Transcript File

Chapter 41
Drugs Used in Men’s
and Women’s Health
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Lesson 41.1
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Objectives


Discuss leukorrhea and the products used to
treat Candida albicans, Trichomonas
vaginalis, and Gardnerella vaginalis.
Identify important personal hygiene measures
to educate women and men regarding
prevention of the spread of sexually
transmitted infections.
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Vaginitis


Leukorrhea is not a disease but symptom of
an underlying disorder
Most common cause is infection of the lower
reproductive tract
 Common organisms: Candida albicans,
Trichomonas vaginalis, Gardnerella vaginalis

Products to treat vaginitis
 Miconazole (Monistat)
 Metronidazole (Flagyl)
 See Table 41-2 for further discussion
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Nursing Assessment
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



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Be aware of increasing frequency of sexual
activity among adolescents
History of current symptoms
Medication history
Psychosocial considerations
Laboratory and diagnostic studies
Physical examination
Proper approach and use of confidential
information will encourage responses during
interviews
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Sexually Transmitted Infections

Instructions for adolescents
 Rate of STIs is high among those who have
unprotected sexual contact with multiple partners
 Do thorough assessment of sexual activity and
practices
 For those sexually active, counsel regarding safe
sex practices and voluntary testing
 All adolescents should be taught about abstinence
and safe sex practices
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Audience Response Question 1

The community health nurse is educating a group of
adolescents on contraception methods. Which
statement made by one of the participants suggests a
correct understanding of the information?
A.
B.
C.
D.
“Oral contraceptives are 100% effective at preventing
pregnancy.”
“Male condoms prevent transmission of all sexual
infections.”
“Now that I have a prescription for the pill, I won’t need to
go back to the nurse practitioner.”
“If my period doesn’t come at the expected time, I’ll contact
the health center.”
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Instructions for Women

Teaching self-care regarding STIs
 Refrain from using irritating vaginal substances
 Warm sitz baths may help relieve irritation
 Discuss good personal hygiene practices
 Hormonal and surgical contraceptive methods do
not protect against STIs
 Use chemical and physical barriers such as
condoms to protect against STIs
 Properly apply vaginal medications
 Stress need for annual Pap smear to detect
cervical cancer
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Instructions for Men

Teaching self-care regarding STIs
 Discuss good personal hygiene practices
 Discuss appropriate interventions for men with
altered sexual function
 Latex condoms can be effective in reducing
transmission of HIV and some STIs, but are not
effective against STIs transmitted by skin-to-skin
contact
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Lesson 41.2
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Objectives
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Differentiate between the actions and the
benefits of the combination pill and the
minipill.
Describe the major adverse effects and
contraindications to the use of oral
contraceptive agents.
Identify the patient teaching necessary with
the administration of the transdermal
contraceptive and the intravaginal hormonal
contraceptive.
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Objectives (cont.)


Describe pharmacologic treatments of benign
prostatic hyperplasia.
Describe the pharmacologic treatment of
erectile dysfunction.
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Drug Class: Oral Contraceptives

Actions
 Estrogens block the pituitary release of FSH; progestins
inhibit pituitary release of LH

Uses
 Induce contraception by inhibiting ovulation

Common adverse effects
 Nausea, weight gain, depression

Serious adverse effects
 Breakthrough bleeding, yeast infection, blurred vision,
severe headaches, dizziness, leg pain, chest pain, shortness
of breath, acute abdominal pain, blood clots, CV events
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Drug Class: Oral Contraceptives

Types
 Combination pill—taken for 21 days of the
menstrual cycle; contains estrogen and progestin
• Subdivided into three classes: monophasic, biphasic,
triphasic
 Minipill—taken every day; contains only progestin
 Extended and continuous–cycle—24-day or 84day cycles followed by a short placebo period

Teach patient what to do if dose missed
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Audience Response Question 2

What is the primary difference between a
combination oral contraceptive and the
minipill?
The minipill contains only estrogen.
B. The combination pill contains estrogen and
progestin.
C. The minipill has a decreased risk of tubal
pregnancy.
D. The combination pill is recommended for women
with a history of migraine headaches.
A.
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Drug Class:
Transdermal Contraceptives
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Drug: norelgestromin-ethinyl estradiol transdermal
system (Ortho Evra)
Actions
 Inhibits ovulation

Uses
 Estrogen and progestin hormones are in patch form

Common adverse effects
 Nausea, weight gain, depression

Serious adverse effects
 Vaginal discharge, breakthrough bleeding, blurred vision,
severe headaches, dizziness, leg pain, chest pain, shortness
of breath, acute abdominal pain
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Drug Class: Intravaginal
Hormonal Contraceptive
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
Drug: etonogestrel-ethinyl estradiol vaginal ring
(NuvaRing)
Actions
 Estrogen and progestin inhibit ovulation
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Uses
 Plastic ring dosage form is inserted into vagina

Common adverse effects
 Nausea, weight gain, spotting, depression, mood changes,
headaches, insomnia, fatigue, lack of energy

Serious adverse effects
 Leg pain, chest pain, shortness of breath

Teach patient correct insertion technique
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Audience Response Question 3

Which adverse effect should a woman using
the etonogestrel-ethinyl estradiol vaginal ring
(NuvaRing) report to her health care
provider?
Nausea
B. Weight gain
C. Blurred vision
D. Menstrual spotting
A.
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Drug Class: Alpha-1 Adrenergic
Blocking Agents
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BPH symptoms are similar to prostate cancer
Actions
 Block alpha-1 receptors on the prostate gland,
causing muscle relaxation, allowing greater
urinary outflow
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Uses
 Reduce mild to moderate urinary obstruction in
men with BPH

Common adverse effects
 Drowsiness, headache, dizziness, weakness,
lethargy; tachycardia, fainting
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Drug Class: Antiandrogen Agents
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
Drug: dutasteride (Avodart)
Actions
 Inhibit enzyme 5-alpha reductase, reduce DHT
levels
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Uses
 Treat symptoms of BPH, reduce risks of urinary
retention, minimize need for surgery for BPH

Common adverse effects
 Impotence, decreased libido, decreased volume of
ejaculate
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Drug Class: Antiandrogen Agents
(cont.)


Drug: finasteride (Proscar)
Actions
 Inhibits enzyme 5-alpha reductase, reduce DHT
levels

Uses
 Treat symptoms of BPH, reduce risks of urinary
retention, minimize need for surgery for BPH, treat
male pattern baldness

Common adverse effects
 Impotence, decreased libido, decreased volume of
ejaculate
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Audience Response Question 4

Which medication is not used for male benign
prostatic hyperplasia (BPH)?
A.
B.
C.
D.
Tamsulosin (Flomax)
Finasteride (Proscar)
Dutasteride (Avodart)
Hydrochlorothiazide (HydroDIURIL)
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Drug Class:
Phosphodiesterase Inhibitors

Actions
 Selective inhibitor of PDE-5 enzyme

Uses
 Treat male erectile dysfunction; pulmonary arterial
hypertension

Common adverse effects
 Headache, flushing of the face and neck, color
vision impairment

Serious adverse effects
 Hypotension, dizziness, angina, loss of vision,
sustained erection
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Audience Response Question 5

Which category of drugs is contraindicated
with the concurrent use of the
phosphodiesterase inhibitor sildenafil
(Viagra)?
Beta-adrenergic blockers
B. Alpha-adrenergic blockers
C. Nitrates
D. Anticholinergics
A.
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