Ppt chapter 52

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 52

Drugs Affecting Women’s Health and Sexuality

Chapter 52

Drugs Affecting Women’s Health and Sexuality


Physiology Physiology

• The female sex hormones are responsible for producing female sexual characteristics, developing the female reproductive system, and maintaining pregnancy.

• The two types of female sex hormones are estrogen and progestin.

• Both are steroidal compounds that the ovaries begin to secrete at puberty and that the placenta secretes during pregnancy.

• The adrenal cortex also secretes estrogen and progestin, but in much smaller amounts.


Menstrual CycleMenstrual Cycle


Pathophysiology Pathophysiology

• If a woman is deficient in endogenous sex hormones, she does not experience normal sexual development.

• When a woman’s estrogen levels drop during menopause, the ending of the monthly ovarian cycles, she experiences several changes.

• In postmenopausal women, the loss of estrogen contribute to the development of osteoporosis.

• Osteoporosis is characterized by low bone mineral density.

• Deficiency of sex hormones is the leading cause of osteoporosis.


Estrogens Estrogens

• Many different types of exogenous estrogen differ somewhat in terms of indications, route of administration, and pharmacokinetics.

• Routes of administration may be oral, intramuscular (IM), transdermal, or topical (as vaginal creams).

• Most of these estrogens are used for correction of low endogenous estrogen or in birth control products combined with progestins.

• Prototype drug: conjugated estrogen (Premarin)


Conjugated Estrogen: Core Drug Knowledge Conjugated Estrogen: Core Drug Knowledge

• Pharmacotherapeutics

– Used primarily in hormone replacement therapy

• Pharmacokinetics

– Metabolism: liver. Excreted: kidneys.

• Pharmacodynamics

– Stimulates the development of the female sex organs and secondary female sexual characteristics


Conjugated Estrogen: Core Drug Knowledge (cont.)Conjugated Estrogen: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Black Box warning in the labels indicates that the drug increases the risk of cardiovascular events.

• Adverse effects

– Increases the risk of stroke and coronary heart disease, breakthrough bleeding, headache, nausea, vomiting, bloating, abdominal cramps, and chloasma

• Drug interactions

– No important drug interactions are associated with conjugated estrogen.


Conjugated Estrogen: Core Patient Variables Conjugated Estrogen: Core Patient Variables

• Health status

– Assess blood pressure and breast for any masses.

• Life span and gender

– Check the patient’s age.

• Environment

– Causes photosensitivity


Conjugated Estrogen: Nursing Diagnoses and Outcomes Conjugated Estrogen: Nursing Diagnoses and Outcomes

• Ineffective Sexuality Patterns related to therapy for female hypogonadism or lack of intrinsic estrogen

– Desired outcome: The patient will develop normal sex organs and secondary sexual characteristics while using estrogen drug therapy.

• Risk for Delayed Growth and Development related to intrinsic estrogen deficiency and early hypophysis closing from estrogen replacement therapy

– Desired outcome: The patient will achieve normal growth and development while using drug therapy.


Conjugated Estrogen: Nursing Diagnoses and Outcomes (cont.)Conjugated Estrogen: Nursing Diagnoses and Outcomes (cont.)

• Decisional Conflict related to comparison of risks and benefits of postmenopausal estrogen replacement therapy

– Desired outcome: The patient will make an informed decision about estrogen replacement therapy after comparing personal risks and benefits.


Conjugated Estrogen: Planning and InterventionsConjugated Estrogen: Planning and Interventions

• Maximizing therapeutic effects

– Administer conjugated estrogen cyclically.

• Minimizing adverse effects

– Monitor for signs of thrombophlebitis and thromboembolus.

– In women with a uterus, the combination of estrogen and progestin should always be used to minimize the risk of endometrial cancer.


Conjugated Estrogen: Teaching, Assessment, and EvaluationConjugated Estrogen: Teaching, Assessment, and Evaluation

• Patient and family education

– Teach patients and their families about the therapeutic purpose of estrogen.

– Provide instruction on how to take the estrogen.

• Ongoing assessment and evaluation

– If the patient is a prepubescent girl, evaluate for normal sexual development with estrogen therapy, and monitor the patient’s growth as appropriate.


QuestionQuestion

• The Women’s Health Initiative (WHI) found that menopausal women who had moderate-to-severe vasomotor symptoms had benefit from estrogen therapy.

– A. True

– B. False


Answer Answer

• A. True

• Rationale: The Women’s Health Initiative (WHI) found that menopausal women who had moderate-to-severe vasomotor symptoms at the start of the study experienced a small benefit in their sleep quality with 3 years of estrogen-progestin therapy.

• However, therapy provided no benefit for other health-related quality-of-life measures, such as general health, vitality, mental health, relief from depressive symptoms, or sexual satisfaction.


Progestins Progestins

• Progestins consist of progesterone and its derivatives.

• Through stimulation or inhibition, they regulate secretion of pituitary gonadotropins.

• Progestins also inhibit spontaneous uterine contractions.

• Prototype drug: progesterone (Prometrium, Crinone)


Progesterone: Core Drug Knowledge Progesterone: Core Drug Knowledge


– Helps produce normal menstrual cycles


– Administered: oral or IM. Metabolism: liver. Excreted: kidneys.


– Exogenous progesterone affects the body in ways similar to those of endogenous progesterone.


