Ppt chapter046

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction to Clinical Pharmacology

Chapter 46-Male and Female Hormones


Male Hormones: UsesMale Hormones: Uses

• Androgen therapy used as: Replacement therapy

Anabolic steroid: Uses

• Androgen hormone inhibitors: Uses


Male Hormones: Adverse Reactions Male Hormones: Adverse Reactions • Androgens:

– In men

•Breast enlargement; Testicular atrophy

•Inhibition of testicular function; Impotence

•Enlargement of penis; Jaundice; Male pattern baldness

– In women- receiving androgen preparation for breast carcinoma

•Amenorrhea; Virilization


Male Hormones: Adverse Reactions (cont’d)Male Hormones: Adverse Reactions (cont’d)

• Anabolic Steroids:

– Virilization; Nausea; Diarrhea; Fluid and electrolyte imbalances

– Testicular atrophy; Jaundice; Anorexia; Muscle cramps

• Androgen hormone inhibitor:

– Impotence; Decreased libido; Decreased volume of ejaculate


Male Hormones: Contraindications and Precautions Male Hormones: Contraindications and Precautions

• Male hormones and hormone inhibitors: Contraindicated:

– Hypersensitivity to drugs; Liver disorders; Cardiac disease; Prostate gland disorders

• Anabolic steroids:

– Contraindicated to enhance physical appearance or athletic performance

– Used cautiously: Risk of prostate enlargement and prostate cancer


Male Hormones: Interactions Male Hormones: Interactions

Interactant Drug Effect of Interaction

Oral anticoagulants Increased antidiuretic effect

Imipramine and androgen Increased risk for paranoid behavior

Sulfonylureas and anabolic steroids

Increased risk for hypoglycemia


Nursing Process: Assessment Nursing Process: Assessment

• Preadministration assessment:

– Androgens: Take and record vital signs and weight; Review tests; Note abnormalities

– Anabolic steroids: Evaluate and record physical, nutritional status before starting therapy; assess weight, blood pressure, pulse, respiratory rate

– Androgen hormone inhibitor: Ask about symptoms of BPH; Record all symptoms in patient’s chart


Nursing Process: Assessment (cont’d)Nursing Process: Assessment (cont’d)

• Ongoing assessment:

– Weigh patient with advanced breast carcinoma daily or as ordered

– Notify primary health care provider: Significant increase or decrease in weight

– Take vital signs every 4 to 8 hours; Evaluate response to drug therapy based on original assessment findings


• Expected outcomes

– Optimal response to therapy

– Support of patient needs related to the management of adverse reactions

– Understanding of and compliance with the prescribed therapeutic regimen

Nursing Process: PlanningNursing Process: Planning


Nursing DiagnosesNursing Diagnoses

• Excess fluid volume

• Disturbed body image


Nursing Process: Implementation Nursing Process: Implementation

• Promoting an optimal response to therapy:

– Demonstrate placement of the tablet

•Warn the patient not to swallow the tablet but to allow it to dissolve in the mouth

•Remind patient not to smoke or drink water until tablet is dissolved


Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)

• Monitoring and managing patient needs:

– Excess fluid volume: Monitor fluid and electrolyte disturbances; Daily comparison of patient’s preadministration weight with current weights; Symptoms to note; Report findings

– Disturbed body image: Suggest wearing of wig if hair loss occurs and makeup for mild skin pigmentation


Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)• Educating the patient and the family:

– Androgens

•Notify if nausea, vomiting, swelling of legs, or jaundice occurs

•Oral tablets: Take with food or snack

•Buccal tablets: Place tablet between cheek and molars- dissolve in mouth

•Testosterone transdermal system: Apply according to directions


Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)• Educating the patient and the family: Anabolic

steroids (cont’d):

– Take drug with food or meals

– Keep primary health care provider or clinic visits

– Androgen hormone inhibitor: Take drug without regard to meals

– Inform primary health care provider if sexual partner is or may become pregnant


Nursing Process: Evaluation Nursing Process: Evaluation

• Therapeutic response is achieved

• Adverse reactions: Identified and reported

• Patient and family demonstrate: Understanding of the drug regimen

• Patient verbalizes: Understanding of treatment modalities and importance of continued follow-up care


Female Hormones: Uses Female Hormones: Uses

• Estrogens are used to:

– Relieve moderate to severe vasomotor symptoms of menopause

– Female hypogonadism; Atrophic vaginitis

– Osteoporosis in women post menopause

– Palliative treatment: Advanced prostatic carcinoma

– Advanced breast carcinoma


Female Hormones: Uses (cont’d)Female Hormones: Uses (cont’d)• Progestins used:

– Treatment of amenorrhea, endometriosis, functional uterine bleeding

– Oral contraceptives

• Contraceptive Hormones:

– Regulating menstrual cycle and decreased blood loss

– Treatment of: Iron deficiency anemia, dysmenorrhea


Female Hormones: Adverse ReactionsFemale Hormones: Adverse Reactions• Estrogens:

– Central nervous system

– Dermatologic

– Gastrointestinal

– Genitourinary

– Local

– Ophthalmic

– Miscellaneous


Female Hormones: Adverse ReactionsFemale Hormones: Adverse Reactions

• Progestin: Breakthrough bleeding, spotting, change in

menstrual flow, amenorrhea Breast tenderness, edema, weight increase

or decrease Acne, chloasma, melasma, insomnia,

mental depression Contraceptive hormones:

Vary depending on estrogen or progestin content


Female Hormones: Contraindications and Precautions Female Hormones: Contraindications and Precautions

• Contraindicated: Hypersensitivity to drugs; Breast cancer; Estrogen-dependent neoplasms; Undiagnosed abnormal genital bleeding; Thromboembolic disorder

• Precautions:

– Estrogens: patients with gallbladder disease, hypercalcemia, cardiovascular disease, and liver impairment

– Progestins: patients with history of migraine headaches, epilepsy, asthma, cardiac or renal impairment


Female Hormones: Interactions Female Hormones: Interactions Interactant Drug Effect of Interaction

Estrogens

Oral anticoagulants Decreased anticoagulant effect

Tricyclic antidepressants Increased effectiveness of antidepressant

Barbiturates or rifampin Increased risk for breakthrough bleeding

Hydantoins Increased risk for breakthrough bleeding and pregnancy


Interactant Drug Effect of Interaction

Progestins

Anticonvulsants, barbiturates, or rifampin

Decreased effectiveness of progestin

Penicillins or tetracyclines Decreased effectiveness of oral contraceptives

Female Hormones: Interactions (cont’d) Female Hormones: Interactions (cont’d)


Nursing Process: AssessmentNursing Process: Assessment

• Preadministration assessment:

– Obtain complete health history

•Menstrual history; Thrombophlebitis or other vascular disorders

•Smoking; Liver diseases

– Enter in patient’s record: General evaluation of patient’s physical and mental status if treated for cancer


• Ongoing assessments:

– Outpatients: Obtain blood pressure, pulse, respiratory rate, weight

• Question patient regarding any adverse drug effects, as well as result of drug therapy

• Weigh patient and report steady weight gain or loss




• Hospitalized patients:

– Take vital signs daily

– Observe adverse drug reactions: Liver or cardiovascular system

– Weigh patient weekly; Report significant weight gain or loss

– Observe and evaluate signs: Response to therapy in patients with breast or prostate cancer


Nursing Process: Planning Nursing Process: Planning

• Expected outcome

– Optimal response to therapy

– Support of patient needs related to the management of adverse reactions

– Reduction in anxiety

– Understanding of and compliance with prescribed therapeutic regimen


Nursing Diagnoses Nursing Diagnoses

• Individual Effective Therapeutic Regimen Management

• Excess Fluid Volume

• Ineffective Tissue Perfusion

• Imbalanced Nutrition

• Anxiety



• Promoting an optimal response to therapy:

– Estrogens: Give instructions on proper use when - given vaginally for atrophic vaginitis

– Contraceptive hormones: Monophasic oral contraceptives: Administered on 21-day regimen

– Contraceptive implant system: Capsules provide contraceptive protection for 5 years; May be removed


• Promoting an optimal response to therapy (cont’d):

– Medroxyprogesterone acetate contraceptive injection

•Synthetic progestin used in the treatment of abnormal uterine bleeding and secondary amenorrhea

•Also used as contraceptive



Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)• Monitoring and managing patient needs:

– Individual effective therapeutic regimen management: Monitor patient with diabetes taking female hormones

– Excess fluid volume: Weigh hospitalized patient daily; Keep accurate record of intake and output; Encourage ambulation

– Imbalanced nutrition: Encourage diet with adequate amounts of protein and carbohydrates, low in fats


Nursing Process: ImplementationNursing Process: Implementation• Monitoring and managing patient needs

(cont’d):

– Ineffective tissue perfusion: Monitor patient for signs of thromboembolic effects

– Anxiety: Explain that taking progestin counteracts negative effect of estrogen- can prevent estrogen-induced cancer of uterus


Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)• Educating the patient and family:

– Estrogens and Progestins: Notify

•Pain in legs, chest or abdomen; Shortness of breath

•Lumps in breast; Vision or speech disturbances; Weakness or numbness in limbs

– Oral contraceptives: Report

•Retention or edema; Blurred vision; Chest pain; Yellowed skin or eyes


Nursing Process: Implementation (cont’d)Nursing Process: Implementation (cont’d)• Educating the patient and family (cont’d):

– Estradiol transdermal system

•Procedure

– Intravaginal application: Use applicator correctly, wash applicator after each use in warm water with mild soap and rinse well


Nursing Process: Evaluation Nursing Process: Evaluation

• Therapeutic effect is achieved

• Adverse reactions: Identified; Reported; Managed using appropriate nursing interventions

• Anxiety is reduced

• Patient verbalizes: Understanding of dosage regimen; Importance of continued follow-up care; Importance of complying with the prescribed therapeutic regimen


End of Presentation

Ppt chapter046

Health & Medicine

primary health care

androgen therapy

precautions male hormones

anabolic steroids contd

drug therapy

drug regimen patient

weigh patient

reported patient