Uterine Stimulants

Oxytocin

This is both a drug and a naturally occurring hormone in the body

Stored in the hypothalamus and moves to the posterior pituitary.

method of action:

Once released, oxytocin stimulates a positive feedback loop. This means that it increases the effect of oxytocin, therefore causing uterine contractions.

Uses:

Induces labor (may be indicated for postterm pregnancy, premature rupture of membranes, preeclampsia- induction of labor)

Enhances labor (indicated for dysfunctional labor)

Delivery of placenta (indicated for postpartum and miscarriage

Management of postpartum hemorrhage

Stress testing

kkkk

Estrogens

moa:

block bone resorption and reduce low-density lipoprotein (LDL) levels. At high levels, they suppress the release of FSH

reminder what FSH does: stimulates growth of ovaries in females

stimulates sperm production in males

Drugs to do with estrogens:

Estradiol (most common!)

Therapeutic uses of Estrogens:

Contraception, along with progestins

Acne in young females

Relief of moderate to severe postmenopausal manifestations (hot flashes, mood changes)

Prevention of postmenopausal osteoporosis

Treatment of dysfunctional uterine bleeding

Treatment of prostate cancer, and hypogonadism

Treatment of moderate to severe vulvar atrophy

Atrophic vaginitis

Breast cancer of prostate cancer

Ovarian failure or castration

Complications of estrogen:

Endometrial and ovarian cancers: this can happen when estrogen is used alone for post menopausal therapy.

To prevent: Administer progestins along with estrogen

Clients should report: persistent vaginal bleeding and schedule and endometrial biopsy every 2 years and pelvic exam yearly.

Potential risk for estrogen dependent breast cancer: most often in postmenopausal women who use estrogen with progestin

As a nurse you should: rule out estrogen dependent breast cancer before starting therapy

Client Education: examine breasts regularly. obtain yearly breast exams by a provider, and periodic mammograms.

Estrogen can cause altered coagulation: it can either suppress blood coagulation or promote it, the effect depends on genetic influences. monitor for embolic events (like a MI, pulmonary embolism, DVT, or stroke)

Increased risk for MI and CAD for clients who are older than 60.

As a nurse you should: monitor for pain, swelling, warmth, or erythema of lower legs.

Client education: avoid all nicotine products

Reduce risk of cardiovascular disease

Adverse effects:

Thrombolytic events: SERIOUS!

hallmark symptoms are

bleeding, bruising, edema, swelling, redness, warmth, etc. LOOK FOR THESE.

Nausea: most common

Hypertension, thrombophlebitis, edema

Vomiting, diarrhea, constipation, abdominal pain

Photosensitivity or chloasma

Amenorrhea, breakthrough uterine bleeding

Tender breasts, fluid retention, headaches

BLACK BOX warning for repro cancer risk, cardiovascular disorders, dementia

Contraindications for estrogens:

Pregnancy

Lactation: they can alter the quality and quantity of breast milk

Family or client history of heart disease

Atypical vaginal bleeding that is not diagnosed

Breast or estrogen dependent cancer

Prepubertal children

Interactions:

Reduces the effectiveness of warfarin.

Nursing actions: if used concurrently, monitor INR and PTT. Warfarin may need to be adjusted

Concurrent use of phenytoin can decrease effectiveness of estrogens

Nursing actions: monitor for decreased estrogen effects. alternative form of contraception may be indicated.

Concurrent use of corticosteroids can increase effects of corticosteroid; monitor for increased corticosteroid effects.

Smoking increases risk for thrombophlebitis; don’t smoke, use alternative treatment if unable to quit

Decreases effects of anticoagulants, oral hypoglycemics, or thyroid medications when used concurrently: monitor for decreased effects, and adjust dosages as needed. monitor glucose and thyroid levels.

Concurrent use with tricyclic antidepressants may promote depressant toxicity

Decrease effectiveness of birth control if used with rifampin (TB drug) and/or St.John’s wort.

