1. Reproductive System Drugs
Chapter 24
Reproductive System Drugs

2. Introduction
Hormones that regulate reproductive system functions include endogenous chemical substances
Originate within different areas of the body
Reproductive hormones categories
Gonadotropic
Androgens
Estrogens
Progestins 2

3. Introduction (cont’d.)
The following slides discuss various reproductive system drugs
Refer to the chapter for specific side effects, contraindications, and interactions 3

4. Gonadotropics Gonadotropic hormones include:
Follicle-stimulating hormone (FSH)
Stimulates development of ovarian follicles in the female and sperm production in testes of the male
Luteinizing hormone (LH)
Works in conjunction with FSH to induce secretion of estrogen, ovulation, and development of corpus luteum 4

5. Gonadotropics (cont’d.)
Luteotropic hormone (LTH)
Stimulates secretion of progesterone by the corpus luteum and secretion of milk by the mammary gland 5

6. Androgens Male sex hormones
Secreted mainly in the interstitial tissue of the testes in the male and secondarily in the adrenal glands of both sexes
Inadequate production in the male may be due to pituitary malfunction or to atrophy, injury to, or removal of the testicles, resulting in eunuchism or eunuchoidism 6

7. Erectile Dysfunction Medications
Inability to achieve or maintain an erection sufficient for satisfactory performance
Incidence increases with age
Nitric oxide: principal mediator in attaining and maintaining an erection
Phosphodiesterase (PDE) inhibitors
Block phosphodiesterase type 5, found in the corpus cavernosum
Thought to impair the production of nitric oxide 7

8. Estrogens Female sex hormones
Produced mainly by the ovary and secondarily by the adrenal glands
Responsible for development of female secondary sexual characteristics
Produce an environment suitable for fertilization, implantation, and nutrition of the early embryo
Affect secretion of hormones FSH and LH from the anterior pituitary gland 8

9. Estrogens (cont’d.) Menopause Estrogen therapy (ET): estrogen alone
Natural life event, or can be artificially induced
Levels of estrogen and progesterone are reduced, leading to vasomotor symptoms and atrophic vaginitis
Estrogen therapy (ET): estrogen alone
Associated with increased risk of endometrial carcinoma in women with an intact uterus
When progestin is combined with estrogen, the risk of endometrial cancer is substantially reduced 9

10. Progestins Progesterone
Hormone secreted by the corpus luteum and adrenal glands
Responsible for changes in uterine endometrium in the second half of the menstrual cycle
Preparation for implantation, development of maternal placenta after implantation, and development of mammary glands
Progestins are synthetic drugs that exert progesterone-like activity 10

11. Progestins (cont’d.) Contraceptive agents
Suppress release of pituitary hormones, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)
Results in ovulation prevention
Progestin-only contraceptives
Prevent pregnancy by inhibiting ovulation, changing cervical mucus, and creating a thin, atrophic endometrium not conducive to sustaining the fertilized ovum 11

12. Choice of Contraceptives
Estrogen-progestin oral contraceptives
Classified according to estrogen content and formulation
Monophasic, biphasic, triphasic, and four-phasic
Extended- or continuous-cycle oral contraceptives
Decrease or eliminate hormone-free interval 12

13. Choice of Contraceptives (cont’d.)
Progestin-only contraceptives
Recommended for patients who do not tolerate estrogen or in whom it is contraindicated
Progestin-containing intrauterine device
Mirena contains a reservoir of levonorgestrel, a synthetic progestin
Releases small amounts of progesterone daily, providing five years of continuous contraception protection 13

14. Choice of Contraceptives (cont’d.)
Postcoital contraception
Combined estrogen-progestin contraceptive pills used in case of emergency
Not without risk
Available option to women who are exposed to an unintentional risk of pregnancy
Examples: Next Choice and ulipristal acetate 14

15. Drugs for Labor and Delivery
Oxytocin is a hormone that stimulates the uterus to contract, thus inducing childbirth
Also acts on the mammary gland to stimulate the release of milk
Synthetic chemicals used to stimulate uterine contractions are called oxytocics
Include oxytocin and prostaglandin E1 and E2
Goal of labor induction
Facilitate vaginal delivery of a healthy infant 15

16. Drugs for Labor and Delivery (cont’d.)
Prostaglandins are released as a natural part of the cervical ripening process
Those causing contraction of the myometrial muscle include dinoprostone or prostaglandin E2 (Prostin E2, Cervidil, Prepidil), and the oral synthetic prostaglandin E1 analog, misoprostol (Cytotec), and the prostaglandin F2-alpha analog carboprost (Hemabate) 16

17. Drugs for Labor and Delivery (cont’d.)
Mifepristone (RU-486)
Antiprogesterone drug used to terminate an unwanted pregnancy (in conjunction with misoprostol)
Only for use very early in pregnancy
Methylergonovine
Semisynthetic ergot alkaloid used for prevention and treatment of postpartum and postabortion hemorrhage 17

18. Drugs for Labor and Delivery (cont’d.)
Terbutaline
Classified as a bronchodilator drug
Also used with careful monitoring in the management of preterm labor
Magnesium sulfate
For prevention and control of seizures in eclamptic patients
Preeclampsia is characterized by new-onset hypertension, edema, and proteinuria during pregnancy 18

19. Other Gonadotropic Drugs
Gonadotropin-releasing hormones (GnRH)
Act in the pituitary to suppress ovarian and testicular hormone production and inhibit estrogen and androgen synthesis
GnRH analogs that inhibit gonadotropin secretion are used in the management of endometriosis
Examples: Lupron and Synarel 19