C H A P T E R 4 0
Drugs affecting the female reproductive system
617
FERTILITY DRUGS
Fertility drugs
stimulate the female reproductive
system. The following fertility drugs are in use: cetro
relix (
Cetrotide
), chorionic gonadotrophin (
Pregnyl
),
choriogonadotropin alfa (
Ovidrel
), clomiphene (
Clomid
and others), follitropin alfa (
Gonal-F
), follitropin beta
(
Puregon
), ganirelix (
Orgalutran
), lutropin alfa (
Luveris
)
and menopausal gonadotrophin (
Menopur
). Table 40.2
gives more information on these agents.
Therapeutic actions and indications
Women without primary ovarian failure who cannot get
pregnant after 1 year of trying may be candidates for the
use of fertility drugs. Fertility drugs work either directly
CARE GUIDE FOR J.M.: ORAL CONTRACEPTIVES
Assessment: History and examination
Assess the woman’s health history for allergies to any
oestrogens; pregnancy or breastfeeding status; breast
or genital cancer; hepatic dysfunction; coronary
artery disease; thromboembolic disease; renal disease;
idiopathic vaginal bleeding; metabolic bone disease;
diabetes; and smoking history.
Focus the physical examination on the following:
Neurological: orientation, reflexes, affect, mental status
Skin: colour, lesions
Cardiovascular: pulse, cardiac auscultation, blood pressure,
oedema, perfusion
Gastrointestinal: abdominal examination, liver examination
Genitourinary: pelvic examination, Pap smear, urinalysis
Eye: ophthalmological examination
Implementation
Administer medication as prescribed.
Administer with meals if upset stomach is a problem.
Provide analgesics for headache if appropriate.
Advise the woman that if she wears contact lenses, the shape
of her cornea may change and she may need a new
prescription or may no longer be able to wear them.
Provide at least an annual physical examination, including
Pap smear and breast examination.
Monitor perfusion and complaints of pain, tingling or
numbness.
Provide support and reassurance to deal with drug therapy.
Provide teaching regarding drug name, dosage, what to do
if a dose is missed, adverse effects, precautions, warnings
to report and safe administration.
Evaluation
Evaluate drug effects: prevention of pregnancy.
Monitor for adverse effects: signs of liver dysfunction;
gastrointestinal upset; oedema; changes in secondary
sex characteristics; headaches; thromboembolic
episodes; breakthrough bleeding.
Evaluate the effectiveness of the teaching program and
comfort and safety measures.
TEACHING FOR J.M.
• An oral contraceptive (OC), or birth control pill, contains
specific amounts of female sex hormones that work to
make the body unreceptive to pregnancy and to prevent
ovulation (the release of the egg from the ovary). Because
these hormones affect many systems in your body, it is
important to have regular physical checkups while you
are taking this drug.
• Many drugs affect the way that OCs work. To be safe,
avoid the use of over-the-counter drugs and other drugs
unless you first check with your healthcare provider.
• Some of the following adverse effects may occur:
•
Headache, nervousness
. Check with your healthcare
provider about the use of an analgesic; this effect
usually passes after a few months on the drug.
•
Nausea, loss of appetite
. This usually passes with time;
consult your healthcare provider if it is a problem.
•
Swelling, weight gain
. Water retention is a normal effect
of these hormones. Limiting salt intake may help.
You may have trouble with contact lenses if you wear
them because the body often retains fluid, which may
change the shape of your eye. This usually adjusts over
time.
•
Blood clots in women who smoke cigarettes
. Cigarette
smoking can aggravate serious side effects of OCs, such
as the formation of blood clots. When taking OCs, it is
advisable to cut down, or preferably to stop, cigarette
smoking.
• Tell any doctor, nurse or other healthcare provider that
you are taking this drug.
• Report any of the following to your healthcare provider:
pain in the calves or groin; chest pain or difficulty
breathing; lump in the breast; severe headache, dizziness,
visual changes; severe abdominal pain; yellowing of the
skin; pregnancy.
• Bleeding (a false menstrual period) should occur during
the time that the drug is withdrawn. Report bleeding at
any
other time to your healthcare provider.
• It is important to have regular medical checkups,
including Pap tests, while you are taking this drug. If you
decide to stop the drug to become pregnant, consult
with your healthcare provider.
• A package insert is included with the drug. Read this
information and feel free to ask any questions that you
might have.
• Keep this drug and all medications out of the reach of
children.
