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INTRODUCTION

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medroxyprogesterone (me-drox-ee-proe-jess-te-rone)

Alti-MPA, Amen, Curretab, Cycrin, Depo-Provera, Depo-Sub Q Provera 104, Gen-Medroxy, Novo-Medrone, Provera, Provera Pak, Ratio-MPA

Classification

Therapeutic: antineoplastics, contraceptive hormones

Pharmacologic: hormones, progestins

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Indications
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To decrease endometrial hyperplasia in postmenopausal women receiving concurrent estrogen (0.625 mg/day conjugated estrogens). Treatment of secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance. IM: Treatment of advanced unresponsive endometrial or renal carcinoma; Management of endometriosis-associated pain (Depo-Sub Q Provera 104 only). Unlabeled Use: Obesity-hypoventilation (pickwickian) syndrome, sleep apnea, hypersomnolence.

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Action
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A synthetic form of progesterone—actions include secretory changes in the endometrium, increases in basal body temperature, histologic changes in vaginal epithelium, relaxation of uterine smooth muscle, mammary alveolar tissue growth, pituitary inhibition, and withdrawal bleeding in the presence of estrogen. Therapeutic Effects: Decreased endometrial hyperplasia in postmenopausal women receiving concurrent estrogen (combination with estrogen decreases vasomotor symptoms and prevents osteoporosis). Restoration of hormonal balance with control of uterine bleeding. Management of endometrial or renal cancer. Prevention of pregnancy.

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Adverse Reactions/Side Effects
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CNS: depression. EENT: retinal thrombosis. CV: PULMONARY EMBOLISM, thromboembolism, thrombophlebitis. GI: drug-induced hepatitis, gingival bleeding. GU: cervical erosions. Derm: chloasma, melasma, rashes. Endo: amenorrhea, breakthrough bleeding, breast tenderness, changes in menstrual flow, galactorrhea, hyperglycemia, spotting. F and E: edema. Metab: bone loss. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND ANGIOEDEMA, weight gain, weight loss.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of thrombophlebitis (localized pain, swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

  • Monitor signs of allergic reactions including anaphylaxis and angioedema. Signs include pulmonary symptoms (tightness in the chest and throat, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Notify physician immediately if these reactions occur.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain.

  • Monitor and report depression or other changes in mood and behavior.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or sustained weight loss or gain, or a substantial change in lean body mass.

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Interventions
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  • Because of the risk of thromboembolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Institute weight-bearing and resistance exercises as tolerated to maintain bone mineral density and ...

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