Chapter 24 Therapeutic Agents for the Reproductive System

Avodart/dutasteride

5-Alpha-Reductase Inhibitor Indication: BPH Route: Oral Dosage: 0.5 mg Side effects: Erectile dysfunction, ejaculatory dysfunction, decrease in libido

Proscar/finasteride

5-Alpha-Reductase Inhibitor Indication: BPH Route: Oral Dosage: 5 mg Daily Side Effects; Dizziness, erectile dysfunction, ejaculatory dysfunction, decrease in libido

Jalyn/dutasteride & tamsulosin

5-Alpha-Reductase Inhibitors/Alpha-1 Blockers Indication: BPH Route: PO Dose: 0.5 mg dutastride/0.4 mg tamsulosin

block

5-Alpha-reductase inhibitors___ the conversion of testosterone to a more active androgen (5-alpha-dihydrotestosterone [DHT]) that increases the growth of cells, thus reducing prostate tissue growth.

Benign

A condition, tumor, or growth that is not cancerous and therefore will not metastasize (spread)

Premenstrual syndrome

A group of symptoms that occur before the onset of menstruation (eg, bloating, edema, headache, mood swings, and breast discomfort)

Negative Feedback

A self-regulating mechanism in which the output of a system has input or control on the process; in this case, the stimulus results in reactions that reduce the effects of the stimulus

assisted reproductive technology (ART)

A treatment that may help with infertility is___, which uses in vitro fertilization, embryo transfer, and both egg and sperm transfer.

Dysmenorrhea

Abdominal pain attributable to menstrual cramping

Amenorrhea

Absence of menstruation

Flomax/tamsulosin

Alpha-1 Blocker Indication: BPH Route: Oral Dosage: 0.4 mg 30 minutes after the same meal daily

orthostatic hypertension

Alpha-blockers for BPH work selectively to inhibit alpha-1 receptor sites. Some agents (eg. terazosin) are less selective for prostate tissue and more appropriate for hypertension treatment. Agents such as terazosin and doxazosin commonly cause_____.

spermicide

An agent that kills sperm

Testosterone

An anabolic sex hormone produced in the testes that stimulates the development of male sexual characteristics

Progesterone

An anabolic sex hormone that stimulates the uterus to prepare for pregnancy.

Depot

An area of the body where a substance can accumulate or be stored for later distribution

morning after pill

An emergency form on contraception is the___, which prevents conception and pregnancy after intercourse.____ are contraceptives formulated of high dose progestin only or both estrogen and progestin. The combined emergency contraceptive form is about 75% effective, but one almost universal side effect is nausea and vomiting.

Teratogen

Any agent that causes abnormal embryonic or fetal development

STD

Any disease transmitted by sexual intercourse is considered an_____.

Estrogen

Any of a group of anabolic sex hormones that promote the development and maintenance of female sexual characteristics

Abortifacient

Any treatment that causes abortion of a fetus

Notifiable Infectious Diseases

Bacterial, viral, fungal, and protozoal organisms can cause STDs. If untreated, some STDs can cause irreversible sterility, blindness, and death. Several diseases, including chlamydia, gonorrhea, hepatitis, acquired immunodeficiency syndrome AIDS), and syphilis, are on the list of_____. The law requires medical practitioners to notify the local health department in these cases.

50

Benign prostatic hyperplasia (BPH) occurs in about half of men by age

dormant (latent)

Certain STDs (eg, syphilis, herpes) can remain ____ for long periods.

Menopause

Cessation of menstruation; a natural phenomenon in which a woman passes from as reproductive state to a nonproductive state

Depo-Provera/medroxyprogesterone

Class: Contraceptive (Progestin Only) Indications: Amenorrhea, contraception, abnormal uterine bleeding, endometrial cancer, endometriosis. Routes: Oral; Injection (IM, subcut) (Shot q 3 mo)

androgens

Collectively,____ are the male sex hormones. Testosterone is the most abundant___. At puberty,___ stimulate the formation of secondary male characteristics such as increased muscle mass, voice deepening, and facial hair growth. Although females produce testosterone,___ play a less significant role in female sexual characteristics development and reproductive processes.

monophasic, biphasic, triphasic, estrophasic

Combination oral contraceptives may consist of estrogen and progestin to inhibit ovulation. The progestin only contraceptives are called "mini pills". Providers most frequently prescribe the highly effective combination contraceptives. These combination medications come in____, _____,____and_____

abnormal uterine

Conditions such as_____ bleeding can result from hormone imbalance, abnormal ovulation, and even infertility.

Norelgestromin (Ortho Evra)

Contraceptive patch applied weekly for 3 weeks, followed by 1 patch-free week.

Next Choice One Dose, Plan B, One-Step, React

Contraceptive product Dosage: 1-2 Tablet(s) as soon as possible within 72 hr of intercourse depending on if using single-dose regimen or two-dose regimen.

