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

Adverse effects Adverse effects associated with fertility drugs include a greatly increased risk of multiple births and birth defects; ovarian overstimulation (abdominal pain, distension, ascites, pleural effusion); and headache, fluid retention, nausea, bloating, uterine bleeding, ovarian enlargement, gynaecomastia and febrile reactions (possibly due to stimulation of progesterone release). Prototype summary: Clomiphene Indications: Treatment of ovarian failure in women with normal liver function and normal endogenous oestrogens; off-label use: treatment of male sterility. Actions: Binds to oestrogen receptors, decreasing the number of available oestrogen receptors, which gives the hypothalamus the false signal to increase FSH and LH secretion, leading to ovarian stimulation. Pharmacokinetics: Route Onset Peak Duration PO 5–8 days Unknown 6 weeks T 1/2 : 5 days, with hepatic metabolism and excretion in the faeces. Adverse effects: Vasomotor flushing, visual changes, abdominal discomfort, distention and bloating, nausea, vomiting, ovarian enlargement, breast tenderness, ovarian overstimulation, multiple pregnancies.

which would be exacerbated by the effects of the drug. ■ ■ Perform a complete physical assessment to establish baseline status before beginning therapy and during therapy to monitor for any potential adverse effects. ■ ■ Assess skin and lesions; orientation, affect and reflexes; and blood pressure, pulse, respiration and adventitious sounds to determine cardiac function and perfusion and to detect changes in blood flow or thromboembolism. ■ ■ Complete or assist with pelvic and breast examinations and ensure collection of specimen for Pap smear to establish a baseline of GU health and detect early changes as a result of drug therapy. ■ ■ Monitor the results of laboratory tests, such as renal and hepatic function studies, to evaluate for possible dysfunction that might interfere with metabolism and excretion of the drug ; and check hormonal levels as indicated to determine the effectiveness of therapy and reduce the risk of ovarian hyperstimulation. ■ ■ Assess the cause of dysfunction before beginning therapy to ensure appropriate use of the drug. ■ ■ Complete a pelvic examination before each use of the drug to rule out ovarian enlargement, pregnancy or uterine problems. ■ ■ Check urine oestrogen and oestradiol levels before beginning therapy to verify ovarian function. ■ ■ Administer with an appropriate dose of HCG as indicated to ensure beneficial effects. ■ ■ Discontinue the drug at any sign of ovarian overstimulation and arrange for hospitalisation to monitor and support the person if this occurs. ■ ■ Provide women with a calendar of treatment days, explanations of adverse effects to anticipate, and instructions on when intercourse should occur to increase the therapeutic effectiveness of the drug. ■ ■ Provide warnings about the risk and hazards of multiple births so the person can make informed decisions about drug therapy. ■ ■ Offer support and encouragement to deal with low self-esteem issues associated with infertility . ■ ■ Provide teaching about proper administration technique, appropriate disposal of needles and syringes, measures to avoid adverse effects, warning signs of problems and the need for regular evaluation to enhance the person’s knowledge about drug therapy and to promote compliance. Implementation with rationale

Care considerations for people receiving fertility drugs

Assessment: History and examination

■ ■ Assess for contraindications or cautions: history of allergy to any fertility drug to avoid

hypersensitivity reaction s; current status of pregnancy and breastfeeding, which are contraindications or cautions to the use of the drug ; primary ovarian failure, which would not respond to these agents ; thyroid or adrenal dysfunction due to effects on hypothalamic– pituitary axis ; ovarian cysts, which could be stimulated and become larger as a result of the drug’s stimulatory effects ; idiopathic uterine bleeding, which could reflect an underlying medical problem that could be exacerbated by the stimulatory effects of the drug ; thromboembolic diseases, which could increase the woman’s risk for thrombus formation ; and respiratory diseases,