Pharmacology - The Reproductive and Genitourinary Systems

Finasteride and dutasteride

Examples: Finasteride and dutasteride
-Treatment of benign prostatic hypertrophy (also reduces the risk of prostate cancer) and treatment of androgenic alopecia.
-Reduces amount of testosterone produced in the prostate

Examples: Finasteride and dutasteride
-Reduced libido and ejaculate volume, reduced prostate-specific antigen (PSA) levels, gynecomastia (clients who were assigned male at birth).

Examples: Finasteride and dutasteride
-Tell clients about the possibility of reduction in libido and ejaculate volume, obtain a baseline PSA level and monitor periodically, expect PSA levels to decline with therapy, evaluate any increases in PSA level, monitor for breast enlargement, evaluate if there is concern for body image.

Examples: Finasteride and dutasteride
-Take orally, with or without food, crush the tablets if needed, expect medication therapy to be lifelong, ensure that clients who were assigned female at birth do not handle the medication, expect therapeutic effects to take 6 to 12 months.

Examples: Finasteride and dutasteride
-Pregnancy (teratogenic), clients who were assigned female at birth, children.

Examples: Finasteride and dutasteride
-Liver impairment, obstructive uropathy.

Tamsulosin and Silodosin

Examples: Tamsulosin and Silodosin
Treatment of benign prostatic hypertrophy; antagonizes the alpha-adrenergic receptors which promotes relaxation of smooth muscle in the prostate gland and in the outlet of the bladder. Increased urine flow and decreased BPH manifestations, such as urgency, frequency, and nocturia, are the result

Examples: Tamsulosin and Silodosin
-Reduced ejaculate volume
-Ejaculation failure
-Retrograde ejaculation
-Headache and dizziness, hypotension, fainting (nonselective alpha blockers, not tamsulosin/silodosin).

Examples: Tamsulosin and Silodosin
Take orally once a day, take at the same time each day, 30 min after the same meal, swallow the capsules whole; do not crush or chew them.

Examples: Tamsulosin and Silodosin
Expect decreases in ejaculate volume and ejaculation failure, report headache not relieved with an over-the-counter analgesic, have blood pressure checked regularly, rise slowly from a reclining or sitting position, report dizziness or fainting, do not engage in dangerous activities if dizziness occurs or tends to recur, advise client this medication will need to be taken lifelong.

Examples: Tamsulosin and Silodosin
Concurrent use of erectile dysfunction medications such as sildenafil, clients assigned female at birth, children.

Examples: Tamsulosin and Silodosin
Renal impairment, history of syncope, hypotension.

Examples: Tamsulosin and Silodosin
Medications that lower blood pressure can increase hypotensive effects of nonselective alpha blockers, erythromycin, itraconazole, nefazodone, and HIV protease inhibitors increase levels of nonselective alpha blockers, cimetidine may worsen orthostatic hypotension.

Treatment of urinary urge incontinence caused by overactive bladder and neurogenic bladder. It accomplishes this by blocking muscarinic receptors in the detrusor muscle allowing the bladder to relax. Simultanusly causes contraction of the internal sphincter of the bladder preventing the release of urine at undesired times.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Dry mouth, constipation, urinary retention, mydriasis (pupil dilation), dry eyes, blurred vision, headache, dizziness, drowsiness, fever, heat exhaustion.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Monitor for anticholinergic effects, bowel elimination patterns, urinary elimination patterns, especially in older adults, and recommend periodic eye examinations.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Take orally (either short-acting syrup or tablets) two to four times a day; extended-release (ER) tablets once a day; swallow ER tablets whole; apply transdermal patch twice a week.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Suck on hard candy, sip water, increase fluid and fiber intake, report undesirable changes in urinary elimination, and avoid becoming overheated.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Angle-closure glaucoma, myasthenia gravis, gastrointestinal obstruction, genitourinary obstruction, active cardiac dysfunction.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
Urinary tract infection, hiatal hernia with reflux, hyperthyroidism, hypertension, benign prostatic hypertrophy, autonomic hypertrophy, liver or renal disease.

Example: Oxybutynin, darifenacin, solifenacin, and tolterodinel
CYP3A4 inhibitors may increase toxicity; CYP3A4 inducers decrease effectiveness.