Depo-Provera/medroxyprogesterone acetate

Contraceptive products Dosage: IM injection every 3 months

NuvaRing/etonogestrel

Contraceptive products Dosage: Ring remains in vagina for 3 wk and then is removed for 1 wk; user repeats cycle

menopausal symptoms

Currently many practitioners prescribe HRT as short-term therapy to help women with severe____

Benign prostatic hyperplasia (BPH)

Enlargement of the prostate

Prostatism

Enlargement of the prostate gland

mifepristone

For safety, this medication must be used within the first 7 weeks of pregnancy. Because of the abortifacient effects of the medication, a qualified health care professional in the prescriber's office must administer___ on 3 seperate office visits over 1 to 2 weeks.

Polymenorrhea

Frequent menstruation

Lupron/leuprolide

Gonadotropin-Releasing Hormone Indication: Endometriosis Dosage Range: 3.75 mg IM once a month (max 6 mo) or 11.25 mg every 3 months for 2 doses

Menorrhagia

Heavy menstrual flow over a long menstrual period.

Tech Note

In rare cases, a prescriber will use clomiphene (Clomid) and menotropins (Menopur) for male infertility. Some use these agents off- label for oligospermia (low sperm concentration in the semen)

biphasic

In___ regimen, the estrogen dose remains constant, but the second half of the cycle's progestin dose increases.

monophasic

In____ regimens, the daily estrogen and progestin dose remains constant throughout the menstrual cycle.

Clomid/clomiphene

Indication: Ovulation induction (main drug for infertility) Dosage Range: 50 mg PO once daily for 5 days (begin on or about day 5 in the cycle; can be repeated 30 days later if needed)

Valtrex/valacyclovir

Indications: Herpes, varicella Route: Oral Dose: Varies by indication Side effects: Headache, nausea, abdominal pain, fatigue

Pelvic Inflammatory Disease (PID)

Inflammation of the female genital tract, accompanied by fever and lower abdominal pain

Prostatitis

Inflammation of the prostate gland

Levonorgestrel (Mirena)

Intrauterine device (IUD) that contains only progestin; contraceptive action lasts up to 5 years.

Oligomenorrhea

Light and infrequent menstrual periods

Premature menopause

Loss of ovarian function before age 40

Hypomenorrhea

Low menstrual flow over a short menstrual period

Androgen

Male hormone

women

Male hormones are used to treat endometrial or breast cancer, endometriosis, and fibrocystic disease in______

abortion pill

Mifeprex, or mifepristone (formerly known as RU-486) is more commonly known as the____

21 days

Oral contraceptive effectiveness largely depends on the women's adherence to the medication regimen. Usually, a women will start the medication on the fifth day of the menstrual cycle. She should take the pill at the same time each day for____.

side effects

Oral contraceptives has the highest incidence of___. These range from nausea and vomiting to menstrual abnormalities to thrombotic complications.

schedule III

Originally natural testosterone came from bull testes. Now manufactures chemically synthesize it. Because of the abuse potential of androgen (anabolic steroids) products, the DEA placed these products on the____ list.

HIV

Patients can spread____ by intercourse or needle sharing. Herpesvirus can move from mother to child through child birth

levonorgestrel

Plan B One-Step contains one or two large doses of___ and comes as a single- or two- dose regimen that has to be administered within 72 hours of intercourse.

nitrates

Possible side effects of phosphodiesterase inhibitors include headaches, flushing of the skin, gastrointestinal symptoms, nasal congestion, and diarrhea. Patients taking____ should not take sildenafil (Viagra) or related drugs concurrently because of the potential for dangerous decreases in blood pressure that can occur upon combination.

lifestyle changes

Several treatments effectively lessen BPH symptoms. Treatments range from____ to medication or surgery.

Etonogestrel and ethyinyl (NuvaRing)

Similar to the traditional oral contraceptive but administered as a vaginal ring. It can be left in place for up to 3 weeks.

protect

Some may mistakenly believe that oral birth control to contraceptive gels can___ against STDs, but this is not true. Some vaccines such as Gardasil can provide protection against certain human papilloma virus (HPV) infections but do not protect against all STD's

Etonogestrel and ethyinyl estradiol (NuvaRing), Levonorgestrel (Mirena), Norelgestromin (Orth Evra)

Some non-oral contraceptive dosage forms include:

oral contraceptive

Some___ side effects include nausea, vomiting, mood changes, appetite changes, changes in sex drive, and headaches.

