C H A P T E R 4 0
Drugs affecting the female reproductive system
615
Prototype summary: Raloxifene
Indications:
Prevention and treatment of osteoporosis
in postmenopausal women.
Actions:
Increases bone mineral density without
stimulating the endometrium; modulates effects of
endogenous oestrogen at specific receptor sites.
Pharmacokinetics:
Route Onset
Peak
Duration
PO Varies
4–7 hours
24 hours
T
1/2
:
27.7 hours, with hepatic metabolism and
excretion in the faeces.
Adverse effects:
Venous thromboembolism, hot
flushes, skin rash, nausea, vomiting, vaginal
bleeding, depression, light-headedness.
Care considerations for people receiving sex
hormones or oestrogen receptor modulators
Assessment: History and examination
■
■
Assess for contraindications or cautions: history
of allergy to any sex hormone or component
of the drug product
to avoid hypersensitivity
reactions
; current status related to pregnancy
and breastfeeding
due to adverse effects on
the fetus and neonate
; hepatic dysfunction
that might interfere with drug metabolism
;
cardiovascular disease, breast or genital cancer,
renal disease or metabolic bone disease,
which
could be exacerbated by oestrogen use
; history
of thromboembolism or smoking,
which may
increase the person’s risk for embolic conditions
;
idiopathic vaginal bleeding or pelvic disease,
which
could represent an underlying problem that could
be exacerbated with the use of these drugs
; and
history of asthma or epilepsy,
which could be
exacerbated by progestogen use.
■
■
Perform a physical assessment to establish a baseline
status before beginning therapy and during therapy
to determine the effectiveness of therapy and
evaluate for any potential adverse effects.
■
■
Assess abdomen, including auscultation of bowel
sounds and palpation of the liver,
to identify
abnormalities.
Measure abdominal girth as
indicated
to evaluate for bloating.
■
■
Assess skin colour, lesions and texture; affect,
orientation, mental status and reflexes; and blood
pressure, pulse, cardiac auscultation, oedema
and perfusion,
which will reflect circulatory
status and show any changes associated with
thromboembolism.
■
■
Complete or assist with pelvic and breast
examinations. Ensure specimen collection for Pap
smear; obtain a history of the woman’s menstrual
cycle
to provide baseline data and to monitor for
any adverse effects that could occur
.
■
■
Arrange for ophthalmic examination (particularly
if the person wears contact lenses)
because
hormonal changes can alter the fluid in the eye and
curvature of the cornea, which can change the fit
of contact lenses and alter visual acuity.
■
■
Monitor the results of laboratory tests, including
urinalysis and renal and/or hepatic function tests,
to determine the need for possible dose adjustment
and identify early indications of dysfunction.
See the Critical thinking scenario for additional
information related to a person who is taking
contraceptives.
Implementation with rationale
■
■
Administer drug as prescribed
to prevent adverse
effects
; administer with food if GI upset is severe
to relieve GI distress.
■
■
Provide analgesics
for relief of headache as
appropriate.
■
■
Strongly urge the woman to stop smoking
to
reduce the risk of thromboembolism.
■
■
Encourage taking of small, frequent meals
to assist
with nausea and vomiting.
■
■
Monitor for swelling and changes in vision or fit of
contact lenses
to monitor for fluid retention and
fluid changes.
■
■
Arrange for at least an annual physical
examination, including pelvic examination, Pap
smear and breast examination,
to reduce the risk
of adverse effects and to monitor drug effects.
■
■
Assess the woman periodically for changes in
perfusion or signs of vessel occlusion
because of the
risk of thromboembolism.
■
■
Monitor liver function periodically for the person
on long-term therapy
to evaluate liver function and
ensure discontinuation of the drug at any sign of
hepatic dysfunction.
■
■
Offer support and reassurance
to deal with the
drug and drug effects.
■
■
Provide thorough teaching, including steps to
take if a dose is missed or lost, measures to
avoid adverse effects, signs and symptoms that
may indicate a problem and the need for regular
evaluation,
to enhance knowledge about drug
therapy and to promote compliance.
Evaluation
■
■
Monitor response to the drug (palliation of signs
and symptoms of menopause, prevention of
