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UNIT XIII.

Drugs
Affecting the
Reproductive System
Drugs Related To
Female
Reproductive
Cycle
Drugs that decrease uterine
muscle contractility
 Preterm Labor
 labor that occurs between 20 wks and 37
wks of pregnancy
 fetus with estimated weight between 500-
2499 g
 regular contractions occur at < 10 min
intervals over 30 to 60 minutes
 contractions strong enough to result in 2 cm
cervical dilation and 80% effacement
 occurs in 8 to 10 & of all pregnancies
 Risk Factors
◦ maternal age <18
◦ maternal age >40
◦ low socioeconomic status
◦ previous history of preterm
delivery
◦ intrauterine infection
◦ polyhydramnios
◦ multiple gestation
uterine anomalies
antepartum hemorrhage
smoking
drug use
urinary tract infection
incompetent cervix
Contraindications of Tocolysis

 pregnancy of < 20 wks (confirmed by


ultrasound)
 bulging or premature rupture of membranes
 confirmed fetal death or anomalies
incompatible with life
 maternal hemorrhage and evidence of
severe fetal compromise
 chorioamnionitis
 Tocolytic Therapy
◦ drug therapy to decrease uterine muscle
contraction
◦ uses beta adrenergic receptor antagonist or the
calcium antagonist magnesium sulfate
GOAL:
◦ to interrupt or inhibit uterine contraction to create
additional time for in utero fetal maturation
◦ to delay delivery so antenatal corticosteroids can
be delivered to facilitate lung maturation
◦ to allow safe transport of the mother to an
appropriate facility
Beta Sympathomimetic Drugs

 Terbutaline (Brethine)
Mechanism of Action
 stimulating beta receptors on smooth muscle
 frequency and intensity of uterine
contractions decrease as the muscle relaxes
 decrease uterine contraction
Therapeutic Uses
 PTL
Side Effects
 Maternal S/E  nausea
 tremors  vomiting
 malaise  diarrhea
 weakness  constipation
 dyspnea  erythema
 tachycardia (maternal  sweating
and fetal)  hyperglycemia
 increased systolic  hypokalemia
pressure and decreased
diastolic pressure
 chest pain
 Most Serious Adverse Reactions
 pulmonary edema
 dysrhythmias
 ketoacidosis
 anaphylactic shock
 Fetal S/E
 Tachycardia
 potential hypoglycemia resulting from fetal
hyperinsulinemia caused by maternal
hyperglycemia
Nursing Implications
 Monitor and assess uterine activity and
FHR
 Maintain client in left lateral position as
much as possible to facilitate
uteroplacental perfusion.
 Monitor V/S / unit protocol, specifically
maternal pulse. Report maternal HR >110
beats/min.
 Report auscultated cardiac dysrhythmias.
An ECG may be ordered.
 Auscultate breath sounds every 4 H. Notify
health care provider if respirations are
>30/min or if there is a change in quality.
(wheezes, rales, coughing)
 Monitor daily weight to assess fluid
overload; strict I&O measurement.
 Report baseline FHR that is >180 beats/min
or any significant increase in uterine
contractions from pretreatment baseline.
 Report persistence of uterine contractions
despite tocolytic therapy.
 Report leaking of amniotic fluid, any
vaginal bleeding or discharge or complains
of rectal pressure.
 Be alert to presence of hypoglycemia and
hypoglycemia in the newborn delivered
within 5 H of discontinued Beta-
sympathomimetic drugs.
 Assist clients on bed rest and home
tocolytic therapy to plan for assistance with
self-care and family responsibilities.
Corticosteroid Therapy

 Mechanism of Action
 Accelerates lung maturation
 Therapeutic Uses
 PTL to decrease the incidence of RD
 Betamethasone (Celestone)
 When PTL occurs before the 33rd AOG,
corticosteroid therapy with betamethasone
may be prescribed , 12 mg IM every 24 H X 2
doses
Adverse Reactions

