Week 2 Study Guide
Chapter 22: Drugs Affecting the Reproductive System
Androgens uses, effects, side effects and monitoring and
Testosterone is the primary male androgen. Endogenous androgens are responsible for: normal
growth, maturation, maintenance of male sex organs and secondary sexual characteristics. It also is
responsible for the skeletal growth spurth in puberty,activates subaceous glands which can lead to
acne, it enhances RBC production and plays a role in libido. Testosterone is highly protein bound. In
males it is produced in the testes. Women produce small amounts in the ovary.
Testosterone degradation happens in the liver. Excreted through the urine.
Precautions/contraindications: include male breast cx, prostate cx, pregnancy category X. and
lactation. Transdermal and testosterone gel IS NEVER indicated for women and must not be used
by them. Men that use wash hands after application, let dry before putting on clothes. Watch for
edema. Be cautious with cardiac, renal or hepatic disease.
Androgens are used for tx of deficiency states with men with hypogonadism, both sexes, cx and hiv.
It also can be used for libido, endometriosis, post menopausal in women. Illegally androgens have
been used to enhance athletic abilities. Androgens are crucial in the maintenance of sexual function
across the male life span. They remain stabe until age 55 years when a gradual decline begins. At
70 years it becomes rapid. With men experiencing rapid decrease in muscle mass, strength and
libido. They have protein metabolism, liver synthesis of clotting factors and renal production of
erythropoietin. When men attempt to replace these hormones to increase athletiscim it alters the
male reproduction process and reduces sperm through stopping the FSH
Androgens can mimic the bodies endogenous processes however long term use can develop
hepatitis. Liver cx. Men may develop gynecomastia and decreased sperm, acne and baldness,
decreased libido, depression and headache, scrotal pain, urination pain. Women can have
menstrual irregularities occur through suppression of gonadotropin secretion.
Androgen can cause GI N/V/edema/Jaundice/liver problems. It also can suppress clotting factors as
well as increase RBC production which can contribute to hemorrhage and thrombus formation.
Interactions with anticoagulants, diabetic agents, corticosteroids. Warfarin especially.
Oral testosterone is less expensive than those administered via other routes. Transdermal best
absorption
Monitoring: monitoring serum testosterone levels as well as therapeutic effect, in general all patients
on androgen therapy lipid tracking, liver tests and CBC. Also do a PSA and digital prostate
evaluation prior to starting of therapy.
Calcium levels may become abnormal in breast cx patients. Liver tests every 6 months. Watch for
edema and CHF. If used in prepubertal males perform an xray every 6 months. Older patients
should reduce sodium in their diet to avoid CHF while on androgens
Antiandrogens:
Antiandrogens can include several different types. Androgen hormone inhibitors are 5 aplpha
reductase inhibitors. They are enzyme inhibitors that block testosterone into dihydrotestosterone.
This type of drug can be used to tx BPH and men baldness. Lupron is a gonadotropin releasing
hormone or luteinizing hormone antagonist. They are used for tx in prostate cx and for management
of endometriosis, and fibroids. Spironolactone or Aldactone is an aldosterone antagonist that is used
as a diuretic.
Use of alpha 1 adrenergic antagonists may experience hypotension, syncopy, impotence, decreased
libido. Should have caution with concurrent use of agents that potentiate the alpha 1 adrenergic
blocking and agents that increase the risk of hypotension.
Finasteride, a steroid like drug inhibits 5 alspa reductaseit affects the prostate seminal vesicles and
epididymides and hair. Absorbs well orally. Begins action 8 hours from administration last 24 hours.
, Metabolized in the liver. Will reduce the prostate size. 90% bound to plasma. Main adverse effects
are decreased libido and impotence.
Dutasteride has the same mechanism of action. Peak action 2 to 3 hours after administration. Binds
to plasma protein. Metabolized in the liver. Women should not handle the pill when pregnant. S/e
decreased libido, impotence.
Leuprolide is a LH agonist. It suppresses the gonads for cx treatment. It can be used in children to tx
precocious puberty. In gyno it is used to reduce uterine fibroids, endometriosis and PCOS. Works
90% time
Estrogens and Antiestrogens: uses, effects, contraindications, side effects, monitoring
Estrogen like testosterone is an endogenous hormone with multiple actions. Its primary role is the
maturation and function of the female reproductive system.
