Drugs for Female Reproductive System Nursing Considerations & Management

The female reproductive system works in a cyclical fashion and altering the components of this cycle can have a variety of effects to the body. Hormones and hormonal-like agents are primarily the drugs that affect the female reproductive system.

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Table of Common Drugs and Generic Names

Here is a table of commonly encountered female reproductive system drugs, their generic names, and brand names:

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Female Sex Hormones

Female sex hormones both can be used to replace missing hormones or to decrease the release of endogenous hormones. The female sex hormones include estrogen and progesterone.

Therapeutic Action

The desired and beneficial actions of female sex hormones are as follows:

Estrogens

• The most potent endogenous female sex hormone responsible for estrogen effects on the body.
• Affect the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
• Responsible for the proliferation of the endometrial lining and are known to compete with androgens for receptor sites.
• The loss of estrogen is responsible for the signs and symptoms of menopause in the uterus, vagina, breasts, and cervix.

Progestins

• Transform the proliferative endometrium into a secretory endometrium. They also inhibit the secretion of FSH and LH.
• Prevent follicle maturation and ovulation as well as uterine contraction.
• Exact mechanism of action in its function as a contraceptive is not known but it it thought that circulating progestins and estrogens “trick” the hypothalamus and pituitary and prevent the release of gonadotropin-releasing hormone (GnRH), FSH, and LH. Therefore, follicle development and ovulation are prevented.

Indications

Female sex hormones are indicated for the following medical conditions:

Estrogens

• Used for hormone replacement therapy (HRT) in small doses when ovarian activity is blocked or absent.
• Used as palliation for the discomforts of menopause in the first few years of menopause, when many of the beneficial effects of estrogen are lost.
• Treat female hypogonadism and ovarian failure; to prevent postpartum breast engorgement.
• To slow bone loss in osteoporosis.
• Palliation of cancers that have known receptor sensitivity.

Progestins

• Transform the proliferative endometrium into a secretory endometrium. They also inhibit the secretion of FSH and LH.
• Prevent follicle maturation and ovulation as well as uterine contraction.
• Exact mechanism of action in its function as a contraceptive is not known but it it thought that circulating progestins and estrogens “trick” the hypothalamus and pituitary and prevent the release of gonadotropin-releasing hormone (GnRH), FSH, and LH. Therefore, follicle development and ovulation are prevented.

Here are some important aspects to remember for indication of female sex hormones in different age groups:

Children

• Have undergone little testing in children. They can cause premature closure of epiphysis so caution is important in growing children.
• Smallest dose possible is used for prescribed oral contraceptives in teenage girls.

Adults

• Women receiving any of these drugs should receive an annual medical examination, including breast examination and Pap smear, to monitor for adverse effects and underlying medical conditions.
• Women taking estrogen should be advised not to smoke because of the increased risk of thrombotic events.
• Women who are receiving these drugs for fertility programs should receive a great deal of psychological support and comfort measures to cope with the many adverse effects associated with these drugs. The risk of multiple births should be explained.
• Drugs are used in treatment of specific cancers in males and they should be advised about the possibility of estrogenic effects.
• Not indicated during pregnancy or lactation because of potential for adverse effects on the fetus or neonate.

Older adults

• HRT is no longer commonly used by postmenopausal women.

Pharmacokinetics (Estrogen)

Here are the characteristic interactions of female sex hormone estrogen and the body in terms of absorption, distribution, metabolism, and excretion:

Pharmacokinetics (Progestins)

Here are the characteristic interactions of female sex hormone progestin and the body in terms of absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

Estrogens

The following are contraindications and cautions for the use of estrogens and progestins:

• Allergy to estrogens. Prevent hypersensitivity reactions.
• Idiopathic vaginal bleeding, breast cancer, estrogen-dependent cancer. Can be exacerbated by drug.
• History of thromboembolic disorders, cerebrovascular accident, heavy smokers. Increased risk of thrombus and embolus development
• Hepatic dysfunction. Estrogen have effects on liver function.
• Pregnancy. Estrogen are linked to serious fetal defects
• Lactating women. Possible effects to the neonate
• Metabolic bone disease. Estrogen has bone-conserving effect and could exacerbate the disease.
• Renal insufficiency. Can interfere with the renal excretion of the drug and increase the risk for potential adverse effects on fluid and electrolyte balance
• Hepatic impairment. Can alter the metabolism of the drug and increase the risk for the adverse effects, including those on the liver and GI tract.

