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Focus on Pharmacology Essentials for Health Professionals

Focus on Pharmacology Essentials for Health Professionals. Jahangir Moini, MD, MPH. Chapter 23 Effects of Drugs on the Reproductive System. Synthetic Androgens: Uses.

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Focus on Pharmacology Essentials for Health Professionals

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  1. Focus on PharmacologyEssentials for Health Professionals Jahangir Moini, MD, MPH Chapter 23Effects of Drugs on the Reproductive System

  2. Synthetic Androgens: Uses • Main indication in men is to supplement low levels of testosterone to correct hypogonadism or cryptorchidism(absence of one or both testes from the scrotum) ; other uses in men are for increasing sperm production • Used in women to treat postpartum breast engorgement, endometriosis (the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the ovaries), and fibrocystic breast disorders

  3. Synthetic Androgens: Adverse Effects • Common: insomnia, excitation, skin flushing, anorexia, diarrhea, jaundice, hypercalcemia, hypercholesterolemia, sodium retention, edema • May cause renal calculi, bladder irritability, and increased libido

  4. Synthetic Androgens: Contraindications • Contraindicated in patients with serious cardiac, liver, or kidney disease; prostate or breast cancer; pregnancy and lactation • Testosterone alters glucose tolerance tests and may increase creatinine and creatinine secretion

  5. Synthetic Androgens: Patient Information • Advise patients to take oral androgens with meals to reduce gastric upset. • Instruct male patients to report priapism and decreased flow of urine.

  6. Female Sex Hormones • Anterior pituitary releases hormones FSH and LH • Ovaries, adrenal cortex, and placenta (during pregnancy) release estrogens and progesterones

  7. Synthetic Estrogens: Uses • Used as hormone replacement therapy in women who have had ovaries removed or are postmenopausal; for prevention and treatment of osteoporosis in older women; as palliative therapy for breast and prostate carcinoma in men; and to treat abnormal bleeding

  8. Synthetic Estrogens: Adverse Effects • Common: anorexia, nausea, vomiting, stomach cramping, flatulence, headaches, changes in libido, edema, breast discomfort or enlargement • In men, cause feminization, atrophy of sex organs, loss of facial or body hair

  9. Synthetic Estrogens: Contraindications • Contraindicated in breast cancer, pregnancy, and lactation • Use caution in patients with liver disease, gallbladder disease, endometriosis, pancreatitis, diabetes mellitus, heart failure, and kidney dysfunction • Interactions may cause toxic levels of cyclosporine

  10. Synthetic Estrogens: Patient Information • Advise patients to take drug as directed, not skipping or increasing or decreasing dose. • Advise women not to breast feed.

  11. Testosterone Use During Pregnancy Use of testosterone during pregnancy can cause masculinization of the fetus, particularly if taken during first trimester.

  12. Estrogens During Pregnancy • Use of estrogens during the first trimester of pregnancy may increase the risk of fetal malformations

  13. Estrogen and Menopause • Postmenopausal women who are taking estrogens should also take progestin to prevent: • Endometrial hyperplasia • Endometrial carcinoma • Progestin is not necessary in women who have had a hysterectomy

  14. Progestins: Uses • Block follicular maturation and ovulation • Used to treat amenorrhea, functional uterine bleeding, endometriosis, and premenstrual syndrome

  15. Progestins: Adverse Effects • Common: vaginal candidiasis, breakthrough bleeding, dysmenorrhea, amenorrhea, breast tenderness, edema, acne, pruritus, mental depression • Serious: thromboembolic disorder, pulmonary embolism

  16. Progestins: Contraindications • Contraindicated with breast or genital cancer; in patients with impaired liver function, undiagnosed vaginal bleeding, miscarriage, thrombophlebitis, and thromboembolic disorders • Use cautiously in anemia, diabetes, or abnormal Pap smear

  17. Progestins: Patient Information • Advise patients to avoid exposure to prolonged UV light. • Tell patients to immediately report sudden severe headache or vomiting, dizziness or fainting, numbness in an extremity, acute chest pain, sudden vision loss.

  18. Estrogen–Progestin Combinations in Postmenopause • The use of such combination drugs in postmenopausal women is controversial. The benefits of use are protection against: • osteoporosis • colon cancer • The risks of using such combination drugs include: • cardiovascular disease • breast cancer • thromboembolism

  19. Contraceptive Hormones: Uses • Provide negative feedback to hypothalamus • This inhibits gonadotropin-releasing hormone • The pituitary therefore cease secretion of FSH, which would normally stimulate ovulation

  20. Oral Contraceptives: Adverse Effects • Common: nausea, abdominal pain, gallbladder disease, breast tenderness or pain, weight gain, dysmenorrhea, amenorrhea, • Serious: thromboembolism, stroke, myocardial infarction

  21. Oral Contraceptives: Contraindications • Pregnancy and lactation • Genital bleeding of unknown cause • Coronary artery disease • Liver dysfunction • Endometrial or breast cancer • Severe hypertension • Diabetes with vascular involvement

  22. Oral Contraceptives: Patient Information • Instruct patients to follow the dosing schedule carefully and to use barrier contraception when taking antibiotics. • Instruct patients to report calf pain or tenderness, shortness of breath, chest pain, visual disturbances, drooping eyelids, or double vision.

  23. Oral Contraceptives and Surgery Oral contraceptives should be discontinued 4 weeks before surgery because of the risk of postoperative thromboembolism.

  24. Smoking and Oral Contraceptives Smoking while taking oral contraceptives can cause serious adverse effects to the cardiovascular system.

  25. Oxytocics: Uses • Used to initiate or improve uterine contractions during delivery (only after cervix is dilated); also used to stimulate milk letdown following delivery

  26. Oxytocics: Adverse Effects • Common: nausea, vomiting, dizziness, headache • Serious: maternal cardiac arrhythmias, hypertensive episodes, intracranial hemorrhage

  27. Oxytocics: Contraindications • Must not be used to induce labor prior to delivery of the placenta • Contraindicated in unfavorable fetal position or presentation, obstetric emergencies, fetal distress • May interact with vasoconstrictor drugs to cause severe hypertension

  28. Oxytocics: Patient Information • Instruct patients to report: • Cold or numb fingers or toes • Severe cramping • Chest pain • Sudden or severe headache.

  29. Uterine Relaxants: Uses • Used in management of preterm labor

  30. Uterine Relaxants: Adverse Effects • Common: headache, nausea, vomiting, nervousness, restlessness, sweating, emotional upset • Serious: Chest pain, arrhythmias, pulmonary edema

  31. Uterine Relaxants: Contraindications • Uterine relaxants are contraindicated in patients with: • Antepartum hemorrhage (before birth) • Eclampsia (seizures) • Uncontrolled diabetes • Bronchial asthma • Pulmonary hypertension • Cardiac disease

  32. Uterine Relaxants: Patient Information Advise patients about potential adverse effects and drug interactions.

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