Examples: cabergoline and bromocriptine
Correction of amenorrhea from excessive secretion of prolactin and treatment of infertility.
MA:
-Inhibits secretion of gonadotropin-releasing hormone, leading to a drop in LH and FSH
-Causes dopamine levels to rise decreasing prolactin

Examples: cabergoline and bromocriptine
Nausea, headache, dizziness, pulmonary fibrosis, pericardial fibrosis, valvular disorders, retroperitoneal fibrosis.

Examples: cabergoline and bromocriptine
Begin treatment at lowest therapeutic dose, monitor serum prolactin levels, monitor for worsening GI manifestations and vomiting, monitor for headache and other CNS effects, monitor blood pressure.

Examples: cabergoline and bromocriptine
Take orally twice per week on the same days of the week, with or without food; discontinue when prolactin levels are within the expected reference range.

Examples: cabergoline and bromocriptine
Take medication with food if GI manifestations persist, report headache or dizziness, and take over-the-counter analgesics to relieve headache.

A significant reduction in liver function affecting metabolism.

Examples: Mirabegron, vibegron
Used for treating urinary urgency and frequency caused by overactive bladder. This is accomplished by inhibiting the signaling pathways that tell the brain the bladder should be emptied.

Examples: Mirabegron, vibegron
-Hypertension
-UTI
-Headache
-Nasopharyngitis
-Upper respiratory tract infection

Examples: Mirabegron, vibegron
Administer 25 to 50 mg once daily, with or without food. Pediatric clients may be prescribed granules based on weight that should be taken with food.

Examples: Mirabegron, vibegron
Contraindicated for clients who have severe uncontrolled hypertension

An off-label therapeutic use of Beta2 Adrenergic Agonists like terbutaline.

Treatment aimed at delaying preterm labor.

Example: Terbutaline
-Relieve bronchospasm in respiratory disorders
-Used off label for tocolytic therapy to relax the uterus

Example: Terbutaline
Patients should report shortness of breath, difficulty breathing, cough, palpitations, chest pain, weakness, nausea, paresthesia, polyphagia, polydipsia, and polyuria.

Example: Terbutaline
Hypoglycemic medications require increased dosing due to hyperglycemic effects; MAOIs and tricyclic antidepressants increase risks of hypertension, tachycardia, and angina.

Example: bethanechol
-Used to treat urinary retention
-Activates muscarinic receptors in the detrusor muscle that lines the bladder, causing the bladder to contract. Also relaxes the internal sphincter of the bladder allowing urine to be voided.

Example: bethanechol
Possible effects include hypotension, bradycardia, excessive gastric acid, salivation, diarrhea, fecal incontinence, bronchoconstriction, dizziness, and fainting.

Example: bethanechol
Oral intake three to four times a day, taken 1 hour before or 2 hours after meals.

Example: bethanechol
Patients should report dizziness, increase fluid intake, report difficulty breathing, and avoid dangerous activities if dizziness occurs.

Example: bethanechol
Conditions such as hypotension, hyperthyroidism, low cardiac output, asthma, gastric ulcers, urinary tract obstruction, intestinal obstruction, and recent intestinal surgery.

Example: bethanechol
Cholinesterase inhibitors worsen cholinergic effects; mecamylamine worsens abdominal manifestations; procainamide, quinidine, atropine, and epinephrine interfere with therapeutic effects.

Emergency contraceptive

Abdominal pain, Breast pain, Changes in menstruation, Fatigue, Dizziness, Headache, Nausea, Ectopic pregnancy

Client should take within 72 hours of unprotected sex; Administer antiemetic 30 minutes prior to reduce nausea

One single dose of 1.5 mg or two doses of 0.75 mg, 12 hours apart

Carbamazepine, Phenytoin, St. John's wort, CYP3A4 substance, HIV protease inhibitors, Non-nucleoside reverse transcriptase inhibitors

Example: methylergonovine
-Used to prevent and treat postpartum hemorrhage or hemorrhage following spontaneous abortion
-Cause strong uterine contractions by stimulating smooth muscle in the uterus

Example: methylergonovine
Prevention and treatment of postpartum and post-abortion hemorrhage

Example: methylergonovine
Rare with PO or IM administration - more common when administered IV; Hypertension; Nausea, vomiting (rare with oral administration); Cramps; Arrhythmias; Seizures

Example: methylergonovine
Monitor blood pressure; Monitor for nausea and vomiting; Monitor for headache and note any worsening of headache; Monitor heart rate; Monitor for manifestations of seizure activity; Institute seizure precautions if indicated