Antiestrogens have limited use by most practitioners. Clomephene is used for ovulation stimulation
by infertility clinics adverse s/e include hot flashes, multiple gestation, visual symptoms, cervical
mucus abnormalities, ovary cx, ovarian cysts enlargement and liver disease.. Danazol is used for
endometriosis/thrombocytopenic purpura. Black box warning for hepatic function. Adverse effects is
long, usually not used in the clinic setting. And tamoxifen is used for female cx. Can cause leg
cramps hot flashes.
Monitor INR and supplement Calcium andvit. D for bone health. Risk for thrombus.
Precautions and Contraindication
These include current or prior estrogen cx, pregnant, undiagnosed dysfunctional uterine
bleeding,DVT, arterial thromboemboli, clotting disorders, severe hepatic disease. Other
contraindications that should be talked about are cardiovascular disease, htn, diabetes, gallbladder
disease, obesity, endometriosis, seizure disorder, migraine. Migraines with aura are at increased risk
for stroke and SHOULD NOT be prescribed estrogen.
Every 10 year o fuse there is a increased risk of breast cx non estrogen.
Higher incidence of CHD, sroke and thromemboli with women taking estrogen.
Estrogens are pregnancy category X medications.
Most of the adverse reactions to estrogens are dose related. MI, htn, Altered clotting factors and
thromboembolism.
Estrogens can interfere with laboratory measurement of endocrine and liver function tests and
thyroid binding globulin, Women may experience impaired glucose tolerance. Most common
interactions are with anticoags, antidepressants, barbituates, antituberculosis, corticosteroids,
seizure control medication, and drugs for spasticity.
Estrogen may reduce risk for colon cx
Estrogen is associated with bone formation and has osteoprotective benefits.
Monitoring
Oral contraception, ERT and HRT are chronic medications that are taken for months or years. Blood
pressure should be monitored.Baseline blood tests including a lipid panel. Annual mammograms,
pelvic evals, and cardiovascular assessments. Monitor blood pressures. Patients with seizure will
need initial monitoring of seizure medication then every 6 months to ensure it remains therapeutic.
Educate on not smoking while taking combined birth control
Adverse effects: smoking/diabetic puts patinets at higher risk of blood clots, should watch for severe
headache, visual changes, leg pain. If a woman starts bleeding postmenopausal it can be a signof
cx
Birth control May cause weight gain and cause depression. It . It is also contraindicated in woman
over 35.
Progesterones and Progesterone antagonists: uses, precautions, side effects, monitoring
Chapter 22: Drugs Affecting the Reproductive System
Androgens uses, effects, side effects and monitoring and
Testosterone is the primary male androgen. Endogenous androgens are responsible for: normal
growth, maturation, maintenance of male sex organs and secondary sexual characteristics. It also is
responsible for the skeletal growth spurth in puberty,activates subaceous glands which can lead to
acne, it enhances RBC production and plays a role in libido. Testosterone is highly protein bound. In
males it is produced in the testes. Women produce small amounts in the ovary.
Testosterone degradation happens in the liver. Excreted through the urine.
Precautions/contraindications: include male breast cx, prostate cx, pregnancy category X. and
lactation. Transdermal and testosterone gel IS NEVER indicated for women and must not be used
by them. Men that use wash hands after application, let dry before putting on clothes. Watch for
edema. Be cautious with cardiac, renal or hepatic disease.
Androgens are used for tx of deficiency states with men with hypogonadism, both sexes, cx and hiv.
It also can be used for libido, endometriosis, post menopausal in women. Illegally androgens have
been used to enhance athletic abilities. Androgens are crucial in the maintenance of sexual function
across the male life span. They remain stabe until age 55 years when a gradual decline begins. At
70 years it becomes rapid. With men experiencing rapid decrease in muscle mass, strength and
libido. They have protein metabolism, liver synthesis of clotting factors and renal production of
erythropoietin. When men attempt to replace these hormones to increase athletiscim it alters the
male reproduction process and reduces sperm through stopping the FSH
Androgens can mimic the bodies endogenous processes however long term use can develop
hepatitis. Liver cx. Men may develop gynecomastia and decreased sperm, acne and baldness,
decreased libido, depression and headache, scrotal pain, urination pain. Women can have
menstrual irregularities occur through suppression of gonadotropin secretion.
Androgen can cause GI N/V/edema/Jaundice/liver problems. It also can suppress clotting factors as
well as increase RBC production which can contribute to hemorrhage and thrombus formation.
Interactions with anticoagulants, diabetic agents, corticosteroids. Warfarin especially.
Oral testosterone is less expensive than those administered via other routes. Transdermal best
absorption
Monitoring: monitoring serum testosterone levels as well as therapeutic effect, in general all patients
on androgen therapy lipid tracking, liver tests and CBC. Also do a PSA and digital prostate
evaluation prior to starting of therapy.
