Female Reproductive Medications - Pharmacology - Reproductive System | @LevelUpRN

Summary

In this Level UP RN video, Cathy covers reproductive system medications, including estrogens, progestins, uterine stimulants, and tocolytic agents. She discusses their uses, side effects, and contraindications, emphasizing the risks of blood clots and bone loss. Key points include monitoring contractions during oxytocin use and the short-term use of terbutaline for pre-term labor. A quiz tests viewers' understanding of the material.

Takeaways

• 🔴 Estrogen medications, including conjugated estrogen and estradiol, are used for contraception, postmenopausal osteoporosis, dysmenorrhea, and prostate cancer.
• ⚠️ Estrogen use increases the risk of blood clots, hypertension, weight gain, edema, and certain types of cancer, making it contraindicated for smokers, those with hypertension, or increased blood clot risk.
• 💊 Progesterone medications like medroxyprogesterone and norethindrone are used for contraception and dysmenorrhea treatment, with similar risks as estrogens, including blood clots and breast cancer.
• 🚫 Injectable medroxyprogesterone (Depo-Provera) carries a black box warning for bone loss, necessitating increased calcium and vitamin D intake.
• 🤰 Uterine stimulants such as oxytocin and dinoprostone are used to induce and enhance labor, with side effects like painful contractions and uterine rupture.
• 👶 Oxytocin is also used to treat postpartum hemorrhage and should be monitored closely for appropriate contraction frequency and duration.
• 💊 Methylergonovine is a uterine stimulant used for postpartum hemorrhage, with side effects like abdominal pain, nausea, and hypertension.
• 🛫 Tocolytic agent terbutaline is used to delay pre-term labor, working by activating Beta-2 receptors for bronchodilation and uterine relaxation, but it has many side effects and a black box warning for long-term use.
• 🚫 Terbutaline should be used for short-term (under 48 hours) and in pregnancies under 37 weeks to prevent maternal and fetal distress.
• 📚 Other tocolytic agents for pre-term labor include magnesium sulfate and nifedipine, a calcium channel blocker.

Q & A

What are estrogens used for?

Estrogen medications are used for contraception, postmenopausal osteoporosis, dysmenorrhea, and prostate cancer.

What are the key side effects of estrogens?

Key side effects of estrogens include embolic effects such as blood clots, hypertension, weight gain, edema, and increased risk of certain types of cancer.

Why are estrogens contraindicated in certain patients?

Estrogens are contraindicated in patients who smoke, have hypertension, or are at increased risk for blood clotting.

What are progesterone medications used for?

Progesterone medications are used for contraception, either alone or in combination with estrogen, and in the treatment of dysmenorrhea.

What side effects are associated with progesterone medications?

Side effects of progesterone include an increased risk for embolic events or blood clots, menstrual changes, edema, and an increased risk for breast cancer.

Why is injectable medroxyprogesterone associated with a risk of bone loss?

Injectable medroxyprogesterone, also known as Depo-Provera, carries a black box warning due to the risk of decreased bone mineral density.

What are uterine stimulants and what are they used for?

Uterine stimulants, such as oxytocin and dinoprostone, are used in the induction and enhancement of labor, and oxytocin is also used in the treatment of postpartum hemorrhage.

What are the side effects of uterine stimulants?

Side effects of uterine stimulants can include painful contractions and uterine rupture.

How should healthcare providers monitor contractions in patients receiving oxytocin?

Contractions should be monitored to ensure they are between 60 and 90 seconds in duration and occur every two to three minutes.

What is the role of magnesium sulfate in the context of uterine stimulants?

Magnesium sulfate can be used to help relax the uterus if there is hyper-stimulation due to oxytocin.

What is the primary use of terbutaline as a tocolytic agent?

Terbutaline is used in the treatment of pre-term labor to delay labor, although it will not prevent it.

What are the side effects of terbutaline?

Side effects of terbutaline include tachycardia, restlessness, and tremor.

What is the significance of the black box warning associated with terbutaline?

The black box warning for terbutaline indicates a risk for significant maternal and fetal distress if it's used for over 48 hours.

Outlines

00:00

💊 Overview of Reproductive System Medications

Cathy from Level UP RN introduces the topic of reproductive system medications, focusing on estrogens, progestins, uterine stimulants, and tocolytic agents. She suggests using pharmacology flashcards to follow along and mentions a knowledge check at the end. Estrogen medications like conjugated estrogen and estradiol are discussed, highlighting their uses in contraception, postmenopausal osteoporosis, dysmenorrhea, and prostate cancer. Side effects include increased risk of blood clots, hypertension, weight gain, edema, and certain cancers. Contraindications include smoking, hypertension, and increased blood clot risk. Progesterone medications like medroxyprogesterone and norethindrone are also covered, with similar uses and side effects, and a black box warning for bone loss with Depo-Provera. Uterine stimulants oxytocin and dinoprostone are used for labor induction and postpartum hemorrhage treatment, with side effects like painful contractions and uterine rupture. Methylergonovine is introduced as a stimulant for postpartum hemorrhage with side effects like abdominal pain and hypertension.