Example: methylergonovine
Check blood pressure before administration. Do not give if BP exceeds parameters set by provider; Give orally for 2 to 7 days or IM every 2 hr as needed; Give the medication IV only for emergency control of severe hemorrhage; Administer IV doses slowly (over 1 min to minimize adverse effects); Administer after the delivery of the placenta; Monitor vital signs and uterine response; Tell clients to expect some cramping

Example: methylergonovine
Induction of labor; Threatened spontaneous abortion; Hypertension

Example: methylergonovine
Sepsis; Liver disease; Renal disease; Do not take if breastfeeding

Example: methylergonovine
Other ergot alkaloids, vasopressors, and triptans increase the risk of hypertension; Protease inhibitors and itraconazole increase the risk of toxicity; Smoking increases vasoconstrictive effects; Grapefruit juice increases blood levels of medication

Examples: conjugated estrogen, medroxyprogesterone acetate
-Substitutes the normally fluctuating amounts of estrogen in the premenopausal client with a smaller, but stable, amount of estrogen to prevent menopausal manifestations

Examples: conjugated estrogen, medroxyprogesterone acetate
Relief of postmenopausal manifestations (vasomotor), and vulvar and vaginal atrophy; Prevention of postmenopausal osteoporosis

Examples: conjugated estrogen, medroxyprogesterone acetate
Nausea; Hypertension; Breast cancer; Breakthrough bleeding and other menstrual irregularities; Edema.

Examples: conjugated estrogen, medroxyprogesterone acetate
Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident; Encourage clients who smoke to quit smoking; Plan for temporary use of HRT (3 to 4 years) for vasomotor manifestations; Inform clients that this effect diminishes with time; Monitor blood pressure; Recommend mammograms and breast examinations at appropriate intervals; Discontinue the medication for any indications of breast cancer; Monitor the pattern and amount of any reported bleeding; Monitor for edema and weight gain.

Examples: conjugated estrogen, medroxyprogesterone acetate
Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath; Do not smoke; Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events; Exercise regularly and follow a healthy, low-fat diet; Take oral forms with food; Take pill or apply transdermal patch at bedtime; Obtain regular blood pressure checks; Perform breast self-examination every month; Obtain a mammogram and breast examination at the recommended intervals; Report vaginal bleeding or spotting to the provider; Advise client to report edema to provider.

Examples: conjugated estrogen, medroxyprogesterone acetate
History of or other risk for thromboembolic events; Suspected or confirmed breast, vaginal, cervical, or endometrial cancer; Liver disease; Undiagnosed vaginal bleeding.

Examples: conjugated equine estrogen, vaginal estradiol cream
-Substitutes the normally fluctuating amounts of estrogen in the premenopausal client with a smaller, but stable, amount of estrogen to prevent menopausal manifestations

Examples: conjugated equine estrogen, vaginal estradiol cream
Relief of severe menopausal manifestations (vasomotor) and vulvar and vaginal atrophy; Prevention of postmenopausal osteoporosis.

Examples: conjugated equine estrogen, vaginal estradiol cream
Nausea; Thromboembolism: thrombophlebitis, pulmonary embolism, stroke, myocardial infarction; Hypertension; Endometrial hyperplasia, endometrial and ovarian cancer.

Examples: conjugated equine estrogen, vaginal estradiol cream
Inform clients that this effect diminishes with time.

Symptoms related to blood vessel changes, such as hot flashes.

A hormone that regulates various functions in the female reproductive system, often prescribed with estrogen.

Conditions that prevent the use of HRT, such as a history of thromboembolic events or certain cancers.

Conditions that require caution when using HRT, such as hypertension and diabetes.

Certain medications like rifampin and St. John's wort can reduce the effectiveness of estrogens.

Examples: betamethasone and dexamethasone
-Stimulates fetal lung maturity (increases surfactant production) and helps reduce the risk of complications

To accelerate lung maturity in fetuses between 24 and 34 weeks' gestation.

Potential side effects include pulmonary edema, hyperglycemia, and hypertension.

Administer 12 mg IM for 2 to 3 doses 24 hr apart.

Clients should report shortness of breath, cough, and increased sputum production.

Glucocorticoids can decrease antibody responses to vaccines and can increase the risk of infection from live vaccines.