Calcium levels may become abnormal in breast cx patients. Liver tests every 6 months. Watch for
edema and CHF. If used in prepubertal males perform an xray every 6 months. Older patients
should reduce sodium in their diet to avoid CHF while on androgens
Antiandrogens:
Antiandrogens can include several different types. Androgen hormone inhibitors are 5 aplpha
reductase inhibitors. They are enzyme inhibitors that block testosterone into dihydrotestosterone.
This type of drug can be used to tx BPH and men baldness. Lupron is a gonadotropin releasing
hormone or luteinizing hormone antagonist. They are used for tx in prostate cx and for management
of endometriosis, and fibroids. Spironolactone or Aldactone is an aldosterone antagonist that is used
as a diuretic.
Use of alpha 1 adrenergic antagonists may experience hypotension, syncopy, impotence, decreased
libido. Should have caution with concurrent use of agents that potentiate the alpha 1 adrenergic
blocking and agents that increase the risk of hypotension.
Finasteride, a steroid like drug inhibits 5 alspa reductaseit affects the prostate seminal vesicles and
epididymides and hair. Absorbs well orally. Begins action 8 hours from administration last 24 hours.
, Metabolized in the liver. Will reduce the prostate size. 90% bound to plasma. Main adverse effects
are decreased libido and impotence.
Dutasteride has the same mechanism of action. Peak action 2 to 3 hours after administration. Binds
to plasma protein. Metabolized in the liver. Women should not handle the pill when pregnant. S/e
decreased libido, impotence.
Leuprolide is a LH agonist. It suppresses the gonads for cx treatment. It can be used in children to tx
precocious puberty. In gyno it is used to reduce uterine fibroids, endometriosis and PCOS. Works
90% time
Estrogens and Antiestrogens: uses, effects, contraindications, side effects, monitoring
Estrogen like testosterone is an endogenous hormone with multiple actions. Its primary role is the
maturation and function of the female reproductive system.
Antiestrogens have limited use by most practitioners. Clomephene is used for ovulation stimulation
by infertility clinics adverse s/e include hot flashes, multiple gestation, visual symptoms, cervical
mucus abnormalities, ovary cx, ovarian cysts enlargement and liver disease.. Danazol is used for
endometriosis/thrombocytopenic purpura. Black box warning for hepatic function. Adverse effects is
long, usually not used in the clinic setting. And tamoxifen is used for female cx. Can cause leg
cramps hot flashes.
Monitor INR and supplement Calcium andvit. D for bone health. Risk for thrombus.
Precautions and Contraindication
These include current or prior estrogen cx, pregnant, undiagnosed dysfunctional uterine
bleeding,DVT, arterial thromboemboli, clotting disorders, severe hepatic disease. Other
contraindications that should be talked about are cardiovascular disease, htn, diabetes, gallbladder
disease, obesity, endometriosis, seizure disorder, migraine. Migraines with aura are at increased risk
for stroke and SHOULD NOT be prescribed estrogen.
Every 10 year o fuse there is a increased risk of breast cx non estrogen.
Higher incidence of CHD, sroke and thromemboli with women taking estrogen.
Estrogens are pregnancy category X medications.
Most of the adverse reactions to estrogens are dose related. MI, htn, Altered clotting factors and
thromboembolism.
Estrogens can interfere with laboratory measurement of endocrine and liver function tests and
thyroid binding globulin, Women may experience impaired glucose tolerance. Most common
interactions are with anticoags, antidepressants, barbituates, antituberculosis, corticosteroids,
seizure control medication, and drugs for spasticity.
Estrogen may reduce risk for colon cx
Estrogen is associated with bone formation and has osteoprotective benefits.
Monitoring
Oral contraception, ERT and HRT are chronic medications that are taken for months or years. Blood
pressure should be monitored.Baseline blood tests including a lipid panel. Annual mammograms,
pelvic evals, and cardiovascular assessments. Monitor blood pressures. Patients with seizure will
need initial monitoring of seizure medication then every 6 months to ensure it remains therapeutic.
Educate on not smoking while taking combined birth control
Adverse effects: smoking/diabetic puts patinets at higher risk of blood clots, should watch for severe
headache, visual changes, leg pain. If a woman starts bleeding postmenopausal it can be a signof
cx
Birth control May cause weight gain and cause depression. It . It is also contraindicated in woman
over 35.
Progesterones and Progesterone antagonists: uses, precautions, side effects, monitoring
