1. 26
Drugs Used to Treat Reproductive Conditions

2. Figure 26-1 The male reproductive system.

3. Table 26-1 Functions of the Male Reproductive System

4. Table 26-1 (continued) Functions of the Male Reproductive System

5. Table Male Hormones

6. Table 26-2 (continued) Male Hormones

7. Synthetic Androgens: Uses
Main indication in men is to supplement low levels of testosterone to correct hypogonadism or cryptorchidism; other uses in men are for increasing sperm production
Used in women to treat postpartum breast engorgement, endometriosis, and fibrocystic breast disorders

8. Synthetic Androgens: Adverse Effects
Common: insomnia, excitation, skin flushing, anorexia, diarrhea, jaundice, hypercalcemia, hypercholesterolemia, sodium retention, edema
May cause renal calculi, bladder irritability, and increased libido

9. Synthetic Androgens: Contraindications
Contraindicated in patients with serious cardiac, liver, or kidney disease; prostatic or breast cancer; pregnancy and lactation
Testosterone alters glucose tolerance tests and may increase creatinine and creatinine secretion.

10. Synthetic Androgens: Patient Information
Advise patients to take oral androgens with meals to reduce gastric upset.
Instruct male patients to report priapism and decreased flow of urine.

11. Anabolic Steroids and Elderly Men
The risk of prostate cancer increases in elderly men who take androgens.

12. Figure 26-2 The female reproductive system.

13. Figure 26-2 (continued) The female reproductive system.

14. Table 26-3 Functions of the Female Reproductive System

15. Female Sex Hormones Anterior pituitary releases hormones FSH and LH
Ovaries, adrenal cortex, and placenta (during pregnancy) release estrogens and progesterones

16. Table 26-4 Major Synthetic Estrogens

17. Synthetic Estrogens: Uses
Bind to intracellular receptors that stimulate DNA and RNA to synthesize proteins

18. Synthetic Estrogens: Uses
Used as hormone replacement therapy in women who have had ovaries removed or are postmenopausal; for prevention and treatment of osteoporosis in older women; as palliative therapy for breast and prostatic carcinoma in men; and to treat abnormal bleeding and atrophic vaginitis in women

19. Synthetic Estrogens: Adverse Effects
Common: anorexia, nausea, vomiting, stomach cramping, flatulence, headaches, changes in libido, edema, breast discomfort or enlargement
In men, cause feminization, atrophy of sex organs, loss of facial or body hair

20. Synthetic Estrogens: Contraindications
Contraindicated in breast cancer, pregnancy, and lactation
Use caution in patients with liver disease, gallbladder disease, endometriosis, pancreatitis, diabetes mellitus, heart failure, and kidney dysfunction
Interactions may cause toxic levels of cyclosporine and theophylline

21. Synthetic Estrogens: Patient Information
Advise patients to take drug as directed, not skipping or increasing or decreasing dose.
Advise women not to breast feed.

22. Testosterone Use During Pregnancy
Use of testosterone during pregnancy can cause masculinization of the fetus, particularly if taken during first trimester

23. Estrogens During Pregnancy
Use of estrogens during the first trimester of pregnancy may increase the risk of fetal malformations, including:
Cleft palate
Heart defect
Dislocated hips
Absent tibiae
Polydactylia

24. Estrogen and Menopause
Postmenopausal women who are taking estrogens should also take progestin to prevent:
Endometrial hyperplasia
Endometrial carcinoma
Progestin is not necessary in women who have had a hysterectomy.

25. Table Progestins

26. Table 26-5 (continued) Progestins

27. Progestins: Uses Block follicular maturation and ovulation
Used to treat amenorrhea, functional uterine bleeding, endometriosis, and premenstrual syndrome

28. Progestins: Adverse Effects
Common: vaginal candidiasis, chloasma, cervical erosion, breakthrough bleeding, dysmenorrhea, amenorrhea, breast tenderness, edema, acne, pruritus, mental depression
Serious: thromboembolic disorder, pulmonary embolism

29. Progestins: Contraindications
Contraindicated with breast or genital cancer; in patients with impaired liver function, undiagnosed vaginal bleeding, miscarriage, thrombophlebitis, and thromboembolic disorders
Use cautiously in anemia, diabetes, history of psychotic depression or salpingitis, or abnormal Pap smear.

