Drugs Affecting the Female Reproductive System PDF

Drugs Affecting the Female Reproductive System Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 40) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Integrate knowledge...

Drugs Affecting the Female Reproductive System Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 40) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Integrate knowledge of the effects of sex hormones on the female body to explain the therapeutic and adverse effects of these agents when used clinically. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with drugs that affect the female reproductive system. 3. Discuss the use of drugs that affect the female reproductive system across the lifespan. 4. Compare and contrast the prototype drugs estradiol, raloxifene, norethindrone, clomiphene, oxytocin, and dinoprostone with other agents in their class. 5. Outline the nursing considerations, including important teaching points to stress, for patients receiving drugs that affect the female reproductive system.  DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM ACROSS THE LIFESPAN Children: Adults: o Estrogens and progestins have been minimally o Women taking these drugs should undergo annual tested in children. medical exams, including breast exams and Pap smears. o These hormones should be used cautiously in o Adverse effects should be discussed, and women on growing children due to their impact on estrogen should avoid smoking due to the risk of epiphyseal closure. thrombotic events. o For teenage girls, the lowest effective dose of o Men using these drugs for cancer treatment should be oral contraceptives should be prescribed, with informed about potential estrogenic effects. careful monitoring for metabolic and other o Women in fertility programs need psychological support effects. and frequent monitoring, with an explanation of the risks of multiple births. Older Adults: o Patients using abortifacients require psychological o Hormone Replacement Therapy (HRT) is less support and written lists of symptoms to watch for. common for postmenopausal women due to conflicting reports on benefits and risks. o These drugs should not be used during pregnancy or lactation due to risks to the fetus or neonate. o Patients should be supported in making informed decisions about HRT and its interaction with alternative therapies. SITES OF ACTION OF DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM SEX HORMONES AND ESTROGEN RECEPTOR MODULATORS SEX HORMONES AND ESTROGEN RECEPTOR MODULATORS SEX HORMONES FEMALE SEX HORMONES Estrogens: o Types include estradiol (e.g., Estrace, Climara), conjugated estrogens (Premarin), esterified estrogen (Menest), and estropipate (Ogen). Progestins: ❖ Examples include: o Drospirenone (Yasmin, Yaz) o Etonogestrel (Implanon) o Levonorgestrel (Mirena) o Medroxyprogesterone (Provera) o Norethindrone (Aygestin) o Norgestrel (generic) o Progesterone (Prometrium) o Desogestrel (in many contraceptive combinations) o Ulipristal (Ella), used as a postcoital contraceptive. VARIETY OF ADVERSE EFFECTS AND TOXICITIES ASSOCIATED WITH DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM. AVAILABLE FORMS OF ESTROGEN & PROGESTIN  SEX HORMONES Estrogens: o Used for hormone replacement therapy (HRT) when ovarian activity is absent or blocked. o Palliation for menopausal discomforts during early menopause. o Treat female hypogonadism, ovarian failure, and prevent postpartum breast engorgement. o Part of combination contraceptives and slows bone loss in osteoporosis. o Palliation in cancers with receptor sensitivity (e.g., androgen-dependent prostate cancers). o Important for female reproductive system development and secondary sex characteristics. o Affect FSH and LH release, conserve calcium and phosphorus, and promote bone formation. Therapeutic Actions & o Prevent ovulation and postpartum breast discomfort. Indications o Protect the heart from atherosclerosis and retain calcium in bones. o Can have negative reactions when used long-term in postmenopausal women (as shown by the Women’s Health Initiative). Progestins: o Used as contraceptives, often combined with estrogens. o Treat primary and secondary amenorrhea, functional uterine bleeding, and in fertility programs. o Some progestins treat cancers with receptor site sensitivity. o Transform proliferative endometrium into a secretory one, inhibit FSH and LH, and prevent follicle maturation and ovulation. o Inhibit uterine contractions and have some anabolic and estrogenic effects. o "Trick" the hypothalamus and pituitary into preventing follicle development and ovulation when used as contraceptives. Estrogens: o Well absorbed through the gastrointestinal tract, metabolized in the liver, and excreted in urine. o Cross the placenta and enter breast milk. Pharmacokinetics Progestins: o Well absorbed, undergo hepatic metabolism, and excreted in urine. o Cross the placenta and enter breast milk. o Available in various forms: vaginal ring (NuvaRing), subdermal implant (etonogestrel), morning-after pill (Plan B, Ella).  