DRUGS AFFECTING

REPRODUCTIVE SYSTEM
Presented by: BSN 2A Group 1
Topic Content:

• Classification of the Drugs and sample

• Actions
• Indications
• Adverse/Side Effects
• Nursing Management
• Patient Education
Classification of the Drugs and sample
Classification: Estrogens/ Estrogen Derivative
Drug sample: estradiol (Estrace)
Mechanism of Action

• Estrogen replacement helps maintain

genitourinary function and reduces vasomotor
symptoms when estrogen production declines
as a result of menopause, surgical removal of
ovaries, or other estrogen deficiency states.

• In men, estrogens inhibit pituitary secretion of

luteinizing hormone and decrease testicular
secretion of testosterone. These actions may
decrease prostate tumor growth and lower the
level of prostate specific antigen (PSA).
INDICATIONS

•Treatment of moderate to severe vasomotor

symptoms associated with the menopause.

•Treatment of moderate to severe symptoms

of vulvar and vaginal atrophy associated with
the menopause. When prescribing solely for
the treatment of symptoms of vulvar and
vaginal atrophy, topical vaginal products should
be considered.
Adverse Reactions

• CNS: Affect liability, chorea, dementia, depression, dizziness,

headache, irritability, migraine headache, nervousness, stoke
• CV: Deep venous thrombosis, hypertension, MI, peripheral
edema, pulmonary embolism, thromboembolism,
thrombophlebitis
• EENT: Intolerance of contact lenses, retinal vascular
thrombosis, vision changes ENDO: Breast enlargement, pain,
tenderness, or tumors; breast cancer; fibrocystic breast
changes; gynecomastia; hyperglycemia; nipple discharge
• GI: Abdominal cramps or pain, anorexia, bloating, bowel
obstruction (vaginal ring), cholelithiasis, constipation,
diarrhea, elevated liver function test results, enlargement of
hepatic hemangiomas, gallbladder disease or obstruction,
hepatitis, increased appetite, nausea, pancreatitis, vomiting
• GU: Amenorrhea, breakthrough bleeding, cervical
erosion, clear vaginal discharge, decreased libido (males),
dysmenorrhea, endometrial cancer, impotence, increased
libido (females), ovarian cancer, pelvic pain, prolonged or
heavy menstrual bleeding, ring adherence, testicular
atrophy, uterine leiomyomata, vaginitis, vaginal
candidiasis, worsening of endometriosis
• MS: Arthralgia, leg cramps
• RESP: Pulmonary embolism
• SKIN: Acne, alopecia, erythema multiforme or nodosum,
hirsutism, jaundice, melasma, oily skin, prutitis, purpura,
rash, seborrhea, urticaria
• Other: Angioedema, folic acid deficiency, hypercalcemia
(in metastatic bone disease), hypersensitivity, toxic shock
syndrome (vaginal ring), weight gain or loss
Nursing Considerations
Assessment
Interventions
• History Taking  
• Allergy to estrogens Caution patient of the risks of
• breast cancer estrogen use, the need to
• undiagnosed abnormal genital prevent pregnancy during
bleeding treatment, for frequent
• pregnancy medical follow-up, and for
• lactation periodic rests from drug
treatment.
• renal insufficiency  
Assess patient Blood pressure,
pulse rate and urine output.
Physical Assessment ESTRACE (estradiol vaginal
• Skin color auscultation cream, USP, 0.01%) should not
• Lesions Blood Pressure be used during pregnancy.
• Edema Pelvic examination
• breast examination
 
Patient Education
• Before therapy starts, inform patient of risks involved in estrogen
therapy, such as increased risk of breast, endometrial, or ovarian
cancer; cardiovascular disease; dementia (if age 65 or over);
gallbladder disease; and vision abnormalities. Advise patient to
remain recumbent for at least 30 minutes after applying estradiol
vaginal cream.
• Inform her that she may use a sanitary napkin (but not a tampon)
to protect clothing after application.
• Teach patient proper application and use of transdermal patch.
Instruct her not to apply patch to breasts, waistline, or other
areas where it may not adhere properly. Advise her to rotate
application sites at least weekly and to remove old patch before
applying new one. If patch falls off, instruct her to reapply it to
another area or to apply a new patch and continue the original
treatment schedule. Caution her not to expose patch to sun for
long periods. Explain that she may bathe while wearing the
patch.
• Teach patient to apply Estrogel to clean, dry skin of
one arm, using applicator. Emphasize importance of
transferring all of the gel from applicator to arm. Tell
patient to spread gel as thinly as possible over
entire inside and outside of arm from wrist to
shoulder. Advise her to wash her hands with soap
and water afterward and to avoid fire and smoking
until gel has dried because it’s flammable. Tell
patient never to apply gel to breasts.
Classification: Estrogens/ Estrogen Derivative