Examples: leuprolide, nafarelin
-Treatment of endometriosis
-Treats anemia associated with uterine fibroid tumors
-Treats advanced prostate cancer

Examples: leuprolide, nafarelin
-Initially increases levels of LH and FSH
-Then has opposite effect, lowering LH, FSH, estrogen, and progesterone levels so much that the body thinks menopause has occurred. This causes the overgrown tissue to shrink.

Examples: leuprolide, nafarelin
-Vasomotor instability (hot flashes)
-Vaginal dryness
-Headache
-Bone loss due to lack of estrogen

Examples: leuprolide, nafarelin
-Limit medication therapy to 6 months.
-Monitor for bone loss in longer-term therapy

Examples: leuprolide, nafarelin
Give via IM injection monthly or give depot form IM every 3 to 4 months.

Examples: leuprolide, nafarelin
-Perform weight-bearing exercise daily
-Consume adequate calcium and vitamin D
-Report headache, dizziness, or paresthesia

Examples: leuprolide, nafarelin
-Pregnancy - teratogenic effects
-Allergy to benzyl alcohol
-Abnormal vaginal bleeding
-Metastatic cerebral lesions

Example: Clomiphene
-Blocks the effect of estrogen receptors on the pituitary gland which increases GRH secretion
-This increases secretion of LH and FSH stimulating the ovary to produce mature follicles and promoting ovulation

Example: Clomiphene
-Treatment of infertility
-Promotes ovulation

Example: Clomiphene
-Breast engorgement
-GI manifestations
-Visual disturbances
-Abdominal pain
-Multiple gestation

Example: Clomiphene
-Take orally, beginning 5 days after menstruation onset and continuing therapy for 5 days.

Example: Clomiphene
Pregnancy, primary ovarian failure, undiagnosed uterine bleeding, liver disease, uncontrolled thyroid disease, thrombophlebitis.

Example: Clomiphene
-Tricyclic antidepressants, phenothiazines, and methyldopa increase prolactin concentrations, thus interfering with fertility.

Example: Depot Medroxyprogesterone Acetate (DMPA)
-Prevents pregnancy by suppressing gonadotropin-releasing hormone and inhibiting ovulation

Example: Depot Medroxyprogesterone Acetate (DMPA)
-Amenorrhea, irregular menstrual periods, injection site reactions, increased risk for ectopic pregnancy if become pregnant while taking DMPA, venous thromboembolism, liver disease, headache, breast discomfort, weight gain, depression, bone loss and increased risk for fractures is associated with long-term use (> 2 years).

Example: Depot Medroxyprogesterone Acetate (DMPA)
-Determine client is not pregnant prior to beginning DMPA. Administer every 3 months by injection. Intramuscular injections are administered by a healthcare professional. Subcutaneous injections may be self-administered. Monitor BP, blood glucose, liver function, and lipids.

Does not provide protection against STIs. Teach injection procedures, sharps disposal, and injection reminders. If an injection is administered more than 2 weeks late, the client should use an additional contraceptive method.

Pregnancy, hormone-sensitive breast cancer, thromboembolic disease, liver disease.

Discontinue DMPA if client experiences sudden visual changes or migraines. Discontinue DMPA if client with a history of depression develops manifestations of depression.

-Rifampin
-Ritonavir
-Phenobarbital
-Carbamazepine
-Phenytoin
-St. John's wort

Used to prevent and treat seizure activity in clients with severe preeclampsia or eclampsia.

Flushing, diaphoresis, drowsiness, muscle weakness, maternal hypotension, bradycardia, bradypnea, depressed/absent deep tendon reflexes (DTRs), altered level of consciousness, decreased urine output, magnesium toxicity, reduced variability of fetal heart rate.

Monitor infusion site, check client for adverse effects, monitor blood pressure, pulse, and respiratory rate every 15 to 30 min, report respiratory rate of 12/min or less, monitor DTRs every 1 to 4 hr, monitor level of consciousness, monitor strict input and output, report urine output of less than 25 to 30 mL/hr, monitor serum magnesium levels, ensure antidote for toxicity is readily available, monitor breath sounds, report presence of crackles, monitor fetal heart rate for decreased variability.

Loading dose of 4 to 6 g magnesium sulfate intermittent IV bolus as a secondary infusion over 15 to 30 min; maintenance dose by continuous infusion at 2 g/hr.

