McKenna's Pharmacology for Nursing, 2e

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P A R T 7  Drugs acting on the reproductive system

KEY POINTS

pregnancy, decreased risk factors for coronary artery disease, palliation of certain cancers). ■ ■ Monitor for adverse effects (liver changes, GI upset, oedema, changes in secondary sex characteristics, headaches, thromboembolic episodes, breakthrough bleeding). ■ ■ Monitor for potential drug–drug interactions as indicated. ■ ■ Evaluate the effectiveness of the teaching plan: person can name drug, dosage, adverse effects to watch for, specific measures to avoid them and warning signs and symptoms. ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.

■■ Oestrogens are hormones associated with the development of the female reproductive system and secondary sex characteristics; pharmacologically, oestrogens are used to prevent conception, to stimulate ovulation in women with hypogonadism and, to a lesser extent, to replace hormones after menopause. ■■ Progestogens maintain pregnancy and are also involved with development of secondary sex characteristics. Progestogens are used as part of combination contraceptives, to treat amenorrhoea and functional uterine bleeding and as part of fertility programs. ■■ Oestrogen receptor modulators are used to stimulate specific oestrogen receptors to achieve therapeutic effects of increased bone mass without stimulating the endometrium and causing other, less desirable oestrogen effects. condoms and the rhythm method and their reliability can be discussed. The use of hormones for birth control should then be explained, including the 96% to 98% reliability of these methods when used correctly. The numerous delivery methods for these hormones should be outlined. A variety of possibilities exist, ranging from the transdermal patch, to injection, to the vaginal ring, to the traditional tablet, and the use of the subdermal implant and intrauterine devices. J.M. elects to go with an oral contraceptive (OC). She states that she has a good memory, and taking them every day won’t be a problem. She swims regularly and thinks that the patch might be an issue if it comes off, and she is not comfortable with anything being injected or inserted into her body. J.M. will need teaching about drug and herbal interactions with the OC and will need to have written instructions on what to do if a dose is missed. The action that should be taken if a dose is missed can be very complicated and involves knowing on which day in the cycle the dose was missed. It is also important to stress that the OC will not protect J.M. from sexually transmitted infections and that precautions will need to be taken to avoid exposure to these diseases. She should also be advised not to smoke because smoking combined with OC use increases the risk for emboli. The adverse effects that she might experience should be reviewed and the importance of an annual pelvic examination and Pap test should be stressed. A trusting relationship is important at this time so that J.M. can feel free to call with questions or problems in the future.

CRITICAL THINKING SCENARIO Birth control

THE SITUATION J.M. is a 25-year-old woman who is being seen in her gynaecologist’s office for a routine annual physical examination and Pap test. J.M. reports that she has just become sexually active and would like to start using contraceptives. She has some concerns about stories she has heard about “the pill” and would like to know the safest and most effective birth control to use. She is interested in what other methods are available and what the advantages and disadvantages of each form might be. CRITICAL THINKING What teaching and counselling issues will be important for J.M. at this time? What important issues should be discussed when explaining the benefits and drawbacks of various contraceptive measures? What teaching information needs to be stressed with J.M. if she elects to use oral contraceptives? DISCUSSION This appointment presents a good opportunity for the healthcare provider to allow J.M. to discuss this new aspect of her life. She may have questions about the experience and about things she should be doing or should be questioning. The risk of sexually transmitted infections, as well as pregnancy, can be discussed. J.M. needs full information about the various forms of birth control that are available for use. Non-pharmacological measures such as