SEX HORMONES Estrogens o Contraindicated in: Known allergies to estrogens; Idiopathic vaginal bleeding; Breast cancer or estrogen-dependent cancers; History of thromboembolic disorders (including cerebrovascular accident); Heavy smokers (due to increased thrombus/embolus risk); Hepatic dysfunction; Pregnancy (risk of fetal defects); & Breastfeeding (possible effects on neonate). o Caution in: Metabolic bone disease (estrogen's bone-conserving effect may worsen condition) Contraindications (C.Is) Renal insufficiency (risk of adverse effects on fluid/electrolyte balance) & Cautions Hepatic impairment (can alter drug metabolism and increase adverse effects) Progestins o Contraindicated in: Pelvic inflammatory disease (PID); Sexually transmitted diseases; Endometriosis or pelvic surgery (due to progestins' effects on uterine vasculature); Drospirenone: Risk of hyperkalemia with renal disorders, liver disease, adrenal dysfunction, or potassium-altering drugs. o Caution in: Epilepsy, migraines, asthma, cardiac or renal dysfunction (may exacerbate these conditions) Estrogens o Common GU effects: Breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, changes in libido. o Systemic effects: Fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, edema o GI effects: Nausea, vomiting, abdominal cramps, bloating, colitis o Serious GI effects: Acute pancreatitis, cholestatic jaundice, hepatic adenoma Progestins (Adverse effects vary by administration route): Adverse Effects (AEs) o Systemic effects: Similar to estrogen o Dermal patch: Systemic effects, local skin irritation o Vaginal gel: Headache, nervousness, constipation, breast enlargement, perineal pain o Intrauterine systems: Abdominal pain, endometriosis symptoms, abortion, PID, IUD expulsion o Vaginal use: Local irritation, swelling o Drospirenone: Can increase potassium levels (antimineralocorticoid activity)  SEX HORMONES Estrogens o Drugs that enhance hepatic metabolism (e.g., barbiturates, rifampin, tetracyclines, phenytoin) decrease serum estrogen levels. o Increases therapeutic/toxic effects of corticosteroids. o Smoking + estrogens increases thrombus/embolus risk. o Grapefruit juice inhibits estrogen metabolism, increasing serum levels. o St. John’s wort may decrease estrogen effectiveness (discouraged with contraceptives). o Herbal/alternative therapies for menopause may interact with estrogens. Progestins o Reduced effectiveness when combined with: Drug-drug Interactions ✓ Barbiturates ✓ Carbamazepine ✓ Phenytoin ✓ Griseofulvin ✓ Penicillins ✓ Tetracyclines ✓ Rifampin ✓ Recommendation: Use alternative contraception if birth control is required. o St. John’s wort: Can affect progestin metabolism, making progestin-containing contraceptives less effective. ✓ Recommendation: Avoid this combination. SEX HORMONES  ESTROGEN RECEPTOR MODULATORS: Raloxifene (Evista) & Toremifene (Fareston) o Not hormones but affect specific estrogen receptor sites, stimulating some and blocking others. Therapeutic Actions & Indications o Developed to mimic some positive effects of estrogen replacement while minimizing adverse effects. o Toremifene discussed further in antineoplastic therapy. o Administered orally, well absorbed from the GI tract. Pharmacokinetics o Metabolized in the liver and excreted via feces. o Crosses the placenta and enters breast milk. o Contraindicated in patients with known allergy, pregnancy, or lactation. Contraindications (C.Is) & Cautions o Use caution in patients with a history of venous thrombosis or smoking due to increased blood clot risk. o GI upset, nausea, vomiting, and fluid balance changes. Adverse Effects (AEs) o Headache, dizziness, visual and mental changes, hot flashes, skin rash, edema, vaginal bleeding. o Venous thromboembolism as a dangerous side effect. o Cholestyramine reduces absorption. Drug-drug Interactions o Highly protein-bound drugs (e.g., diazepam, ibuprofen) may interfere with binding. o Warfarin use decreases prothrombin time; close monitoring needed.  SEX HORMONES OR ESTROGEN RECEPTOR MODULATORS Nursing Considerations Nursing Diagnosis Planning o Assess for contraindications or cautions. o Perform a physical assessment to establish a baseline status before beginning therapy and during therapy to determine the o Excess fluid volume related to fluid effectiveness of therapy and evaluate for any potential adverse retention effects. o Acute pain related to systemic side o The patient will receive o Assess abdomen, including auscultation of bowel sounds & effects of GI pain and headache the best therapeutic effect palpation of liver, to identify abnormalities. Measure abdominal Ineffective tissue perfusion (cerebral, from the drug therapy. girth as indicated to evaluate for bloating. o Assess skin color, lesions, and texture; affect, orientation, mental cardiopulmonary, peripheral) related