Chapter 28-Pharmacology- Reproductive System Disorders

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CHAPTER 28
REPRODUCTIVE SYSTEM DISORDERS
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LEARNING OBJECTIVES
• DISCUSSING SEX HORMONES AND THEIR FUNCTION IN
HUMAN REPRODUCTION.
• DESCRIBING MEDICATIONS USED IN TREATING DISEASES
SPECIFIC TO THE MALE AND FEMALE REPRODUCTIVE
SYSTEMS.
• DESCRIBING PROS AND CONS OF DIFFERENT FORMS OF
CONTRACEPTIVE MEDICATIONS.

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3
LEARNING OBJECTIVES (CONT’D.)
• DISCUSSING EFFECTIVENESS OF MEDICATIONS USED TO
TREAT INFERTILITY.
• PROVIDING INFORMATION ON MEDICATIONS FOR
PREMENSTRUAL SYNDROME AND DYSMENORRHEA.
• IDENTIFYING MEDICALS FOR ENDOMETRIOSIS.

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4
LEARNING OBJECTIVES (CONT’D.)
• DISCUSSING MEDICATIONS FOR ERECTILE DYSFUNCTION
AND THE DANGERS WHEN USED WITH NITRATE
MEDICATIONS.
• DISCUSSING CATEGORIES OF MEDICATIONS THAT IMPAIR
SEXUAL FUNCTION AS A SIDE EFFECT.
• PROVIDING PATIENT EDUCATION FOR COMPLIANCE WITH
MEDICATIONS USED TO TREAT DISEASES AND CONDITIONS
OF THE REPRODUCTIVE SYSTEM.

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SEXUALLY TRANSMITTED
DISEASES:
COMMON SYMPTOMS
• PELVIC OR GENITAL PAIN
• DYSURIA, HEMATURIA, PURULENT DISCHARGE
• BURNING, ITCHING ON URINATION
• URINARY FREQUENCY, INCONTINENCE
• DYSPAREUNIA
• FEVER, MALAISE
• LESIONS IN GENITAL AREA

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INFERTILITY: COMMON
SYMPTOMS
• STDS, REPRODUCTIVE ORGAN INFECTIONS
• SCAR TISSUE FROM PREVIOUS INFECTION OR SURGERY
• ABNORMAL PREGNANCIES
• ENDOMETRIOSIS, BLOCKED FALLOPIAN TUBES, TUMORS
• CONGENITAL MALFORMATIONS
• DECREASED SPERM COUNT

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FEMALE REPRODUCTIVE TRACT
DISORDERS:
COMMON SYMPTOMS
• FEVER
• ABNORMAL VAGINAL DISCHARGE AND ITCHING
• PAIN IN LOWER ABDOMEN OR PELVIC REGION
• DYSPAREUNIA, SEXUAL DYSFUNCTION
• ABNORMAL MENSTRUATION

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REPRODUCTIVE TRACT DISORDERS:
COMMON SYMPTOMS FOR BOTH
GENDERS
• GENITAL LESIONS
• BREAST CHANGES INCLUDING GROWTHS, MASTITIS, AND
DISCHARGE
• PSYCHOLOGICAL RESPONSE TO HORMONE CHANGES

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MALE REPRODUCTIVE TRACT
DISORDERS:
COMMON SYMPTOMS
• FREQUENCY, URGENCY, PAIN, BURNING ON URINATION
• OLIGURIA
• SEXUAL DYSFUNCTION
• PAIN, SWELLING, LESIONS OF ANY REPRODUCTIVE ORGAN

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• ANXIETY, DEPRESSION
• HEADACHES
• RISK OF
THROMBOEMBOLIC
DISORDERS
• HYPERTENSION,
MYOCARDIAL
INFARCTION, STROKE
• RISK OF CERVICITIS
• RISK OF GALLBLADDER
DISEASE
• MENSTRUAL
IRREGULARITIES
• VISUAL DISTURBANCES
REPRODUCTIVE SYSTEM
MEDICATIONS:
COMMON SIDE EFFECTS
• EDEMA, WEIGHT GAIN
• ACNE, SKIN
DISCOLORATION
• INCREASED OR
DECREASED LIBIDO
• ENLARGED BREAST
TISSUE
• HIRSUTISM, DEEPENING
OF VOICE
• AMENORRHEA
• NAUSEA, VOMITING

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11
FEMALE REPRODUCTIVE SYSTEM
Figure 28-1 The female reproductive system. (From Frazier MS, Drzymkowski JW: Essentials of human diseases and
conditions, ed 4, St Louis, 2008, Saunders.)