Progestins

• Pelvic inflammatory disease (PID), sexually transmitted diseases, endometriosis, pelvic surgery. Progestins have effects on the vasculature of the uterus.
• Drosperinone is contraindicated in patients who are at risk for hyperkalemia due to its antimineralocorticoid effects and the risk of hyperkalemia.
• Epilepsy, migraine headaches, asthma, cardiac or renal dysfunction. Potential exacerbation of these conditions.

Adverse Effects

Use of female sex hormones may result to these adverse effects:

Estrogen

• GI: nausea, vomiting, abdominal cramp, bloating, colitis, acute pancreatitis, cholestatic jaundice, hepatic adenoma
• GU: breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, changes in libido
• Systemic effects: fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, edema

Progestins

• Systemic effects are similar to estrogen.
• Dermal patch contraceptives are associated with same systemic effects, as well as local skin irritation.
• Vaginal gel use is associated with headache, nervousness, constipation, breast enlargement, and perineal pain.
• Intrauterine systems are associated with abdominal pain, endometriosis, abortion PID, and expulsion of the intrauterine device.
• Vaginal use is associated with local irritation and swelling.

Interactions

The following are interactions involved in the use of female sex hormones:

Estrogen

• Barbiturates, rifampin, tetracyclines, phenytoin: decreased serum estrogen levels
• Corticosteroids: increased therapeutic and toxic effects of corticosteroids.
• Nicotine: Increased risk of thrombi and emboli
• Grapefruit juice: inhibition of metabolism of estradiols
• St. John’s wort: can affect metabolism of estrogens and can make estrogen-containing contraceptives less effective.

Progestins

• Barbiturates, carbamazepine, phenytoin, griseofulvin, penicillin, tetracyclines, rifampin: reduced effectiveness of progestins
• St. John’s wort: can affect the metabolism of progestins and can make progestin-containing contraceptives less effective.

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Estrogen Receptor Modulators

Estrogen receptor modulators are agents that either stimulate or block specific estrogen receptor sites.

Therapeutic Action

The desired and beneficial actions of depolarizing estrogen receptor modulator are:

• To produce some of the positive effects of estrogen replacement while limiting the adverse effects.
• To increase bone mineral density without stimulating the endometrium.

Indications

Estrogen receptor modulators are indicated for:

• Prevention and treatment of osteoporosis in postmenopausal women.

Here are some important aspects to remember for indication of estrogen receptor modulators in different age groups:

Children

• Have undergone little testing in children. They can cause premature closure of epiphysis so caution is important in growing children.

Adults

• Women receiving any of these drugs should receive an annual medical examination, including breast examination and Pap smear, to monitor for adverse effects and underlying medical conditions.
• Not indicated during pregnancy or lactation because of potential for adverse effects on the fetus or neonate.

Older adults

• HRT is no longer commonly used by postmenopausal women.

Pharmacokinetics

Here are the characteristic interactions of estrogen receptor modulators and the body in terms of absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

Contraindications and cautions for the use of estrogen receptor modulators are the following:

• Allergy to estrogen receptor modulators. Prevent hypersensitivity reactions.
• Pregnancy, lactation. Potential effects on the fetus or neonate.
• History of venous thrombosis or smoking. Increased risk of blood clot formation if smoking and estrogen are combined.

Adverse Effects

Use of estrogen receptor modulators may result to these adverse effects:

• Raloxifene has been associated with GI upset, nausea, and vomiting.
• Changes in fluid balance may cause headache, dizziness, visual changes, and mental changes.
• Specific estrogen receptor stimulation may cause hot flashes, skin rash, edema, and vaginal bleeding.

