PHARMACOLOGY

PART 7 Drugs Acting on the Reproductive System

1. Introduction to the Reproductive System

➢ Male and female reproductive systems arise from the same fetal cells. The female ovaries store ova
and produce the sex hormones estrogen and progesterone; the male testes produce sperm and the
sex hormone testosterone.
➢ The hypothalamus releases GnRH at puberty to stimulate the anterior pituitary release of FSH and LH,
thus stimulating the production and release of the sex hormones. Levels are controlled by a series of
negative feedback systems.
➢ Female sex hormones are released in a cyclical fashion. Release of an ovum for possible fertilization
is termed ovulation. The female hormones prepare the body for pregnancy, including maintenance of
the pregnancy if fertilization occurs.
➢ If pregnancy does not occur, the prepared inner lining of the uterus is sloughed off as menstruation
in the menstrual cycle, so that the lining can be prepared again when ovulation reoccurs.
➢ Menopause in women and the male climacteric in men occur when the body no longer produces sex
hormones; the hypothalamus and anterior pituitary respond by releasing increasing levels of GnRH,
FSH, and LH in an attempt to achieve higher levels of sex hormones.
➢ The testes produce sperm in the seminiferous tubules in response to FSH stimulation and testosterone
in the interstitial cells in response to LH stimulation.
➢ Testosterone is responsible for the development of male sex characteristics. These characteristics can
be maintained by the androgens from the adrenal gland once the body has undergone the changes of
puberty.
➢ The human sexual response involves activation of the sympathetic nervous system to allow a four-
phase response: stimulation, plateau, climax, and resolution.
 2. Drugs Affecting the Female Reproductive System

➢ Estrogens primarily are used pharmacologically: to replace hormones lost at menopause to reduce
the signs and symptoms associated with menopause, to stimulate ovulation in woman with
hypogonadism, and in combination with progestins for oral contraceptives.
➢ Progestins, which include progesterone and all of its derivatives, are female sex hormones that are
responsible for the maintenance of a pregnancy and for the development of some secondary sex
characteristics.
➢ Progestins are used in combination with estrogens for contraception, to treat uterine bleeding, and
for palliation in certain cancers with sensitive receptor sites.
➢ Fertility drugs stimulate FSH and LH in women with functioning ovaries to increase follicle
development and improve the chances for pregnancy.
➢ A major adverse effect of fertility drugs is multiple births and birth defects.
➢ Oxytocic drugs act like the hypothalamic hormone oxytocin to stimulate uterine contractions and
induce or speed up labor and to control bleeding and promote postpartum involution of the uterus.
➢ Abortifacients are drugs that stimulate uterine activity to cause uterine evacuation. These drugs can
be used to induce abortion in early pregnancy or to promote uterine evacuation after intrauterine
fetal death.
➢ Tocolytics are drugs that relax the uterine smooth muscle; they are used to stop premature labor in
patients after 20 weeks of gestation. Hydroxyprogesterone caproate is the only drug approved for this
purpose in this country.
3. Drugs Affecting the Male Reproductive System
➢ Androgens are male sex hormones—specifically testosterone or testosterone-like compounds.
➢ Androgens are responsible for the development and maintenance of male sex characteristics
and secondary sex characteristics or androgenic effects.
➢ Side effects related to androgen use involve excess of the desired effects as well as potentially
deadly hepatocellular carcinoma.
➢ Androgens can be used for replacement therapy or to block other hormone effects, as is seen
with their use in the treatment of specific breast cancers.
➢ Anabolic steroids are analogues of testosterone that have been developed to have more
anabolic or protein-building effects and fewer androgenic effects.
➢ Anabolic steroids have been abused to enhance muscle development and athletic performance,
often with deadly effects.
➢ Anabolic steroids are used to increase hematocrit and improve protein anabolism in certain
depleted states.
➢ Penile erectile dysfunction can inhibit erection and male sexual function.
➢ Alprostadil, a prostaglandin, can be injected into the penis to stimulate erection.
➢ The PDE5 inhibitors are oral agents that act quickly to promote vascular filling of the corpus
cavernosum and promote penile erection. They differ in duration and time of onset. They are
 effective only in the presence of sexual stimulation. They are also used in the treatment of
pulmonary arterial hypertension.
➢ Dangerous cardiovascular effects, including death, have occurred when the PDE5 inhibitors are
combined with organic nitrates or alpha-blockers. Careful patient teaching is very important to
avoid this drug– drug interaction.
Reference:
Karch, A. M. (2013). Focus on nursing pharmacology. Sixth edition. Philadelphia: Wolters Kluwer.