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MALE REPRODUCTIVE SYSTEM
Figure 28-2 The male reproductive system. (From Frazier MS, Drzymkowski JW: Essentials of human diseases and
conditions, ed 4, St Louis, 2008, Saunders.)

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INFLUENCE OF HORMONES ON
THE REPRODUCTIVE SYSTEM
MALE
• FSH AND ICSH STIMULATE TESTOSTERONE PRODUCTION.
FEMALE
• FSH STIMULATES PRODUCTION OF ESTROGEN.
• DECLINING LEVELS OF ESTROGEN AND PROGESTERONE
DURING THE MENSTRUAL CYCLE CAUSE MENSTRUATION.
• LEVELS OF ESTROGEN DECREASE AT MENOPAUSE.

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HORMONE REGULATION
Figure 28-3 Hormone regulation of the menstrual cycle and ovarian function. (From Applegate EJ: Anatomy and
physiology learning system, ed 4, St Louis, 2010, Saunders.)

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ANDROGENS AND ANABOLIC
STEROIDS
• ANDROGEN: MALE SEX HORMONE
• PRINCIPAL ANDROGEN IS TESTOSTERONE
• STIMULATE PRODUCTION OF RED BLOOD CELLS AND
INCREASE MUSCLE MASS
• ANABOLIC STEROIDS: SYNTHETIC ANDROGENS
• SCHEDULE III
• ANABOLIC ANDROGENS ARE CONTRAINDICATED DURING
PREGNANCY.
• ANABOLIC STEROIDS HAVE TOXIC EFFECTS ON LIVER.

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TESTOSTERONE THERAPY
• TESTOSTERONE BRINGS ABOUT A SENSE OF WELL-BEING
AND RESTORES MENTAL EQUILIBRIUM.
• FOR REPLACEMENT THERAPY, NATURAL TESTOSTERONE IS
PREFERRED TO SYNTHETIC ANDROGENS.
DELIVERY SYSTEMS
• INJECTION
• TRANSDERMAL
• APPLIED TO BACK OR SCROTUM
• SITES ROTATED DAILY

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BENIGN PROSTATIC
HYPERTROPHY (BPH)
• BPH OBSTRUCTS THE BLADDER NECK AND COMPRESSES
THE URETHRA, RESULTING IN URINARY RETENTION AND AN
INCREASED RISK OF URINARY TRACT INFECTION.
• INCREASE IN GLANDULAR AND CONNECTIVE TISSUE MASS
OF PROSTATE
• OCCURS IN 75% OF MEN BY AGE 70
• CAUSES HESITANCY ON URINATION, DECREASE IN
STREAM/FORCE OF URINE, DRIBBLING, FREQUENCY, AND
NOCTURIA

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MEDICATIONS FOR BENIGN
PROSTATIC HYPERTROPHY
• HYTRIN
• FLOMAX
• CARDURA
• PROSCAR
• CAN BE TERATOGENIC TO MALE FETUS
• FEMALE PARTNER SHOULD NOT BECOME PREGNANT WHILE
PATIENT IS TAKING THE DRUG.

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ESTROGENS
• ESTROGEN: FEMALE SEX HORMONE
• SUPPORT DEVELOPMENT AND MAINTENANCE OF
REPRODUCTIVE ORGANS, SECONDARY SEX
CHARACTERISTICS
• INFLUENCE PHYSIOLOGY OF REPRODUCTION
• BLOCK BONE MASS REABSORPTION, PROMOTE DEPOSITS OF
MINERALS
• DURING PUBERTY, ESTROGENS PROMOTE THE GROWTH OF
LONG BONES.
• IN POSTMENOPAUSAL WOMEN, ESTROGEN REPLACEMENT
HELPS MAINTAIN BONE MASS.

