Estrogens

Progestins

Follicle Stimulating Hormone (FSH)

Luteinizing Hormone (LH)

1) combo: estrogen and progestin

2) Progestin only

1) Monophasic

2) Biphasic-rare

3) triphasic-most like women's hormones

1) prevent pregnancy

2) treat endometriosis and hypermenorrhea

3) produce cyclic withdrawal bleeding

4) postcoital emergency contraception

Absolute: thrombophlebitis, CVA, abnormal liver, smokers over 35, suspected pregnancy, breast cancer,

Relative: HTN, cardiac disease, diabetes, gallbladder disease, epilepsy, migraines, uterine leiomyoma

decrease risk of ovarian and endometrial cancer, PID, benign breast disease, anemia, acne

reduce cramps, lighter,shorter, and more predictable flow

thromboembolic disorders

HTN, Cancer

teratogenic effect

uterine bleeding

benign hepatic adenoma

glucose intolerance

edema, dizziness, headache, depression, n/v, weight gain

Combo OC Drug interactions

that reduce the effects of OC's

Anti-TB

antivirals

antiepileptic drugs

st. john's wart

barbituates

antibiotics

Comb OC drug interactions

whose effects are reduced by OC's

warfarin

insulin

hypoglycemias

beta blockers

Combo OC drug interactions

whose effects are increased by OC's

theophyline-bronchodilator

imipramine-antidepressant

Subdermal etonorgestrel implant

depot medroxprogesterone acetate "depo shot'

intrauterine devices

Spermicides

Barrier devices

-condomes

-diaphragm

-cervical cap

blocks uterine progestone receptors then cervix softens and induction of labor

Emergerncy contraceptive

2 high dose progestin

1 w/i 72 hours another 12 hours later

1) estradiol- most active

2) estrone

2) estriol

1) steroidal

-conjugated estrogens, estradio, transdermal

2) nonsteroidal- not available in US

-chlorotrianisene

1) develop and maintenance of female reproduction

2) secondary sex characteristics

1) treat/prevent estrogen deficiency

-atrophic vaginitis  -dysmenorrhea

-hot flashes  -uterine bleeding

-osteopororsis

2) Continuous combined hormone replacement therapy

-fixed estrogen/progestin combo products 

Estrogen dependent cancer

abnormal vaginal bleeding

prognancy

thromboembolic disorder/history

Estrogen

Adverse Effects

N/V/D/C

abdominal pain

HTN, edema

thrombolytic events

phtosensitvity/chloasma

amenorrhea, break through bleeding

fluid retention, tender breasts, HA

Synthetic

1) Provera

2) Megace

3) hydroxyprogesterone

Dysfunctional uterine bleeding from hormones, fibroids, cancer

primary/secondary amenorrhea

prevent miscarriage

alleviate PMS

management of anorexia/aids and cancer pnts b/c increase appetite

Progestins Adverse Effects

Liver dysfunction

thrombophlebitis

N/V/edema/weight gain

amenorrhea/bleeding/spotting

Estrogen and Progestin

Nursing Implications

Photosensitivity

report weight gain of 10lb in 3 months

follow up with papsmear and breast exam

small dose needed

what to do if miss dose

take PO w/ meal, IM deep and rotate

-Fasomax (B) Calcitonin (H)

prevention and treatment

biphosphanates used for glucocorticoid induced osteoporosis and Paget's disease

Evista (SERM)

prevent of postmenopausal osteoporosis

Forteo (hormone)

used for those with highest risk of fractures- grows bone back

Adverse Effects of

Bisphosphonates

HA, GI upset, Joint pain

Risk of esophageal burns- need to sit up 30mins

Adverse Effects of

SERMS

Same symptoms of Menopause

-hot flashes  -leg cramps

-risk venous thromboembolism

-leukopenia

SERMS- d/c 72 hours before and during any prolonged immobility

monitor for therapeutic effect ex DXA scan

Monitor for adverse effects

nonsteroidal ovulation stimulant

blocks estrogen receptors in the uterus and brain- false low estrogen

causes increase Gn-Rh, FSH, and LH

causes maturation of ovarian follicles

causes ovulation and increases conception

Clomiphene (Clomid)

Adverse Effects

enlarged ovaries

hot flashes, mood swings

abdominal/pelvic pain

N/V, HA

breast pain, abnormal bleeding

increased appetite

mixture of FSH and LH

stimulates development of ovarian follicles

causes ovulation

can be given to men for spermatogenesis

recombinant form of HCG

-cause rupture and ovulation of mature ovarian follicle and maintenance of corpus luteum

used to stimulate ovulation

Fertility Drug

Indication

induce ovulation in anovulatory patients

promote spermatogensis in infertile men

Fertility Drugs

Adverse Effects

tachycardia, phlebitis, DVT

dizzy, HA, flush, depression, anxiety, nervous, fatigue

N/bloat/constipation

Ovarian hyperstimulation

multi preggers

blurred vision, breast pain

Fertility Drug

Nursing IMplication

take drugs as ordered-essential for effective outcomes

keep journal while on drugs

emotional support

Alter uterine contractions

promote labor

prevent start/progression of labor

decrease risk of postpartum hemorrhage

increase force and frequence of contractions

prevent postpartum uterine atony and hemorrhage

natural hormone

potent contractions of myometrium, smooth muscle fibers of uterus

softens cervix and enhances uterine muslce tone

mifeprex, RU 486

stimulates uterine contractions to induce abortion

give w/ prostaglandin drug for elective abortions

Induce labor and increase labor when contractions are weak

put on a pump and monitor fetal HR

prevent postpartum bleeding

complete/incomplete abortion-miscarriage

promote milk ejection

uterine stimulant

adverse effects

hypo/hyper tension, chest pain

HA, dizzy, faint

N,V, D

vaginal pain, cramp

leg cramp, joint swell, chills, fever, weak, blurred vision

Uterine stimulant

Implications

assess mother and fetal vital signs

continuous fetal monitoring if given to promote labor

uterine relaxant

stop labor before term

given after 20th week before 37th

also bed rest, sedation, hydration

Uterine relaxant

stimulant of Beta 2 adrenergic of uterine smooth muscle for off label use

used to stop labr

IV on a pump, monitor Fetal heart rate

hyperreflexive with high levels of Mag

Uterine relaxants

adverse effects

palpitations, tachycardia, HTN

tremors, anxiety, insomnia, HA, dizzy

N/V, anorexia, D/C

Hyperglycemia, HypoKalemia*

dyspnea, hyperventilation

Uterine relaxants

Implications

Asses baseline vitals of mom and baby, weight, blood glucose, renal and liver function

smoking history

medical and medication history

give drug as ordered