Palliative

Something that brings relief but does not cure

Tech Note

The current recommendation for contraceptive transdermal patches, such as Ortho Evra, is to apply the patch to the upper arm, back, abdomen, or buttock. The patient should wear the patch for 1 week the remove it. She should apply a new patch the same day of the week that the first patch was applied. The fourth week should be patch free.

endocrine system

The male and female reproductive systems operate interdependently with other systems such as the______ (which provides the hormones responsible for the maturation, development, and regulation of the reproductive system) and the urinary system.

male condoms

The most common barrier method is the___. ____ come in latex, polyurethane, and lamb intestine forms.

depot

The oil-based injectable estrogen medications, called___ medications, are prepared to prolong the medications action

estrogen

The primary oral___ products in use clinically are conjugated____ and estradiol.____ are also available in several forms; some forms are unique, such as implants, vaginal inserts, and transdermal system.

hormones

The principle medications that affect the female reproductive system are_____

History of PID, Age, multiple sex partners

The risks factors for pelvic inflammation disease (PID) are:

progestins

The side effects associated with___ include weight gain, stomach pain and cramping, swelling of the face and legs, headaches, mood swings, anxiety, weakness, rashes, acne, and insomnia.

ovaries

The two___ in women are responsible for the production (oogenesis) and secretion of one or, in rare cases, two eggs or more (ovulation) each month

Hormone Replacement Therapy (HRT)

The use of___ for menopausal symptoms is controversial. Although effective in treating menopausal symptoms such as hot flashes, mood swings, and night sweats, ___ may increase a women's risk of developing breast cancer, stroke, blood clots, and heart disease.

prostate

The___ is about the size and shape of a walnut. It encircles part of the urethra, the tube that carries urine out of the bladder and through the penis

5-alpha-reductase inhibitors, Alpha blockers

Two primary drug classes help BPH:____ and_____. ____ reduce the prostate size. It can take up to 6 months to achieve maximum effectiveness. ____ act quickly to lessen urinary BPH symptoms, although they do not stop the enlargement process.

Viekira Pak, Harvoni

Two recent trade name medications for hepatitis C include the____ and ___. Both medications have multiple active ingredients combined in a single pill, increasing compliance. These drugs are very expensive ($40,000-45,000)

Nocturia

Urination at night

testosterone replacement therapy

We can treat male hypogonadism symptoms effectively with____.

progestins

We use___, for treating amenorrhea and abnormal uterine bleeding from hormone imbalances, for contraception, in combination with estrogen hormone replacement therapy (HRT) to prevent endometrial overgrowth if the women has an intact uterus, and as therapy for renal and endometrial cancer.

Testosterone

___ also carries responsibility for secondary sex characteristics such as male voice deepening into puberty and increased muscle development.

Estrogen, testosterone

___ and ___ are present in both men and women, although their effects are somewhat different because of the different concentrations present in each gender.

Menopause

___ is a natural transition that happens between the ages of 50 and 60 years. The effects of___ increase the risk of osteoporosis and heart disease after ___ is complete.

Finasteride

___ is also available in 1 mg dose under the trade name Propecia for the treatment of male pattern baldness.

estrogen, testosterone

___ is available in tablet form, topical lotions or gels, or as transdermal patches,___ is available in injectable form, gels, or topical patches.

Hormone treatment

___ is the most common treatment for infertility.

5-Alpha-reductase inhibitors

___ may cause birth defects; therefore a women who is pregnant should avoid contact with crushed or broken tablets because the active drug can penetrate through the skin.

Adverse effects

___ of estrogens in females may include photosensitivity, nausea, vomiting, and bloating. Dysmenorrhea, breast tenderness and enlargement, and increased susceptibility to thrombotic disease are also risks of estrogen treatment.

Sperm

___ production begins before puberty and declines with age, although most men produce sperm throughout their lifetime. The production of testosterone (also from the testes) helps adjacent organs grow.

Oral contraceptives

___ provide birth control by preventing ovum fertilization through an oral dosage form.

triphasic

___ regimes divide the menstrual cycle into three phases. The progestin amount changes in each phases.

Androgens

___ suppress the effects of estrogen, thus preventing rapid growth. For women with endometriosis, ____ can cause suppression of the endometrium and thus prevent the excessive uterine bleeding associated with the disease.

Estrogen

___ therapy has many side effects; therefor prescribe's use the smallest dose for the shortest time necessary. All___ have a Pregnancy Category X rating because they can act as teatogens.

Estrogens

____ are one of the most common forms of medical therapy used for conditions of the female reproductive system.

Erectile dysfunction (ED)

____ is the inability of the male to achieve or maintain an erection, commonly referred to as impotence. ____ is caused by an insufficient amount of blood flowing to the penis rather than a lack of sexual desire.

African American

____ men are more likely to develop prostate cancer, as are men who have relatives with prostate cancer.

Progesterone

____, naturally occurring as progestin is the female hormone secreted from day 14 through day 28 of the menstrual cycle.

Menopause

an age-related natural loss of hormone production. Although this is not a "disease", menopausal symptoms such as hot flashes can lead women to seek hormone replacement therapy (HRT)

Pelvic inflammatory disease (PID)

an inflammation of the female reproductive organs. The severe inflammation of the uterine lining, fallopian tubes , or ovaries can cause chronic pain and permanent infertility.___ is often caused by a sexually transmitted infection (STI), although this is not exclusively the case.

Prostatocystitis

inflammation of the prostate gland and the bladder