copyright © 2015 cengage learning® chapter 24 reproductive system drugs

Copyright © 2015 Cengage Learning®

Chapter 24Reproductive System Drugs


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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• 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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• 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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copyright © 2015 cengage learning® chapter 24 reproductive system drugs

Documents

cengage learning chapter

secretion of estrogen

secretion of hormones

hormone fsh

development of corpus

secretion of progesterone

adrenal glands responsible

release of pituitary