Reproductive System Pharmacology PDF

PHARMACOLOGY RELATED TO THE REPRODUCTIVE SYSTEM Jeffrey A. Lucero, RN, LPT Session Objectives At the end of the session, the learners are expected to: Illustrate the normal anatomy and physiology of the reproductive system Describe some deviations from the normal anatomy and...

PHARMACOLOGY RELATED TO THE REPRODUCTIVE SYSTEM Jeffrey A. Lucero, RN, LPT Session Objectives At the end of the session, the learners are expected to: Illustrate the normal anatomy and physiology of the reproductive system Describe some deviations from the normal anatomy and physiology of the reproductive system Develop a drug study on reproductive system drugs Share with the class information and insight about herbal medicines used for the reproductive system based on the journal reading. Hormonal Physiology involving the Reproductive System There are deviations from NORMAL. Medications for PREGNANCY How does pregnancy happen? ✓ Ovulation ✓ Fertilization ✓ Blastocyst formation ✓ Implantation Changes in drug action during pregnancy include: Effect of circulating steroid hormones on the liver’s metabolism of drugs. Reduced gastrointestinal motility & reduced gastric pH. Increased glomerular filtration rate & increased renal perfusion, resulting in more rapid renal excretion of drugs. Changes in drug action during pregnancy include: Expanded maternal circulating blood volume, resulting in dilution of drugs Alteration in the clearance of drugs in later pregnancy, resulting in decrease in serum & tissue concentration of drugs  Drugs should not be ordered in lower doses with longer intervals between doses because of the possibility of subtherapeutic serum concentrations.  The placenta plays an important role in drug use and metabolism. It has an important function as the organ of exchange for numerous substances, including drugs. It allows some substances to transfer quickly or slowly between mother and fetus. Movement of drug in the placenta depends on: Maternal & fetal blood flow Molecular weight of the substance degree of ionization of drug molecule Degree of protein binding Metabolic activity of the placenta Maternal dose Guidelines for drug administration during pregnancy must include determination that the benefits of prescribing a drug outweigh potential short- or long- term risks to the maternal-fetal system. Preventing Congenital Anomalies related to Pharmacologic Exposure Use of alternative pharmacological therapies during the pre- conception period for certain specific pathologies Administration of drugs during pregnancy taking into account the pharmacological effects in relation to the gestation Teratogens Common Drugs Given during Pregnancy Vitamins and Minerals Antihypertensives Analgesics Corticosteroids Drugs for GI Discomforts Tocolytics  Vitamins and Minerals Vitamin and Dosage Indication Adverse Reaction Nursing Responsibilities Vitamin A Promotes good Bone and liver damage Emphasize that this should 10,000 IU twice a week embryonic Nausea and diarrhea not be taken before the 4th starting on the 4th growth Skin irritation month of pregnancy month of pregnancy Enhances Birth defects Do not give if woman is maternal tissue already taking repair *if dosage is not followed multivitamins Vitamin B9 (Folic Prevents neural Possible allergic reaction Encourage intake of folate Acid) tube defect in Intensely yellow urine for women planning to get 400 μg (non-pregnant) the fetus pregnant. and 600 μg (pregnant) Prevents daily megaloblastic anemia in the mother  Vitamins and Minerals Mineral and Dosage Indication Adverse Reaction Nursing Responsibilities Iron (Fe) Prevents maternal Dark or black stool Dilute and administer thru straw 18 mg (non-pregnant) iron deficiency Gastric irritation Best when administered with and 27 mg (pregnant) anemia Constipation empty stomach or citrus drink daily Do not administer iron with milk, cereal, tea, coffee, or eggs Supplied by organ meats and green leafy vegetables Calcium (Ca) Prevention of pre- Feeling gassy, Ensure the client takes correct 1,000 mg (non- eclampsia from 20 bloated, and dosage of calcium pregnant) and 1,300 mg weeks of gestation constipated Major sources of calcium (pregnant) daily Miscarriage for include dairy products calcium overdose  Analgesics Drug and Dosage Indication Adverse Reaction Nursing Responsibilities Acetaminophen Pain and fever Skin eruptions, urticaria, unusual Should be taken at a 4-to-6- Max daily dose is 4,000 mg bruising, erythema, hour intervals. Hypoglycemia, jaundice Onset of effects after oral Category: B Hemolytic anemia, neutropenia, ingestion is within 10 to 30 leukopenia, pancytopenia, and minutes; peak action occurs thrombocytopenia at 1 to 2 hours; duration is from 3 to 5 hours WOF allergy Use cautiously in patients who are at risk for infection. Aspirin and Ibuprofen Prostaglandin Can inhibit labor initiation Start first with Low-dose aspirin (81 mg/day) synthetase Greater maternal blood loss at nonpharmacologic pain relief prophylaxis for women at high risk inhibitor with delivery Monitor mother for any signs of preeclampsia initiated between antipyretic, Increased risk for anemia in of bleeding 12 and 28 weeks of gestation and analgesic, and pregnancy and antepartum Monitor CBC continued daily until delivery