o The patient will have status, and reflexes; and blood pressure, pulse, cardiac auscultation, to changes in the blood vessels limited adverse effects to edema, and perfusion, which will reflect circulatory status and show concerning drug therapy and risk of the drug therapy. any changes associated with thromboembolism. thromboemboli o Complete or assist with pelvic & breast exams. Ensure specimen o Unbalanced nutrition: Less than body o The patient will have an collection for Pap smear; obtain a history of the patient’s menstrual requirements related to GI distress understanding of the drug cycle to provide baseline data and to monitor for any adverse effects therapy, adverse effects to associated with drug therapy that could occur. o Arrange for ophthalmic examination (particularly if the patient wears o Risk for ineffective management of anticipate, and measures contact lenses) because hormonal changes can alter the fluid in the therapeutic regimen related to to relieve discomfort and eye and curvature of the cornea, which can change the fit of contact complexities of drug regimen improve safety. lenses and alter visual acuity. o Deficient knowledge regarding drug o Monitor the results of laboratory tests, including urinalysis and renal therapy and/or hepatic function tests, to determine the need for possible dose adjustment and identify early indications of dysfunction.  SEX HORMONES OR ESTROGEN RECEPTOR MODULATORS Implementation with Rationale Evaluation o Monitor patient response to the drug o Administer drug as prescribed to prevent adverse effects; administer with food if GI upset is severe (palliation of signs and symptoms of menopause, prevention of pregnancy, to relieve GI distress. decreased risk factors for coronary o Provide analgesics for relief of headache as appropriate. artery disease, palliation of certain o Strongly urge the patient to stop smoking to reduce the risk of thromboemboli. cancers). o Encourage the use of small, frequent meals to assist with nausea and vomiting. o Monitor for adverse effects (liver o Monitor for swelling and changes in vision or fit of contact lenses to monitor for fluid retention and changes, GI upset, edema, changes in fluid changes. secondary sex characteristics, o Arrange for at least an annual physical examination, including pelvic examination, Pap smear, and headaches, thromboembolic episodes, breakthrough bleeding). breast examination, to reduce the risk of adverse effects and to monitor drug effects. o Monitor for potential drug–drug o Assess the patient periodically for changes in perfusion or signs of vessel occlusion because of the interactions as indicated. risk of thromboemboli. o Evaluate the effectiveness of the o Monitor liver function periodically for the patient on long-term therapy to evaluate liver function teaching plan (the patient can name and ensure discontinuation of the drug at any sign of hepatic dysfunction. the drug, dosage, adverse effects to o Offer support and reassurance to deal with the drug and drug effects. Provide thorough patient watch for, specific measures to avoid teaching, including steps to take if a dose is missed or lost, measures to avoid adverse effects, signs them, and warning signs and symptoms). and symptoms that may indicate a problem, and the need for regular evaluation to enhance patient o Monitor the effectiveness of comfort knowledge about drug therapy and to promote compliance. measures and compliance with the regimen. ESTROGEN MODULATORS Raloxifene & Tamoxifen are used in breast cancer FERTILITY DRUGS  FERTILITY DRUGS o Used for women without primary ovarian failure who are unable to conceive after 1 year. o Stimulate follicles, ovulation, or hypothalamus to increase FSH and LH levels for ovarian follicular development. o Often combined with HCG to maintain follicle and hormone production. o Used in cases where women have functioning ovaries and their partners are fertile. Therapeutic Actions & o May also stimulate multiple follicle development for ova harvesting for in vitro fertilization (IVF).Menotropins stimulate Indications spermatogenesis in men with low sperm counts. o Cetrorelix inhibits premature LH surges during ovarian stimulation. o Follitropin alfa/beta and menotropins stimulate follicular development and spermatogenesis. o Urofollitropin stimulates follicle development and ovulation. o Well absorbed, treated like endogenous hormones, metabolized in the liver, and excreted by the kidneys. Pharmacokinetics o Available in injectable forms: cetrorelix, chorionic gonadotropin, follitropin alfa/beta, menotropins, ganirelix, urofollitropin. o Clomiphene is an oral agent. o Contraindicated in primary ovarian failure, thyroid/adrenal dysfunction, ovarian cysts, pregnancy, idiopathic uterine bleeding, and Contraindications (C.Is) known allergy. & Cautions o Caution in breastfeeding women, those with thromboembolic or respiratory diseases due to potential adverse effects. o Increased risk of multiple births, birth defects, ovarian overstimulation (abdominal pain, ascites, pleural effusion). Adverse Effects (AEs) o Other side effects: headache, fluid retention, nausea, bloating, uterine bleeding, ovarian enlargement, gynecomastia, and febrile reactions. Drug-drug Interactions o No mention in the book.  