💊Pharmacology for Nurses Unit 36 – Reproductive Health Drugs

Key Concepts and Terminology

• Reproductive health drugs medications used to manage various aspects of reproductive health (contraception, fertility, menstrual disorders, menopause)
• Hormones chemical messengers secreted by endocrine glands that regulate bodily functions
  • Estrogen primary female sex hormone responsible for development and regulation of female reproductive system
  • Progesterone hormone involved in menstrual cycle, pregnancy, and embryogenesis
  • Testosterone primary male sex hormone responsible for development and maintenance of male reproductive system
• Contraceptives methods or devices used to prevent pregnancy (birth control pills, intrauterine devices, condoms)
• Fertility treatments medications or procedures used to assist in conception (clomiphene, gonadotropins, in vitro fertilization)
• Menstrual disorders conditions that affect menstrual cycle (dysmenorrhea, amenorrhea, menorrhagia)
• Menopause natural decline in reproductive hormones marking end of menstrual cycles and fertility

Hormonal Physiology Basics

• Hypothalamic-pituitary-gonadal axis (HPG axis) system of endocrine glands and hormones that regulate reproductive function
  • Hypothalamus releases gonadotropin-releasing hormone (GnRH) stimulating pituitary gland
  • Pituitary gland secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH) regulating gonadal function
  • Gonads (ovaries in females, testes in males) produce sex hormones (estrogen, progesterone, testosterone)
• Menstrual cycle monthly series of changes in female reproductive system preparing for potential pregnancy
  • Follicular phase development of ovarian follicles and increase in estrogen levels
  • Ovulation release of mature egg from ovary triggered by LH surge
  • Luteal phase formation of corpus luteum and increase in progesterone levels preparing uterus for implantation
• Feedback loops hormonal interactions that maintain homeostasis in reproductive system
  • Negative feedback inhibits further hormone production when levels are high (estrogen inhibits FSH, progesterone inhibits LH)
  • Positive feedback stimulates hormone production when levels are low (estrogen stimulates LH surge triggering ovulation)

Types of Reproductive Health Drugs

• Hormonal contraceptives contain synthetic estrogen and progestin to prevent ovulation and alter cervical mucus (combined oral contraceptives, transdermal patches, vaginal rings)
  • Progestin-only contraceptives contain only progestin and primarily thicken cervical mucus (minipills, injectable contraceptives, implants)
• Emergency contraceptives prevent pregnancy after unprotected intercourse or contraceptive failure (levonorgestrel, ulipristal acetate)
• Fertility drugs stimulate ovulation and improve fertility (clomiphene citrate, gonadotropins)
• Hormone replacement therapy (HRT) replaces declining hormones during menopause to alleviate symptoms (estrogen therapy, estrogen-progestin therapy)
• Selective estrogen receptor modulators (SERMs) act on estrogen receptors with tissue-specific effects (raloxifene for osteoporosis prevention, tamoxifen for breast cancer treatment)
• Aromatase inhibitors block conversion of androgens to estrogens used in breast cancer treatment (anastrozole, letrozole)
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists modify HPG axis used in fertility treatments and hormone-dependent cancers (leuprolide, ganirelix)

Mechanism of Action

• Hormonal contraceptives suppress ovulation by providing constant levels of estrogen and progestin inhibiting FSH and LH release
  • Progestins thicken cervical mucus making it less permeable to sperm
  • Alter endometrium making it less receptive to implantation
• Emergency contraceptives delay or inhibit ovulation and may prevent fertilization or implantation
  • Levonorgestrel primarily works by inhibiting ovulation
  • Ulipristal acetate blocks progesterone receptors delaying ovulation and altering endometrium
• Fertility drugs stimulate ovulation by acting on HPG axis
  • Clomiphene citrate blocks estrogen receptors in hypothalamus increasing GnRH and gonadotropin secretion
  • Gonadotropins (FSH, LH) directly stimulate follicular development and ovulation
• Hormone replacement therapy replenishes estrogen and progesterone levels alleviating menopausal symptoms (hot flashes, vaginal atrophy, bone loss)
  • Estrogen therapy alone used in women without a uterus
  • Estrogen-progestin therapy used in women with a uterus to prevent endometrial hyperplasia
• SERMs bind to estrogen receptors acting as agonists or antagonists depending on target tissue
  • Raloxifene acts as an agonist in bone and antagonist in breast and uterus
  • Tamoxifen acts as an antagonist in breast tissue used in breast cancer treatment
• Aromatase inhibitors block conversion of androgens to estrogens reducing estrogen levels used in postmenopausal breast cancer treatment
• GnRH agonists initially stimulate gonadotropin release but with continuous use desensitize receptors suppressing HPG axis used in fertility treatments and hormone-dependent cancers
  • GnRH antagonists directly block GnRH receptors suppressing gonadotropin release used in assisted reproductive technology

Indications and Uses

• Hormonal contraceptives used for birth control, menstrual regulation, and treatment of conditions (endometriosis, polycystic ovary syndrome)
• Emergency contraceptives used after unprotected intercourse or contraceptive failure to prevent unintended pregnancy
• Fertility drugs used to treat infertility due to anovulation or unexplained infertility
  • Clomiphene citrate first-line treatment for ovulatory disorders
  • Gonadotropins used in assisted reproductive technology (in vitro fertilization, intrauterine insemination)
• Hormone replacement therapy used to alleviate menopausal symptoms and prevent osteoporosis
• SERMs used for osteoporosis prevention (raloxifene) and breast cancer treatment (tamoxifen)
• Aromatase inhibitors used in postmenopausal breast cancer treatment to reduce estrogen levels
• GnRH agonists used in fertility treatments to control ovarian stimulation and in hormone-dependent cancers (prostate cancer, endometriosis)
  • GnRH antagonists used in assisted reproductive technology to prevent premature ovulation

