Medications r/t Female/Male/ Urinary Reproductive System adverse effects and monitoring

Sex hormones

Estrogens – conjugated equine estrogens

• Contraindicated in breast or other estrogen-dependent cancers, history of blood clots or stroke, smokers, and liver dysfunction.

• Contraindicated in pregnancy (category X) and breastfeeding

• Adverse effects are usually GU – breakthrough bleeding, menstrual irregularities, amenorrhea, libido changes

• Systemic effects – fluid retention, electrolyte disturbances, headache, dizziness, weight gain, edema

• Cause increased risk of endometrial, uterine, and breast cancers, stroke, DVT, dementia

  • Impairs coagulation, especially in women > 60 (MI, PE, DVT, Stroke)

• Regular monitoring is important. Reduce cardiac risk factors.

• Discontinue prior to surgical procedures due to clotting

Sex hormones

Progesterone- medroxyprogesterone

• Contraindicated in endometriosis or pelvic surgery – impacts uterine vasculature

• Adverse effects depend on dose and route. Systemic effects similar to estrogen.

• Can exacerbate epilepsy, migraines, asthma

• Can cause breakthrough bleeding, amenorrhea, breast tenderness, edema, migraines

• Risk for cancer, thromboembolic events, breakthrough bleeding, edema, jaundice, migraines and headaches

• Pregnancy Category X

Sex hormones

Estrogen-Progesterone Combinations

Emergency Oral Contraceptives - progestin with levonorgestrel

• Risks for thrombotic events, HTN, cancers, hyperglycemia, breakthrough bleeding

• Contraindicated in women over 35, smokers, history of cardiac or clotting events

• Pregnancy category X

• Given in cyclic pattern (usually 28 day regimen) – can be extended or taken continuously 

  • Often include 7 days of inert pill (no medication) to allow withdrawal bleed

• Verify client is not pregnant

• Quit smoking

• Report swelling/redness/pain in lower extremities, SOB, severe headache

• Take pills at the same time every day

Sex Hormones

Emergency Oral Contraceptives - progestin with levonorgestrel

• Adverse effects include menstrual irregularities, abdominal pain, nausea

• Of note: may be less effective among with BMI >30

Medications Affecting Labor and Delivery

Uterine Stimulants - oxytocin

• Side effects are related to excess effects – uterine hypertonicity, spasm, rupture. Postpartum hemorrhage, decreased fetal HR

• Other adverse effects – cardiac arrhythmias, hypertension, N&V, water intoxication

• Monitor mom’s vital signs, fetal heart rate, labor progression

• Onset Labor- Monitor contractions and baby hr, ooze milk

• ouch this contraption hurts- h20 intoxication

Medications Affecting Labor and Delivery

Tocolytic Medications - terbutaline

• Cause nervousness, restlessness, tremor, tachycardia, decreased potassium, increased glucose

• Increased fetal HR and neonatal hypoglycemia may occur

Hormone Replacement

Androgens- testosterone

• Adrenergic effects – acne, edema, hirsutism, voice deepening, oily skin & hair, weight gain, penile enlargement, testicular atrophy (secondary sex characteristics)

• Postpubescent males may have inhibition of testicular function, gynecomastia, priapism, baldness, reduced libido

• 3 Black Box Warnings:

  • Blood pressure increases, may be severe enough to cause major adverse cardiovascular events. Consider cardiac risk, evaluate BP frequently.

  • Transdermal gel or creams can cause “secondary exposure,” especially of children. Virilization of children can happen.

  • Pulmonary oil microembolism – from IM injection. See cough, dyspnea, chest pain, dizziness, syncope

• Can increase cholesterol, risk for prostate cancer risk

• Can also cause dizziness, headache, sleep disorders, fatigue, rash, liver problems, edema

Drugs that block Testosterone Production

Alpha reductase inhibitor- finasteride

• Cause headache, fatigue, dizziness, lethargy, tachycardia, GI upset, sexual dysfunction (decreased libido, impotence), gynecomastia

• Increased antihypertensive effects when taken with other antihypertensives, nitrates, or erectile dysfunction drugs

Erectile Dysfunction

Phosphodiesterase type 5 Inhibitor- sildenafil

• Contraindicated in anatomic obstruction, penile implants.

• Cannot be takin in combination with organic nitrates (nitroglycerin) or alpha-adrenergic blockers – can cause potentially fatal hypotension

• Do not take with grapefruit juice (increases serum levels). Avoid taking with or after a high-fat meal, which may delay absorption and onset

• Adverse effects: Hearing Loss, headache, abnormal vision, flushing, UTI, rash, hypotension, priapism

• Risk for MI (sudden death), hearing loss

Anti-infective- nitrofurnatoin

• Can cause nausea, vomiting, diarrhea, anorexia, dysuria, flatulence

• Prolonged use can cause fungal or bacterial superinfection

• Avoid use in older population

Urinary Rentention

Alpha-1 adrenergic antagonists- tamsulosin

• Cause CNS problems (HA, dizziness, weakness); CV problems (arrhythmias, hypotension, edema, HF). Vasodilation can cause flushing, congestion, retrograde ejaculation, priapism

• First-dose orthostatic hypotension

• Increased hypotensive effects if given with other vasodilators and antihypertensive meds

Urinary Analgesic- phenazopyridine

• Causes urine to turn reddish-orange (harmless, will self-resolve). May stain clothing and contact lenses.

• May interfere with urinalysis results

• Can cause headache, rash, GI disturbances

Urinary Antispasmodic

Anticholinergic- oxybutynin

• Adverse effects are related to the blocking of the parasympathetic nervous system: nausea, vomiting, dry mouth, vision changes, tachycardia

  • Numerous anticholinergic effects

• Dizziness, drowsiness, blurred vision, etc.