05:01

📚 Quiz and Additional Medication Information

The video concludes with a quiz to test understanding of the key points. The first question confirms that estrogen is contraindicated for smokers and those with hypertension. The second question emphasizes the importance of increasing calcium and vitamin D intake for patients on injectable medroxyprogesterone to prevent bone loss. The third question addresses whether contractions every two minutes lasting 60 seconds in a mom receiving oxytocin are a concern, which they are not as they are within the normal range. The summary also mentions terbutaline, a tocolytic agent used for pre-term labor and asthma/COPD, with side effects like tachycardia and tremor. A black box warning is highlighted for its use over 48 hours due to maternal and fetal distress risk. Other tocolytic agents like magnesium sulfate and nifedipine are briefly mentioned. The video ends with an invitation to subscribe, share, like, and comment on the video for further engagement.

Keywords

💡Estrogen

Estrogen is a group of hormones that play a crucial role in the development of female reproductive tissues and secondary sexual characteristics. In the video, estrogens such as conjugated estrogen and estradiol are mentioned as medications that bind to estrogen receptors in the body and are used for contraception and postmenopausal osteoporosis. They also have potential side effects like increasing the risk of blood clots and certain types of cancer.

💡Progestin

Progestin refers to a class of hormones that help regulate the menstrual cycle and maintain pregnancy. In the context of the video, progestins like medroxyprogesterone and norethindrone are contraceptives that can be used alone or in combination with estrogen. They share similar side effects with estrogens, including an increased risk of blood clots and menstrual changes.

💡Uterine Stimulants

Uterine stimulants are medications that cause the uterus to contract. The video discusses oxytocin and dinoprostone as examples used to induce and enhance labor. These medications can cause side effects like painful contractions and, in severe cases, uterine rupture.

💡Tocolytic Agents

Tocolytic agents are medications used to inhibit or suppress premature uterine contractions and delay labor. Terbutaline, highlighted in the video, is a tocolytic agent that activates Beta-2 receptors to relax the uterus and delay labor, although it does not prevent it. It is used for short-term treatment of pre-term labor.

💡Contraception

Contraception refers to the use of methods or devices to prevent pregnancy. The video mentions that both estrogens and progestins are used for contraception, either alone or in combination, to prevent ovulation and fertilization.

💡Dysmenorrhea

Dysmenorrhea is painful menstruation. In the script, it is mentioned that both estrogens and progestins can be used to treat dysmenorrhea by regulating the hormonal balance and reducing uterine contractions.

💡Postmenopausal Osteoporosis

Postmenopausal osteoporosis is a condition where bone density decreases, making bones fragile and more likely to break, often occurring in women after menopause. The video explains that estrogens are used to treat this condition by helping to maintain bone density.

💡Embolic Effects

Embolic effects refer to the formation of blood clots that can travel through the bloodstream and cause blockages in blood vessels. The video script warns that estrogens and progestins can increase the risk of embolic events like deep vein thrombosis (DVT) and pulmonary embolism (PE).

💡Depo-Provera

Depo-Provera is a brand name for an injectable form of medroxyprogesterone, a progestin. The video discusses its use for contraception and a significant side effect of bone loss, which is why patients using Depo-Provera are advised to increase their calcium and vitamin D intake.

💡Methylergonovine

Methylergonovine is a uterine stimulant used to manage postpartum hemorrhage by causing the uterus to contract. The video mentions potential side effects such as abdominal pain, nausea, and hypertension, and cautions that it should not be given to patients with hypertension.

💡Hypertension

Hypertension, or high blood pressure, is a condition where the force of the blood against the artery walls is consistently too high. The video script indicates that patients with hypertension should avoid estrogen and methylergonovine due to the increased risk of adverse effects.

Highlights

Introduction to reproductive system medications including estrogens, progestin, uterine stimulants, and tocolytic agents.

Estrogens are used for contraception, postmenopausal osteoporosis, dysmenorrhea, and prostate cancer.

Key side effects of estrogens include embolic effects (e.g., DVT, PE, MI, stroke), hypertension, weight gain, and increased cancer risk.

Estrogens are contraindicated for patients who smoke, have hypertension, or have an increased risk of blood clots.

Progestins like medroxyprogesterone and norethindrone are used for contraception and treating dysmenorrhea.

Progestin side effects include embolic events, menstrual changes, edema, and increased breast cancer risk.

Injectable medroxyprogesterone (Depo-Provera) has a black box warning for bone loss and patients should increase calcium and vitamin D intake.

Uterine stimulants like oxytocin and dinoprostone are used to induce labor and treat postpartum hemorrhage.

Oxytocin should be monitored for contraction frequency and duration; hyperstimulation can be managed with magnesium sulfate.

Methylergonovine is another uterine stimulant used for postpartum hemorrhage and is contraindicated in patients with hypertension.

Terbutaline is a tocolytic agent used to delay labor by activating Beta-2 receptors in the lungs, causing bronchodilation and uterine relaxation.

Terbutaline has side effects like tachycardia, restlessness, and tremor, and carries a black box warning for maternal and fetal distress if used over 48 hours.

Other tocolytic agents for pre-term labor include magnesium sulfate and nifedipine, a calcium channel blocker.

Quiz: Estrogen is contraindicated for patients who smoke or have hypertension.

Quiz: Key teaching for patients receiving injectable medroxyprogesterone is to increase calcium and vitamin D intake to prevent bone loss.

Quiz: Contractions lasting 60 to 90 seconds and occurring every two to three minutes are normal during oxytocin administration.

Transcripts

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 hit 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. I invite you to subscribe to our channel and share  

a link with your classmates and friends in nursing  school. If you found value in this video, be sure  

and hit the like button, and leave a comment and  let us know what you found particularly helpful.