REPRODUCTIVE/GENITOURINARY SYSTEMS

100 bux-fousheé

oral contraceptives

ethinyl estradiol + drospirenone

drug therapy for menopause (estrogen HRT)

conjugated equine estrogen & estrogen + medroxyprogesterone

drug therapy for endometrial hyperplasia and endometriosis

leuprolide & medroxyprogesterone acetate

drug therapy for infertility

clomiphene, hCG, and cabergoline

drug therapy for inducing uterine contractions

oxytocin, methylergonovine, and dinoprostone

drug therapy to stop uterine contractions

terbutaline

drug therapy for fetal lung maturity

betamethasone

drug therapy for seizures

magnesium sulfate

drug therapy for male reproductive system

testosterone, finasteride, tamsulosin, and sildenafil

drug therapy for GU system

oxybutynin & bethanechol

ethinyl estradiol + drospirenone (oral contraceptive)

mimics the properties of natural hormones except provides a constant level of these hormones to suppress secretion of FSH and LH, effectively preventing ovulation and pregnancy. also works to thicken cervical mucus and prevent sufficient thickening of the endometrium. ADRs include an increased risk for thromboembolisms (MIs, PEs, strokes), abnormal uterine bleeding, promoted growth of existing breast cancer, HTN depending on amount of estrogen in drug (less common), and hyperkalemia. clients should have their BP checked regularly. monitor for any indications of DVT, PE, MI, or stroke; encourage clients to quit smoking, monitor K levels, watch EKG, and recommend mammograms. teratogenic (obvió).

conjugated equine estrogen (estrogen HRT)

works by binding to estrogen receptors in target tissues to substitute normally fluctuating amounts of estrogen with a smaller, more stable amount of estrogen to prevent menopausal manifestations. ADRs include nausea (decreases w/ use), HTN, endometrial hyperplasia (increased risk for cancer), and thromboembolisms (PE, stroke, MI). monitor for any s/s of thromboembolitic events, encourage clients to quit smoking, and encourage short term use of this drug to avoid cardiovascular effects. monitor BP closely and for vaginal bleeding.

estrogen + medroxyprogesterone (estrogen + progesterone HRT)

works to replace estrogen and progesterone with smaller, more stable levels to prevent menopausal manifestations and prevent hyperplasia in the endometrium, which is no longer necessary in clients undergoing menopause as it increases cancer risk. ADRs include nausea, HTN, thromboembolitic events, vaginal bleeding, edema/wt gain, and possibly breast cancer. monitor for thromboembolitic events, encourage clients to stop smoking, encourage short term use, and monitor BP and mammograms. client should report vaginal bleeding and edema.

leuprolide (GnRH agonist)

acts on the pituitary to affect and eventually decrease levels of LH, FSH, estrogen, and progesterone. the levels of these hormones decrease so much, that the body can be fooled into thinking menopause has begun, causing the overgrowth of endometrial tissue to shrink and relieve manifestations of endometriosis. ADRs include menopausal s/s (hot flashes, vaginal dryness, headache, bone loss) and osteoporosis. clients should not take this drug for longer than 6 months to reduce risk of osteoporosis. monitor client for bone loss and do DEXA scans at recommended intervals. vitamin b6 and e supplements can reduce vasomotor manifestations. teratogenic

medroxyprogesterone acetate

a form of progesterone that works to relieve endometrial hyperplasia, endometriosis/dysfunctional uterine bleeding, and endometrial cancer. ADRs include thromboembolisms, breast cancer, breakthrough bleeding/menstrual irregularities, nausea, and edema. monitor for s/s of clots, encourage clients to stop smoking and to stay up to date on mammograms, and monitor for vaginal bleeding. many drugs and herbs decrease the efficacy of this drug. teratogenic.

clomiphene (LH/FSH stimulant)

blocks the effect of estrogen receptors on the pituitary gland, increasing the amount of GRH released which then stimulates the release of LH and FSH, causing the production of mature follicles and ovulation to occur. ADRs include vasomotor s/s, breast engorgement, GI s/s, visual disturbances, ovarian hyperstimulation, rupturing of ovarian cysts, and multiple gestation. monitor clients for all ADRs; give orally once daily for 5 days, beginning 5 days after the start of menses. client should take the med at the same time everyday and take a missed dose as soon as possible. for two missed doses, client should consult the provider. teratogenic and a hazardous drug to handle.

hCG (ovulation stimulant)

causes ovulation by stimulating the release of LH in female clients who do not ovulate; usually given after another fertility medication stimulates a follicle to mature. ADRs include hyperstimulation of ovaries, rupturing of ovarian cysts leading to pain and bleeding in peritoneal cavity, and CNS manifestations. monitor for ADRs; before administration, confirm that follicular maturation has occurred via an intravaginal sonography or an ultrasound.

cabergoline (dopamine agonist)

increases the amount of available dopamine which decreases prolactin levels, allowing the menstrual cycle to begin properly/as normal as hormone levels increase. ADRs include nausea, headache, dizziness, pulmonary fibrosis, pericardial fibrosis, valvular disorders, and retroperitoneal fibrosis. begin treatment at the lowest possible dose, monitor serum prolactin levels, and for worsening CNS/GI effects. discontinue when prolactin levels are within the expected reference range.

