McKenna's Pharmacology for Nursing, 2e

608

P A R T 7  Drugs acting on the reproductive system

Drug therapy across the lifespan

BOX 40.1

Drugs affecting the female reproductive system CHILDREN The oestrogens and progestins have undergone little testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. If oral contraceptives are prescribed for teenage girls, the smallest dose possible should be used and the child should be monitored carefully for metabolic and other effects. ADULTS Women who are 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.The potential for adverse effects should be discussed and comfort measures provided. Women taking oestrogen should be advised not to smoke because of the increased risk of thrombotic events. If any of these drugs is used in males for the treatment of specific cancers, the person should be advised about the possibility of oestrogenic effects and appropriate support should be offered.

PREGNANCY AND BREASTFEEDING When combinations of these hormones are used as part of fertility programs, women need 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, as should the need for frequent monitoring. When prostaglandins are used, people need a great deal of psychological support. Written lists of signs and symptoms to report and what to expect are more effective than just verbal lists in this time of potential stress. These agents are not for use during pregnancy or breastfeeding because of the potential for adverse effects on the fetus or neonate. commonly used by postmenopausal women. Reports of benefits and risks are frequent and conflicting, and women need support and reliable information to make informed decisions about the use of these drugs. If women are also using alternative therapies, their effects on the HRT and other possible prescription drugs need to be carefully evaluated. OLDER ADULTS Hormone replacement therapy (HRT) is no longer

TABLE 40.1

DRUGS IN FOCUS Sex hormones and oestrogen receptor modulators

Drug name

Dosage/route

Usual indications

Sex hormones Oestrogens

Transdermal patch: 2-8 mg/day topically Tablet: 1–2 mg/day PO

Hormone replacement therapy; short-term management of oestrogen deficiency due to menopause Management of signs and symptoms of menopause, prostate cancer, inoperable breast cancer; treatment of female hypogonadism, postpartum breast engorgement; to retard the progress of osteoporosis Available only in combination form, used as oral contraceptive Used in combination contraceptives; treatment of acne and premenstrual dysphoric disorder (PMDD); relief of signs and symptoms of menopause Contraceptive for women; being investigated as a male contraceptive agent Intrauterine contraceptives; also used as “morning after” pill; component in many combination contraceptives

oestradiol (Estrofem, Estradot)

oestrogens conjugated (Premarin)

0.3–1.25 mg/day PO

Progestogens desogestrel (Marvelon)

desogestrel 0.15 mg with 30 mcg ethinyloestradiol, 1 tab PO daily

drospirenone (Yasmin, YAZ)

Yasmin: 3 mg with 30 mcg ethinyloestradiol YAZ: 3 mg with 0.02 mg oestradiol

etonogestrel (Implanon, NuvaRing)

Implanon: 68 mg implanted subdermally for up to 3 years, may be replaced at that time

NuvaRing: 0.12 mg with 0.015 mg ethinyloestradiol as a vaginal ring

levonorgestrel (Mirena, Levonelle)

Mirena: 52 mg inserted intrauterine for up to 5 years Levonelle: 1.5 mg PO taken within 72 hours of sexual intercourse 5–10 mg/day PO for 5–10 days for amenorrhoea; 200–500 mg/day PO for cancer therapy

medroxyprogesterone (Provera)

Treatment of amenorrhoea (orally); palliation of certain cancers (injection)