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ESTROGENS
• PROGESTIN: FEMALE SEX HORMONE SECRETED BY CORPUS
LUTEUM
• TREAT AMENORRHEA, ABNORMAL UTERINE BLEEDING,
CONTRACEPTION
• PROGESTIN AND ESTROGEN USED IN COMBINATION FOR
POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY
• ESTROGEN LOSSES IN MENOPAUSE MAY CAUSE HOT FLASHES,
LOSS OF BONE MASS, OR INCREASED RISK FOR CORONARY
HEART DISEASE.

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HORMONE REPLACEMENT
THERAPY (HRT)
ADMINISTRATION
• COMPLETE A PHYSICAL EXAM BEFORE THERAPY STARTS.
• APPLY ESTRADIOL TRANSDERMAL PATCHES TO CLEAN, DRY
AREA ON ABDOMEN OR TRUNK.
• INSTILL INTRAVAGINAL ESTROGEN PREPARATIONS HIGH IN
VAGINA; PATIENT SHOULD MAINTAIN RECUMBENT
POSITION FOR 30 MINUTES.
• TAKE MEDICATION WITH FOOD TO REDUCE SIDE EFFECTS.
• NOTIFY PHYSICIAN IF PERSISTENT VAGINAL BLEEDING
DEVELOPS IN MENOPAUSAL WOMEN.
• DISCONTINUE IMMEDIATELY IF PREGNANCY IS SUSPECTED.

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HORMONE REPLACEMENT
THERAPY (HRT)
SIDE EFFECTS
• NAUSEA IS MOST COMMON SIDE EFFECT.
• BREAKTHROUGH BLEEDING, SPOTTING, AMENORRHEA, AND
BREAST TENDERNESS ARE POSSIBLE.
• SUNLIGHT/ULTRAVIOLET LIGHT EXPOSURE CAN CAUSE
SUNBURN-LIKE REACTION.
• WOMEN WHO ARE CONSIDERING USE OF HRT MUST
BALANCE IMPROVED WELL-BEING AGAINST THE
POSSIBILITY OF CANCER.

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• ESTRACE,
ESTRADERM,
CLIMARA, ESTRING
• DELESTROGEN
• GYNOGEN LA
• ESTINYL
• ESTRATAB
• ESTRATEST
• PREMARIN
ESTROGENS
• Prempro
(estrogen with
progesterone)
• Premphase
• Aquest
• Ogen, Ortho-Est
• TACE

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PROGESTIN
• PROGESTERONE IS A NATURALLY OCCURRING
PROGESTIN.
• PROGESTINS MAY ALSO BE MADE SYNTHETICALLY.
• DOSAGE ADJUSTMENTS MAY BE MADE TO MOST
MEDICATIONS BY CHANGING THE STRENGTHS OF THE
TWO MAJOR COMPONENTS.

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SELECTED PROGESTINS
• CRINONE, GESTEROL
• PROVERA, AMEN, CYCRIN
• DEPO-PROVERA
• HYLUTIN
• MEGACE
• MICRONOR, NORLUTIN

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ORAL CONTRACEPTIVES
CONTRACEPTION: PREVENTION OF FERTILIZATION OF THE
OVUM OR SUBSEQUENT ONSET OF PREGNANCY
ORAL CONTRACEPTIVES
• MOST EFFECTIVE FORM OF EASILY REVERSIBLE BIRTH
CONTROL AVAILABLE
• TWO MAIN CATEGORIES
• ESTROGEN-PLUS-PROGESTIN COMBINATIONS
• PROGESTIN ONLY (MINIPILLS)

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ORAL CONTRACEPTIVES
SIDE EFFECTS
• SERIOUS SIDE EFFECTS ARE RARE
• RISK OF THROMBOEMBOLISM IS MINIMAL EXCEPT FOR
HEAVY SMOKERS OR IN WOMEN WITH HISTORY OF
THROMBOEMBOLYTIC DISEASE
• COMBINATIONS PROTECT AGAINST OVARIAN AND
ENDOMETRIAL CANCER
• TERATOGENIC

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ORAL CONTRACEPTIVES CON’T
• ORAL CONTRACEPTIVES HAVE THE LARGEST SPECTRUM OF
ADVERSE EFFECTS BUT ARE RELATIVELY SAFE IN NONSMOKING
WOMEN WITH NORMAL CARDIOVASCULAR FUNCTION.
• FOR THE SAFE USE OF ORAL CONTRACEPTIVES, A THOROUGH
MEDICAL HISTORY AND PHYSICAL EXAMINATION IS
NECESSARY, WITH ROUTINE FOLLOW-UP ALSO NECESSARY TO
PREVENT ADVERSE CONDITIONS.
• MOST ORAL CONTRACEPTIVES ARE TAKEN IN A SEQUENCE OF
21 DAYS, FOLLOWED BY SEVEN DAYS OF NO PILL, AN INERT
PILL, OR AN IRON PILL.

