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Pharmacology Mod 7
Reproductive and Genitourinary
| Question | Answer |
|---|---|
| Indications of oral contraceptives | prevent pregnancy, reduce fluid retention, decreased risk for hormonal headaches |
| Prototype oral contraceptive drug | ethinyl estradiol and drospirenone (Yasmin) |
| Action of oral contraceptives | mimics natural hormones, provides constant levels of hormones, thickens cervical mucous, inadequately prepares uterine lining |
| Adverse effects of oral contraceptives | increased risk of thromboembolism, uterine bleeding, increased growth of breast malignancies, hypertension, hyperkalemia |
| Interventions for oral contraceptives | monitor for signs of DVT/MI/CVA, encourage to quit smoking, monitor potassium levels, monitor BP, monitor pattern & amount of uterine linings, mammogramgs |
| Administration of oral contraceptives | same time each day, follow instructions for missed pill |
| Instructions for oral contraceptives | report leg pain/edema & chest pain, regular BP and self breast exams, report signs of hyperkalemia, report menstrual issues |
| Contraindications for oral contraceptives | pregnancy category X, risk for thromboembolic events, breast cancer, over 35 who smoke, altered liver/renal function |
| Interactions with oral contraceptives | ACE inhibitors, warfarin, rifampin, phenobarbital, primidone, carbamazepine, St Johns Wort, theophylline, diazepam, TCAs |
| Drug therapy for contraception and PMS includes what drugs | Oral contraceptives (enthinyl estradiol and drospirenone (Yasmin)) |
| Drug therapy for menopause includes what drugs | Estrogen HRT, Estrogen and Progesterone HRT |
| Indications of estrogen HRT | relieves menopausal symptoms, prevent vulvar and vaginal atrophy, prevent postmenopausal osteoporosis |
| Prototype estrogen HRT drug | conjugated equine estrogen (Premarin) |
| Action of estrogen HRTs | binds to estrogen receptors in target tissues |
| Adverse effects of estrogen HRTs | nausea, hypertension, endometrial hyperplasia, increased risk for thromboembolism |
| Interventions for estrogen HRTs | monitor for DVT/MI/Stroke, encourage to quit smoking, no more than 3-4 years, monitor BP, monitor for vaginal bleeding, patients with intact uterus should be prescribed progesterone as well |
| administration of estrogen HRTs | oral: same time each day transdermal: apply patches to clean, dry, in tact skin on abdomen or trunk at recommended interval intravaginal: according to dosing schedule |
| instructions for estrogen HRTs | report leg pain & edema, report chest pain, don't smoke, exercise regularly, healthy low fat diet, take oral form with food, report persistent vaginal bleeding |
| Contraindications for estrogen HRTs | risk for thromboembolic events, breast/cervical/vaginal cancer, liver disease |
| Interactions with estrogen HRTs | warfarin, rifampin, ritonavir, phenobarbital, carbamazepine, primidine, phenytoin, hypoglycemic drugs, theophylline, TCAs, diazepam |
| Indications for estrogen and progesterone HRT | relieve severe menopausal symptoms, prevent postmenopausal osteoporosis |
| prototype estrogen and progesterone HRT drug | conjugated estrogen, medroxyprogesterone acetate (Prempro) |
| action of estrogen and progesterone HRTs | binds to estrogen receptors, substitutes a stable amount of estrogen, progesterone antagonizes tissue growth in uterus |
| adverse effects of estrogen and progesterone HRTs | nausea, hypertension, thromboembolism, acute cardiac events, vaginal bleeding/spotting, edema, weight gain, breast cancer |
| Interventions for estrogen and progesterone HRTs | monitor for DVT/CVA/MI, encourage to quit smoking, nausea diminishes with time, monitor BP, discontinue for signs of breast cancer, monitor pattern/amount of vaginal bleeding, monitor for edema and weight gain |
| Administration of estrogen and progesterone HRTs | continuous use and same time each day |
| Instructions for estrogen and progesterone HRTs | report leg pain & edema, report chest pain, stop smoking, regular BP checks, exercise regularly, healthy low fat diet, take oral form with food, report vaginal bleeding |
| Contraindications for estrogen and progesterone HRTs | risk for thromboembolic events, suspected or confirmed cancer, liver disease, vaginal bleeding |
