Ogen

estropipate

Ogen

Ortho-Est

Indications

Action

Pharmacokinetics

Time/action profile (estrogenic effects)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• headache (most frequent)
• dizziness
• lethargy
• mental depression

Ear, Eye, Nose, Throat

• intolerance to contact lenses (most frequent)
• worsening of myopia or astigmatism

Cardiovascular

• MI (life-threatening)
• thromboembolism (life-threatening)
• edema (most frequent)
• hypertension (most frequent)

Gastrointestinal

• nausea (most frequent)
• weight changes (most frequent)
• anorexia
• ↑ appetite
• jaundice
• vomiting

Genitourinary

women:
• amenorrhea (most frequent)
• breakthrough bleeding (most frequent)
• dysmenorrhea (most frequent)
• cervical erosion
• loss of libido
• vaginal candidiasis
men:
• erectile dysfunction (most frequent)
• testicular atrophy (most frequent)

Dermatologic

• acne (most frequent)
• oily skin (most frequent)
• pigmentation
• urticaria

Endocrinologic

• gynecomastia (men) (most frequent)
• hyperglycemia

Fluid and Electrolyte

• hypercalcemia
• sodium and water retention

Musculoskeletal

• leg cramps

Miscellaneous

• breast tenderness (most frequent)

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Assess BP before and periodically throughout therapy.
  • Monitor intake and output ratios and weekly weight. Report significant discrepancies or steady weight gain.
• Menopause: Assess frequency and severity of vasomotor symptoms.
• Lab Test Considerations: May cause increased HDL, phospholipids, and triglycerides, and decreased serum LDL and total cholesterol concentrations.
  • May cause increased serum glucose, sodium, cortisol, prolactin, prothrombin, and factor VII, VIII, IX, and X levels. May decrease serum folate, pyridoxine, antithrombin III, and urine pregnanediol concentrations.
  • Monitor hepatic function before and periodically throughout therapy.
  • May cause false interpretations of thyroid function tests, false increases in norepinephrine platelet-induced aggregability, and false decreases in metyrapone tests.

Potential Nursing Diagnoses

Implementation

• Oral: Administer PO doses with or immediately after food to reduce nausea.
• Vaginal: Manufacturer provides applicator with cream. Dose is marked on the applicator. Wash applicator with mild soap and warm water after each use.

Patient/Family Teaching

• Instruct patient to take oral medication as directed. If a dose is missed, take as soon as remembered as long as it is not just before next dose. Do not double doses.
  • Explain medication schedule to women on 21-day cycle followed by 7 days of not taking medication. Encourage patient to take medication at the same time each day.
  • If nausea becomes a problem, advise patient that eating solid food often provides relief.
  • Advise patient to report signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain, swelling, or tenderness in extremities; headache; chest pain; blurred vision), mental depression, hepatic dysfunction (yellowed skin or eyes, pruritus, dark urine, light-colored stools), or abnormal vaginal bleeding to health care professional.
  • Instruct patient to stop taking medication and notify health care professional if pregnancy is suspected.
  • Caution patient that cigarette smoking during estrogen therapy may increase risk of serious side effects, especially for women over age 35.
  • Caution patient to use sunscreen and protective clothing to prevent increased pigmentation.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise patient treated for osteoporosis that exercise has been found to arrest and reverse bone loss. The patient should discuss any exercise limitations with health care professional before beginning program.
  • Emphasize the importance of routine follow-up physical exams, including BP; breast, abdomen, and pelvic examinations; Papanicolaou smears every 6–12 mo; and mammogram every 12 mo or as directed. Health care professional will evaluate possibility of discontinuing medication every 3–6 mo. If on continuous (not cyclical) therapy or without concurrent progestins, endometrial biopsy may be recommended, if uterus is intact.
• Vaginal: Instruct patient in the correct use of applicator. Patient should remain recumbent for at least 30 min after administration. May use sanitary napkin to protect clothing, but do not use tampon. If a dose is missed, do not use the missed dose, but return to regular dosing schedule.

Evaluation/Desired Outcomes

• Resolution of menopausal vasomotor symptoms.
  • Decreased vaginal and vulvar itching, inflammation, or dryness associated with menopause.
• Normalization of estrogen levels in patients with ovariectomy or hypogonadism.
• Prevention of osteoporosis.