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OTHER FORMS OF
CONTRACEPTION
IMPLANTS
• SUBDERMAL SYSTEM
• NORPLANT
TRANSDERMAL PATCHES
• MONOPHASIC
• WORN FOR A WEEK
CONTRACEPTION BY INJECTION
• 3-MONTH CONTRACEPTION
• DEPO-PROVERA

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OTHER FORMS OF
CONTRACEPTION
INTRAUTERINE DEVICES (IUDS)
• PARAGARD
• PROGESTASERT
SPERMICIDES
• FOAMS
• GELS
• CREAMS
• SUPPOSITORIES

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OTHER FORMS OF
CONTRACEPTION
BARRIER DEVICES
• MALE AND FEMALE CONDOMS
• DIAPHRAGMS
• CERVICAL CAPS
POSTCOITAL CONTRACEPTION
• “MORNING AFTER” PILL- PLAN B
• “ABORTION” PILL (FOLLOWING )- RU486

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RU-486 (ABORTION PILL)
• MIFEPRISTONE
• STOPS GESTATION OF EARLY PREGNANCY (WORKS ONLY IN
FIRST 9 WEEKS)
• STIMULATES UTERINE CONTRACTIONS
• BLEEDING AND CRAMPING TYPICALLY OCCUR AFTER
ADMINISTRATION OF THE PILL AND LASTS FROM 9-16 DAYS.
• GIVEN BY QUALIFIED HEALTH CARE PROFESSIONALS ONLY
• FOLLOW-UP VISIT MUST ASCERTAIN ABORTION COMPLETE

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DRUGS FOR PREMENSTRUAL
SYNDROME AND DYSMENORRHEA
PREMENSTRUAL SYNDROME (PMS)
• DEVELOPMENT OF PHYSICAL AND PSYCHOLOGICAL
SYMPTOMS JUST BEFORE MENSTRUATION
• RESOLVE A FEW DAYS AFTER ONSET OF BLEEDING
• DYSMENORRHEA: PAINFUL MENSTRUATION

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MEDICATIONS FOR INFERTILITY
• INFERTILITY: DECREASED ABILITY TO REPRODUCE; OCCURS
IN BOTH GENDERS
TREATMENT BY FOLLICULAR STIMULATION
• CLOMIPHENE
• MENOTROPIN
• UROFELLITROPIN
TREATMENT FOR AMENORRHEA
• BROMOCRIPTINE

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MEDICATIONS FOR INFERTILITY
MALE INFERTILITY
• DECREASED DENSITY OR MOTILITY OF THE SPERM
• ABNORMAL QUALITY OR VOLUME OF SEMEN

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MEDICATIONS FOR
ENDOMETRIOSIS
DANAZOL
• CAUSES ATROPHY OF ENDOMETRIAL TISSUE
GOSERELIN
• INJECTABLE IMPLANT ADMINISTERED INTO ABDOMEN WALL
EVERY 4 WEEKS FOR 6 MONTHS
NAFARELIN
• TOPICAL NOSE SPRAY FOR ENDOMETRIOSIS
• ALSO USED FOR PRECOCIOUS PUBERTY (BOTH SEXES)

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VIAGRA
SILDENAFIL
• TREATS ERECTILE DYSFUNCTION (MEN)
• CAUSES INCREASED BLOOD FLOW TO PENIS
• ERECTION DOES NOT OCCUR WITHOUT SEXUAL
STIMULATION.

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• ALDOMET
• CATAPRES
• WYTENSIN
• TENEX
• ISMELIN
• ALDACTONE
• BENADRYL
SELECTED MEDICATIONS THAT
IMPAIR LIBIDO
• PHENERGAN
• CHLOR-TRIMETON
• VALIUM
• TAGAMET
• ZANTAC
• INDERAL