FERTILITY DRUGS Nursing Considerations Nursing Diagnosis Planning o Assess for contraindications or cautions. o Perform a complete physical assessment to establish baseline status o Disturbed body image related to before beginning therapy and during therapy to monitor for any drug treatment and diagnosis o The patient will receive potential adverse effects. Acute pain related to headache, o Perform a psychological assessment to determine teaching and the best therapeutic effect fluid retention, or GI upset support needs as these patients are often stressed, anxious, and can from the drug therapy. experience bouts of depression, which the nurse will need to be o Sexual dysfunction related to o The patient will have ready to address. alterations in normal hormone o Assess skin and lesions; orientation, affect, and reflexes; and blood limited adverse effects to control Deficient knowledge pressure, pulse, respiration, and adventitious sounds to determine the drug therapy. regarding drug therapy cardiac function and perfusion and to detect changes in blood flow o The patient will have an or thromboemboli. o Risk for impaired tissue perfusion o Complete or assist with pelvic and breast examinations and ensure understanding of the drug (cardiopulmonary, peripheral) collection of specimen for Pap smear to establish a baseline of GU therapy, adverse effects to related to increased risk for health and detect early changes as a result of drug therapy. anticipate, and measures o Monitor the results of laboratory tests, such as renal and hepatic thrombus formation to relieve discomfort and function studies, to evaluate for possible dysfunction that might o Situational low self-esteem interfere with metabolism and excretion of the drug; and check improve safety. related to the need for fertility hormonal levels as indicated to determine the effectiveness of therapy and reduce the risk of ovarian hyperstimulation. drugs  FERTILITY DRUGS Implementation with Rationale Evaluation o Assess the cause of dysfunction before beginning therapy to ensure appropriate use of the drug. o Complete a pelvic examination before each use of the drug to rule out ovarian o Monitor patient response to enlargement, pregnancy, or uterine problems. the drug (ovulation). o Check urine estrogen and estradiol levels before beginning therapy to verify ovarian o Monitor for adverse effects function. (abdominal bloating, weight o Administer with an appropriate dose of HCG as indicated to ensure beneficial effects. gain, ovarian overstimulation, o Discontinue the drug at any sign of ovarian overstimulation and arrange for multiple births). hospitalization to monitor and support the patient if this occurs. o Evaluate the effectiveness of o Provide a calendar of treatment days, explanations of adverse effects to anticipate, and the teaching plan (the patient instructions on when intercourse should occur to increase the therapeutic effectiveness can name the drug, dosage, of the drug. adverse effects to watch for, o Provide warnings about the risk and hazards of multiple births so the patient can make and specific measures to avoid informed decisions about drug therapy. them). o Offer support and encouragement to deal with low self-esteem, stress, anxiety, and o Monitor effectiveness of possible depression issues associated with infertility. comfort measures and o Provide patient teaching about proper administration technique, appropriate disposal of compliance with the regimen. needles and syringes, measures to avoid adverse effects, warning signs of problems, and the need for regular evaluation to enhance patient knowledge about drug therapy and to promote compliance.  UTERINE MOTILITY DRUGS Uterine motility drugs: Hydroxyprogesterone caproate (Makena): o Stimulate uterine contractions to assist o Approved in 2011 to reduce the risk of preterm labor (oxytocics) birth in women with single-fetus pregnancies o Induce abortion (abortifacients) and a history of singleton spontaneous preterm birth o Tocolytics: o Not approved for use in multiple-fetus o Drugs used to slow uterine activity pregnancies Terbutaline: o Synthetic progestin with progestin effects and o Beta2-selective adrenergic agonist adverse effects o Used off-label as a tocolytic to relax the o Administered via intramuscular injection once a gravid uterus and prolong pregnancy week from 16–20 weeks of gestation until the 37th week o In 2011, the FDA issued a black box warning due to significant risks, stating this use was not an approved indication. UTERINE MOTILITY DRUGS  OXYTOCICS o Oxytocics stimulate uterine contractions by affecting