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1. Meds Affecting Reproduction
(General Key Points)
N203
ATI (Unit 12)
Reproductive System -

2. · Testosterone produced by testes, ovaries, and adrenal cortex. Primary androgen in
both genders.
· ♀: Primary estrogen and progestional are estradiol and progesterone. Both made
in ovaries  maturation of ♀ reproductive organs & 2º sex characteristics.
· Menstruation results from  progesterone toward end of cycle
· Menopausal symptoms result from  estrogen levels.
· Clinical uses of hormone preparations: Hormone deficiencies and oppositional
treatment of hormone-dependent cancers.
· Postmenopausal HRT: Benefits include vasomotor symptom relief and prevention
of osteoporosis. Risks include embolic events and cancers.
· Oral contraceptives suppress ovulation using ethinyl, estradiol, and
norethindrone
· OC risks are minimal except in smokers and those with Hx of embolic events.
· Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics are
used to delay preterm labor.

3. Oxytocics
N203
ATI (Unit 12)
Reproductive System -

4. Expected Action:
Proto: oxytocin (Pitocin)
Others: methylergonovine (Methergine)
·  strength, frequency, and duration of uterine contractions
Therapeutic Uses: ·
· Methergine: Emergency intervention for serious postpartum hemorrhage
· Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of
postpartum bleeding // Fetal stress testing // Milk letdown (intranasal)
Adverse Effects: ·
· Methergine: Hypertensive crisis (IV): Headache, nausea, BP
· Oxytocin: Uterine rupture {Relax myometrium ĉ Mg(SO4)}
Contraindications/Precautions: ♀ (?) · Methergine: Hypertension
· Methergine: Cardiovascular, renal, or hepatic failure.
· Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs,
cephalopelvic disproportion, prolapsed umbilical cord, fetal distress.
Interactions: · Vasopressors  hypertension
Education: · Use infusion pump and gradually  rate
·  contractions longer than 60 sec, freq > q 2-3 min  infusion

5. Tocolytic Medications
N203
ATI (Unit 12)
Reproductive System -

6. Expected Action:
Proto: Terbutaline sulfate (Brethine)
Others: magnesium sulfate, ritodrine
· Selectively activates β2-adrenergic receptors  uterine smooth muscle relaxation
Therapeutic Uses: · Delay of preterm labor
Adverse Effects: · Tremors, anxiety, headache (β2 skeletal muscle side effects)
· Tachycardia, palpitations, chest pain (β1 side effects)
Contraindications/Precautions: ♀ (?) · Pregnancy // lactation
Interactions: · Concurrent use of β-blockers  blunt effects
· Concurrent use of adrenergic agonists  additive effects
· Concurrent use of MAOIs  Hypertension

7. Androgens
N203
ATI (Unit 12)
Reproductive System -

8. Expected Action:
Proto: testosterone (Delatestryl) — Others: fluoxymesterone
(Halotestin), methyl testosterone (Oreton), danazol (Danocrine)
· Growth and maturation of ♂ sex organs and 2º sex characteristics. Promotes
skeletal muscle growth.
Therapeutic Uses: · Hypogonadism in androgen-deficient men
· Delayed puberty · Palliative treatment of androgen-responsive breast cancer
Adverse Effects: · Hypercalcemia (ĉ breast cancer treatment)
· CV risks:  LDL,  HDL, edema · Hepatotoxicity
· ♂: Acne, facial hair, gynecomastia, impotence, priapism
· ♀: Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities
Contraindications/Precautions: ♀ (X) · Pregnancy · Prostate cancer
· Liver, heart, or renal failure ·
Interactions: · Hepatotoxic drugs:  risk of liver damage
· Warfarin, oral hypoglycemics, and glucocorticoids  androgen effects on
metabolism can  levels of these.
Education: · Report weight gain > 2 lb/week.

