeletal muscle. Promotes synthesis of erythropoietin.

Used for male hypogonadism, replacement therapy when males testes fail, delayed puberty, palliation in advanded breast CA, and in menopause replacement therapy.

ADV FX: virilization: acne, deepened voice, increased libido, increased body hair, masculinization in childeren, premature epiphyseal closure in kids, can increase cholesterol adn cause cholestatic hepatitis, rare jaundice, liver CA w/prolonged use, lower HDL, elevates LDL (BAD).. edema, gynomastia, not used in pregancy.
Taken oral... not long due to hepatotoxicity risk.

Front 17

Sildenafil (Viagra)

Back 17

enhances normal erectile response to sexual stimuli.
Arterial dilation increases local blood flow and pressure, and relaxation of trabecular smooth muscle results in expansion and engorgement of corpus cavernosum. 1/2 life: 4 hrs. (erection can last upto 4 hours-6hrs!)
Used with erectile dysfunction
oral.
Adv. effects: hypotension-systemic, don't take with nitrates...or grapefruit juice. Can cause life threatening hypotension.
Priapism(Erectoinlsting more than 6 hours), ischemic optic neuropathy-(blurred or loss of vision -stop drug immediately!).
Caution with alphablockers-vasoconstriction occurs with these.
can cause: sudden hearing loss, headache, flushing, dyspepsia. caustion in men with MI, stroke, life threatening dyrhythmias in past 6 months, resting hypotension, resting hypertension, heart failure, unstable angina.

Front 18

Finasteride (Proscar)

Back 18

prostate med.
5 alpha reductase inhibitor.
by decreasing DHT, finasteride promotes regressoin of prostate epithelial tissue and decreases mechanical obstruction of urethra. Most effective if significant prostatic hypertropy.
Benefits develop slowly over 6-12 months. reduces risk of prostate CA (decreases PSA). decreases ejaculate volume and libido in 5-10% OF PTS. may also see gynomastia.
Route: oral.

Front 19

Tamsulosin (flomax)

Back 19

alpha 1 adrenergic antagoinist.
relaxes smooth muscle in the bladder neck, prostate capsule & prostatic urethra to decrease dynamic obstruction of urethra---it enlarges the pathway.
symptom improvement and increased urinary flow develop rapidly. effective if mild prostatic enlargement. best if started in men with early hypertrophy. doesn't reduce PSA levels.
adv. fx: abnormal ejaculation.
Oral.