Transcript Chapter 24

Chapter 24
Reproductive System Drugs
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Introduction
• Hormones that regulate reproductive
system functions include endogenous
chemical substances
– Originate within different areas of the body
• Reproductive hormones categories
– Gonadotropic
– Androgens
– Estrogens
– Progestins
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Introduction (cont’d.)
• The following slides discuss various
reproductive system drugs
– Refer to the chapter for specific side effects,
contraindications, and interactions
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Gonadotropics
• Gonadotropic hormones include:
– Follicle-stimulating hormone (FSH)
• Stimulates development of ovarian follicles in the
female and sperm production in testes of the male
– Luteinizing hormone (LH)
• Works in conjunction with FSH to induce secretion
of estrogen, ovulation, and development of corpus
luteum
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Gonadotropics (cont’d.)
– Luteotropic hormone (LTH)
• Stimulates secretion of progesterone by the corpus
luteum and secretion of milk by the mammary
gland
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Androgens
• Male sex hormones
– Secreted mainly in the interstitial tissue of the
testes in the male and secondarily in the
adrenal glands of both sexes
– Inadequate production in the male may be
due to pituitary malfunction or to atrophy,
injury to, or removal of the testicles, resulting
in eunuchism or eunuchoidism
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Erectile Dysfunction Medications
• Inability to achieve or maintain an erection
sufficient for satisfactory performance
– Incidence increases with age
– Nitric oxide: principal mediator in attaining and
maintaining an erection
• Phosphodiesterase (PDE) inhibitors
– Block phosphodiesterase type 5, found in the
corpus cavernosum
• Thought to impair the production of nitric oxide
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Estrogens
• Female sex hormones
– Produced mainly by the ovary and secondarily
by the adrenal glands
– Responsible for development of female
secondary sexual characteristics
– Produce an environment suitable for
fertilization, implantation, and nutrition of the
early embryo
– Affect secretion of hormones FSH and LH
from the anterior pituitary gland
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Estrogens (cont’d.)
• Menopause
– Natural life event, or can be artificially induced
– Levels of estrogen and progesterone are
reduced, leading to vasomotor symptoms and
atrophic vaginitis
• Estrogen therapy (ET): estrogen alone
– Associated with increased risk of endometrial
carcinoma in women with an intact uterus
• When progestin is combined with estrogen, the risk
of endometrial cancer is substantially reduced
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Progestins
• Progesterone
– Hormone secreted by the corpus luteum and
adrenal glands
– Responsible for changes in uterine
endometrium in the second half of the
menstrual cycle
• Preparation for implantation, development of
maternal placenta after implantation, and
development of mammary glands
– Progestins are synthetic drugs that exert
progesterone-like activity
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Progestins (cont’d.)
• Contraceptive agents
– Suppress release of pituitary hormones,
follicle-stimulating hormone (FSH), and
luteinizing hormone (LH)
• Results in ovulation prevention
• Progestin-only contraceptives
– Prevent pregnancy by inhibiting ovulation,
changing cervical mucus, and creating a thin,
atrophic endometrium not conducive to
sustaining the fertilized ovum
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Choice of Contraceptives
• Estrogen-progestin oral contraceptives
– Classified according to estrogen content and
formulation
• Monophasic, biphasic, triphasic, and four-phasic
• Extended- or continuous-cycle oral
contraceptives
– Decrease or eliminate hormone-free interval
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Choice of Contraceptives (cont’d.)
• Progestin-only contraceptives
– Recommended for patients who do not
tolerate estrogen or in whom it is
contraindicated
• Progestin-containing intrauterine device
– Mirena contains a reservoir of levonorgestrel,
a synthetic progestin
• Releases small amounts of progesterone daily,
providing five years of continuous contraception
protection
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Choice of Contraceptives (cont’d.)
• Postcoital contraception
– Combined estrogen-progestin contraceptive
pills used in case of emergency
– Not without risk
– Available option to women who are exposed
to an unintentional risk of pregnancy
– Examples: Next Choice and ulipristal acetate
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Drugs for Labor and Delivery
• Oxytocin is a hormone that stimulates the
uterus to contract, thus inducing childbirth
– Also acts on the mammary gland to stimulate
the release of milk
• Synthetic chemicals used to stimulate
uterine contractions are called oxytocics
– Include oxytocin and prostaglandin E1 and E2
• Goal of labor induction
– Facilitate vaginal delivery of a healthy infant
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Drugs for Labor and Delivery
(cont’d.)
• Prostaglandins are released as a natural
part of the cervical ripening process
– Those causing contraction of the myometrial
muscle include dinoprostone or prostaglandin
E2 (Prostin E2, Cervidil, Prepidil), and the oral
synthetic prostaglandin E1 analog, misoprostol
(Cytotec), and the prostaglandin F2-alpha
analog carboprost (Hemabate)
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Drugs for Labor and Delivery
(cont’d.)
• Mifepristone (RU-486)
– Antiprogesterone drug used to terminate an
unwanted pregnancy (in conjunction with
misoprostol)
– Only for use very early in pregnancy
• Methylergonovine
– Semisynthetic ergot alkaloid used for
prevention and treatment of postpartum and
postabortion hemorrhage
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Drugs for Labor and Delivery
(cont’d.)
• Terbutaline
– Classified as a bronchodilator drug
– Also used with careful monitoring in the
management of preterm labor
• Magnesium sulfate
– For prevention and control of seizures in eclamptic
patients
• Preeclampsia is characterized by new-onset
hypertension, edema, and proteinuria during pregnancy
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Other Gonadotropic Drugs
• Gonadotropin-releasing hormones (GnRH)
– Act in the pituitary to suppress ovarian and
testicular hormone production and inhibit
estrogen and androgen synthesis
– GnRH analogs that inhibit gonadotropin
secretion are used in the management of
endometriosis
– Examples: Lupron and Synarel
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