 1. seizures
 2. headache
 3. vertigo
 4. edema
 5. hypertension
 6. increased sweating
 7. petechiae
 8. ecchymoses
 9. facial erythema
Nursing Interventions

 Shake the suspension well. Avoid exposing to


excessive heat or light.
 Inject into large muscle, but not to deltoid,
avoid local atrophy.
 Monitor maternal V/S.
 Maintain accurate I & O.
 Check blood glucose if used for client with
diabetes.
Dexamethasone

 Has a rapid onset of action and shorter


duration of action
 Must be prescribed in a shorter frequency
 6 mg IM every 12 H X 4 doses
 Adverse Reaction
 insomnia
 nervousness
 increased appetite
 headache
 hypersensitivity reaction
 arthralgia
Drugs that Enhance Uterine
Muscle Contractility
 Before labor induction begins, risks and
benefits and the status of the mother and
the fetus must be assessed:
 gestational age of fetus
 size of the fetus in relation to the client’s
pelvis
 cervical ripening
Oxytoxin

 Mechanism of Action
 facilitates smooth muscle contraction in the
uterus
 Therapeutic Uses
 to reduce or augment labor contractions; to
treat uterine atony; milk letdown (intranasal
spray)
Side Effects
 Maternal effects with undiluted IV use only
 hypotension
 dysrhythmias
 tachysystole
 oterine hyperstimulation
Adverse Reactions

 Seizure
 Water intoxication if given in electrolyte free-
solution or at a rate greater than 20 mU/min
(nausea, vomiting, hypotension, tachycardia
and cardiac arrhythmias)
Nursing Interventions

◦ Have tocolytic agenrs and oxygen readily available.


◦ Monitor I & O.
◦ Monitor maternal pulse and BP, uterine activity and
FHR during oxytocin infusion.
◦ Maintain client in sitting or lateral recumbent
position to promote placental infusion.
 Monitor for signs of uterine rupture which
include FHR decelerations, sudden increased
pain, loss of uterine contraction, hemorrhage
and rapidly developing hypovolemic shock.
Ergot Alkaloids

 Mechanism of Actions
 Act by direct smooth-muscle-cell receptor
stimulation
 Therapeutic Uses
 prevention and treatment of post-partum
hemorrhage
Side Effects and Adverse
Reactions
 uterine clamping
 nausea and vomiting
 dizziness
 hypertension with IV administration
 sweating
 tinnitus
 chest pain
 dyspnea
 itching
Nursing Interventions

 Monitor client’s BP per agency protocol.


 Protect drugs from exposure to light.
 Monitor for side-effects or symptoms of ergot
toxicity (ergotism). Notify physician if systolic
BP increases by 25 mmHg or diastolic BP by
20 mmHg over baseline
Drugs for Pregnancy induced
Hypertension