Interactions

The following are drug-drug interactions involved in the use of estrogen receptor modulators:

• Cholestyramine: reduced raloxifene absorption
• Highly protein-bound drugs (e.g. diazepam, ibuprofen, indomethacin, naproxen): interference on binding sites
• Warfarin: decreased prothrombin time if taken with raloxifene

Nursing Considerations

Here are important nursing considerations when administering female sex hormones and estrogen receptor modulators:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

• Assess for the mentioned cautions and contraindications (e.g. drug allergies, cardiovascular diseases, metabolic bone disease, history of thromboembolism, etc.) to prevent any untoward complications.
• Perform a thorough physical assessment (e.g. bowel sounds, skin assessment, vital signs, mental status, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
• Assist with pelvic and breast examinations. Ensure specimen collection for Pap smear and obtain a history of patient’s menstrual cycle to provide baseline data and to monitor for any adverse effects that could occur.
• Arrange for ophthalmic examination especially for patients who are wearing contact lenses because hormonal changes can alter the fluid in the eye and curvature of the cornea, which can change the fit of contact lenses and alter visual acuity.
• Monitor laboratory test results (e.g. urinalysis, renal and hepatic function tests, etc.) to determine possible need for a reduction in dose and evaluate for toxicity.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

• Ineffective tissue perfusion related to changes in the blood vessels brought about by drug therapy and risk of thromboemboli
• Excess fluid volume related to fluid retention
• Acute pain related to systemic side effects of gastrointestinal (GI) pain and headache

Implementation with Rationale

These are vital nursing interventions done in patients who are taking female sex hormones and estrogen receptor modulators:

• Administer drug with food to prevent GI upset.
• Provide analgesic for relief of headache as appropriate.
• Provide small, frequent meals to assist with nausea and vomiting.
• Monitor for swelling and changes in vision or fit of contact lenses to monitor for fluid retention and fluid changes.
• Provide comfort measures to help patient tolerate drug effects.
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote understanding and compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

• Monitor patient response to therapy (palliation of signs and symptoms of menopause, prevention of pregnancy, decreased risk factors for coronary artery disease, and palliation of certain cancers).
• Monitor for adverse effects (e.g. GI upset, edema, changes in secondary sex characteristics, headaches, thromboembolic episodes, and breakthrough bleeding).
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.

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Fertility Drugs

Fertility drugs are agents that stimulate the female reproductive system.

Therapeutic Action

The desired and beneficial actions of fertility drugs are as follows:

• Can be used by women without primary ovarian failure who cannot get pregnant after 1 year of unprotected sexual intercourse.
• Work either directly stimulate follicles and ovulation or stimulate the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova.

Indications

Fertility drugs are indicated for the following medical conditions:

• Treatment of infertility in women with functioning ovaries whose partners are fertile.
• Used to stimulate multiple follicle development for harvesting of ova for in vitro fertilization.
• Menotropins are used to stimulate spermatogenesis in men with low sperm counts and otherwise normally functioning testes.
• Cetrorelix inhibits premature LH surges in women undergoing controlled overain stimulation by acting as a GnRH antagonist.
• Follitropin alfa and follitropin beta are FSH molecules injected to stimulate follicular development in the treatment of infertility and for harvesting of ova in vitro fertilization.

Pharmacokinetics

Here are the characteristic interactions of fertility drugs and the body in terms of absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

The following are contraindications and cautions for the use of fertility drugs:

• Allery to fertility drug. Prevent hypersensitivity reactions
• Primary ovarian failure. These drugs only work to stimulate functioning ovaries
• Thyroid or adrenal dysfunction. Drugs have effects on the hypothalamic-pituitary acxis
• Ovarian cysts. Can be stimulated by the drugs and can become larger
• Pregnancy. Due to the potential for serious fetal effects
• Idiopathic uterine bleeding. Can represent an underlying problem that could be exacerbated by the stimulatory effects of these drugs.
• Lactation. Risk of adverse effects on the baby
• Thromboembolic disease. Increased risk of thrombus formation
• Women with respiratory diseases. Alterations in fluid volume and blood flow can overtax the respiratory system.

Adverse Effects

Use of fertility drugs may result to these adverse effects:

• Greatly increased risk of multiple births and birth defects
• Ovarian overstimulation: abdominal plain, distention, ascites, pleural effusion
• Others: headache, fluid retention, nausea, bloating, uterine bleeding, ovarian enlargement, gynecomastia, and febrile reactions possibly due to stimulation of progesterone release.