| Interactions with estrogen and progesterone HRTs | rifampin, ritonavir, phenobarbital, carbamazepine, primidone, phenytoin, St Johns Wort, hypoglycemic drugs, theophylline, diazepam, librium, TCAs, warfarin, ketoconazole |
| what is endometrial hyperplasia | endometirum lining of uterus becomes too thick |
| what is endometriosis | inner tissue lining of uterus grows outside uterus |
| drug therapy for endometrial hyperpasia and endometriosis includes what drugs | GnRH agonists (leuprolide (Lupron, Lupron Depot)), Progesterones (medroxyprogesterone acetate (Provera)) |
| indications for GnRH agonists | endometriosis, uterine fibroids, advanced prostate cancer in males |
| prototype GnRH agonist drug | leuprolide (Lupron, Lupron Depot) |
| action of GnRH agonists | chemically induced menopause, overgrowth of endometrial tissue shrinks |
| adverse effects of GnRH agonists | hot flashes, vaginal dryness, headache, bone loss |
| interventions for GnRH agonists | limit therapy to 6 months (because of bone loss), monitor for bone loss, suggest vitamin B6 and E supplements, water soluble vaginal lubricants, monitor for headache |
| administration of GnRH agonists | IM injection monthly, rotate injection sites, refrigerate unopened vials, expect amenorrhea |
| instructions for GnRH agonists | perform weight bearing exercise, calcium and vitamin D, avoid hot flash triggers, use vaginal lubricants, report headache or dizziness, OTC analgesics for headache |
| contraindications for GnRH agonists | pregnancy category X, allergy to benzyl alcohol, abnormal vaginal bleeding, metastatic cerebral lesions |
| interactions with GnRH agonists | estrogens, androgens |
| drug therapy for infertility includes what drugs | LH and FSH stimulant (clomiphene (Clomid)), ovulation stimulant (hCG (Pregnyl)), hyperprolactinemia (cabergoline) |
| indications for LH and FSH stimulant | treats infertility by promoting ovulation |
| prototype LH and FSH stimulant drug | clomiphene (Clomid) |
| action of LH and FSH stimulant | blocks effects of estrogen receptors on potuitary --> increased secretion of GRH --> stimulates secretion of LH and FSH --> stimulates ovary to produce mature follicls --> ovulation occurs |
| adverse effects of LH and FSH stimulant | hot flashes, breast engorgement, nausea, abdominal discomfort, blurred vision, flashes of light, dizziness, ovarian hyperstimulation, multiple gestation usually twins |
| interventions for LH and FSH stimulant | cold compresses, OTC analgesics, monitor for visual alterations, monitor for vomiting, monitor for signs of ovarian enlargement, multiple gestation may occur |
| administration of LH and FSH stimulant | 5 days after onset of menses for 5 days, take at same time each day, take missed dose ASAP |
| instructions for LH and FSH stimulant | expect hot flashes, supportive bra, take with food, report visual disturbances, report pelvic pain, be aware of possibility of twins |
| contraindications for LH and FSH stimulant | pregnancy category x, ovarian failure, uterine bleeding, liver disease, uncontrolled thyroid disease, thrombophlebitis |
| interactions with LH and FSH stimulant | TCAs, phenothiazines, methyldopa, black cohosh |
| indications for ovulation stimulant | promotes ovulation, infertility in conjuction with drug therapy for follicular maturation |
| prototype ovulation stimulant drug | hCG (Pregnyl) |
| action of ovulation stimulant | stimulates secretion of LH, causes ovulation after another fertility drug has stimulated maturation of follicle |
| adverse effects of ovulation stimulant | ovarian hyperstimulation, ovarian cyst rupture, fatigue, headache, restlessness, irritability |
| interventions for ovulation stimulant | monitor for signs of hyperstimulation syndrome (N/V/D, abdominal pain/bloating), monitor for indications of bleeding into the peritoneum |
| administration of ovulation stimulant | confirm follicular maturation has occured, give via IM injection |
| instructions for ovulation stimulant | seek medical care for abdominal or pelvic pain, OTC analgesic for headache |
| contraindications for ovulation stimulant | pregnancy category X, pituitary tumor, uncontrolled thyroid disease, adrenal insufficiency |
| interactions with ovulation stimulant | black cohosh |
| indication for hyperprolactinemia | infertility, corrects amenorrhea from excessive secretion of prolactin |
| prototype hyperprolactinemia drug | cabergoline |