oxytocin (uterine stimulant)

can be administered to stimulate onset and progression of labor; closely related to ADH. ADRs include hyperstimulation of the uterus, which could cause uterine rupture and death of both the mother and the infant, hypertensive crisis, and water intoxication. monitor clients closely for increasing BP, Is and Os, length/strength/duration of contractions, and LOC. any indication of hyperstimulation (contractions lasting longer than 1 min) should be responded to with lying the client on their side, stopping the infusion, and administering O2. also be sure to monitor fetal HR.

methylergonovine (ergot alkaloid)

cause strong uterine contractions by stimulating smooth muscle in the uterus, helping stop bleeding in the postpartum period or following a surgical or spontaneous abortion. ADRs include HTN, stroke, n/v, uterine cramps, arrhythmias, and seizures. ADRs are usually only seen when given IV. monitor clients BP and HR closely, be ready to institute seizure precautions if indicated. administer in the postpartum period, not during labor.

dinoprostone (synthetic prostaglandins)

prepares the cervix for delivery by activating enzymes that keep it closed and inflexible at the start of pregnancy, then softening it and starting uterine contractions later in pregnancy. administered via endocervical catheter/retreieval tape. ADRs include amniotic fluid embolism, uterine rupture, headache, nausea, vomiting, diarrhea, chills, or hypotension. monitor contractions and be prepared to administer a uterine relaxant.

terbutaline (beta adrenergic agonist)

interferes with a key enzyme involved in uterine contractions to temporarily stop contractions in preterm labors to delay delivery (off-label use). the only beta-2 agonist used as a tocolytic. ADRs include respiratory effects (pulmonary edema, dyspnea, cough, tachypnea), cardiac effects (tachycardia, MI, chest pain, palpitations, hypotension), hypokalemia, and hyperglycemia. some ADRs can be experienced by the fetus itself. monitor respiratory status/oxygen saturation, EKG, blood glucose, heart rate, fetal heart rate, and potassium level.

betamethasone (glucocorticoid)

works to stimulate fetal lung maturity and reduce the risk of complications such as respiratory distress and intraventricular hemorrhage. always given IM. ADRs include pulmonary edema when combined with tocolytic, hyperglycemia in those with diabetes, HTN, and immunosuppression. monitor vital sighs, lung sounds, and blood glucose.

magnesium sulfate

works to treat preterm labor and to prevent/treat seizures during severe preeclampsia or eclampsia. ADRs include diarrhea, flushing, diaphoresis, drowsiness, muscle weakness, CNS effects, decreased urine output, and toxicity (shows hypotension, depressed DTR, and altered LOC). use extreme caution when giving over IV to work to avoid toxicity (serum levels should be 4-7 mEq/L). stop infusion if respiratory rate is less than 12. monitor VS, Is and Os, tendon reflexes, and fetal HR. antidotes are calcium gluconate or calcium chloride.

testosterone

hormone replacement therapy that treats hypogonadism, delayed puberty, and testicular failure in clients assigned male at birth. in females, it can treat breast cancer. ADRs include virillization (development of male secondary sex characteristics in clients assigned female at birth and children), increased growth of undiagnosed prostate cancer, edema/wt gain, and premature growth plate closure. can also cause liver toxicity in 17-alpha-alkylated forms. monitor Is and Os, weight, sodium levels, bone x-rays, and liver function.

finasteride

inhibits the enzyme 5-alpha reductase to decrease amount of testosterone produced in the prostate and regress prostate tissue growth, treating BPH and obstruction of urinary urethra. ADRs include reduced libido and ejaculation volume, and gynecomastia (breast enlargement). PSA levels are also reduced. obtain a baseline level PSA value for patients on this drug and tell them to get checked for prostate cancer if PSA levels do not decline during treatment. avoid in clients who are pregnant or of child bearing age due to potential of birth defects. a lifelong therapy.

tamsulosin

antagonizes the alpha-adrenergic receptors, causing relaxation of smooth muscle in the prostate gland and in the outlet of the bladder, resulting in increased urine flow and decreased BPH manifestations. ADRs include reduced ejaculation volumes, ejaculation failure, and retrograde ejaculation (flows up into the bladder rather than out). other ADRs include dizziness and headache. educate clients on effects on ejaculation and tell them this is a lifelong therapy.

sildenafil

inhibits PDE-5 in the p3nis to sustain er3tions and make them harder and longer lasting. exerts no therapeutic effect if the client is not already feeling frisky. ADRs include priapism (persistent er3ction lasting more than 4 hours), which can lead to permanent tissue damage and impotence. other ADRs include headache, hypotension, fainting, dizziness, and sudden loss of vision or hearing. take 1 hour prior to laying the pipe, once per day. can interact with drugs that cause hypotension, especially nitroglycerin.

oxybutynin (anticholinergic)

blocks the muscarinic receptors in the detrusor muscle, causing the bladder to relax and the internal sphincter to contract, allowing urine to stay in the bladder/treating incontinence. ADRs include anticholinergic effects, which are dry mouth, constipation, blurred vision, headaches, dizziness, fever, heat exhaustion, and urine retention (desired). monitor BMs and voiding for s/s of bladder distention and UTIs. client should obtain periodic eye exams as intraocular pressure can increase.

bethanechol (cholinergic)

activates the muscarinic receptors in the detrusor muscle to cause the bladder to contract and to relax the internal sphincter, allowing urine to pass. ADRs include hypotension, bradycardia, excessive gastric acid secretion, salivation, diarrhea, fecal incontinence, and bronchoconstriction. monitor clients’ blood pressure, HR, and respiratory status. clients should avoid activities requiring alertness.