neuroreceptor sites, especially in the gravid uterus. Therapeutic Actions & Indications o Oxytocin, a synthetic hormone, also stimulates lacteal glands for milk ejection in lactating women. o Used to prevent and treat uterine atony after delivery, preventing postpartum hemorrhage. o Rapidly absorbed via parenteral or oral administration. o Metabolized in the liver and excreted in urine and feces. o Cross the placenta and enter breast milk. Pharmacokinetics o Administered intramuscularly (IM) or intravenously (IV); methylergonovine also available in oral form post-delivery to promote uterine involution. o Oxytocin used in nasal form to stimulate milk letdown in lactating women. o Contraindicated in cases of allergy to oxytocics, cephalopelvic disproportion, unfavorable fetal position, complete Contraindications (C.Is) & Cautions uterine atony, or early pregnancy. o Caution in patients with coronary disease, hypertension, previous cesarean births, or hepatic/renal impairment. o Common: Uterine hypertonicity and spasm, uterine rupture, postpartum hemorrhage, decreased fetal heart rate, GI upset, nausea, headache, dizziness. o Methylergonovine may cause ergotism (symptoms: nausea, BP changes, weak pulse, chest pain, cold extremities, Adverse Effects (AEs) delirium, convulsions). o Oxytocin may cause severe water intoxication, leading to coma or maternal death due to antidiuretic hormone effects. Drug-drug Interactions o No mention in the book.  OXYTOCICS Nursing Considerations Nursing Diagnosis Planning o Assess for contraindications or cautions. o Perform a complete physical assessment to establish a baseline before beginning therapy and during therapy to evaluate drug effectiveness and to determine potential o The patient will receive adverse effects. the best therapeutic effect ✓ Assess the patient’s neurological status, including level from the drug therapy. of orientation, affect, reflexes, and papillary response. o Acute pain related to increased o The patient will have ✓ Monitor vital signs, including pulse and blood pressure; frequency and intensity of limited adverse effects to auscultate lungs for evidence of adventitious sounds. uterine contractions or headache the drug therapy. ✓ Assess labor pattern, including uterine contractions, o Excess fluid volume related to cervical dilation and effacement, and fetal status, o The patient will have an ergotism or water intoxication including fetal heart rate, rhythm, and position. understanding of the drug o Deficient knowledge regarding Institute electronic fetal monitoring as appropriate. therapy, adverse effects to drug therapy ✓ Evaluate uterine tone, noting any indications of atony; anticipate, and measures assess fundal height and uterine involution, and to relieve discomfort and amount and characteristics of vaginal bleeding. improve safety. o Monitor the results of laboratory tests, including coagulation studies and complete blood count to evaluate hematological status.  OXYTOCICS Implementation with Rationale Evaluation o Ensure fetal position (if appropriate) and cephalopelvic proportions to prevent serious complications of delivery. o Regulate oxytocin delivery using an infusion pump between contractions if it is being given to o Monitor patient response to the stimulate labor to regulate dose appropriately. drug (uterine contraction, o Monitor blood pressure and fetal heart rate frequently during and after administration to monitor prevention of hemorrhage, milk for adverse effects. Discontinue the drug if blood pressure rises dramatically. letdown). o Monitor uterine tone and involution and amount of bleeding to ensure safe and therapeutic drug o Monitor for adverse effects (blood use. pressure changes, uterine o Discontinue the drug at any sign of uterine hypertonicity to avoid potentially life-threatening effects; hypertonicity, water intoxication, provide life support as needed. Monitor fetal heart rate and rhythm if given during labor to ensure ergotism). safety of the fetus. o Evaluate the effectiveness of the o Provide nasal oxytocin at bedside with the bottle sitting upright. Have the patient invert the squeeze teaching plan (the patient can bottle and exert gentle pressure to deliver the drug just before nursing to achieve greatest name the drug, dosage, adverse therapeutic effect to stimulate milk letdown. effects to watch for, and specific o Provide patient teaching about administration technique for nasal oxytocin if indicated, required measures to avoid them). monitoring and assessments, danger signs and symptoms to report immediately, possible adverse o Monitor the effectiveness of effects, measures to be instituted to reduce the risk of adverse effects, safety and comfort comfort measures and compliance measures, measures to promote effective breastfeeding as appropriate (for nasal administration of with the regimen. oxytocin), and ongoing need for continued monitoring and evaluation to enhance patient knowledge