Tell the client to report adverse effects, provide comfort measures, instruct the client to change positions slowly, assist the client as needed, explain the purpose of strict measurement of oral intake and urinary output, explain that magnesium sulfate is used to prevent seizures, explain the importance of frequent monitoring of respiratory status and fetal heart rate.

Anuria, hypermagnesemia, heart block, hypocalcemia.

Kidney disease, cardiac disease.

Decreased absorption of tetracyclines, calcium channel blockers increase antihypertensive effects.

Examples: ethinyl estradiol and drospirenone, ethinyl estradiol and norethindrone
-Mimic properties of natural hormones but provide constant levels resulting in the suppression of FSH and LH secretion preventing ovulation

Prevention of pregnancy, reduction in fluid retention associated with premenstrual syndrome, decreased risk for uterine and ovarian cancers, pelvic inflammatory disease, benign breast disease, ovarian cysts.

Thromboembolism, hyperkalemia (due to the drospirenone), hypertension, uterine bleeding, increased growth of breast malignancies.

Monitor for indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident; encourage clients who smoke to quit; monitor potassium levels and electrocardiogram periodically; monitor blood pressure; monitor the pattern and amount of any reported bleeding.

-Hypertension - Can cause in increase in blood pressure by increasing blood levels of angiotensin and aldosterone
-ACE inhibitors and other medications that can elevate serum potassium can cause hyperkalemia (due to drospirenone)
-Rifampin, ritonavir, phenobarbital, carbamazepine, primidone, phenytoin, and St. John's wort can reduce the effectiveness of oral contraceptives
-Oral contraceptives can reduce the effects of warfarin and hypoglycemic medications
-Oral contraceptives can increase levels of theophylline, diazepam, chlordiazepoxide, and tricyclic antidepressants.

A natural substance in the body released by the adrenal cortex that has vasoconstrictive properties

A natural substance in the body that is released by the adrenal cortex and promotes reabsorption of water in the kidneys

Example: hCG
Promotion of ovulation and treatment of infertility in conjunction with medication therapy for follicular maturation.

Ovarian hyperstimulation, ovarian cyst rupture, CNS effects: irritability, headache, fatigue, restlessness.

When used with clomiphene, give 7 to 9 days after the previous dose of clomiphene. When used with menotropins or follitropins, give 1 day after the previous dose.

Concurrent use with tricyclic antidepressants, butyrophenones, phenothiazines, and methyldopa may impair fertility.

Uterine stimulation

Uterine stimulant that induces or enhances labor near or post term. Also treats postpartum hemorrhage

-Produced by the pituitary gland
-Smooth muscle of the uterus develops more receptors to oxytocin as pregnancy progresses
-Natural oxytocin is also responsible for causing milk to be ejected after delivery

-Hyperstimulation of the uterus (can cause uterine rupture and death of both mother and infant)
-Hypertensive crisis and water intoxication due to its antidiuretic effect

Monitor length, strength, and duration of contractions.
-contractions longer than 60 seconds, more frequently than every 2-3 minutes, or having a resting uterine pressure greater than 15-20 mm Hg are s/s of uterine hyperstimulation syndrome

-For indications of hyperstimulation, turn clients on their side, stop the infusion, and administer oxygen.
-Be prepared to administer a uterine relaxant
-Monitor for headache, nausea, vomiting, and increasing blood pressure.
-Monitor intake and output and level of consciousness.

Gradually increase the flow rate by 1 to 2 milliunits/min every 30 to 60 min until contractions last 1 min or less every 2 to 3 min.

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Treatment of erectile dysfunction
-Inhibits PDE-5 (causes an enzymatic reaction that ends erection) causing sustained and harder erection. *Exerts no therapeutic effect if the client is not sexually aroused

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Priapism (persistent erection)
-Headache
-Hypotension, fainting, dizziness
-Sudden loss of hearing (rare)
-Irreversible loss of vision (rare)

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Tell clients about the risk of impotence following priapism.
-Explain that treatment involves aspirating blood from the corpus cavernosum and irrigating with a vasoconstrictor
-Monitor for hearing loss and vision changes

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Take orally 1 hr before sexual activity - limit to once daily.

