1. Chapter 39 Gonadal Hormones 39-1 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Lesson 39.1 39-2 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Objectives  Describe gonads and their function.  Describe the body changes that can be anticipated with the administration of androgens, estrogens, or progesterone.  Identify the uses of estrogens and progestins.  Compare the adverse effects seen with the use of estrogen hormones with those seen with androgens. Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-3

4. Objectives (cont.)  Differentiate between the common adverse effects and those requiring consultation with the physician that occur with the administration of estrogen or progesterone. Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-4

5. Gonadal Hormones  Testosterone  Develop male sex organs; voice; hair distribution; male body form  Androgens  Produce masculinizing effects  Estrogen  Breast development, voice quality, broad pelvis, menstruation  Progesterone  Implantation of fertilized ovum, continuation of pregnancy, prepare breasts for lactation Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-5

6. Patient Education  Discuss expectations of therapy  Seek cooperation with medication adherence  Enlist patient’s aid with maintaining written record of signs and symptoms appropriate to his or her condition  Use baseline assessment to track response to drug therapy Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-6

7. Drug Class: Estrogens  Actions  Affect release of gonadotropins that cause capillary dilatation, fluid retention, protein metabolism, and inhibit ovulation and postpartum breast engorgement  Uses  Relieve hot flash symptoms of menopause; contraception; hormone replacement therapy after oophorectomy; treat osteoporosis; treat severe acne: slow disease process in advanced prostatic cancer and breast cancer Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-7

8. Drug Class: Estrogens (cont.)  Therapeutic outcomes  Contraception; hormonal balance; osteoporosis prevention; lessen severe acne in females  Common adverse effects  Headache, migraine, insomnia, weight gain, edema, breast tenderness, nausea  Serious adverse effects  Hypertension, thrombophlebitis, hyperglycemia, breakthrough bleeding Smoking increases risks Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-8

9. Audience Response Question 1  A patient has received a prescription for oral contraceptives. Which assessment finding causes the nurse to evaluate risk factors and question the prescribed medication? A. Occurrence of regular menstrual periods B. A history of smoking C. Age of 34 years D. Patient has one living child Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-9

10. Audience Response Question 2  Which gonadal medication does the nurse expect to be prescribed for an older patient with prostate cancer? A. Conjugated estrogen (Premarin) B. Testosterone (Striant) C. Fluocinonide (Lidex) D. Fluoxymesterone (Androxy) 39-10 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Audience Response Question 3  Which is not a use for estrogen? A. To relieve menopausal symptoms B. As an ingredient in contraceptives C. To relieve symptoms during pregnancy D. To treat severe acne in females 39-11 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Drug Class: Progestins  Actions  Inhibit secretion of pituitary gonadotropins, inhibit ovulation  Uses  Treat secondary amenorrhea, breakthrough bleeding, endometriosis, contraception  Common adverse effects  Weight gain, edema, tiredness, oily scalp, acne  Serious adverse effects  Breakthrough bleeding, amenorrhea, cholestatic jaundice, headache, mental depression Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-12

13. Audience Response Question 4  What is the action of progestins when they are taken to treat an abnormal period? A. Causing breakthrough bleeding in 24 hours B. Stopping bleeding and causing the endometrium to shed C. Increasing the secretion of pituitary gonadotropins D. Increasing the maturation of ovarian follicles 39-13 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Drug Class: Androgens  Actions  Dominant male sex hormone  Uses  Treat hypogonadism, eunuchism, androgen deficiency, and palliation of breast cancer in postmenopausal women with certain types of cancer (suppress cancer cells)  Common adverse effects  Gastric irritation  Serious adverse effects  Electrolyte imbalance, edema; hypercalcemia; masculinization; hepatotoxicity Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 39-14

15. Audience Response Question 5  A 15-year-old boy who is small and developmentally delayed for his age is being evaluated for delayed secondary sexual characteristics. If the health care provider determines the child would benefit from hormonal therapy, which type of hormone does the nurse expect to be prescribed? A. Corticosteroids B. Mineralocorticoids C. Luteinizing hormone D. Androgens 39-15 Mosby items and derived items © 2013, 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.