Progestins

Most commonly used:

-Levonorgestrel (Plan B)

-Medroxyprogesterone (Provera, Depo-Provera)

inibits the secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation, stimulates the growth of mammary tissue, and has an antineoplastic action against endometrial cancer.

used to treat uterine bleeding, secondary amenorrhea, endometrial cancer, and renal cancer, and is also used as a contraceptive. : this is the one she said in the SLIDE. she did not go in depth to any of the other ones. You CAN take this drug with food or milk to decrease GI upset

Administration: IM: deep into large muscle mass, rotate sites, injection may be painful

you should not be gaining more than five pounds on this medication

-Megestrol (Megace)

-Norethindrone acetate (Avgestin)

-Norgestrel (Ovrette, Ovral)

-Progesterone (Prometrium)

-Etonogestrel implant (Implanon)

Administration: Oral, IM, subcut, transdermal, and intravaginal. Anticipate withdrawal bleeding 3-7 days after stopping the medication.

moa: binds with progesterone receptors in the cell nucleus to induces secretory changes in the endometrium: probably thickens mucus secretions, increases basal body temperature, thickens the vaginal mucosa, relaxes the uterine smooth muscle, stimulates mammary alveolar tissue growth, and feedback inhibition of the release of pituitary gonadotropins.

Indications: treatment of functional uterine bleeding caused by:

-hormonal imbalance

-Fibroids

-Uterine cancer

-Treatment of primary and secondary amenorrhea

-Adjunctive and palliative treatment of some cancers and endometriosis

-Contraception alone or with estrogens

-Amenorrhea-it will initiate menses

-Endometriosis

-Support early pregnancy

-Prevention of preterm birth

-Alleviation of premenstrual syndrome symptoms

Complications

Breast cancer in postmenopausal clients when used in combination with estrogens.

To prevent: teach client how to do regular breast self exams, mammograms, and clinical breast exams.

Thromboembolic events: MI, pulmonary embolism, thrombophlebitis, stroke

Discourage clients from smoking, and monitor for pain, swelling, warmth, or erythema of lower legs. NOTIFY PROVIDER OF CHEST PAIN OR SHORTNESS OF BREATH

Breakthrough bleeding, amenorrhea, breast tenderness

Client education: obtain baseline clinical breast exam and Pap smear, and report abnormal vaginal bleeding.

Edema: Monitor blood pressure, I and O and weight gain.

cholestatic Jaundice: Monitor for indications of jaundice (yellowing of skin and sclera of eyes). Monitor liver enzymes

Migraine headaches: Notify provider of severe headache.

BLACK BOX WARNING FOR REPRODUCTIVE CANCER RISK, CARDIOVASCULAR DISORDERS, DEMENTIA

Contraindications:

Pregnancy

Lactation

If pregnancy is planned or suspected

Undiagnosed vaginal bleeding

History of thromboembolic disease, cardiovascular, or cerebrovascular disease

History of breast or genital cancers

Use cautiously in clients with diabetes mellitus, seizures, and migraine headaches.

Interactions:

Increase effects of benzodiazepines, voriconazole.

May be decreased if taken with barbiturates, carbamzepine, phenytoin, rifampin, and St Johns Wort.

Evaluation of medication effectiveness:

Restoration of hormonal balance with control of uterine bleeding, restoration of menses, decrease in endometrial hyperplasia in postmenopausal clients receiving concurrent estrogen, control of the spread of endometrial cancer.

Oral contraceptive medications

Estrogen-progestin combinations. OCs that only contain progestin are minipills.

There are monophasic, biphasic, triphasic, or quadriphasic.

Monophasic OCs: dose of estrogen to progestin is the same throughout the cycle. Other classifications, the estrogen/progestin changes to duplicate a typical menstrual cycle

Medications:

Combined oral contraceptives with estrogen plus progestin

-Ethinyl estradiol and norethindrone

-Ehinyl estradiol and drospirenone

-Progestin only oral contraceptives: Norethindrone

Other medications:

Transdermal patch: Ethinyl estradiol and norelgestromin

Vaginal contraceptive ring: Ethinyl estradiol and etonogestrel

Parenteral: depot medroxyprogesterone acetate available for IM use and for subcutaneous use

Etonogestrel implants

Hormonal IUD