Nursing Considerations

Here are important nursing considerations when administering fertility drugs:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

• Assess for the mentioned cautions and contraindications (e.g. drug allergies, primary ovarian failure, thyroid or adrenal dysfunction, ovarian cysts, idiopathic uterine bleeding, thromboembolic diseases, etc.) to prevent any untoward complications.
• Perform a thorough physical assessment (e.g. skin condition, vital signs, neurological status, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
• Assist with pelvic and breast examinations. Ensure specimen collection for Pap smear and obtain a history of patient’s menstrual cycle to provide baseline data and to monitor for any adverse effects that could occur.
• Monitor laboratory test results (e.g. hormonal levels, renal and hepatic function tests, etc.) to determine possible need for a reduction in dose and evaluate for ovarian hyperstimulation.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

• Acute pain related to headache, fluid retention, or GI upset
• Sexual dysfunction related to alterations in normal hormone control
• Disturbed body image related to drug treatment and diagnosis

Implementation with Rationale

These are vital nursing interventions done in patients who are taking fertility drugs:

• Assess the cause of dysfunction before beginning therapy to ensure appropriate use of the drug.
• Complete a pelvic examination before each use of the drug to rule out ovarian enlargement, pregnancy, or uterine problems.
• Check urine estrogen and estradiol levels before beginning therapy to verify ovarian function.
• Administer with an appropriate dose of human chorionic gonadotropin as indicated to ensure beneficial effects.
• Discontinue the drug at any sign of ovarian overstimulation and arrange for hospitalization to monitor and support the patient if this occurs.
• Provide women with a calendar of treatment days, explanations of adverse effects to anticipate, and instructions on when intercourse should occur to increase the therapeutic effectiveness of the drug.
• Provide warnings about the risk and hazards of multiple births so the patient can make informed decisions about drug therapy.
• Offer support and encouragement to deal with low self-esteem issues associated with infertility.
• Provide comfort measures to help patient tolerate drug effects.
• Educate client on drug therapy to promote understanding and compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

• Monitor patient response to therapy (ovulation).
• Monitor for adverse effects (e.g. abdominal bloating, weight gain, ovarian overstimulation, multiple births).
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.

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Uterine Motility Drugs: Oxytocics

Uterine motility drugs stimulate uterine contractions to assist labor (oxytocics) or induce abortion (abortifacients).

Therapeutic Action

The desired and beneficial actions of oxytocics are the following:

• To stimulate uterine contractions like the action of the hypothalamic hormone oxytocin stored in the posterior pituitary.
• They directly affect neuroreceptor sites to stimulate uterine contraction and are especially effective in the gravid uterus.
• Oxytocin, a synthetic form of the hypothalamic hormone, also stimulates the lacteal glands in the breast to contract, promoting milk ejection in lactating women.

Indications

Oxytocics are indicated for:

• Prevention and treatment of uterine atony after delivery, thus reducing the risk of postpartum hemorrhage.

Pharmacokinetics

Here are the characteristic interactions of oxytocics and the body in terms of absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

The following are contraindications and cautions for the use of oxytocics:

• Allery to oxytocics. Prevent hypersensitivity reactions.
• Cephalopelvic disproportion, unfavorable fetal position, complete uterine atony, early pregnancy. Can be compromised by uterine stimulation.
• Coronary disease, hypertension. Due to effect of causing arterial contraction which could raise blood pressure or compromise coronary blood flow.

Adverse Effects

Use of oxytocics may result to these adverse effects:

• Excessive effects: uterine hypertonicity and spasm, uterine rupture, postpartum hemorrhage, decreased fetal heart rate
• Common effects: GI upset, nausea, headache, dizziness
• Ergotism caused by ergonovine and methylergonovine: nausea, blood pressure changes, weak pulse, dyspnea, chest pain, numbness and coldness in extremities, confusion, excitement, delirium, convulsions, coma
• Oxytocin has caused severe water intoxication with coma and even maternal death when used for a prolonged period.