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Seek medical care immediately for an erection lasting more than 4 hr
-Report headache

Examples: sildenafil, vardenafil, tadalafil, and avanafil
Concurrent use of nitroglycerin or other nitrates; Children

Myocardial infarction, cerebrovascular accident, or potentially fatal dysrhythmias within the past 6 months; Unstable angina; Heart failure; Hepatic or renal disease

Examples: sildenafil, vardenafil, tadalafil, and avanafil
-Nitrates (nitroglycerin) increase the risk of life-threatening hypotension
-CYP3A4 inhibitors (grapefruit juice, ketoconazole, erythromycin, itraconazole, cimetidine, and others) increase plasma levels and the risk of adverse effects -Alpha-adrenergic antagonists such as doxazosin and medications used to treat benign prostatic hypertrophy can cause orthostatic hypotension
-Rifampin can decrease medication levels

medroxyprogesterone acetate

-Treatment of endometriosis
-Treatment of dysfunctional uterine bleeding
-Treatment of endometrial carcinoma

Example: medroxyprogesterone acetate
Thromboembolism; Breast cancer; Breakthrough bleeding and other menstrual irregularities; Nausea; Edema

Example: medroxyprogesterone acetate
Give orally daily or cyclically or via IM injection; Expect amenorrhea and other menstrual irregularities

Example: medroxyprogesterone acetate
Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath; Do not smoke; Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events; Perform breast self-examination every month; Obtain a mammogram and breast examination at the recommended intervals; Report any unusual breakthrough bleeding or spotting or changes in menstrual patterns; Take oral forms with food; Take at bedtime

Asthma; Seizures; Cerebrovascular accident; Migraines; Cardiac or kidney dysfunction

Rifampin, ritonavir, phenobarbital, carbamazepine, primidone, phenytoin, and St. John's wort can reduce the effectiveness of progesterones; Progesterones may require adjustments in the dosage of hypoglycemic medications

Examples: dinoprostone, misoprostol
-A medication used for the promotion of cervical ripening before labor induction and stimulation of uterine contractions after cervical ripening.
-Mimics the actions of natural prostaglandins (activates an enzyme called collagenase which softens the cervix) then stimulates labor by starting utering contractions
*This can shorten the process of labor and lessen the need for some cesarean births

Examples: dinoprostone, misoprostol
Amniotic fluid embolism, uterine rupture, headache, chills or hypotension, nausea, vomiting, diarrhea.

Examples: dinoprostone, misoprostol
Monitor risk factors such as multiple deliveries, length, strength, and duration of contractions, and be prepared to administer a uterine relaxant.

Administer intracervically using a syringe prefilled with the medication in gel form and an endocervical catheter.

Have clients lie supine during instillation and remain supine for 30 min, repeat dosing every 6 hr, twice, if the desired therapeutic effect has not occurred.

Examples: dinoprostone, misoprostol
Monitor uterine activity and fetal heart rate, and report hyperstimulation immediately.

Examples: dinoprostone, misoprostol
Acute pelvic inflammatory disease, active cardiac disease, active lung disease, liver or kidney impairment, fetal malpresentation, nonreassuring fetal heart rate pattern, uterine scarring from previous surgery.

Examples: dinoprostone, misoprostol
Oxytocic agents increase the risk of uterine hyperstimulation.

Treatment of hypogonadism for clients who were assigned male at birth, delayed puberty, and testicular failure; treatment of breast cancer for clients who were assigned female at birth.

Virilization in clients assigned female at birth and children, increased growth of existing prostate cancer, edema/weight gain, liver toxicity, premature epiphyseal closure, gynecomastia.

Inform clients assigned female at birth and children about possible changes in hair growth, voice deepening, menstrual changes, and acne.

Monitor intake and output, weight, and sodium levels periodically, and check if the client is being screened for prostate cancer.

Potential negative effect on growth that should be monitored.

-Testosterone enanthate is available as an IM injection
-17-alpha-alkylated androgens (Methyltestosterone and oxandrolone)**hepatotoxic

Upper arm, back, abdomen, or thigh; rotate sites weekly.

Regular examinations recommended for clients undergoing testosterone treatment.

Pregnancy, breast cancer in assigned male clients, prostate cancer, hypertension, serious cardiac, renal, or hepatic disease.

Androgens may reduce insulin or antidiabetic medication requirements.

Androgens may increase or decrease the effects of oral anticoagulants.

Androgens increase the risk of toxicity when used with cyclosporine.

Protection from pregnancy is decreased if the patch partially or completely detaches for more than 24 hours.

Clients less than 21 days postpartum should not use the patch.