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Cells that develop into ovaries are found where?
remain in the abdomen
Cells that develop and form the testes are found where?
migrate from the abdomen
What are the female reproductive structures?
2 ovaries, 2 fallopian tubes, uterus
accessory structures: vagina, clitoris, labia, breast tissue
what hormones are the female reproductive structures stimulated and maintained by?
estrogen
progesterone
what hormone is the male reproductive structures stimulated and maintained by?
testosterone
what are the male reproductive structures?
2 testes, vas deferens, prostate gland, penis, urethra
what are the effects of estrogen?
first noticed during menarche
manage female characteristics
produced by the ovaries (estradiol, etrone, estriol)
what are the effects of progesterone?
released after ovulation
help to support development of a fetus
effect body temperature to indicate ovulation
What is the main goal of progesterone?
To prepare for and maintain pregnancy
what are the effects of testosterone?
responsible for many sexual and metabolic effects
puberty/physical changes
What do androgens do?
maintain changes caused by testosterone
What is castration?
removal of the testes
what is puberty?
the time of life when a child’s body matures into an adult’s
when is puberty for females?
ages 7-13
when is puberty for males?
ages 9-14
What is GnRH?
gonadotropin-releasing hormone
causes release of FSH and LH
What is FSH?
follicle stimulating hormone
What is LH?
luteinizing hormone
What is the criteria for using infertility drugs?
unable to conceive after 1 year of trying
What causes infertility in women?
ovulation disorder, blocked fallopian tubes, endometriosis, anomalies of the uterus, advanced age
What causes infertility in men?
absence of sperm, declining sperm counts, testicular anomalies, ejaculatory dysfunction
What does the infertility drug Clomiphene citrate do?
Ovarian stimulator that induces ovulation
What does the infertility drug Menotropin do?
given for anovulation to promote development and maturation of follicles
what does the infertility drug Follitropin alfa do?
induces ovulation and promotes fertility
what does the infertility drug Leuprolide do?
unlabeled use for treatment of infertility and used for precocious puberty
what are the adverse effects of infertility drugs?
depends on the drug
multiple births, hot flashes, ovarian enlargement, breast pain, visual disturbances, abdominal distension, HA
What are the pharmacokinetics of infertility drugs?
depends on the drug
PO, IM, SQ
metabolized in liver/excreted in urine
contraindications for infertility drug Clomiphene citrate
liver, thyroid, and adrenal disease
ovarian cysts
abnormal uterine bleeding
contraindications for infertility drug menotropin
liver, thyroid, adrenal disease
ovarian cysts
abnormal uterine bleeding
contraindications for infertility drug follitropins
hypersensitivity
tumors of ovaries, breast, pituitary gland, uterus, or hypothalmus
contraindications for infertility drug human chorionic gonadotropin
hypersensitivity
neoplasms
General considerations for infertility drug Leuprolide**
primary ovarian failure
liver, thyroid, adrenal disease
ovarian cysts
abnormal uterine bleeding
P/L
thromboembolic disorders
Why should all drugs used in pregnancy be avoided or minimized?
Because they are potentially harmful to the fetus!
Which drugs are teratogenic risk category D?
ACE inhibitors
ARBs
Which drugs are teratogenic risk category X?
Anticoagulants
Statins
What is the important education for drug therapy in pregnancy?
Benefits must outweigh the risks!
What are guidelines for education in drug therapy in pregnancy?
ingested drugs reach fetus
avoid drugs if possible
lifestyle/non-therapeutic drugs can affect fetus
avoid herbal supplements
maintain healthy lifestyle
notify health care provider if think pregnant
drugs are excreted in breast milk
avoid alcohol, caffeine, smoking, drugs of abuse
what are drugs used for fetal therapeutic effect?
digoxin
levothyroxine
penicillin
betamethasone
Rh immune globulin (mom Rh -)
what are drugs used for maternal therapeutic effect?
prenatal vitamins/minerals
folic acid
meds for: pregnancy associated probs, chronic disease, preterm labor, labor pain management, labor induction, post partum hemorrhage prevention
What are drugs that are used for constipation while pregnant?
psyllium, docusate, milk of magnesia
what drugs are used for GERD while pregnant?
histamine 2 blockers
antacids
what drug is used for gestational diabetes?
insulin
what drugs are used for preeclampsia (HTN disorder)?
MgSO4 (magnesium sulfate)
hydralazine
nifedipine
labetalol
what drugs are used for infections while pregnant?
Group B strep = Penicillin
HIV = Zidovudine
Flu = Flu vaccine
What are the drugs that alter uterine motility?
Tocolytics
How do Tocolytics work?
Inhibit labor and maintain the pregnancy
what is preterm labor?
uterine contractions before 37 weeks
What is the goal of tocolytics for labor?
To delay birth long enough for antenatal administration of a corticosteroid to mom to improve pulmonary maturity and function of fetal lungs by increasing surfactant
examples of tocolytics
NSAIDs = indomethacin
Calcium Channel blockers = Nifedipine
Beta agonist = terbutaline sulfate
magnesium sulfate
BBW for tocolytic: Indomethacin
Cardiovascular events and GI bleed
BBW for tocolytic: terbutaline sulfate
potential maternal heart problems and death
What is a prostaglandin that induces labor?
Misoprostol
What is an oxytocic that induces labor?
Oxytocin
What are uterotonics for postpartum hemorrhage?
drugs that are used to stop postpartum hemorrhage → oxytocin
What are drugs used for lactation induction?
Metoclopramide
Oxytocin
What is a drug used to treat postpartum depression in lactating women?
SSRIs
What does birth control do during lactation?