Nursing Considerations

Here are important nursing considerations when administering oxytocics:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

• Assess for the mentioned cautions and contraindications (e.g. drug allergies, current status of lactation, uterine atony, hypertension, etc.) to prevent any untoward complications.
• Perform a thorough physical assessment (e.g. neurological status, vital signs, laborpattern, uterine tone, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
• Monitor laboratory test results (e.g. coagulation studies, complete blood count, etc.) to evaluate hematological studies.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

• Acute pain related to increased frequency and intensity of uterine contractions or headache
• Excess fluid volume related to ergotism or water intoxication

Implementation with Rationale

These are vital nursing interventions done in patients who are taking oxytocics:

• Ensure fetal position (if appropriate) and cephalopelvic proportions to prevent serious complications of delivery.
• Regulate oxytocin delivery using an infusion pump between contractions if it is being given to stimulate labor to regulate dose appropriately.
• Monitor blood pressure and fetal heart rate frequently during and after administration to monitor for adverse effects.
• Monitor uterine tone and involution and amount of bleeding to ensure safe and therapeutic drug use.
• Provide comfort measures to help patient tolerate drug effects.
• Educate client on drug therapy to promote understanding and compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

• Monitor patient response to therapy (uterine contraction, prevention of hemorrhage, milk “let down”).
• Monitor for adverse effects (e.g. blood pressure changes, uterine hypertonicity, water intoxication, ergotism).
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.

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Abortifacients

Therapeutic Action

The desired and beneficial action of abortifacient is:

• To stimulate uterine activity, dislodging any implanted trophoblasts and preventing implantation of any fertilized egg.

Indications

Abortifacients are indicated for:

• Evacuation of uterine contents via intense uterine contractions
• Approved for use to terminate pregnancy at 12-20 weeks from the date of the last menstrual period.

Pharmacokinetics

Here are the characteristic interactions of abortifacients and the body in terms of absorption, distribution, metabolism, and excretion:

Contraindications and Cautions

The following are contraindications and cautions for the use of abortifacients:

• Allergy to abortifacients and prostaglandins. Prevent hypersensitivity reactions
• After 20 weeks from the last menstrual period. Too late into the pregnancy for an abortion
• Active PID, CV, hepatic, renal, pulmonary disease. Can be exacerbated by the effects of the drug.
• Lactation. Potential for serious effects on the neonate.
• Asthma, hypertension, adrenal disease. Can be exacerbated by drug effects
• Acute vaginitis, scarred uterus. Can be aggravated by uterine contractions

Adverse Effects

Use of abortifacients may result to these adverse effects:

• Due to exaggeration of desired effects: abdominal cramping, heavy uterine bleeding, perforated uterus, uterine rupture
• Others: headache, nausea, vomiting, diarrhea, diaphoresis, backache, rash

Nursing Considerations

Here are important nursing considerations when administering abortifacients:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

• Assess for the mentioned cautions and contraindications (e.g. drug allergies, active PID, CV diseases, etc.) to prevent any untoward complications.
• Perform a thorough physical assessment (e.g. neurological status, vital signs, skin condition, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
• Monitor laboratory test results (e.g. leukocyte count, hemoglobin and hematocrit, complete blood count, etc.) to monitor for excess bleeding.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

• Acute pain related to uterine contractions or headache
• Ineffective coping related to abortion or fetal death

Implementation with Rationale

These are vital nursing interventions done in patients who are taking abortifacients:

• Administer via route indicated, following the manufacturer’s directions for storage and preparation, to ensure safe and therapeutic use of the drug.
• Confirm the age of pregnancy before administering the drug to ensure appropriate use of the drug.
• Confirm that abortion or uterine evacuation is complete by assessing vaginal bleeding and passing of tissue in the vaginal blood to avoid potential bleeding problems.
• Monitor blood pressure frequently during and after administration to assess for adverse effects.
• Monitor uterine tone and involution and the amount of bleeding during and for several days after use of the drug to ensure appropriate response to and recovery from the drug.
• Provide comfort measures to help patient tolerate drug effects.
• Educate client on drug therapy to promote understanding and compliance.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

• Monitor patient response to therapy (evacuation of uterus).
• Monitor for adverse effects (e.g. GI upset, blood pressure changes, nausea, hemorrhage, etc.).
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.

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