PHARM CH. 6 Drugs n stuff
Clomiphene citrate
(Clomid) PO is an ovarian stimulator and selective estrogen receptor. This drug increases the amount of follicle-stimulating hormone (FSH) secreted by the pituitary gland, thus inducing ovulation for women who have infrequent or absent menstrual periods. Health care providers use it for the treatment of ovulatory failure in women who have tried to become pregnant but have failed. Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. Clomiphene is a mixture of zuclomiphene and enclomiphene. Metabolized by the liver, the drug has a half-life of 5 to 7 days. It is excreted in the feces and urine. Possible adverse effects of clomiphene include hot flashes, breast pain and tenderness, and uterine bleeding. Some women have reported blurred vision, visual changes, and headaches. Contraindications include liver disease, thyroid or adrenal disease, ovarian cysts, and abnormal uterine bleeding.
Leuprolide
(Eligard, Lupron) IM every month up to 6 months- is a gonadotropin-releasing hormone that has an unlabeled use in the treatment of infertility. Administered subcutaneously, it prevents premature ovulation and enhances the production of a larger quantity of quality eggs. Potential adverse effects of leuprolide include hot flashes, headache, mood swings, insomnia, vaginal dryness, decreased breast size, painful intercourse, and bone loss.
Follitropin alfa
(Gonal-F) and follitropin beta (Follistim AQ) SUB Q are drugs used to stimulate follicle development and thus promote fertility. Administration is subcutaneous, in calibrated syringes provided by the manufacturer. It is important that the drugs not be shaken before administration. After receiving follitropins, as with menotropins, women should also receive hCG (see later discussion)—1 day after the last dose of follitropin. The adverse effects of the follitropins are similar to those of clomiphene. Contraindications include hypersensitivity as well as the presence of tumors in the ovary, breast, pituitary gland, uterus, or hypothalamus. It is necessary to monitor serum estradiol levels to determine the medication response.
Menotropin
(Menopur, Repronex) IM or SUB Q is a gonadotropin given to women who have been diagnosed with anovulation. The drug stimulates FSH and luteinizing hormone (LH) to promote the development and maturation of ovarian follicles. Administration may be subcutaneous, in alternating sides of the abdomen, or intramuscular, in large muscles. Following its administration, the woman receives human chorionic gonadotropin (hCG) (see later discussion). Menotropin is well absorbed and excreted in the urine. During menotropin therapy, it is necessary to monitor both hCG and serum estradiol measurements. The adverse effects and contraindications of menotropin are similar to those of clomiphene citrate.
uterotonics
drugs to control postpartum bleeding
Tocolytics
drugs used to stop preterm labor
Human chorionic gonadotropin
or hCG, is manufactured as Novarel or Pregnyl. SUB Q OR IM This drug is a human formulation of hCG that is obtained from the urine of pregnant women. It is usually used as a replacement for LH. After administration of this form of hCG (after administration of menotropin or follitropin), the LH stimulates ovulation.