Administration and Dosing

• Oral contraceptives taken daily at same time
  • Combined oral contraceptives typically taken for 21 days followed by 7-day hormone-free interval
  • Progestin-only pills (minipills) taken continuously without hormone-free interval
• Transdermal patches applied weekly for 3 weeks followed by patch-free week
• Vaginal rings inserted for 3 weeks followed by ring-free week
• Injectable contraceptives administered intramuscularly every 3 months (medroxyprogesterone acetate)
• Implants inserted subdermally providing contraception for 3-5 years (etonogestrel)
• Emergency contraceptives taken as soon as possible after unprotected intercourse
  • Levonorgestrel single dose of 1.5 mg or two doses of 0.75 mg taken 12 hours apart
  • Ulipristal acetate single dose of 30 mg
• Fertility drugs dosage individualized based on patient response and monitoring
  • Clomiphene citrate typically started at 50 mg daily for 5 days beginning on day 3-5 of menstrual cycle
  • Gonadotropins administered subcutaneously or intramuscularly with dosage adjusted based on ovarian response
• Hormone replacement therapy dosage individualized based on symptoms and risk factors
  • Estrogen therapy available in oral, transdermal, and vaginal formulations
  • Progestin added for women with a uterus to prevent endometrial hyperplasia
• SERMs and aromatase inhibitors oral medications taken daily
  • Raloxifene 60 mg daily for osteoporosis prevention
  • Tamoxifen 20-40 mg daily for breast cancer treatment
  • Aromatase inhibitors (anastrozole, letrozole) 1 mg daily for breast cancer treatment
• GnRH agonists and antagonists dosage depends on indication and formulation
  • Leuprolide acetate injectable formulations administered monthly or every 3-6 months for endometriosis or prostate cancer
  • Ganirelix acetate administered subcutaneously daily during controlled ovarian stimulation for assisted reproductive technology

Side Effects and Contraindications

• Hormonal contraceptives common side effects include nausea, breast tenderness, headaches, and irregular bleeding
  • Contraindicated in women with history of thromboembolism, stroke, or liver disease
  • Combined hormonal contraceptives increase risk of venous thromboembolism and should be used with caution in women over 35 who smoke
• Emergency contraceptives generally well-tolerated with nausea being most common side effect
  • No known contraindications but should not be used as regular method of contraception
• Fertility drugs side effects include ovarian hyperstimulation syndrome (OHSS), multiple pregnancies, and ovarian torsion
  • Clomiphene citrate contraindicated in women with liver disease or uncontrolled thyroid disorders
  • Gonadotropins contraindicated in women with primary ovarian failure or uncontrolled pituitary or thyroid disorders
• Hormone replacement therapy side effects include breast tenderness, vaginal bleeding, and increased risk of venous thromboembolism
  • Contraindicated in women with history of breast cancer, endometrial cancer, or unexplained vaginal bleeding
• SERMs side effects include hot flashes, leg cramps, and increased risk of venous thromboembolism
  • Raloxifene contraindicated in women with history of venous thromboembolism
  • Tamoxifen increases risk of endometrial cancer and should be used with caution in women with a uterus
• Aromatase inhibitors side effects include hot flashes, joint pain, and osteoporosis
  • Contraindicated in premenopausal women and those with severe osteoporosis
• GnRH agonists and antagonists side effects include hot flashes, vaginal dryness, and decreased bone mineral density
  • Contraindicated in women with undiagnosed vaginal bleeding or pregnancy

Nursing Considerations and Patient Education

• Assess patient's understanding of reproductive health drugs, indications, and proper use
  • Provide clear instructions on administration, dosing, and missed dose management
  • Emphasize importance of consistent and correct use for optimal efficacy
• Review potential side effects and management strategies
  • Encourage patients to report any adverse effects or concerns to healthcare provider
  • Discuss signs and symptoms that require immediate medical attention (severe pain, vision changes, severe headaches)
• Educate patients on non-pharmacological methods for managing reproductive health concerns
  • Lifestyle modifications (healthy diet, regular exercise, stress reduction) can alleviate menopausal symptoms
  • Fertility awareness methods can be used in conjunction with contraceptives for improved efficacy
• Assess patient's risk factors and contraindications before initiating therapy
  • Obtain thorough medical history including smoking status, thromboembolism history, and family history of hormone-sensitive cancers
  • Perform necessary screenings (blood pressure, lipid profile, breast and pelvic exams) before starting treatment
• Monitor patient's response to therapy and adjust dosage as needed
  • Schedule regular follow-up appointments to assess efficacy, side effects, and adherence
  • Perform periodic laboratory tests (liver function, lipid profile) and imaging studies (bone mineral density) as indicated
• Collaborate with interdisciplinary team to provide comprehensive care
  • Consult with reproductive endocrinologists, gynecologists, or oncologists as needed for specialized care
  • Refer patients to mental health professionals for support in coping with infertility, menopausal transitions, or cancer diagnosis
• Promote informed decision-making and patient autonomy
  • Provide balanced information on risks and benefits of reproductive health drugs
  • Encourage patients to express their preferences, values, and concerns regarding treatment options
  • Support patients in making decisions that align with their reproductive goals and quality of life