Progesterone: Core Drug Knowledge (cont.)Progesterone: Core Drug Knowledge (cont.)


– Hypersensitivity

• Adverse effects

– Progesterone may increase the risk of breast and ovarian cancer when given in combination with estrogen to postmenopausal women


– No known drug interactions are associated with progesterone


Progesterone: Core Patient Variables Progesterone: Core Patient Variables

• Health status

– Assess for contraindications to therapy.


– Pregnancy Category B

• Environment

– Caution patients about exposure to ultraviolet light


Progesterone: Nursing Diagnoses and Outcomes Progesterone: Nursing Diagnoses and Outcomes • Disturbed Body Image related to potential breakthrough

bleeding, spotting, changes in menstrual flow, weight gain, or breast tenderness secondary to adverse effects of drug therapy

– Desired outcome: The patient will not experience substantial adverse effects from drug therapy to alter body image.

• Risk for Injury related to loss of vision, onset of thrombotic disorders, and depression secondary to adverse effects of drug therapy

– Desired outcome: The patient will not suffer an injury related to adverse effects of drug therapy.


Progesterone: Planning and InterventionsProgesterone: Planning and Interventions


– The dosing schedule varies depending on the clinical indication for using progesterone.


– Take steps to minimize the adverse effects of progesterone therapy.

– Do not give drug to patients with contraindications to therapy.


Progesterone: Teaching, Assessment, and EvaluationProgesterone: Teaching, Assessment, and Evaluation


– Instruct patients and their families on the therapeutic and adverse effects of progesterone.

– Teach patients how to perform breast self-examination.


– Monitor premenopausal women taking progesterone for return of normal menstrual flow and cessation of abnormal bleeding.


QuestionQuestion

• Progesterone is also added to postmenopausal HRT therapy

– A. To decrease the risk of endometrial cancer

– B. To prevent ovarian cancer

– C. To decrease the risk of coronary artery disease

– D. To prevent breast cancer


AnswerAnswer

• A. To decrease the risk of endometrial cancer

• Rationale: Progesterone is added to postmenopausal HRT to decrease the risk of endometrial cancer from estrogen therapy.


Oral Contraceptives Oral Contraceptives

• Contain estrogen and progesterone or just progesterone

• Oral contraceptives are given to prevent pregnancy.

• Inhibit ovulation by suppressing the gonadotropins FSH and LH

• Oral contraceptives should be prescribed with the smallest effective dose of estrogen possible.

• Oral contraceptives are known to interact with penicillins and tetracyclines.


Bisphosphonates Bisphosphonates

• The bisphosphonate drug class affects normal and abnormal bone resorption.

• Prototype drug: alendronate (Fosamax)


Alendronate: Core Drug Knowledge Alendronate: Core Drug Knowledge


– Used to treat and prevent osteoporosis


– Administered: oral. Excreted: kidneys.


– Inhibits both normal and abnormal bone resorption


Alendronate: Core Drug Knowledge (cont.)Alendronate: Core Drug Knowledge (cont.)


– Hypocalcemic or hypersensitive

• Adverse effects

– Musculoskeletal pain, flatulence, acid regurgitation, esophageal ulcer, gastritis, headache, and erythema


– Due to drug interaction, it is recommended to wait at least 30 minutes after taking alendronate before taking any other drug.


Alendronate: Core Patient Variables Alendronate: Core Patient Variables

• Health status

– Assess past medical history and contraindications to drug.


– Pregnancy Category C

• Lifestyle, diet, and habits

– Review dietary eating habits

• Environment

– Assess environment where drug will be given.

• Culture and inherited traits

– Asian and white women are at increased risk for osteoporosis.


Alendronate: Nursing Diagnoses and Outcomes Alendronate: Nursing Diagnoses and Outcomes • Risk for Injury related to fractures from osteoporosis or

Paget disease

– Desired outcome: The patient using drug therapy will have no fractures.

• Potential Complication: Electrolyte Imbalance related to drug therapy with alendronate

– Desired outcome: The patient will not experience electrolyte imbalance.

• Potential Complication: Altered GI Function related to adverse effects of drug therapy with alendronate

– Desired outcome: The patient will experience either no or minimal adverse effects.


Alendronate: Planning and InterventionsAlendronate: Planning and Interventions


– Provide patient education


– Take measures to correct preexisting hypocalcemia before treatment.

– Monitor electrolytes during therapy.


Alendronate: Teaching, Assessment, and EvaluationAlendronate: Teaching, Assessment, and Evaluation


– Teach patients to take alendronate at least 30 minutes before eating.

– Patients should swallow the medicine with 6 to 8 ounces (180 to 240 mL) of plain water.


– Verify throughout therapy that the patient is not experiencing hypocalcemia or other adverse effects from alendronate therapy.


QuestionQuestion

• Patient teaching regarding proper administration of alendronate should include which of the following?

– A. Medication can be taken before bedtime.

– B. Medication can be taken with other medications.

– C. Medication should be taken on an empty stomach with 8 oz of water.

– D. Both A and D

– E. All of the above


AnswerAnswer

• C. Medication should be taken on an empty stomach with 8 oz of water.

• Rationale: Alendronate should be taken first thing in the AM on an empty stomach with a full glass of water; the patient needs to remain upright for 1 hour after administration. Alendronate should not be given within 30 minutes of other medications.

Documents

Ppt chapter 52