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

FERTILITY DRUGS Fertility drugs stimulate the female reproductive system. The following fertility drugs are in use: cetro­ relix ( Cetrotide ), chorionic gonadotrophin ( Pregnyl ), choriogonadotropin alfa ( Ovidrel ), clomiphene ( Clomid and others), follitropin alfa ( Gonal-F ), follitropin beta ( Puregon ), ganirelix ( Orgalutran ), lutropin alfa ( Luveris ) CARE GUIDE FOR J.M.: ORAL CONTRACEPTIVES Assessment: History and examination Assess the woman’s health history for allergies to any oestrogens; pregnancy or breastfeeding status; breast or genital cancer; hepatic dysfunction; coronary artery disease; thromboembolic disease; renal disease; idiopathic vaginal bleeding; metabolic bone disease; diabetes; and smoking history. Focus the physical examination on the following: Neurological: orientation, reflexes, affect, mental status Skin: colour, lesions Cardiovascular: pulse, cardiac auscultation, blood pressure, oedema, perfusion Gastrointestinal: abdominal examination, liver examination Genitourinary: pelvic examination, Pap smear, urinalysis Eye: ophthalmological examination Implementation Administer medication as prescribed. Administer with meals if upset stomach is a problem. Provide analgesics for headache if appropriate. Advise the woman that if she wears contact lenses, the shape of her cornea may change and she may need a new prescription or may no longer be able to wear them. Provide at least an annual physical examination, including Pap smear and breast examination. Monitor perfusion and complaints of pain, tingling or numbness. Provide support and reassurance to deal with drug therapy. Provide teaching regarding drug name, dosage, what to do if a dose is missed, adverse effects, precautions, warnings to report and safe administration. Evaluation Evaluate drug effects: prevention of pregnancy. Monitor for adverse effects: signs of liver dysfunction; gastrointestinal upset; oedema; changes in secondary sex characteristics; headaches; thromboembolic episodes; breakthrough bleeding. Evaluate the effectiveness of the teaching program and comfort and safety measures. TEACHING FOR J.M. • An oral contraceptive (OC), or birth control pill, contains specific amounts of female sex hormones that work to

make the body unreceptive to pregnancy and to prevent ovulation (the release of the egg from the ovary). Because these hormones affect many systems in your body, it is important to have regular physical checkups while you are taking this drug. • Many drugs affect the way that OCs work. To be safe, avoid the use of over-the-counter drugs and other drugs unless you first check with your healthcare provider. • Some of the following adverse effects may occur: • Headache, nervousness . Check with your healthcare provider about the use of an analgesic; this effect usually passes after a few months on the drug. • Nausea, loss of appetite . This usually passes with time; consult your healthcare provider if it is a problem. • Swelling, weight gain . Water retention is a normal effect of these hormones. Limiting salt intake may help. You may have trouble with contact lenses if you wear them because the body often retains fluid, which may change the shape of your eye. This usually adjusts over time. • Blood clots in women who smoke cigarettes . Cigarette smoking can aggravate serious side effects of OCs, such as the formation of blood clots. When taking OCs, it is advisable to cut down, or preferably to stop, cigarette smoking. • Tell any doctor, nurse or other healthcare provider that you are taking this drug. • Report any of the following to your healthcare provider: pain in the calves or groin; chest pain or difficulty breathing; lump in the breast; severe headache, dizziness, visual changes; severe abdominal pain; yellowing of the skin; pregnancy. • Bleeding (a false menstrual period) should occur during the time that the drug is withdrawn. Report bleeding at any other time to your healthcare provider. • It is important to have regular medical checkups, including Pap tests, while you are taking this drug. If you decide to stop the drug to become pregnant, consult with your healthcare provider. • A package insert is included with the drug. Read this information and feel free to ask any questions that you might have. • Keep this drug and all medications out of the reach of children.

and menopausal gonadotrophin ( Menopur ). Table 40.2 gives more information on these agents.

Therapeutic actions and indications Women without primary ovarian failure who cannot get pregnant after 1 year of trying may be candidates for the use of fertility drugs. Fertility drugs work either directly