Progesterone-only birth control
higher dose progesterone leads to reduction in milk production
what are the 3 ovarian estrogens?
estradiol, estrone, estriol
progesterone: nonpregnant
secreted by corpus luteum last half of cycle
progesterone: pregnant
maintains the pregnancy/prepares breast for lactation
how long is the menstrual cycle?
28 days
what phase of the menstrual cycle: Days 1-14 ?
follicular phase
what phase of the menstrual cycle: 15-28 ?
luteal phase
what does progesterone do to cholesterol?
decrease HDL
increase LDL
what are common reproductive health problems for women?
premenstrual syndrome (PMS)
premenstrual dysphoric disorder (PMDD)
endometriosis
menopause
what is the first line of therapy for treating PMS/PMDD
antidepressants: SSRIs or SNRIs
what is the second line of therapy for treating PMS/PMDD
oral contraceptives: progestins
if the main symptoms of PMS/PMDD are anxiety/insomnia, what is drug used for treatment?
benzodiazepines: alprazolam
what drugs are used to manage endometriosis?
NSAIDs
Hormonal contraceptives
GnRH agonists
what is treatment for endometriosis based on?
severity of symptoms, response to treatment, cost, and contraceptive needs
how is menopause treated?
hormone replacement therapy (HRT) - estrogen
only for severe symptoms
combo drug
what are estrogens given for?
to replace low/missing hormones
What is an example of an estrogen given?
conjugated estrogen
what are the pharmacokinetics of estrogen?
oral - slowly released
-highly protein bound with long half life: 6-20 hours
-metabolized in liver/excreted in bile and urine
transdermal patches
-avoid first-pass effect
what are the actions of conjugated estrogen?
circulate to target cell
affects primarily the reproductive system
-skeletal, metabolic, coagulation, skin, and SQ tissues
what are the uses for conjugated estrogen?
birth control, menopause, replacement therapy, slow bone loss in osteoporosis, palliative care for metastatic breast cancer, prostate cancer
What are the adverse effects of conjugated estrogen?
CV= increased risk of VTE
Menstrual= breakthrough bleeding
CNS= migraines, depression
other= weight gain
BBW: increased risk of endometrial cancer/breast cancer; increased risk of VTE, MI, stroke, PE; increased risk of dementia
contraindications for conjugated estrogen?
thromboembolic disorders
undiagnosed vaginal/uterine bleeding
tobacco use
nursing implications for conjugated estrogen?
preventing interactions with nicotine, antibiotics
administer the smallest dose possible; with patches, avoid prolonged sun exposure
assess for AEs, s/sx of VTE
patient education for conjugated estrogen?
report unusual bleeding, educate on s/sx of VTE, if taking birth control = use backup birth control if on antiseizure meds or antibiotics
what is the progestin example medication?
medroxyprogesterone acetate
what are the pharmacokinetics of progestins
rapidly absorbed
half-life varies depending on route of admission
PO, IM, sustained release, gel
actions of progestins
diffuse freely in cells
act on endometrial lining
suppress pituitary hormones to inhibit ovulation
inhibit spontaneous uterine contractions
what are the uses for progestins?
to prevent hyperplasia of the endometrial lining
contraceptive = in combo with estrogens
treat amenorrhea/functional uterine bleeding
fertility programs
oncology
Plan B
adverse effects of progestins
CV = increased risk of MI, stroke, HTN, VTE, PE
menstrual = irregular bleeding
CNS = migraines, depression, irritability
Skin = acne, hirsutism
other = weight gain, edema, cancer
what is the BBW for progestins?
loss of calcium leading to bone loss; NOT for pregnancy
not for use with estrogen to prevent CV disease; increased risk of VTE, MI, stroke, PE, dementia
contraindications of progestins
active CV disease
VTE
cerebral hemorrhage
carcinoma of breast, ovaries, endometrium
what are the nursing implications for progestins?
prevent interactions= may alter liver function labs, monitor lipid panels
adverse effects: breakthrough bleeding
patient education - monitor BP, glucose, lipid panel, PAP, mammogram; weight weekly, report unusual bleeding, s/sx of VTE, use backup birth control if taking abx or antiseizure meds
What is an example of an estrogen-progestin combo drug?
ethinyl estradiol with norethindrone (ortho-novum 1/35) → contraception
conjugated estrogen-medroxyprogesterone → hormone replacement therapy
what are the pharmacokinetics of estrogen-progestin combo therapy?
highly protein bound
half-life varies
PO, IM, implant, IUD
what are the actions of estrogen-progestin combo therapies?
inhibiting ovulation
stabilizes endometrium
suppresses LH surge
what are the uses for estrogen-progestin combo therapy drugs?
primary use: contraception (4 types)
treatment of PMS/PMDD
what are adverse effects of estrogen-progestin combo therapy?
CV- increased risk of MI, stroke, HTN, VTE, PE
GI- increased risk of gallbladder disease
CNS- migraines
What is the BBW for estrogen-progestin combo therapy?
loss of calcium, leading to bone loss; increased risk of VTE, MI, stroke, PE;
cigarette smoking increases risk of CV adverse events especially after 35 years of age
what are the contraindications of estrogen-progestin combo therapy?
smoking
women older than 35
liver dysfunction
what are the nursing implications for estrogen-progestin combo therapy?
several drugs reduce its effects: antibiotics, antiseizures, benzodiazepines
use alternative method of birth control if dose is missed
Patient education: it does not prevent STDs, do NOT smoke
what are types of androgens?
testosterone, androstenedione, dehydroepiandrosterone (DHEA)
How are androgens synthesized?
by cholesterol
__________ cells in the testes are stimulated by ___________ to secrete testosterone.
Leydig; LH
what are 3 common reproductive health problems for men?
androgen deficiency
erectile dysfunction
benign prostatic hypertrophy