Drug sample: estrogens, Conjugated

(Premarin)
Mechanism of Action

• Estrogen replacement helps maintain

genitourinary function and reduces vasomotor
symptoms when estrogen production declines
as a result of menopause, surgical removal of
ovaries, or other estrogen deficiency states.

• In men, estrogens inhibit pituitary secretion of

luteinizing hormone and decrease testicular
secretion of testosterone. These actions may
decrease prostate tumor growth and lower the
level of prostate specific antigen (PSA).
Indication

• It is used by women to help reduce symptoms of

menopause (such as hot flashes, vaginal dryness). These
symptoms are caused by the body making less estrogen.

• Certain estrogen products may also be used by women

after menopause to prevent bone loss (osteoporosis).

• Certain estrogen products may also be used by men and

women to treat cancers (certain types of prostate
cancer, breast cancer that has spread to other parts of the
body) and by women who are not able to produce
enough estrogen (for example, due to hypogonadism,
primary ovarian failure).
Adverse Reactions

• CNS: Asthenia, dementia, depression, dizziness, growth benign

meningioma, headache, insomnia, migraine headache, mood
disturbance, nervousness, paresthesia, stroke
• CV: Hypertension, MI, peripheral edema, thromboembolism,
thrombophlebitis, vasodilation
• EENT: Intolerance of contact lenses, pharyngitis, retinal vascular
thrombosis, rhinitis, sinusitis
• ENDO: Breast enlargement, pain, tender- ness, or tumors;
gynecomastia (men); hot flashes; hyperglycemia
• synthetic estrogens, B (conjugated) 449
• GI: Abdominal cramps or pain, anorexia, cholestatic jaundice,
constipation, diarrhea, flatulence, gallbladder disease or
obstruction, hepatic hemangioma enlargement, hepatitis,
increased appetite, ischemic colitis, nausea, pancreatitis,
vomiting
• GU: Amenorrhea, breakthrough bleeding, cervical erosion, clear
vaginal discharge, decreased libido (men), dysmenorrhea,
endometrial cancer or hyperplasia, impotence, increased libido
(women), leukorrhea, ovarian cancer, prolonged or heavy
menstrual bleeding, testicular atrophy, uterine leiomyomata
enlargement, vaginal candidiasis, vaginitis, vaginal-site reactions
(vaginal administration only) such as burning, irritation, and
genital pruritus
• MS: Arthralgias, back pain
• RESP: Bronchitis, increased cough, pulmonary embolism
• SKIN: Acne, alopecia, chloasma, erythema multiforme, erythema
nodosum, hemorrhagic eruption, hirsutism, melasma, oily skin,
pruritus, purpura, rash, seborrhea, urticaria
• Other: Anaphylaxis, angioedema, flu syndrome, folic acid
deficiency, hypercalcemia (in metastatic bone disease), weight
gain
Nursing Considerations
Assessment
Interventions
• History Taking  
• Allergy to estrogens Caution patient of the risks of
• breast cancer estrogen use, the need to
• undiagnosed abnormal genital prevent pregnancy during
bleeding treatment, for frequent
• pregnancy medical follow-up, and for
• lactation periodic rests from drug
treatment.
• renal insufficiency  
Assess patient Blood pressure,
pulse rate and urine output.
Physical Assessment ESTRACE (estradiol vaginal
• Skin color auscultation cream, USP, 0.01%) should not
• Lesions Blood Pressure be used during pregnancy.
• Edema Pelvic examination
• breast examination
 
