1. Chapter 58
Drugs for Disorders in Women’s Health, Infertility, and Sexually Transmitted Infections
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2. Irregular or Abnormal Uterine Bleeding
Irregular uterine bleeding: Many different medical conditions or pathologies related to the menstrual cycle
Abnormal uterine bleeding (AUB): Wide range of variable bleeding patterns in women
Amenorrhea
Menorrhagia
Metrorrhagia
Menometrorrhagia
Intramenstrual bleeding
Dysfunctional uterine bleeding (DUB)
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3. Amenorrhea
Primary amenorrhea: No menses by age 14 years without secondary sex characteristics or no menses by age 16 years with secondary sex characteristics
Secondary amenorrhea: Absence of a spontaneous menstrual period for 6 consecutive months in women who have experienced menstrual cycles in the past
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4. Progestational Challenge Test
Test uses an oral progestin administered for a limited period of time to confirm that the hypothalamus-pituitary-ovarian (HPO) responses (the hormonal system mediating the menstrual cycle) are intact.
Micronized progesterone (Prometrium)
Medroxyprogesterone acetate (Provera)
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5. Metabolic Syndrome
Polycystic ovarian syndrome (PCOS): Form of metabolic syndrome caused by the oversecretion of luteinizing hormone (LH)
Insulin resistance: Hallmark of PCOS
Metformin (Glucophage)
Clomiphene citrate (Clomid or Serophene)
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6. Abnormal Uterine Bleeding Patterns
Menorrhagia: Regular uterine bleeding greater than 80 mL or lasting more than 7 days
Metrorrhagia: Irregular uterine bleeding greater than 80 mL or lasting more than 7 days
Menometrorrhagia: Combination of these two
Intramenstrual bleeding: Episode of bleeding, usually light, that occurs between menstrual periods
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7. Dysfunctional Uterine Bleeding
Most common classification of irregular bleeding
Extraneous estrogen drug product usually effective in stopping prolonged DUB
Estrogen-progestin combination products
Depot-medroxyprogesterone acetate (Depo-Provera)
IUS/LNG (Mirena)
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8. Pharmacologic Management: Irregular Bleeding
Nonsteroidal antiinflammatory drugs (NSAIDs): mefanamic acid (Ponstel), ibuprofen, and naproxen sodium
CHC products
Progestins: medroxyprogesterone acetate, norethindrone, and micronized progesterone
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9. Dysmenorrhea
Pelvic pain associated with the menstrual cycle, also called cyclic pelvic pain (CPP)
Primary dysmenorrhea
Secondary dysmenorrhea
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10. Pharmacologic Treatment: Dysmenorrhea
Herbal, botanical, and vitamin/mineral therapy
NSAIDs
Hormonal contraception
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11. Endometriosis
Abnormal location of endometrial tissue outside the uterus
Common cause of dysmenorrhea, chronic pelvic pain, and infertility
Most common symptoms of endometriosis are dysmenorrhea and pelvic pain, sometimes including chronic pelvic pain, which lasts more than 6 months and is not associated specifically with menstruation.
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12. Pharmacologic Management of Endometriosis
CHC products
Progestational products
Gonadotropin inhibitors and Gn-RH agonists
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13. Premenstrual Syndrome
Collection of cyclic physical symptoms and perimenopausal mood alterations.
Symptoms increase in the 2 weeks before menstruation and subside after menses begins.
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14. Pharmacologic and Complementary and Alternative Treatment of PMS
Herbal, botanical, or vitamin/mineral therapy
Antidepressant and anti-anxiety medications
Hormonal therapy
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15. Common Vulvovaginal Infections
Vulvovaginal candidiasis (VVC): yeast infection of the vulva or vaginal area treated with antifungal medications
Bacterial vaginosis: treated with metronidazole (Flagyl) or tinidazole (Tindamax)
Trichomoniasis
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16. Infertility
Inability to conceive a child after 12 months of unprotected sexual intercourse
Assessment of woman: alterations in ovarian function and anatomic disorders
Assessment of man: any disease process that prevents sperm production or blocks sperm transport
Refer to Table 58-2, Causes of Infertility.
Refer to Table 58-3, Common Tests for Infertility.
Refer to Table 58-4, Ovulatory Stimulants and Ovulation Control.
Refer to Prototype Drug Chart 58-1, Clomiphene Citrate.
Refer to Nursing Process: Infertility.
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17. Induction of Ovulation
Clomiphene citrate (CC)
Side effects: breast discomfort, fatigue, dizziness, depression, nausea, increased appetite, dermatitis, urticaria, anxiety, weakness, heavier menses, vasomotor flushing, and abdominal bloating or pain
Recombinant FSH, LH, and human chorionic gonadotropin (hCG)
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18. Luteal Phase Deficits
Decreased progesterone levels in the luteal phase of the menstrual cycle (the phase after ovulation)
Decreased luteal-phase progesterone output: luteal-phase deficiency (LPD)
Treatment with progesterone in vaginal, oral, or IM dosing (called luteal-phase support)
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19. Other Drug Treatments Hyperprolactinemia
Elevated level of prolactin is the causative factor of infertility.
Cause: Use of certain drugs, pituitary adenoma
Treatment: Ergot derivative bromocriptine (Parlodel)
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20. Nursing Process: Infertility
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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21. Drug Therapy for Male Infertility
Oligospermia: Semen with a low concentration of sperm
Asthenospermia: Low sperm motility
Testosterone
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22. Sexually Transmitted Infections
Transmission and risk
Bacterial pathogens
Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID.
Treponema pallidum is a spirochete that causes syphilis.
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23. Sexually Transmitted Infections
Viral pathogens
Human papllioma virus: Gardasil
Herpes simplex virus: antiviral medications
HIV
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24. Other Pathogens Pediculosis humanus capitus: head lice
Pediculosis humanus corporus: body lice
Phthirus pubis: pubic lice
Trichomonas vaginalis
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25. Nursing Process: Sexually Transmitted Infections
Assessment
Nursing diagnosis
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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26. Practice Question #1
Use of which substance has been associated with changes in sperm production and viability?
Echinacea
Valerian
St. John’s wort
Green tea
Answer: C
Rationale: St. John’s wort affects sperm cells and causes decreased sperm motility and decreased viability.
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27. Practice Question #2
Nonsteroidal antiinflammatory agents decrease pain associated with dysmenorrhea by
altering the patient’s perception of pain.
blocking the transmission of pain impulse.
preventing the synthesis of prostaglandins.
thinning the blood to allow for better flow.
Answer: C
Rationale: NSAIDs block pain by preventing synthesis of prostaglandins.
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28. Practice Question #3
Which information will the nurse include when teaching a patient about premenstrual syndrome (PMS)?
“Avoid aerobic exercise when experiencing PMS.”
“Increase salt intake when experiencing PMS.”
“Increased calcium intake may help with PMS.”
“Progesterone is effective in the treatment of PMS.”
Answer: C
Rationale: Aerobic exercise and decreased salt intake have the potential to decrease symptoms associated with PMS. Progesterone has not been approved for treatment of PMS by the U.S. Food and Drug Administration.
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29. Practice Question #4
Which of the following is the term for a yeast infection of the vulva or vaginal area?
Vulvovaginal candidiasis
Gonorrhea
Bacterial vaginosis
Trichomoniasis
Answer: A
Rationale: Vulvovaginal candidiasis (VVC) is a yeast infection of the vulva or vaginal area.
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