Transcript Ch. 29-Drugs Used in Men`s and Women`s Healthx

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drug therapy for men’s and women’s health
involves treating genital infections and STDs
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many women use contraceptives for birth control
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drugs are also used in obstetrics
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some men require treatment of prostatic
hyperplasia or erectile dysfunction
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Drug Therapy for Leukorrhea and Genital Infections:
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having vaginal secretions is normal, excessive discharge
is not normal
leukorrhea is an abnormal whitish vaginal discharge
can occur at any age
symptom of an underlying disorder
most common cause is an infection
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STDS: description table 29-1 pg. 358-359
drugs used to treat genital infections: table 29-2 pg.
359 (also see ch. 34)
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Drugs Used for Contraception:
contraception: process or methods used to prevent
pregnancy
oral contraceptives are most common form of birth control in
the United States
goal is to prevent pregnancy
oral contraceptives prevent ovulation
2 types of oral contraceptives: combination pill and mini-pills
› combination pill: contains both estrogen and progestin
 pills packed with 28 tablets
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3 types of combination pills
› mono-phasic: contain a fixed amount of estrogen and progestin,
given daily for 21 days
› bi-phasic: contain fixed dose estrogen and a progestin dose on days
1-10 that is lower than days 11-21
› tri-phasic: have varying amounts of hormones to provide the lowest
dose necessary to prevent conception
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mini-pill: contains only progestin, all 28 tabs contain active
hormones
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Drugs Used for Contraception cont….
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new combination contraceptive
contains levonorgestrel/ehtinyl estradiol
(Seasonale)
woman has only 4 periods a year, one each
season
contains estrogen and progestin in lower doses
than other combination ontraceptives
pack contains 84 active tablets, and 7 that contain
no hormones, one tablet taken daily
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Assisting With the Nursing Process
oral contraceptives:
ASSESSMENT: measure weight and BP (standing/supine)
PLANNING: see box 29-2 pg.361
IMPLEMENTATION: combination pills: first pill is taken on 1st Sunday after
period begins, one pill taken per day at same time til pack is gone
(21 day pack, wait a week and start a new pack. 28 day pack,
start a new pack after finishing a pack)
mini-pills: first pill is taken on first day of period, use other birth control
the first month, take 1 pill daily at same time til pack is gone. Follow
nurses direction for missed doses.
EVALUATION: report and record:
 nausea, weight gain, spotting, changed menstrual flow, missed
periods, depression, mood changes, headaches, brown
pigmentation on forehead, cheeks and nose: common side effects,
RX change is needed if not resolved in 3 months
 vaginal discharge, break-through bleeding, yeast infection:
prescription change and other drugs may be needed
 blurred vision, severe headaches, dizziness, leg pain, chest pain,
shortness of breath, acute abdominal pain: signals serious
complications
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Transdermal Contraceptive:
example: norelgestromin-ethinyl estradiol
transdermal system: Ortho Evra
 contains estrogen and progestin to inhibit
ovulation
 cervical mucous becomes thick, inhibits
sperm from traveling up cervix to the uterus
and fallopian tubes
 hormones also change endometrial wall, this
impairs implantation of a fertilized ovum
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Assisting With the Nursing Process
transdermal contraceptive:
ASSESSMENT: measure BP (standing/supine)
PLANNING: dose form is the patch
IMPLEMENTATION: apply a new patch on the same day of the week “patch
change day”, apply patch to clean, dry, intact, healthy skin, patch sites:
buttock, abdomen, upper outer arm or upper torso, do NOT apply to
breast. Do not apply make up, powder, lotion or cream to the skin or
patch area
(see info pg. 363 on first day start vs Sunday start)
Follow nurses instructions if a patch becomes loose and falls off
another form of birth control is needed the first 7 days of menstrual cycle
EVALUATION: report and record:
 nausea, weight gain, spotting, changed menstrual flow, missed periods,
depression, mood changes, headaches, brown pigmentation on
forehead, cheeks and nose: common side effects, RX change is needed
if not resolved in 3 months
 vaginal discharge, break-through bleeding, yeast infection: prescription
change and other drugs may be needed
 blurred vision, severe headaches, dizziness, leg pain, chest pain,
shortness of breath, acute abdominal pain: signals serious complications
 Drugs
Used in Obstetrics
Obstetric medicine deals with pregnant women,
labor and childbirth, and first 6-8 weeks after birth
 Drugs used in obstetrics for :
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› inducing labor
› controlling breathing
› maintain uterine firmness after delivery
› induce therapeutic abortion
› prevent premature labor
› prevent seizure activity
› promote ovulation
› prevent mother-child blood incompatibilities in future
pregnancies
**** drugs used in obstetrics listed in table 29-3 p. 362****
Delegation Guidelines
Drugs Used in Obstetrics:
Drugs used in obstetrics must be given carefully to
protect the health of the mother and fetus. If
allowed to give such drugs, you need to learn more
about them. Ask for the necessary education and
supervision.
