McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 4 0 Drugs affecting the female reproductive system

■ ■ Complete or assist with pelvic and breast

Prototype summary: Raloxifene Indications: Prevention and treatment of osteoporosis in postmenopausal women. Actions: Increases bone mineral density without stimulating the endometrium; modulates effects of endogenous oestrogen at specific receptor sites. Pharmacokinetics: Route Onset Peak Duration PO Varies 4–7 hours 24 hours T 1/2 : 27.7 hours, with hepatic metabolism and excretion in the faeces. Adverse effects: Venous thromboembolism, hot flushes, skin rash, nausea, vomiting, vaginal bleeding, depression, light-headedness. ■ ■ Assess for contraindications or cautions: history of allergy to any sex hormone or component of the drug product to avoid hypersensitivity reactions ; current status related to pregnancy and breastfeeding due to adverse effects on the fetus and neonate ; hepatic dysfunction that might interfere with drug metabolism ; cardiovascular disease, breast or genital cancer, renal disease or metabolic bone disease, which could be exacerbated by oestrogen use ; history of thromboembolism or smoking, which may increase the person’s risk for embolic conditions ; idiopathic vaginal bleeding or pelvic disease, which could represent an underlying problem that could be exacerbated with the use of these drugs ; and history of asthma or epilepsy, which could be exacerbated by progestogen use. ■ ■ Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the effectiveness of therapy and evaluate for any potential adverse effects. ■ ■ Assess abdomen, including auscultation of bowel sounds and palpation of the liver, to identify abnormalities. Measure abdominal girth as indicated to evaluate for bloating. ■ ■ Assess skin colour, lesions and texture; affect, orientation, mental status and reflexes; and blood pressure, pulse, cardiac auscultation, oedema and perfusion, which will reflect circulatory status and show any changes associated with thromboembolism. Care considerations for people receiving sex hormones or oestrogen receptor modulators Assessment: History and examination

examinations. Ensure specimen collection for Pap smear; obtain a history of the woman’s menstrual cycle to provide baseline data and to monitor for any adverse effects that could occur . ■ ■ Arrange for ophthalmic examination (particularly if the person wears 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 the results of laboratory tests, including urinalysis and renal and/or hepatic function tests, to determine the need for possible dose adjustment and identify early indications of dysfunction. See the Critical thinking scenario for additional information related to a person who is taking contraceptives. Implementation with rationale ■ ■ Administer drug as prescribed to prevent adverse effects ; administer with food if GI upset is severe to relieve GI distress. ■ ■ Provide analgesics for relief of headache as appropriate. ■ ■ Strongly urge the woman to stop smoking to reduce the risk of thromboembolism. ■ ■ Encourage taking of 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. examination, including pelvic examination, Pap smear and breast examination, to reduce the risk of adverse effects and to monitor drug effects. ■ ■ Assess the woman periodically for changes in perfusion or signs of vessel occlusion because of the risk of thromboembolism. ■ ■ Monitor liver function periodically for the person on long-term therapy to evaluate liver function and ensure discontinuation of the drug at any sign of hepatic dysfunction. ■ ■ Offer support and reassurance to deal with the drug and drug effects. ■ ■ Provide thorough teaching, including steps to take if a dose is missed or lost, measures to avoid adverse effects, signs and symptoms that may indicate a problem and the need for regular evaluation, to enhance knowledge about drug therapy and to promote compliance. Evaluation ■ ■ Monitor response to the drug (palliation of signs and symptoms of menopause, prevention of ■ ■ Arrange for at least an annual physical