Reproductive Flashcards by Amanda S.

DES babies

birth defects

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estrogen - reasons to take

Atrophic vaginitis- thinning, drying & inflammation of
vaginal walls
Hypogonadism
🞑 Oral contraception (given with a progestin)
🞑 Dysmenorrhea
🞑 “Hot flashes” of menopause (vasomotor symptoms) 🞑
🞑 Breast & Prostate Cancer
🞑 Osteoporosis

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estrogen contraindications

 Any estrogen-dependent cancer
 Undiagnosed abnormal vaginal bleeding
 Pregnancy - can cause a miscarriage
 Active thromboembolic
disorder or history of stroke,
venous blood clot
Thrombolytic events—most serious

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estrogen adverse

Amenorrhea, breakthrough uterine bleeding
 Tender breasts, fluid retention, headaches (increased fluid)

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Premarin (Enjuvia®, Premarin®)

replace estrogen deficit

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leg cramps

DVTs usually start in the back of the leg so ask about back of leg when sitting for long periods. will hurt when they cross their legs.

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Progestins - produced by…

Produced by corpus luteum, then pregnant placenta
 Synthetic derivatives of progesterone

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Progestins: Indications

Treatment of functional uterine bleeding caused by: after birth
🞑 Hormonal imbalance, fibroids, or uterine cancer
 Treatment of primary and secondary amenorrhea,
palliative cancer & endometriosis
 Prevent conception

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Progestins: Indications - palliative treatment

of some cancers and
endometriosis
 Prevention of threatened miscarriage relaxing uterine smooth muscles
 Alleviation of PMS symptoms

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Progestogens : Indications - Megestrol (Megace) **

synthetic progestin
🞑 Adjunct therapy for treatment of breast and
endometrial cancers
****Management of anorexia, cachexia, or unexplained
weight loss in AIDSpatients
🞑 To stimulate appetite and promote weight gain in
cancer patients
🞑 Female infertility

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Progestins: Adverse Effects

Liver dysfunction- cholestatic jaundice- (flow of bile from
liver slows/stops)
 Thrombophlebitis, thromboembolic disorders,
such as PE
 Nausea, vomiting
 Amenorrhea, breakthrough uterine bleeding,
“spotting”
 Edema, weight gain or loss & depression

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Medroxy-progesterone***

Action: has effects similar to those of progesterone;
inhibits secretion of Pituitary Gonadotropins thus prevents
ovulation
 Class: synthetic progestogens
 Use: treat absent or irregular menstrual periods,
abnormal uterine bleeding. Also used to decrease
the risk of endometrial hyperplasia & renal cancer
 How supplied: tablets, injections\
Dont give to anyone under 25 - leaches calcium out of bones
*****Depo-Provera = 1 shot coverage for 3 months, caution for
under 25 years of age due to bone density issues.

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Medroxyprogesterone (Provera®) - Precautions: Nursing Considerations:

🞑 May causemelasma.Not for usein pregnancy
🞑 Teachwomento do BSE (breast self exam)
🞑 Teachwomen:take Provera by mouthwith or without food.
Takeat the sametime every day, with doses not more than
24 hours a part.
🞑 Teachwomen: If a dose ismissed,take it assoon as
possible. If it is almost time for the next dose, skip the
missed dose and go back to the regular dosing schedule.
Do not take 2 dosesat once
🞑 If miss 2 active pill in 3 weeks or miss 3 or more in a
row. Instruct pt to throw out rest of pack and Start a new
pack that day.

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Contraceptive Drugs - contraindications

Oral medications
🞑 Monophasic, biphasic, and triphasic forms
 Triphasic form most closely duplicates the normal hormonal
levels of the female cycle*
 Depo- Provera- 3 month in 1 shot
🞑 Newer extended cycle products
🞑 Most contain estrogen-progestin combinations

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plan B

 Levon-orgestrel = Plan B, w/in 72 hrs of unprotected sex &
f/up dose 12 hrs after first dose. ($40-50.00)

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Seasonale

( extended cycle), both estrogen & progestin,
women will only have 1 menstrual cycle every 3 months

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Contraceptive Drugs:
Adverse Effects

Drawbacks to the use of these drugs include:
🞑 Hypertension
🞑 Thromboembolism, possible PE, MI, stroke
🞑 Alterations in lipid and carbohydrate metabolism
🞑 Increases in serum hormone concentrations
 These effects are caused by the estrogen
component