Some drugs are given parenterally- by intramuscular or
intravenous injection. Because you do NOT give
parenteral dose forms, they are NOT included in this
chapter. Should a nurse delegate the administration
of such to you, you must:
- remember that parenteral dosages are often very
different from dosages other routes
-Refuse the delegation. Make sure to explain why.
Do NOT just ignore the request. Make sure the nurse
knows that you cannot give drug and why
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Drug Therapy for Benign Prostatic Hyperplasia
prostate gland lies in front of rectum and below bladder
in males, it also surround the urethra
 in young males it’s the size of a walnut, it grows and
enlarges as the man gets older, this is BPH (benign
prostatic hyperplasia)
 usually BPH is not problematic til after age 50, most older
men have symptoms
 BPH causes urinary problems, these include:
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weak urine stream
frequent voidings of small amounts of urine
urgency and leaking or dribbling of urine
frequent urination at night
urinary retention
treament depends on extent of problem
TURP (trans-urethral resection of prostate, common
surgical procedure
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Alpha-1 Adrenergic Blocking Agents
block alpha-1 receptors on the prostate
gland and certain areas of the bladder
neck, muscles relax allowing greater urine flow
 used to treat mild-moderate urinary
obstruction with BPH
 examples: alfuzosin (Uroxatral) and tamsulosin
(Flomax)
 goals of therapy:
› reduce symptoms of BPH
› improve urine flow
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Assisting With the Nursing Process
alpha-1 adrenergic blocking agents:
ASSESSMENT: measure BP (standing/supine)
PLANNING: alfuzosin (Uroxatral) dose from is 10mg extendedrelease tabs
tamsulosin (Flomax) dose form is 0.4mg capsules
IMPLEMENTATION: alfuzosin (Uroxatral) given at once after same
meal each day, tablets should not be chewed/crushed
tamsulosin (Flomax):caspule is given about 30minutes after
same meal each day, dosage may be increased to 0.8mg
after 2-4 weeks of therapy if needed to control symptoms
EVALUATION: report and record:
 drowsiness, headache, dizziness, weakness, lethargy: tend to
be self-limiting, provide for safety
 dizziness, tachycardia, fainting: may develop 15-90minutes
after the first dose, give drug with food to avoid these
symptoms, provide for safety
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Anti-Androgen Agents:
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the following are used to treat BPH:
› dutasteride (Avodart)
› finasteride (Proscar)
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these drugs reduce the cell growth associated with BPH
goals of therapy:
› reduce BPH symptoms
› improve urine flow
› reduce need for surgery
Assisting With the Nursing Process
anti-androgen agents:
ASSESSMENT: ask nurse what to observe/report
PLANNING: dutasteride (Avodart): dose form is 0.5mg
capsules
finasteride (Proscar): dose form is 5mg tablets
IMPLEMENTATION:
-(Avodart): a 0.5mg capsules is given once/day, with or
without food
-finasteride (Proscar): a 5mg tablet is given once a day
with or without food
EVALUATION: report and record:
 complaints of impotence, decreased sexual drive,
decreased volume of ejaculate: tend to be self-limiting
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Drug Therapy for Erectile Dysfunction (ED):
ED or impotence: inability for male to have erection
Causes:
› diabetes
› spinal cord injury
› multiple sclerosis
› prostate problems
› alcoholism
› heart/circulatory disorders
› drug abuse
› psychological factors
› high blood pressure meds
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Phospho-Diesterase Inhibitors:
Drugs result in smooth muscle relaxation, allows
blood to fill the erectile tissue in penis during
sexual stimulation
 An erection that results can last an hour or so
 Goals of therapy:
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› improved erectile function
› sexual satisfaction in men with ED
Assisting With the Nursing Process
Drugs that treat ED:
ASSESSMENT: measure vital signs
PLANNING: see table 29-4 (p. 365) for “Oral Dose Forms”
IMPLEMENTATION: see table 29-4 (p. 365) for “Adult Dosage
Range”, a dose is taken 30 minutes to 4 hours before sexual
activity
EVALUATION: report and record:
 headache, flushing of the face and neck: tend to be selflimiting
 color (blue or green) vision impairment: dosage may need to
be reduced
 hypotension, dizziness, angina: person should lie down and
stop sexual activity, person should NOT take nitroglycerin
for angina
 priapism: prolonged or constant erection, medical attention is
needed if it lasts longer than 4 hours