 Magnesium Sulfate
◦ calcium antagonist
◦ central nervous system depressant
Mechanism of Action
 relaxes the smooth muscle of the uterus
through calcium displacement
 direct depressant effect on uterine muscle
contractility
 increases uterine perfusion
 Therapeutic Uses
 PTL
 Adverse Reactions
 Maternal S/E
 flush
 feelings of increased warmth
 perspiration
 dizziness  nasal congestion
 nausea  heavy eyelids
 headache  blurred vision
 lethargy  decreased GI action
 slurred speech  increased pulse rate
 sluggishness  hypotension
 Increased severity of adverse reaction is
evidenced by
 depressed reflexes
 convulsion
 magnesium toxicity (respiratory depression
and arrest, circulatory collapse, cardiac
arrest)
 Fetal S/E
 decreased fetal heart rate variability
 Neonatal S/E
 slight hypotonia with diminished reflexes
 lethargy for 24 to 48
Nursing Implications
 Monitor V/S, FHR and uterine activity as
ordered. Report respirations <12/min,
which may indicate magnesium sulfate
toxicity.
 Monitor I&O. Report urinary output <30
ml/H.
 Assess breath and bowel sounds as
ordered or at least every 4 H.
 Assess DTR and clonus before initiation of
therapy and as ordered. Notify health care
provider of changes in DTR.
 Weight daily.
 Monitor serum magnesium level as ordered
(therapeutic level is 4 to 7 mg/dl).
 Have calcium gluconate (1 g given over 3
minutes) available as an antidote.
 Observe newborn for 24 to 48 H for
magnesium effects if drug was given to
mother before the delivery.
Drugs Used During the
Postpartum Period
 Purposes
 to prevent uterine atony and postpartum
hemorrhage
 to relieve pain from uterine contractions,
perineal wounds and hemorrhoids1
 to enhance or suppress lactation
 to promote bowel function
 to enhance immunity
Pain Relief for Uterine
Contractions
 Commonly Used  Codeine sulfate
Postpartum Systemic  Ketololac tromethamine
Analgesics (Toradol)
 Acetaminophen  Meperidine (Demerol)
(Tylenol)  Morphine sulfate
 Acetaminophen/codein  Nalbuphine (Nubain)
e (Tylenol #3)  Oxycodone
 Acetaminophen/propox acetaminophen
yphene (Darvocet (Percocet)
N50/Darvocet N-100)
 Ibuprofen (Motrin)
 Pain Relief for Perineal Wounds
 1. benzocaine (Americaine, Dermoplast
OTC)
 2. witch hazel pads (Tucks [50% witch
hazel with glycerine water and
methylparaben])
Side Effects
 burning
 stinging
 tenderness
 edema
 rash
 tissue irritation
 sloughing
 tissue necrosis
 Pain Relief for Hemorrhoids
 Burning
 pruritus
 irritation
 dryness
 folliculitis
 allergic contact dermatitis
 secondary infection
Nursing Implications
 Incorporate client’s cultural framework of
help in nursing plan of care.
 Do not use benzocaine spray when perineal
infection is present.
 Shake benzocaine pay can. Administer 6 to
12 inches from perineum with client lying on
her
 side with top leg up and forward to provide
maximum exposure. This can also be done
with one foot on the toilet seat after
voiding.
 Use witch hazel compresses (Tucks or witch
hazel solution) with an ice pack and a peri-
pad to apply cold to the affected area in
addition to the active agent.
 Store Anusol HC suppositories below 86F
(30C) but protect from freezing. Use gloves
for administration. If client is breastfeeding,
assess to determine whether client is ready
to switch to nonhydrocortisone preparation
(goal is to discontinue use of suppositories
as quickly as possible).
 Check lot numbers and expiration date.
 Use of Proctofoam-HC needs to be explained
carefully to client because directions instruct
the client to place the agent inside the anus,
which is not generally done with obstetric
clients because they may have perineal
wounds that extend into the anus.
 Do not use rectal suppositories in client with
4th degree perineal laceration.
 Lactation Suppression
 Chlorotrianisene
 Deladumone OB
 Bromocriptine mesylate
 Promotion of Bowel Function
 stool softeners
 laxative stimulant
 antiflatulence
Side Effects and Adverse
Reactions
 Docusate sodium (Colace)- Bitter taste,
throat irritation, rash
 Casanthranol and docusate sodium (Peri-
colace)- nausea, abdominal cramping,
diarrhea, rash
 Bisacodyl suppositories (Dulcolax)- proctitis,
inflammation
 Magnesium hydroxide (Milk of Magnesia)-
abdominal cramps, nausea
 Senna (Senakot)- Nausea, vomiting,
diarrhea, abdominal cramps; can also
create diarrhea in breastfeed infants.
 Mineral oil- nausea, vomiting, diarrhea,
abdominal cramps; if aspirated, lipid
pneumonitis may occur
Nursing Implications
 Docusate Sodium (Colace) and Casanthranol
with Docusate Sodium (Peri-colace);
Casanthranol with Docusate Potassium
(Dialose Plus)
 Store at room temperature.
 If a liquid preparation is ordered, give with
milk or fruit juice to mask bitter taste.
 Take with a full glass of water.
 Assess client for any history of laxative
dependence.
 Drug interaction may occur with mineral oil,
phenolphthalein or aspirin.
 Bisacodyl USP (Dulcolax)
◦ Store tablets and suppositories below 77F (25F)
and avoid excess humidity.
◦ Do not crush tablets.
◦ Do not administer within 1 to 2 H of milk or antacid
because enteric coating may dissolve resulting in
abdominal cramping and vomiting.
◦ Take with a full glass of water.
 Mineral Oil
 Do not give with or immediately after
meals.
 Give with fruit juice or carbonated drinks to
disguise taste.
 Magnesium Hydroxide (Milk of
Magnesia)
 Shake container well.
 Do not give 1 to 2 H before or after oral
drugs because of effects on absorption.
 Take with a full glass of water.
 Note that milk of magnesia concentrate is 3X
as potent as regular-strength product.
 Give laxative 1 H before or 1 H after any oral
antibiotic.
 Senna (Senokot)
 Protect from light and heat.
 Simethicone (Mylicon)
 1. Administer after meals and at bedtime.
 2. If chewable tablets ordered instruct client
to chew tablets thoroughly before
swallowing.
Immunizations
Rh (D) Immune Globulin
 Document Rh work-up and eligibility of client
to receive drugs in client record.
 Check lot no. on vial and laboratory slip for
agreement before administration; check
expiration date.
 Administer Rho (D) immune globulin, dose
according to gestational weeks and exposure
and route according to provider orders and
agency.
 Administer intramuscularly, in the deltoid
within 72 H following delivery. If after 72 H,
administer as soon as possible up to 28
days.
 Rho (D) immune globulin administration is
possible though infrequent. Check provider
orders and dose. If IV administration then
reconstitute with normal saline.
 Store at 36 F to 46 F .
 Have epinephrine available to treat
anaphylaxis
Rubella Vaccine