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contraceptive adverse

May alsocause:
🞑 Edema,dizziness, headache, Depression,
nausea, vomiting,diarrhea, increased
appetite, increased weight, breast &
changes, many others

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contraceptive interactions***

penicillin and Cephalosporins

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Contraceptive
Drugs: Interactions - Drugs that may have reduced
effectiveness

Anticonvulsants, beta-blockers, hypoglycemic drugs,
oral anticoagulants, theophylline, hypnotics,
tricyclic antidepressants

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fertility drugs - Clomiphene (Clomid®, others)

Nonsteroidal ovulation stimulant
🞑 Blocks estrogen receptors in the uterus and brain,
resulting in a false signal of low estrogen levels - this will produce twins sometimes bc more than one egg

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fertility - mentropins (Pergonal®)

Standardized mixture of FSH and LH
🞑 Stimulates development of ovarian follicles,
leading to ovulation
🞑 May also be given to
men t to stimulate
spermatogenesis
🞑 From urine of post
menopausal women

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Chorionic gonadotropin alfa (Ovidrel®)

Recombinant form of human chorionic gonadotropin
🞑 Causesrupture and ovulation of mature ovarian
follicles, and maintenance of corpus luteum

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Fertility Drugs: Indications

Used primarily to induce ovulation in anovulatory
patients

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Fertility Drugs: Adverse Effects

Tachycardia, phlebitis, DVT, multiple pregnancies****pregnancies, blurred vision (can indicate a clot - serious-stroke), breast pain, others

Uterine- Active Medications

Promote labor (stimulants) ie oxytocin or Prevent the start or progression of labor (relaxants)

Uterine Stimulants - also called

oxytocics -oxytocin hormone secreted from Posterior lobe of Pituitary gland 1. Oxytocin (hormonal drug) 2. Prostaglandins 3. Ergot derivatives 4. Progesterone antagonist *

Oxytocin (Pitocin®) - synthetic form

🞑 Used to induce labor at or near full-term gestation, and to enhance labor when contractions are weak and ineffectivef

oxytocin other uses

🞑 Prevent or control postpartum uterine bleeding 🞑 Complete an incomplete abortion (after miscarriage) 🞑 Promote milk ejection during lactation

Prostaglandins - uterine stimulants

Natural hormones 🞑 Causepotent contraction of myometrium, smoothmuscle fibers of the uterus 🞑 Used to induce labor by softening the cervix and enhancing uterine muscle tone 🞑 dinoprostone (Prostin E2,Cervidil®, Prepidil ) and misoprostol (Cytotec®)( termination of pregnancy 12 wk-20wk)

 Ergot alkaloids (alk = toxic)

Increase force and frequency of uterine contractions 🞑 Used after delivery of the infant and placenta to prevent postpartum uterine atony and hemorrhage 🞑 methylergonovine (Methergine®)

Progesterone antagonist*- Politically charged “ Abortion Pill”

mi-fe-pristone (Mifeprex®) 🞑 Stimulates uterine contractions to induce abortion 🞑 Given with a prostaglandin drug for elective abortions

Uterine Stimulants: Adverse Effects

 Hypotension or hypertension, chest pain  Headache, dizziness, fainting  Nausea, vomiting, diarrhea  Vaginal pain, cramping  Leg cramps, joint swelling, chills, fever, weakness, blurred vision

Uterine Relaxants: Tocolytics

Stop Labor “To-cease-labor”  Used to stop labor that begins before term to prevent premature birth  Generally used after 20th week of gestation(5 mon)

: Tocolytics - INMT (it's not my time)

= Indomethacin-anti/inflammatory N= Nifedipine-CCB M= Mag Sulfate-relax smooth uterine muscle T= Terbutaline –BB, dec uterine contractions

oxy - increase t - it's not my time

Uterine Relaxants: Tocolytics

Uterine contractions that occur between the 20th and 37th weeks of gestation are considered premature labor  Nonpharmacologic measures 🞑 Bed rest (be on left side - to keep flow of blood going), sedation, hydration

Magnesium sulfate IV***********(don't need to know anything else on this slide)

Magnesium sulfate IV also used to stop labor********must have Ca-Glucanate to tx Mag toxic