Patient Education
•Explain the risks of estrogen therapy, including
increased risk of breast, endometrial, or ovarian
cancer; cardiovascular disease; dementia; and
gallbladder disease.
• Instruct patient how to use vaginal cream and to
cleanse plunger by removing it from barrel and
washing it with mild soap and warm water after
each use.
•Urge patient to immediately report breakthrough
bleeding to prescriber.
•Instruct patient to perform monthly breast self-
examination and to comply with all prescribed follow-up
examinations.
•Warn female patient that long-term use may increase risk
of dementia, heart disease, stroke, gallbladder disease, and
breast or endometrial cancer.
•Inform patient that estrogen vaginal cream may alter
effectiveness of condoms, diaphragms, or cervical caps
made of latex or rubber.
•Instruct patient to notify prescriber if she sees something
that resembles a tablet in her stool.
Classification: Progestins/ Progesterone
Derivative Drug sample: progesterone
(Crinone)
Mechanism of Action

• Progestins affect other hormones, especially estrogen, by

reducing availability or stability of hormone receptor
complex, shutting off estrogen-responsive genes, or
causing negative feedback mechanism that decreases
number of functioning estrogen receptors.

• These actions allow menstrual cycle to function normally,

alleviating amenorrhea and dysfunctional uterine
bleeding and inducing menses. Progestins also act to
transform proliferative uterine endometrium into a more
differentiated, secretory one, which is the basis for using
medroxyprogesterone to treat some types of
amenorrhea.
Indications

• Assisted Reproductive Technology

• Crinone 8% is indicated for progesterone
supplementation or replacement as part of an Assisted
Reproductive Technology ("ART") treatment
for infertile women with progesterone deficiency.

• Secondary Amenorrhea
• Crinone 4% is indicated for the treatment of secondary
amenorrhea. Crinone 8% is indicated for use in women
who have failed to respond to treatment with Crinone
4%.
Adverse Reactions

• CNS: Altered or reduced coordination or speech,

depression, dizziness, drowsiness, fatigue, headache,
irritability, migraine, mood changes, nervousness, post -
menopausal dementia, syncope, unusual tiredness or
weakness
• CV: Fluid retention; hypotension; numbness or pain in
chest, arm, or leg; thromboembolism
• ENDO: Adrenal insufficiency or suppression, breast pain or
tenderness, Cushing’s syndrome, decreased T3 resin
uptake, delayed return of fertility in women, elevated
thyroid-binding globulin, galactorrhea, hyperglycemia,
vaginal spotting
• EENT: Gingival bleeding, swelling, or tenderness; vision
changes or loss GI: Abdominal cramps or pain, diarrhea,
nausea, vomiting
• GU: Amenorrhea, breakthrough bleeding or
metromenorrhagia, decreased libido, hypermenorrhea,
ovarian enlargement or cysts
• HEME: Clotting and bleeding abnormalities
• MS: Back pain, decreased bone density, osteoporosis,
osteoporotic fractures
• RESP: Dyspnea
• SKIN: Acne, alopecia, melasma, rash
• Other: Anaphylaxis; facial fullness; hot flashes; injection-
or implantation-site irritation, pain, or redness; weight
gain
Nursing Considerations
Assessment
Interventions
• History
• Assess patient Blood pressure.
• Allergy to estrogens • Vaginal gel or Crinone are
• breast cancer administered with disposable
• Undiagnosed abnormal genital applicator provided.
bleeding • Monitor pattern and amount
• Renal insufficiency of vaginal bleeding (pad
count).
Physical Assessment • Record baseline data for
comparative value about
• Skin color reflexes
patient's weight and pulse at
• Lesions auscultation onset of progestin therapy.
• Edema Blood Pressure  
• breast examination
• Pelvic examination.
Patient Education

