Medications Affecting Reproductive Tract

Module 5B: Medications Affecting Reproductive Tract

Estrogen Only Medications

• Used for:
  • Relief of postmenopausal symptoms (SISX).
  • Monitoring of blood pressure (BP) and edema.
  • Prevention of postmenopausal osteoporosis.
• Nurse Insights:
  • Estrogen increases the risk for:
  • Osteoporosis.
  • Thromboembolic disorders.
  • Dysfunctional uterine bleeding.
• Contraindications:
  • Breast cancer history (rule out estrogen-dependent conditions).
  • Pregnancy.
  • Lactation.
  • Prepubertal children.
  • Women with a uterus have an increased risk for endometrial and ovarian cancers.
  • AVOID smoking/nicotine use.

Estrogen + Progestin Medications

• Used for:
  • Contraception.
  • Addition of progesterone is utilized to manage risks associated with estrogen.
  • Treatment of dysfunctional uterine bleeding.
• Nurse Insights:
  • Risks associated with estrogen+progestin include:
  • Increased risk for breast cancer.
  • Development of endometrial cancer in menopausal patients.
  • Monitoring required for blood pressure.
• Contraindications:
  • Pregnancy.
  • Lactation (may lead to dry milk).
  • Women who smoke and are over 35 years old.
  • History of breast cancer.
  • Report signs/symptoms of thromboembolic disorders.
  • Risk for hyperkalemia if taken with certain medications.

Progestin Only Medications

• Used for:
  • Contraception.
  • Management of dysfunctional uterine bleeding.
• Nurse Insights:
  • Adverse Reactions (ADR):
  • Symptoms may occur 3-7 days post-administration.
  • Hot flashes.
  • Increased risk for breast cancer and breast enlargement.
  • Increased ovarian size.
• Contraindications:
  • Undiagnosed vaginal bleeding.
  • Pregnancy.
  • Jaundice, migraines.
• Monitoring Required:
  • Regular BP checks for women on oral contraceptives (OC).
  • Report symptoms of deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and stroke.
  • Avoid smoking/nicotine.
• Notes on Progestin Mini-Pills:
  • Considered safe for breastfeeding.

Magnesium Sulfate (for Pre-term Labor)

• Actions:
  • Prevents and treats seizures related to pre-eclampsia and eclampsia.
• Nurse Insights:
  • Strict intake/output monitoring required.
  • Monitor magnesium levels, kidney function, and calcium levels.
  • Signs of magnesium toxicity include maternal hypotension and bradycardia.
  • Monitor respiratory rate > 12 and deep tendon reflexes.

Testosterone

• Anabolic Steroid Abuse:
  • Illegal and can lead to various side effects including:
  • Acne.
  • Testicular atrophy and gynecomastia in men.
  • Masculinization, enlargement of clitoris, and hirsutism in women.
  • Regardless of sex, abuse can increase the risk of heart attack and stroke.

Finasteride (5-Alpha Reductase Inhibitor)

• Usage:
  • Used for benign prostatic hyperplasia (BPH) and treatment of male pattern baldness.
• Adverse Reactions (ADR):
  • Decreased libido, decreased ejaculate volume, gynecomastia.
  • Do not donate blood for at least 6 months post-treatment.
• Contraindications:
  • Pregnancy category X (harmful to the fetus).
  • Monitor prostate-specific antigen (PSA) levels.
  • Caution with liver disease.
• Additional Notes:
  • May take 6 months or longer to see effects.
  • Monitor for erectile dysfunction.

Sildenafil (Viagra)

• Uses:
  • Treats erectile dysfunction.
  • Causes the release of nitric oxide leading to vasodilation and erection.
• Warnings:
  • Priapism: a persistent erection lasting over 4 hours can lead to permanent damage if untreated.
  • Report any loss of hearing.
• Monitoring & Administration:
  • Monitor for hypotension.
  • Patient education includes taking it prior to sexual activity and not exceeding one dose per day.
  • Avoid high-fat foods as they may delay effects.
  • Do not take within 24 hours of nitroglycerin for chest pain, as it may lead to life-threatening hypotension due to vasodilation.