30. Progestins: Patient Information
Advise patients to avoid exposure to prolonged UV light.
Tell patients to immediately report sudden severe headache or vomiting, dizziness or fainting, numbness in an extremity, acute chest pain, sudden vision loss.

31. Estrogen–Progestin Combinations in Postmenopause
The use of such combination drugs in postmenopausal women is controversial. The benefits of use are protection against:
Osteoporosis
Colon cancer

32. Estrogen–Progestin Combinations in Postmenopause
The risks of using such combination drugs include:
Cardiovascular disease
Breast cancer
Thromboembolism

33. Table 26-6 Types of Oral Contraceptives

34. Table 26-6 (continued) Types of Oral Contraceptives

35. Table 26-6 (continued) Types of Oral Contraceptives

36. Contraceptive Hormones: Uses
Provide negative feedback to hypothalamus
This inhibits gonadotropin-releasing hormone
The pituitary therefore ceases secretion of FSH, which would normally stimulate ovulation

37. Oral Contraceptives: Adverse Effects
Common: nausea, abdominal pain, gallbladder disease, hepatic adenomas, breast tenderness or pain, weight gain, dysmenorrhea, amenorrhea, menorrhagia, metrorrhagia
Serious: thromboembolism, stroke, myocardial infarction

38. Oral Contraceptives: Contraindications
Pregnancy and lactation
Genital bleeding of unknown cause
Thrombophlebitis
Coronary artery disease
Liver dysfunction
Endometrial or breast cancer
Severe hypertension
Diabetes with vascular involvement

39. Oral Contraceptives: Patient Information
Instruct patients to follow the dosing schedule carefully and to use barrier contraception when taking antibiotics.
Instruct patients to report calf pain or tenderness, shortness of breath, chest pain, visual disturbances, drooping eyelids, or double vision.

40. Oral Contraceptives and Surgery
Oral contraceptives should be discontinued 4 weeks before surgery because of the risk of postoperative thromboembolism.

41. Smoking and Oral Contraceptives
Smoking while taking oral contraceptives can cause serious adverse effects to the cardiovascular system.

42. Table 26-7 Effects of Drugs on Labor and Delivery

43. Table 26-7 (continued) Effects of Drugs on Labor and Delivery

44. Oxytocics: Uses
Directly act on uterine muscle to produce phasic contractions
Used to initiate or improve uterine contractions during delivery (only after cervix is dilated); also used to stimulate milk letdown following delivery

45. Oxytocics: Adverse Effects
Common: nausea, vomiting, dizziness, headache
Serious: maternal cardiac arrhythmias, hypertensive episodes, intracranial hemorrhage

46. Oxytocics: Contraindications
Must not be used to induce labor prior to delivery of the placenta
Contraindicated in unfavorable fetal position or presentation, cephalopelvic disproportion, obstetric emergencies, fetal distress
May interact with vasoconstrictor drugs to cause severe hypertension

47. Oxytocics: Patient Information
Instruct patients to report:
Cold or numb fingers or toes
Severe cramping
Chest pain
Sudden or severe headache

48. Uterine Relaxants: Uses
They are beta2-adrenergic agonists.
Used in management of preterm labor.

49. Uterine Relaxants: Adverse Effects
Common: headache, nausea, vomiting, nervousness, restlessness, sweating, emotional upset
Serious: chest pain, arrhythmias, pulmonary edema

50. Uterine Relaxants: Contraindications
Uterine relaxants are contraindicated in patients with:
Antepartum hemorrhage
Eclampsia
Uncontrolled diabetes
Bronchial asthma
Pulmonary hypertension
Cardiac disease

51. Uterine Relaxants: Patient Information
Advise patients about potential adverse effects and drug interactions.