Drugs Affecting the Reproductive System

Flashcards on Drugs Affecting the Reproductive System

Examples of Estrogens

estradiol (Estrace, Climara), conjugated estrogens (Premarin), esterified estrogens (Menest)

Uses of Estrogens

Hormone replacement therapy (HRT), relieve uncomfortable menopause symptoms, treat hypogonadism and ovarian failure, contraceptive, osteoporosis

Examples of Progestins

levonorgestrel (Mirena, Plan B), etonogestrel (Implanon), medroxyprogesterone (Provera)

Uses of Progestins

Contraceptive, primary and secondary Amenorrhea, functional uterine bleeding, fertility drug regimens

How do oral contraceptives work?

They block the release of FSH and LH hormones.

Common instructions for taking oral contraceptives

Start taking on 5th day of the menstrual cycle (day 1 is first day of menstrual bleeding), take one tab daily for 21 days, then 7 days of placebo or no pill, then start a new cycle of pills

Instructions for Plan B One-Step (levonorgestrel)

1 tab within 72 hours post intercourse & Available OTC for patients 17 and older in some states

Instructions for Depo-Provera Injections

150mg (1ml) deep IM q3months & BBW: Risk for significant bone loss*

How long are Mirena and Skyla intrauterine devices good for?

Mirena: good for 5 years & Skyla: good for 3 years

Instructions for Ortho Evra transdermal patch

3 patches per cycle: 1 patch per week

Instructions for NuvaRing vaginal ring

Ring inserted vaginally for 3 weeks; 1 week of rest before inserting new ring

Instructions for Implanon & Nexplanon subdermal implant

Implanted subdermally in the upper arm and is effective up to 3 years

Contraindications and cautions for Estrogens

Idiopathic vaginal bleeding, estrogen-dependent cancer, thromboembolic disorders, heavy smoking, pregnancy and breastfeeding, renal and hepatic disease, adolescents - closure of the epiphyses (growth plate)

Contraindications and cautions for Progestins

Same as for estrogen PLUS pelvic inflammatory disease (PID), STD’s, endometriosis, pelvic surgery, cardiac or renal dysfunction, epilepsy and migraine headaches, asthma

Adverse effects of Estrogens

Menstrual irregularities, decreased libido, fluid retention, increased risk of: DVT, PE, Stroke, breast cancer

Interaction between smoking and Estrogen use

Increased risk of thrombi/emboli

Interaction between Grapefruit juice and Estrogen use

Increased serum levels of estrogen

Drug-Drug Interactions between St. John’s Wort/certain antibiotics and Estrogen/Progestin

Decreased effectiveness of both

Adverse effects of Progestin vaginal gel

Constipation, headaches, breast enlargement

Adverse effects of Intrauterine Progestins

Worsening endometriosis, PID, expulsion of IUD device, perforation of the uterine wall (IUD)

Important teaching concepts for patients taking contraceptives

Get routine pelvic exams with Pap Smear, perform self-breast examinations, schedule an ophthalmic examination if they wear contacts or glasses, S/S of DVT, PE, Stroke, use second form of birth control while taking certain antibiotics, do not take St. John’s Wort, avoid grapefruit juice, wash hands with soap and water after applying a gel or cream

Action of Estrogen Receptor Modulators

They stimulate positive receptors and block others

Indications for Raloxifene (Evista)

Treatment and prevention of osteoporosis and reduction of breast cancer risk

Uses of Testosterone and Androgens

Hypogonadism, certain breast cancers, delayed puberty in males, testosterone deficiency

Contraindications and precautions for Male Sex Hormones

Pregnancy and Breastfeeding, presence of prostate cancer, cardiovascular disease, liver dysfunction

Topical testosterone Black Box Warning

Virilization in children

Androgenic effects of Male Sex Hormones

Acne, weight gain, testicular atrophy, hirsutism, Deepened Voice

Example of a Prostaglandin Erectile Dysfunction (ED) Medication

alprostadil (Caverject, Muse)

Examples of Phosphodiesterase Type 5 Receptor Inhibitors (PDE5) Erectile Dysfunction (ED) Medications

avanafil (Stendra), sildenafil (Viagra, Revatio), tadalafil (Cialis), vardenafil (Levitra)

Instructions for Sildenafil (Viagra) & vardenafil (Levitra)

Take approximately 1 hour prior to sexual stimulation & Duration approximately 4 hours

Instructions for tadalafil (Cialis)

Take at least 2 hours before stimulation & Duration approximately 36 hours

Instructions for avanafil (Stendra)

Rapid onset with peak effects in 30-40 minutes; can be taken 15 to 30 minutes before sexual stimulation & Duration of only 2-3 hours

Contraindications and cautions for Erectile Dysfunction (ED) medications

Any anatomical obstruction, anything predisposing someone to priapism, penile implants, prolonged QT interval, coronary artery disease, active peptic ulcer, any use of organic nitrates or alpha-adrenergic blockers

Adverse effects of Erectile Dysfunction (ED) medications

Prolonged priapism, headache, flushing, UTI’s, increased risk of melanoma, dizziness, hearing loss

Drug-drug interactions and considerations for Erectile Dysfunction (ED) medications

Avoid grapefruit juice for 48 hours before and after taking an ED drug, avoid eating high fat meals before taking an ED drug, DO NOT mix with organic nitrates or alpha-adrenergic blockers