C H A P T E R 4 0
Drugs affecting the female reproductive system
619
Adverse effects
Adverse effects associated with fertility drugs include a
greatly increased risk of multiple births and birth defects;
ovarian overstimulation (abdominal pain, distension,
ascites, pleural effusion); and headache, fluid retention,
nausea, bloating, uterine bleeding, ovarian enlargement,
gynaecomastia and febrile reactions (possibly due to
stimulation of progesterone release).
Prototype summary: Clomiphene
Indications:
Treatment of ovarian failure in women
with normal liver function and normal endogenous
oestrogens; off-label use: treatment of male sterility.
Actions:
Binds to oestrogen receptors, decreasing
the number of available oestrogen receptors,
which gives the hypothalamus the false signal to
increase FSH and LH secretion, leading to ovarian
stimulation.
Pharmacokinetics:
Route Onset
Peak
Duration
PO 5–8 days
Unknown 6 weeks
T
1/2
:
5 days, with hepatic metabolism and excretion
in the faeces.
Adverse effects:
Vasomotor flushing, visual changes,
abdominal discomfort, distention and bloating,
nausea, vomiting, ovarian enlargement, breast
tenderness, ovarian overstimulation, multiple
pregnancies.
Care considerations for
people receiving fertility drugs
Assessment: History and examination
■
■
Assess for contraindications or cautions:
history of allergy to any fertility drug
to avoid
hypersensitivity reaction
s; current status
of pregnancy and breastfeeding,
which are
contraindications or cautions to the use of the
drug
; primary ovarian failure,
which would
not respond to these agents
; thyroid or adrenal
dysfunction
due to effects on hypothalamic–
pituitary axis
; ovarian cysts,
which could be
stimulated and become larger as a result of the
drug’s stimulatory effects
; idiopathic uterine
bleeding,
which could reflect an underlying
medical problem that could be exacerbated by the
stimulatory effects of the drug
; thromboembolic
diseases,
which could increase the woman’s risk
for thrombus formation
; and respiratory diseases,
which would be exacerbated by the effects of
the drug.
■
■
Perform a complete physical assessment
to
establish baseline status before beginning therapy
and during therapy to monitor for any potential
adverse effects.
■
■
Assess skin and lesions; orientation, affect and
reflexes; and blood pressure, pulse, respiration and
adventitious sounds
to determine cardiac function
and perfusion and to detect changes in blood flow
or thromboembolism.
■
■
Complete or assist with pelvic and breast
examinations and ensure collection of specimen
for Pap smear
to establish a baseline of GU
health and detect early changes as a result of drug
therapy.
■
■
Monitor the results of laboratory tests, such as
renal and hepatic function studies,
to evaluate
for possible dysfunction that might interfere with
metabolism and excretion of the drug
; and check
hormonal levels as indicated
to determine the
effectiveness of therapy and reduce the risk of
ovarian hyperstimulation.
Implementation with rationale
■
■
Assess the cause of dysfunction before beginning
therapy
to ensure appropriate use of the drug.
■
■
Complete a pelvic examination before each use
of the drug
to rule out ovarian enlargement,
pregnancy or uterine problems.
■
■
Check urine oestrogen and oestradiol levels before
beginning therapy
to verify ovarian function.
■
■
Administer with an appropriate dose of HCG as
indicated
to ensure beneficial effects.
■
■
Discontinue the drug at any sign of ovarian
overstimulation and arrange for hospitalisation
to monitor and support the person
if this occurs.
■
■
Provide women with a calendar of treatment
days, explanations of adverse effects to
anticipate, and instructions on when intercourse
should occur
to increase the therapeutic
effectiveness of the drug.
■
■
Provide warnings about the risk and hazards of
multiple births
so the person can make informed
decisions about drug therapy.
■
■
Offer support and encouragement
to deal with low
self-esteem issues associated with infertility
.
■
■
Provide teaching about proper administration
technique, appropriate disposal of needles and
syringes, measures to avoid adverse effects,
warning signs of problems and the need for
regular evaluation
to enhance the person’s
knowledge about drug therapy and to promote
compliance.