Uterine Relaxants: Adverse Effects

 Palpitations, tachycardia, Hypertension, others  Tremors, anxiety, insomnia, headache, dizziness, others  Nausea, vomiting, anorexia, bloating, diarrhea, constipation  Hyperglycemia, hypokalemia  Dyspnea, hyperventilation

Uterine Relaxants: nursing implications

 Assess baseline vital signs, weight, blood glucose levels, renal and liver function studies  Assess whether the patient smokes  Assess history and medication history  Assess contraindications, including potential pregnancy

relaxants cont*****

 Before giving any uterine stimulants, assess the mother’s vital signs and fetal heart rate, Q 15 min  Uterine relaxants are used when premature labor occurs between the *****20th and 37th weeks of gestation

 Estrogens and progestins - nursing implications

Give IM doses deep in large muscle masses, & rotate sites - very viscous so do it deep - won't leak

infertility - Advise patients to

Advise patients to keep a journal while on fertility drugs

A woman has not taken her oral contraceptive since Monday morning. It is now Thursday morning. What should she do now to prevent pregnancy?

Start over witha newmonthlypack of oral contraceptives. use a second form of contraceptions

Testosterone

Responsible for normal development and maintenance of primary and secondary male sex characteristics 🞑 Development of bone and muscle tissue 🞑 Inhibition of protein catabolism (metabolic breakdown) 🞑 Retention of various electrolytes - Nitrogen, phosphorus Na & K

adrogen

Several synthetic derivatives of testosterone  Long-term dosage forms can last from 2 to 3 days to 2 to 4 weeks  Oral forms have a high first-pass effect - usually not given orally  Transdermal forms available 🞑 Patches and gel

testosterone precautions

 Precautions: not for use in prostate cancer, male breast cancer, heart, liver and kidney disease

testosterone teaching considerations

keep clean oil buildup can cause acne. May experience mild fluid retention. 🞑 Possible stimulation of prostate tissue growth (hypertrophy), with perhaps some increased urination symptoms such as a decreased stream or frequency. 🞑 Pt is at risk for increased risk of developing prostate cancer

Anabolic steroid

Schedule III. may give to men who aren't growing

Androgens: Mechanism of Action

Stimulation of normal growth and development of the male sex organs 🞑 Development and maintenance of male secondary sex characteristics 🞑 Stimulate increased synthesis of body proteins, aiding in the formation of muscular and skeletal proteins

Androgen Inhibitors

5-Alpha-reductase inhibitors  Alpha1-adrenergic blockers  Androgen receptor blockers  Gonadotropin-releasing hormone (Gn-RH) Analogs

Finasteride (Proscar, Propecia®) and Dutasteride (Avodart®)****

unsafe. Inhibits enzyme converting testosterone to DHT more potent form of testosterone stimulates prostate growth.

Alpha1 -Adrenergic Blockers****

1mg= Alopecia - 5mg= BPH

Drugs to Treat Erectile Dysfunction

sildenafil - board will usually use this name, not viagra. (Viagra®) 🞑 First oral drug for tx of ED Longer Duration  vardenafil (Levitra®)  tadalafil (Cialis®)

Drugs to Treat Erectile Dysfunction

Prolonged erection >4 hrs= medical emergency - priatism - NO NITRATES - causes severe hypotension and we can't get it back up and then have heart attack.

Men’s Health Drugs: Adverse Effects

5-alpha-reductase inhibitors Finasteride 🞑 Loss of libido, loss of erection, ejaculatory dysfunction, other effects 🞑 May cause PSA concentrations to decrease 🞑 PSA- Serum “Prostate Specific Antigen” Inc S/sx of prostate CA 🞑 Normal 2.5 – 3 ng/mL (just know these value)

general list of

what nitrates look like - patch, pill, etc.

Nursing Implications - Men’sHealth Drugs: -

get baseline psa and digital rectal exam - it's hasn't been evidenced based yet. GI upset 🞑 Headache 🞑 Back pain 🞑 Dysuria weight, renal functions, do IM deep it hurts when it leaks out

Transdermal Androderm® patches / gel are applied to the skin on the body, never to scrotal skin

Pregnant women should not handle crushed or broken finasteride tablets,

can cause teratogenesis

Finasteride can be used to treat baldness in both men and women.

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Reproductive Flashcards

(61 cards)