Pharmacology, part 50: Reproductive Medications - Estrogen, Progesterone, Uterine Stimulants, Tocolytic Agents

Hi, I'm Cathy, with Level UP RN. In this video, I'm going to begin my coverage of reproductive system medications. Specifically, I'll be covering estrogens, progestin, as well as uterine stimulants, and tocolytic agents. If you have our pharmacology addition to flashcards, be sure to pull those out. I am in the reproductive system. Those are purple cards, and you can follow along. At the end of the video, I'm going to provide you guys a quick little knowledge check to test your understanding of some of the key information I'll be covering in this video. So definitely, stay tuned for that.

First up, we have our estrogens, which include conjugated estrogen and estradiol.

So these medications will bind to estrogen receptors in the body, and they are used for contraception as well as postmenopausal osteoporosis. It can also be used for dysmenorrhea, so that's painful menstruation as well as prostate cancer.

Key side effects of estrogens include embolic effects, so blood clots. So taking estrogen places the patient at higher risk for a DVT, a PE, as well as an MI or a stroke. Other side effects include hypertension, weight gain, edema, and increased risk of certain types of cancer. So some breast cancers are estrogen-dependent. So if a patient has that type of cancer, we absolutely would not want them to take an estrogen.

Key points, this medication is contraindicated in patients who smoke, who have hypertension, or who are at increased risk for blood clotting. So those are all contraindications with estrogen.

Next, we have our progesterone, which include medroxyprogesterone as well as norethindrone.

These medications can be used for contraception, so either alone or in combination with estrogen. It can also be used in the treatment of dysmenorrhea.

So side effects will include an increased risk for embolic events or blood clots, just like what we saw with estrogen. So progesterone would be contraindicated for any patient who is at increased risk for blood clots. Other side effects include menstrual changes, edema, an increased risk for breast cancer. Also, with injectable medroxyprogesterone, which is Depo-Provera, we have an increased risk for bone loss.

In fact, this medication carries a black box warning due to the risk of decreased bone mineral density in patients who use Depo-Provera or injectable medroxyprogesterone. So for those patients, we're definitely going to want to encourage them to increase their intake of calcium and vitamin D to help counteract that side effect.

Now let's talk about some uterine stimulants, which include oxytocin as well as dinoprostone. These medications are used in the induction and enhancement of labor.

Oxytocin is also used in the treatment of postpartum hemorrhage.

The mode of action is to stimulate the uterus, and side effects can include painful contractions as well as uterine rupture. So I can definitely attest to the painful contractions because I did receive oxytocin when I was in labor with my children. So when your patient is on a medication such as oxytocin, you're going to want to closely monitor their contractions. So contractions should be between 60 and 90 seconds in duration, and they should occur every two to three minutes. If our contractions are happening more frequently than that or are lasting longer than that, then that's a problem, and we may need to [de-see] the oxytocin.

Also, keep in mind that magnesium sulfate can be used to help relax the uterus if we are dealing with hyper-stimulation of the uterus due to oxytocin. We also want to keep an eye on mom's blood pressure and pulse, as well as the fetal blood pressure and pulse.

Another uterine stimulant to know is methylergonovine, which I practice saying 5000 times before I hit record. So this medication is used for postpartum hemorrhage.

It has the same mode of action as oxytocin, so it stimulates the uterus.

Side effects can include abdominal pain, nausea and vomiting, and hypertension. So any patient who has hypertension should not receive this medication because of that side effect of hypertension.

The last medication I want to cover in this video is terbutaline, which is a tocolytic agents that is used in the treatment of pre-term labor. So it helps to delay labor but will not prevent it.

So our little-cool chicken hint here on this card to help you remember this medication, and what it's for is when flying, like an airplane, turbulence will possibly delay your arrival time, just like terbutaline delays the arrival of the baby.

So another thing that terbutaline is used for is asthma, as well as COPD.

So the mode of action of terbutaline is that it activates Beta-2 receptors, and it does that in the lungs, so it causes bronchodilation, which is why it's used for asthma and COPD. It also relaxes the uterus, which is why it's used for pre-term labor.

This medication carries a lot of side effects, including tachycardia, restlessness, and tremor.

Also, this medication has a black box warning due to the risk for significant maternal and fetal distress if it's used for over 48 hours.

So a key point with this medication is that we only want to use it for short-term use, so under 48 hours. We should also use this for pregnancies under 37 weeks in gestation. Keep in mind, there are some other tocolytic agents that can be used for pre-term labor, which include magnesium sulfate, as well as nifedipine, which is a calcium channel blocker.

All right, time for quiz. I have three questions for you. First question is a true, false question. Estrogen is contraindicated for a patient who smokes or who has hypertension. The answer is true. Another contraindication is if the patient has an increased risk for blood clots or embolic events. Question number two, what key teaching do you need to provide a patient who is receiving injectable medroxyprogesterone? The answer is, you need to teach that patient to increase their intake of calcium and vitamin D in order to prevent that key side effect of bone loss with this medication. Question number three, a mom receiving oxytocin is having contractions every two minutes that are 60 seconds in duration. Is that cause for concern, yes or no? The answer is no. So it is normal to have contractions that are 60 to 90 seconds in duration, and that occur every two to three minutes.

Okay, that's it for this video. I hope you enjoyed that quiz. If you struggled with any of the answers, then definitely go back and check the flashcards and study what those a little bit longer or re-watch the video, and I'll see you with more reproductive medications in my next video. Next, we have our uterine stimulants, so medications to know include oxytocin, as well as methylergonovine [laughter]. It'd be a miracle if I can get through this video and say methylergonovine, ergonovine. Okay, I got this. Methylergonovine, ergonovine, ergonovine, methylergonovine, methylergonovine, methylergonovine. If I say enough times, I figure it out. Okay, here we go.