1. Reproductive pharmacology
Jennifer kean msn, rn, ccrn

2. Estrogens
Used for contraception, relief of moderate to severe postmenopausal vasovagal reactions (hot flashes, mood changes), prevention of postmenopausal osteoporosis
Used im, IV, oral, topical, transdermal, intravaginal
Estrogens are hormones that are necessary for female sexual maturation and appearance of secondary sex characteristics
Also block bone resorption and lower LDL cholesterol, and can promote or suppress blood coagulation

3. complications
Endometrial and ovarian cancers, and estrogen-dependent breast cancer
Mi, cva, pe, dvt (females older than age 60 have highest risk)
Contraindicated in the following patients:
Family history of heart disease
Undiagnosed atypical vaginal bleeding
Breast or estrogen-dependent cancer
History or risk of thromboembolic disease

4. interactions Estrogens can r educe the effectiveness of anticoagulants
Use of phenytoin can reduce the effectiveness of estrogen
Use of corticosteroids can increase the steroid level
Smoking increases the risk for thrombophlebitis
Use of oral antidiabetic meds or thyroid meds can decrease the effectiveness of those meds

5. Nursing administration
Instruct client to take the med at the sanme time each day
Apply estrogen patches to the trunk; avoid the breast area
Instruct client to report menstrual changes
Encourage monthly breast self-exam
Advise pt. to notify provider of any leg swelling or redness, shortness of breath, or chest pain

6. androgens Testosterone, methyltestosterone
Used in testosterone deficiency, delayed puberty in boys, postmenopausal breast cancer, hypogonadism in males
Complications:
Virilization effects
Epiphyseal closure with resulting loss of height
Hypercholesterolemia
increase risk of prostate cancer
Polycythemia
Edema from sodium and water retention

7. androgens
Contraindicated in older patients, and males who have prostate cancer or liver disease
Interactions:
Androgens can increase the effects of anticoagulants
Also can increase the effects of insulins and other antidiabetic agents
Instruct patients using gel to wash hands after applying and about the risk for misuse
Reduce cholesterol in the diet
Monitor female clients for signa of masculinization

8. 5-alpha reductase inhibitors-finasteride and dutaseride
Decrease usable testosterone by inhibiting the converting enzyme, resulting in reduced prostate size and increased hair growth
Used in benign prostatic hyperplasia and male-patterned baldness
Complications: decrease in libido and ejaculate volume, and gynecomastia
Use with caution in patients who have liver disease
Therapeutic effects can take 6 months or longer

9. Phosphodiesterase type 5 inhibitors
Sildenafil, tadalafil, vardenafil
Action: enhances the effects of nitric oxide released during sexual stimulation, resulting in increased blood flow to the corpus cavernosum and penile erection
Used for erectile dysfunction
Common adverse reactions: headache, flushing, nasal congestion, nausea, priapism, sudden hearing loss

10. Contraindications/precautions
Contraindicated for patients taking meds in the nitrate family, due to the risk of severe hypotension
Use cautiously in patients also on antihypertensives
Advise that grapefruit juice can inhibit absorption
Administer orally before sexual activity
Tadalafil can be taken on a daily basis