of drug therapy and to promote compliance. OXYTOCICS ABORTIFACIENTS  ABORTIFACIENTS Therapeutic Actions & o Abortifacients stimulate uterine activity, dislodging implanted trophoblasts and preventing fertilized egg implantation. Indications o Used to terminate pregnancy between 12 to 20 weeks from the last menstrual period. o Well absorbed, metabolized in the liver, and excreted in the urine. o Used only during pregnancy to end it. Pharmacokinetics o Mifepristone: Oral, takes 5 to 7 days for effect. o Carboprost: IM injection, onset 15 minutes, duration 2 hours. o Dinoprostone: Intravaginal suppository, onset 10 minutes, duration 2 hours. o Should not be used with allergies to abortifacients/prostaglandins or after 20 weeks of pregnancy. Contraindications (C.Is) o Avoid in cases of active PID or acute CV, hepatic, renal, or pulmonary disease. & Cautions o Not recommended during lactation; alternative feeding methods should be used if necessary. o Caution with a history of asthma, hypertension, adrenal disease, vaginitis, or a scarred uterus. o Abdominal cramping, heavy uterine bleeding, perforated uterus, uterine rupture. Adverse Effects (AEs) o Other effects: headache, nausea, vomiting, diarrhea, diaphoresis, backache, rash. Drug-drug Interactions o No mention in the book.  ABORTIFACIENTS Nursing Considerations Nursing Diagnosis Planning o Assess for contraindications or cautions. o Perform a psychological assessment to determine teaching and support needs as these patients are often stressed, are anxious, and can experience bouts of depression, which the nurse will need to be o Acute pain related to uterine o The patient will receive ready to address. contractions or headache the best therapeutic effect o Perform a complete physical assessment before beginning therapy to establish baseline status and during therapy to determine drug o Ineffective coping related to from the drug therapy. effectiveness and evaluate for any potential adverse effects. abortion or fetal death o The patient will have o Confirm date of last menstrual period and estimated duration of o Risk for injury related to limited adverse effects to pregnancy to ensure appropriate use of the drug. the drug therapy. o Assess vital signs, including skin and lesions; orientation and affect; increased risk for heavy vaginal and blood pressure, pulse, and respiration; and auscultate lung bleeding Risk for fluid volume o The patient will have an sounds to monitor for vascular effects, including bleeding and deficit related to blood loss, understanding of the drug hypersensitivity reactions. diarrhea, and diaphoresis therapy, adverse effects to o Assist with or complete a pelvic examination, observe for vaginal discharge, and evaluate uterine tone to monitor effectiveness of the o Deficient knowledge regarding anticipate, and measures drug and the occurrence of adverse effects. drug therapy to relieve discomfort and o Monitor the results of laboratory tests, including complete blood improve safety. count (e.g., leukocyte count, hemoglobin, and hematocrit) to monitor for excess bleeding and urinalysis to monitor for potential infection or reaction to the procedure.  ABORTIFACIENTS Implementation with Rationale Evaluation o Administer via route indicated following the manufacturer’s directions for storage and preparation to ensure safe and therapeutic use of the drug. o Monitor patient response to o Confirm the age of the pregnancy before administering the drug to ensure appropriate use of the drug (evacuation of the drug. uterus). o Confirm that abortion or uterine evacuation is complete by assessing vaginal bleeding and o Monitor for adverse effects (GI passing of tissue in the vaginal blood to avoid potential bleeding problems; prepare for upset, nausea, blood pressure dilation and curettage if necessary to stop excessive blood loss. changes, hemorrhage, uterine o Monitor blood pressure frequently during and after administration to assess for adverse rupture). effects; discontinue the drug if blood pressure rises dramatically. o Evaluate the effectiveness of o Monitor uterine tone and involution and the amount of bleeding during and for several days the teaching plan (the patient after use of the drug to ensure appropriate response to and recovery from the drug. can name the drug, dosage, o Provide support and appropriate referrals to help the patient deal with abortion or fetal adverse effects to watch for, death. and specific measures to avoid o Provide patient teaching, including monitoring necessary during drug administration, comfort them). measures, signs and symptoms of adverse effects, measures to minimize or prevent adverse o Monitor the effectiveness of effects, danger signs and symptoms to report immediately, need for follow-up monitoring and comfort measures and evaluation, and sources for support and referrals to enhance patient knowledge about drug compliance with the regimen. therapy and to promote compliance.