 Nursing Interventions
 1. Protect vaccine from light and store at
35.6 F to 46.4 F before reconstitution.
 2. Reconstitute with dilutent provided and
administer within 8 H.
 3. Administer 0.5 ml vaccine subQ in
upper outer arm. Do not administer IV.
 4. If tuberculin skin test is to be done,
administer it before or simultaneously with
rubella vaccine.
Contraceptives

 Oral Contraceptive Products


 2 Main Types of Oral Contraceptive
 estrogen-progestin combination products
“the pill”
 progestin-only products “the minipill”
Estrogen-Progestin Products

 Mechanism of Action
 suppress pituitary release of follicle
stimulating hormone (FSH) and luteinizing
hormone (LH), which are needed to mature a
graafian follicle in the ovary thereby
inhibiting ovulation
Mechanism of Action
 changes in the endometrium that make it
less favorable for implantation of a fertilized
ovum
 the quantity and viscosity of the cervical
mucus is changed by progestins, making it
hostile to sperm
 3 Types of Combination Product
 1. monophasic- fixed ratio of estrogen to
progestin throughout the menstrual cycle
 2. biphasic- amount of estrogen is fixed
throughout the cycle, but the amount of
progesterone varies.
 3. triphasic- deliver low doses of both
hormones with minimal side effects
 Progestin-only Products
 Mechanism of Action
 1. altering the cervical mucus
 2. altering the endometrium to inhibit
implantation
 3. ovulation is also inhibited
Side Effects and Adverse
Reactions
 Estrogen Excess  8. chloasma
 1. nausea  9. leg cramps
 2. vomiting  10. decreased
 3. dizziness tearing
 4. fluid retention  11. corneal
 5. edema curvature alteration
 12. visual changes
 6. bloating
 13. vascular
 7. breast
tenderness headache
 14. hypertension
 Estrogen Deficiency
 vaginal bleeding
 oligomenorrhea
 nervousness
 dyspareunia
 Progesterone Excess
 1. increased appetite
 2. weight gain
 3. oily skin and scalp
 4. acne
 5. depression
 6. vaginitis
 7. excess hair growth
 8. decreased breast size
 9. amenorrhea after cessation of use
 Progestin Deficiency
 1. dysmenorrhea
 2. bleeding late in the cycle (days 15 to
21)
 3. heavy menstrual flow with clots
 4. amenorrhea
Nursing Implications
 Separate personal views from those of client
regarding contraception and use of specific
products.
 Recognize that many clients on oral
contraceptives abandon the method within a
year; therefore plan to provide client with
alternatives.
 Non nursing mothers can begin combination
oral contraceptives 3 to 4 wks postpartum,
regardless of whether menstruation has
spontaneously occurred.
Alternative Methods of
Contraception
1.Norplant 6. Today Sponge
2.Implanon 7. IUD
3. Depo-Provera 8. Patch
4. Lunelle 9. Medical Abortion
5. NuvaRing
 Emergency Contraception
 postcoital contraception
Drugs Related to
Reproductive Health:
Male Reproductive
Disorders
Substances Related to Male
Reproductive Disorders