9. Estrogens
N203
ATI (Unit 12)
Reproductive System -

10. Expected Action:
Proto: conjugated equine estrogens (Premarin)
Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)
· Growth and maturation of ♀ reproductive tract and 2º sex characteristics. They 
bone resorption and  LDL. At high levels they suppress release of FSH.
Therapeutic Uses: · Dysfunctional uterine bleeding & endometriosis
· Postmenopausal symptoms & osteoporosis · Prostate cancer · Contraception
Adverse Effects: · Risk for estrogen-dependent breast cancer
· Prolonged estrogen  endometrial / ovarian cancers (Give progestins, too)
· Emboli ( risk from smoking) · Feminization, impotence,  libido in ♂
Contraindications/Precautions: ♀ (X) · Pregnancy · Breast cancer
· Risk of thromboembolic disease · Pt. or family Hx of heart disease
Interactions: · Estrogens  η of warfarin · Phenytoin   toxicity
Education: · IM deep into large muscle mass · Apply patches to trunk

11. Progesterones
N203
ATI (Unit 12)
Reproductive System -

12. Expected
Action:
Proto: medroxyprogesterone (Provera)
Others: norethindrone (Micronor), megestrol acetate (Megace)
· Induce favorable conditions for fetal development and maintain pregnancy.  in
progesterone levels  menstruation.
Therapeutic Uses: ·
· Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine
bleeding, amenorrhea, endometriosis, and endometrial cancer.
Adverse Effects: · Breast cancer · Edema · Thromboembolic events
· Breakthrough bleeding, amenorrhea, breast tenderness
Contraindications/Precautions: ♀ (X) · Breast cancer ·
· Hx of thromboembolic, cardiovascular, cerebrovascular disease.
· Undiagnosed vaginal bleeding
Interactions: ·
· Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,
tetracycline, penicillin all η of oral contraceptives.
Education: · Anticipate withdrawal bleeding for 3-7 days

13. Oral Contraceptives
N203
ATI (Unit 12)
Reproductive System -

14. Expected Action: Proto: Ovcon 35 — Others: Necon, ortho-novum
·  fertility by inhibiting ovulation, thickening cervical mucous, and making
lining of endometrium less favorable to implantation.
Therapeutic Uses: · Prevent pregnancy
Adverse Effects: · Hypertension · Thromboembolic events
· Breakthrough or abnormal uterine bleeding · Cervical cancer
Contraindications/Precautions: ♀ (X) · Pregnancy
· Hx of thrombophlebitis and cardiovascular events · Smoker > 35
· Family history or risk factors for breast cancer
Interactions: · OC η of warfarin and oral hypoglycemics
· Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin,
tetracycline, penicillin all η of oral contraceptives.
Education: · Take for 21 days followed by 7 days with no drug
· 1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days

15. Antineoplastic Agent
(1 of 2)
N203
ATI (Unit 12)
Reproductive System -

16. Expected Action: Proto: leuprolide (Lupron)
· Synthetic luteinizing hormone  testosterone levels and  uterine fibroid
growth
Therapeutic Uses: · Palliative treatment of advanced prostate cancer
· Uterine fibroids and endometriosis
Adverse Effects: · Hot flashes · Bone pain
· Thromboembolic events ( risk with smoking)
Contraindications/Precautions: ♀ (X) · Pregnancy and lactation
Education: · Administer leuprolide immediately upon reconstitution
· Administer leuprolide depot preparations deep IM

17. Antineoplastic Agents
(2 of 2)
N203
ATI (Unit 12)
Reproductive System -

18. Expected Action:
Proto: tamoxifen (Nolvadex), Selective Estrogen
Receptor Modulators (SERMs)
· Tamoxifen competes ĉ estrogen   estrogen effects
Therapeutic Uses: · Breast cancer · Breast cancer prevention
Adverse Effects: · Hot flashes · Bone pain · Hyperlipidemia
· Hypercalcemia: Patients with bone metastases  risk for hypercalcemia
Contraindications/Precautions: ♀ (X) · Pregnancy and lactation
· History of DVT
Interactions: · Warfarin:  anticoagulant effect
· Antineoplastic agents:  antineoplastic effects (nausea, vomiting, neutropenia)
Education: · Give with food or fluid if gastric upset occurs
· Omit missed doses · Monitor for weight gain and peripheral edema

19. Erectile Dysfunction
N203
ATI (Unit 12)
Reproductive System -

20. Expected Action:
Proto: sildenafil (Viagra) — Others: tadalafil (Cialis),
vardenafil (Levitra)
· Augments effects of nitric oxide released during stimulation  blood to corpus
cavernosum  penile erection.
Therapeutic Uses: · Erectile dysfunction
Adverse Effects: · Priapism:  if longer than 4 hours
· MI, sudden death: Evaluate and monitor cardiovascular history and health
Contraindications/Precautions: ♀ (?) · Cardiovascular disease
· Taking medications in nitrate family including nitroglycerin
Interactions: · Organic nitrates (nitroglycerin)  fatal hypotension
· Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil
metabolism   plasma level of sildenafil.
Education: · Take 1 hour before sex; limit to 1x/day.