anti- hemorrhage inflammatory Newborn hemostasis is affected Category: C to D properties Irreversible platelet aggregation  Tocolytics Drug and Dosage Indication Adverse Reaction Nursing Responsibilities Magnesium Sulfate Treatment of Circulatory collapse Use caution with renal hypomagnesae Respiratory paralysis insufficiency Loading dose: 4-6 g IV for mia Hypothermia May cause decreased respiratory 20 min; Hypertension Pulmonary edema rate, arrythmias, hypotension, Maintenance: 2-4 g/hr IV Preterm labor Depressed reflexes muscle weakness for Torsade de Hypotension Monitor EKG and respiratory 12-24 hours as tolerated pointes Flushing status after contractions cease Asthma Drowsiness Monitor Mg levels Do not exceed 5-7 days of Anticonvulsant Depressed cardiac Ensure dosage with secondary continuous treatment with eclampsia function practitioner Diaphoresis Calcium gluconate is the Category: D Hypocalcemia antidote Hypophosphatemia Magnesium toxicity results in Hyperkalemia respiratory depress and loss of Visual changes deep tendon reflexes  Nursing Interventions during Tocolytic Therapy Maternal and fetal assessment: Monitor vital signs, FHR, fetal activity, uterine activity. Report respirations fewer than 12 per minute, which may indicate magnesium sulfate toxicity. Monitor input and output (I&O). Report urinary output. Normal is 30ml/hr. Assess breath and bowel sounds as ordered, or at least every 4 hours. Assess deep tendon reflexes (DTR) and clonus before initiation of therapy and as ordered. Notify healthcare provider of changes in DTRs (areflexia or hyporeflexia) and clonus. Assess pain and uterine contractions. Weigh daily at the same time. Monitor serum magnesium levels as ordered (therapeutic level is 4 to 7 mg/dL). Have calcium gluconate (1 g given IV over 3 minutes) available as an antidote. Observe newborn for 24 to 48 hours for magnesium effects if drug was given to mother before the delivery.  Antihypertensive Drug and Dosage Indication Adverse Reaction Nursing Responsibilities Methyldopa Moderate to Angina, Check BP and pulse at severe HPN Bradycardia least q 30min Initially, 250 mg P.O. b.i.d. or t.i.d. in Orthostatic hypotension Monitor BP first 48 hours; then increased or Depression Monitor fluids and decreased, p.r.n., q 2 days. Or 250 Dizziness, Lethargy, Sedation electrolytes to 500 mg I.V. q 6 Rash Report symptoms of hours (maximum dose, 1 g q 6 Gynecomastia mental depression hours). Impotence Dry mouth, Nausea Adjust Vomiting, dosage if other Hemolytic anemia, antihypertensives Thrombocytopenia are added to or Liver toxicity deleted from Arthralgia, therapy. Autoimmune disease, Lupus-like syndrome Category: B (Oral) or C (IV)  GI Discomforts Drug and Dosage Indication Adverse Reaction Nursing Responsibilities Magnesium Antiflatulant and Aluminum-based antacids may Do not administer to clients hydroxide and neutralizes gastric cause constipation, whereas with renal disease aluminum hydroxide acid. magnesium-based antacids have a Concurrent administration laxative with digoxin, indomethacin, with Simethicone effect. or iron salts may decrease Multiple absorption of these drugs formulations available OTC – take as directed Category: C Metoclopramide Antiemetics Restlessness The drug is contraindicated 5-10 mg PO q 8 hours Drowsiness to those with allergic reaction Diarrhea to it. Category: B Weakness Do not give to patients with Insomnia GI obstruction, perforation, Tardive dyskinesia or hemorrhage; pheochromocytoma; or history of seizure  Corticosteroids Drug and Dosage Indication Adverse Reaction Nursing Responsibilities Dexamethasone Fetal lung Insomnia, For systemic administration, development nervousness, increased appetite, do not give drug to nursing 6 mg IM every 12 hours for 4 doses headache, hypersensitivity mothers; drug is secreted in reactions, and arthralgias breast milk. Category: C Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels. Do not give live virus vaccines with immunosuppressive doses of corticosteroids. PO 100-200 mg PO 1 tablet daily PO 500 mg bid daily to 850 mg tid Common deviations from normal findings in the REPRODUCTIVE SYSTEM Polycystic Ovary Syndrome (PCOS) Female Infertility Pharmacologic Treatments Common deviations from normal findings in the REPRODUCTIVE SYSTEM Polycystic Ovary Syndrome (PCOS) Female Fertility Male Infertility Testosterone Pharmacologic Effect of Testosterone Virilizing and anabolic effects Testosterone Pharmacokinetics Anti-Estrogen GnRH GnHs Non-Hormonal Therapy Common deviations from normal findings in the REPRODUCTIVE SYSTEM Polycystic Ovary Syndrome (PCOS) Female Infertility Male Infertility Prostate Enlargement  The enlargement, or hypertrophy, of the prostate gland, extending upward into the bladder and obstructing the outflow of urine. Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs). BPH is common in men older than 40 years. Alpha Blockers  5-α-Reductase Inhibittor works by blocking the action of 5-alpha reductase, which causes prostate enlargement, and by relaxing muscles in the prostate Both finasteride and dutasteride have similar possible side effects including: erectile dysfunction, decreased libido, and depression Phosphodieterase-5 Inhibitor 20/11/2024 End of the presentation. Questions? Prepared by: JALucero, RN, LPT