 Androgen (Testosterone)
 Mechanism of Action
 Development and maintenance of male sex
organs and secondary sex characteristics.
 Therapeutic Indications for Androgen
Therapy
 1.hypogonadism
 2.constitutional growth delay
 Side-effects
 1. abdominal pain
 2. nausea
 3. insomnia
 4. diarrhea/ constipation
 5. hives/ redness at the injection site
 6. increased salivation
 7. mouth soreness
 8. increased/ decreased sexual desire
 Adverse Reaction
 1. virilizing effect (development of 2nd male
sexual characteristics)
 2. acne, skin oiliness
 3. growth of facial hair
 4. vocal huskiness
 5. menstrual irregularity/ amenorrhea
 6. suppressed ovulation/ lactation
 7. baldness or increased hair growth
 8. hypertrophy of clitoris
 MEN
 1. priapism
 2. gynecomastia
 3. urinary urgency
 4. oligospermia
Nursing Implications
 Instruct client and family on proper
administration of the medications, their
reactions for use and potential side- effect.
 2. Teach client that an intermittent approach
to treatment allows for monitoring of
endocrine status between courses of
androgen therapy.
 3. Instruct families pursuing treatment for a
client with delayed puberty about the range
of normal development.
 4. Urge individuals being treated for tissue
wasting to reduce environmental stressors
and promote rest and relaxation, because
stress hormones are catabolic. Muscle
strength will be monitored during treatment.
Anabolic Steroids

 Mechanism of Action
 Maximize the anabolic effects of androgens
and to minimize their androgenic effects
 Therapeutic Indications
 “sport supplements”
 “teen formulas”
 Side-effects
◦ water retention- overloads the kidneys
◦ cardiac damage
Other steroids (athletes)
 hCG, Pregnyl, Novarel, Ovidrel- a hormone
used to treat infertility, which also stimulates
testosterone production
 tetrahydrogestrinone (THG)- potent androgen
developed to escape urine detection
Antiandrogen

 Mechanism of Action
 block the synthesis or actions of androgen

 Therapeutic Indications
◦ benign prostatic hypertrophy
◦ carcinoma of the prostate
◦ male pattern baldness
◦ acne
◦ hirsutism
◦ virilization syndrome in women
◦ precocious puberty
 GnRH or an analogue Eg. Lueprolide- most
effective inhibitor of testosterone synthesis
(LH and testosterone levels fall)
 Ketoconazole- an antimycotic, used for the
treatment of prostatic carcinoma because of
its inhibition of adrenal and gonadal steroid
synthesis
 Androgen receptor antagonist
 Cyproterone acetate- suppresses LH and FSH
secretion
 Flutamide- competes with androgen at
androgen receptor site
 Spironolactone- competes with
dihydrotestosterone at the receptor sites.
Treats hirsutism in women.
 Finasteride- steroids, inhibits conversion of
testosterone to dihydrotestosterone. Used to
treat BPH.