•Instruct woman to notify prescriber if uterine

bleeding continues longer than 3 months or if
menstruation is delayed by 45 days.
•Warn patient taking progestin for noncontraceptive
purposes to use a contraceptive method to prevent
pregnancy because drug may harm fetus.
•Advise female patient to contact prescriber
immediately if she suspects pregnancy or misses a
menstrual period.
•Emphasize importance of using a second method of
birth control when taking other drugs that could
reduce contraceptive effectiveness of progestins.
•Advise patient that some products may contain peanut
oil. If she is allergic to peanuts, tell her to contact
pharmacist to find out if prescribed progestin product
contains peanut oil.
•Advise female patient who vomits shortly after taking
progestin-only oral contraceptive pill not to take another
dose immediately thereafter but to wait until next
scheduled dose before resuming therapy and to use an
additional contraceptive method for 48 hours afterward.
•Caution female patient who vomits within 1 hour of
taking progestin for emergency contraception to contact
prescriber about whether to repeat dose.
Classification: Androgens
Drug sample: testosterone (Striant)
Mechanism of Action

• Primary natural androgen; responsible for normal growth

and development of male sex organs and the
maintenance of secondary sex characteristics; growth and
maturation of the prostate, seminal vesicles, penis,
scrotum, male hair distribution, vocal cord thickening,
alterations in body musculature and fat distribution.

• Therapeutic effect: Correction of hormone deficiency in

male hypogonadism; initiation of male puberty,
suppression of tumor growth in some forms of breast
cancers.
Indications

• Striant is indicated for replacement therapy in adult

males for conditions associated with a deficiency or
absence of endogenous testosterone.

• Hypogonadism in androgen -deficient men. Delayed

puberty in men (enanthate and pellets). Androgen
responsive breast cancer in post-menopausal
women (palliative) (enanthate)
Adverse Reactions/ Side Effects
• CNS: anxiety, confusion, depression, fatigue, headache,
vertigo
• EENT: deepening of voice
• CV: edema GI: abdominal cramps, changes in appetite,
drug-induced hepatitis, nausea, vomiting, buccal-bitter
taste, genigivitis, gum edema, gum tenderness
• GU: menstrual irregularities, prostatic enlargement.
• ENDO: women- change in libido, clitoral enlargement,
breast size Men- acne, facial hair, gynecomastia, erectile
dysfunction, oligospermia, priapism
• F and E: hypercalcemia, hyperkalemia,
hyperphosphatemia,
• Derm: male pattern baldness Local: chronic skin irritation
(transdermal), paint at injection/ implantation site.
Nursing Considerations
Assessment 
Interventions
• Striant should not use by
• History
a woman.
• Allergy to estrogens
• Assess patient Blood
• Male breast cancer
pressure, pulse rate and
• undiagnosed abnormal genital
bleeding
urine output.
• Monitor and inspect the
• renal insufficiency
gum where the Striant
 
buccal system is applied.
Physical Assessment
• Inform the patient to do
• Skin color reflexes
not chew or swallow
• Lesions auscultation
Striant.
• Edema Blood Pressure • The Striant buccal system
• breast examination should remain in place for
• Pelvic examination. 12 hours
Patient Education
• Advise patient to report the following signs and symptoms promptly: in
male patients, priapism (sustained and often painful erections) difficulty
urinating, or gynecomastia; in female patients, virilism ( which may be
reversible if medication is stopped as soon as changes are noticed), or
hypercalcemia (nausea, vomiting, constipation, and weakness).
• Transdermal- Advise patient to notify health care professional if their
female sexual partner develops signs / symptoms of virilization (e. g.
change in body hair distribution, significant increase in acne, deepening of
voice and menstrual regularities).
• Buccal – Instruct the patient to place the rounded slide surface of
the buccal system in a comfortable position against the gum just
above incisor tooth. Hold the system firmly in place with a finger
over the lip and against the product for 30 seconds to ensure
adhesion.
• Topical - Explain application to patient. Advise patient that
women and children should avoid contact with unclothes or
unwashed application site. Patients should cover the application
site (s) with clothing (T – shirt) after solution has dried. For direct
skin - to -skin contact, patient should wash application site
thoroughly with soap and water to remove any testosterone
residue.
 END
Group A1 Members: Reproductive System

Acosta, Airelle Joyce, Coma

Addon, Angelica, Macabia
Agbayani, Rean Hans, Llaneza
Agostosa, Ronalyn, Hernandez
Alvor, Allyson Joyce, Basallo
Andres, Alberto Jr., Dela Cruz
Antazo, Reygine Nicole, Lansangan

THANK YOU!