1. Drugs for Disorders and Conditions of the Female Reproductive System

3. Hypothalamus and Pituitary Regulation of Female Reproductive System
Gonadotropin-releasing hormone (GnRH)
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Act on ovary and cause immature ovarian follicles to begin developing

4. Endocrine System
Various glands that secrete hormones, chemical messengers released in response to a change in the body’s internal environment
The role of hormones is to maintain the body’s homeostasis
“Negative Feedback”

5. Negative Feedback

6. Estrogens and Progestins
(Ovarian):
PROGESTINS
(Uterine):
Responsible for maturation of sex organs and secondary sex characteristics of female
Prepare endometrium for implantation
High progesterone and estrogen levels in final third of uterine cycle provide negative feedback to shut off GnRH, FSH, and LH secretion

7. Used to prevent pregnancy
Oral Contraceptives
Used to prevent pregnancy
Most are combination of estrogens and progestins
Small doses prevent conception by blocking ovulation (negative feedback)

8. Estrogen-Progestin Contraceptives
Act by providing negative feedback to pituitary
Shuts down secretion of LH and FSH
Ovarian cycle cannot mature, ovulation is prevented.

9. Estrogen-Progestin Contraceptives
Progestin-only oral contraceptives (minipills)
Produce thick, viscous mucus at entrance to uterus
Discourages penetration by sperm
Estrogen-Progestin Contraceptives
Advantages?
Disadvantages?
Alternatives?

10. Thromboembolic Disorders Hypertension Migraines High Blood Sugar
Cancer
Increases appetite, weight gain, fatigue, nausea, breast tenderness
Oral Contraceptives
Serious Adverse Effects
Common Side Effects

11. Emergency Contraception
May be administered within 72 hours after unprotected sex
Prevents implantation of fertilized egg
Plan B: levonorgestrel in two doses, 12 hours apart
Preven: combination of ethinyl estradiol and levonorgestrel
Other agents may be given to abort implanted embryo
Mifepristone (Mifeprex, RU-486)
Misoprostol (Cytotec)
Emergency Contraception
Emergency Contraception vs.
Pharmacologic Abortion

12. Menopause
Progressive decrease in estrogen secretion by ovaries, resulting in permanent cessation of menses
Unpleasant symptoms: hot flashes, night sweats, irregular menstrual cycles, vaginal dryness, bone mass loss

13. Hormone Replacement Therapy (HRT)
Estrogen or Estrogen-progestin combinations
Commonly used to treat unpleasant symptoms of menopause
Hormone Replacement Therapy (HRT)

14. Dysfunctional Uterine Bleeding
Hemorrhaging that occurs on noncyclic basis or in abnormal amounts
Progestins are drugs of choice for treating uterine abnormalities
Menorrhagia
Amenorrhea
Endometriosis
Examples:
Early abortion
Pelvic neoplasms
Benign growths

15. Uterine Stimulants and Relaxants
Oxytocics:
Natural hormones secreted by posterior pituitary
Stimulate uterine contractions to induce labor
Suckling stimulates release of oxytocin
Tocolytics:
Slow uterine contractions to delay labor
Used in clients with premature labor

16. Treatment of Female Infertility
Can occur at level of hypothalamus, pituitary, or ovary
Pharmacotherapy targeted to specific cause of dysfunction
Stimulates release of LH
Results in maturation of increased number of ovarian follicles
Rise in LH level sufficient to induce ovulation in 90% of treated women

17. Estradiol and Norethindrone (Ortho-Novun)
Protoype Drugs
Estradiol and Norethindrone (Ortho-Novun)
Conjugated Estrogens (Cenestin, Enjuvia, Premarin)
Medroxyprogesterone Acetate (Provera)
Oxytocin (Pitocin)

18. Estradiol and Norethindrone (Ortho-Novun)
Therapeutic class: combination oral contraceptive
Pharmacologic class: Estrogen/progetin
Prevent ovulation by negative feedback control targeted at hypothalamus and pituitary gland.
Off label indications: acne, endometriosos, dysfunctional uterine bleeding. Improve regular menstrual cycle, decrease incidence of painful menstrual cycle.
Frequent side effects: nausea, breast tenderness, weight gain, breakthrough bleeding.
Most serious cardiovascular adverse effect: htn, thromboembolic disorders.
Interactions: some abx, anticonvulsants decrease effectiveness of ocp

19. Conjugated Estrogens (Cenestin, Enjuvia, Premarin)
Therapeutic class: Hormone
Pharmacologic class: estrogen/hormone replacement therapy
Used to treat moderate to severe symptoms of menopause caused by diminished estrogen secretion by ovaries.
Side effects: nausea, fluid retention, edema, breast tenderness, abdominal cramping, bloating.
Estrogens when used alone have high risk of uterine, breast cancer.

20. Medroxyprogesterone Acetate (Provera)
Therapeutic class: Hormone (agent for dysfucntioanl uterine bleeding)
Pharmacologic class: Progestin
Primary target is endometrium of uterus. Inhibits effect of estrogen on uterus, restoring hormonal balance.
Used for dysfucntional uterine bleeding
Side effects: breast tenderness, break through bleeding, menstrual irregularities. Weight gain, depression, n/v, htn.
Most serious side effect: increased risk for thromboembolic disease. Black box warning: may cause loss of bone mineral density.

21. Oxytocin (Pitocin)
Therapeutic class: Drug to induce labor; uterine stimulant
Pharmacologic class: Hormone; oxytocic
Drug of choice for inducing labor by increasing frequency & force of uterine contractions.
May also be given postpartum to reduce hemorrhage after expulsion of placenta, and to aid in return of normal muscular tone to uterus.
Adverse side effects: rapid, painful uterine contractions and fetal tachycardia.
Complications to mother: uterine rupture

22. Monitor client’s condition Provide client education
Role of Nurse
Monitor client’s condition
Provide client education
Obtain medical, surgical, drug history
Assess lifestyle and dietary habits
Obtain description of symptomology and current therapies

23. Oral Contraceptive Therapy
Monitor for symptoms of thrombophlebitis
Oral contraceptives can mimic certain symptoms of pregnancy
Breast tenderness, nausea, bloating, chloasma
Missing a dose
Antiseizure/antibiotics –reduce effectivenses
Self-Breast Examinations

24. Hormone Replacement Therapy
Monitor client closely for signs and symptoms of thrombus or embolus
Encourage client to report signs of depression, decreased libido
Also headache, fatigue, weight gain

25. Progestin Therapy Common side effects Breakthrough bleeding, nausea
Abdominal cramps, dizziness
Edema, weight gain
Monitor for amenorrhea; sudden, severe headache
Also for signs of pulmonary embolism: sudden severe chest pain, dyspnea
Report symptoms to health-care provider immediately

26. Can cause photosensitivity and phototoxicity
Progestin Therapy
Can cause photosensitivity and phototoxicity
Monitor for pruritus, sensitivity to light, acne, rash, alopecia
Phototoxic reactions cause serious sunburn within 5 to 18 hours

27. Uterine Stimulant Therapy
Frequently assess client in labor
Oxytocin increases frequency and force of uterine contractions
Discontinue infusion if fetal distress detected

28. Uterine Stimulant Therapy
Assess for symptoms of water intoxication
Drowsiness, listlessness, headache
Confusion, anuria, weight gain
Side effects of oxytocin
Anxiety, maternal dyspnea, hypotension or hypertension
Nausea, vomiting, neonatal jaundice
Maternal or fetal dysrhythmias