| adverse effects of hyperprolactinemia | nausea, headache, dizziness, orthostatic hypotension |
| interventions for hyperprolactinemia | begin at lowest possible therapeutic dose, monitor serum prolactin levels, monitor for worsening of GI symptoms |
| administration of hyperprolactinemia | twice a week on same days, with or without food, discontinue when prolactin levels are within expected range |
| instructions for hyperprolactinemia | rise slowly, report headache or dizziness, don't engage in activities if dizzy, OTC analgesic for headache |
| contraindications for hyperprolactinemia | unconrolled hypertension, pregnancy induced hypertension |
| interactions with hyperprolactinemia | phenothiazines, butyriphenones, thioxanthenes, metoclopramide |
| drugs that induce uterine contractions include | Oxytocin (oxytocin (Pitocin)), Ergot Alkaloids (methylergonovine (Methergine)), Synthetic Prostaglandins (dinoprostone (Cervidil), vaginal gel (Prepidil)) |
| indications for oxytocin | uterine stimulant, induces or enhances labor, postpartum hemorrhage |
| prototype oxytocin drug | oxytocin (Pitocin) |
| action of oxytocins | stimulates smooth muscle to contract at the end of pregnancy |
| adverse effects of oxytocins | uterine hyperstimulation, hypertensive crisis, water intoxication |
| interventions for oxytocins | monitor for risk factors suck as multiple delivers, monitor for N/V/D, monitor I&O and level of consciousness (water intoxication), monitor length/strength/duration of contractions, administer oxygen |
| administraion of oxytocins | IV, start at low level and gradually increase flow rate 2 milliunits/min every 30-60 minutes, monitor fetal heart rate, monitor for hyperstimulation |
| instructions for oxytocins | report inceasing duration or strength of contractions, headache, palpitations, nausea, chest pain, drowsiness |
| contraindications for oxytocins | unripe cervix, genital herpes, fetal distress, fetal lung immaturity, placental abnormalities |
| interactions with oxytocins | vasopressors, ephedra, ma huang, cyclopropane, anethesia |
| indications for ergot alkaloids | prevent and treat postpartum and post abortion hemorrhage |
| prototype ergot alkaloids drug | methylergonovine (Methergine) |
| action of ergot alkaloids | cause strong uterine contractions to help stop bleeding |
| adverse effects of ergot alkaloids | hypertension, N/V, headache, bradycardia, seizures |
| interventions for ergot alkaloids | monitor BP and HR, monitor for N/V, monitor for headache, monitor for signs of seizure activity, seizure precautions if needed |
| administration of ergot alkaloids | check BP and don't give if over 140/90, orally for 2-7 days or IM every 2 hours, IV only for emergency, administer after delivery of placenta, monitor for vitals and uterine response, expect some cramping |
| instructions for ergot alkaloids | report nausea, headache, weakness, palpitations |
| contraindications for ergot alkaloids | induced labor, spontaneous abortion, hypertension, uterine sepsis, cardiac disease |
| interactions with ergot alkaloids | parenteral sympathomimetics, triptans, protease inhibitors, itraconazole |
| indications for synthetic prostaglandins | promote softening/shortening/dilating of the cervix before inducing labor, stimulate uterine contractions after the cervix is ready for delivery |
| prototype synthetic prostaglandins drug | dinoprostone (Cervidil), vaginal gel (Prepidil) |
| action of synthetic prostaglandins | prostaglandin activates enzyme collagenase --> breaks down rigis collagen complex and softens cervix --> stimulates uterine contractions |
| adverse effects of synthetic prostaglandins | uterine hyperstimulation, N/V/D, fever |
| interventions for synthetic prostaglandins | monitor length/strength/duration of contractions, be prepared with uterine relaxant, maintain hydration, monitor for temp increases, fever is expected 15-45 minutes after instillation |
| administration of synthetic prostaglandins | gel: void prior, supine, remain supine for 30 mins, repeat dose every 6 hours twice if needed, monitor uterine hyperstimulation vaginal insert: insert into posterior fornix, lie supine for 2 hours, remove when active labor begins or 12 hours later |
| instructions for synthetic prostaglandins | report increasing duration or strength of contractions, report N/V/D and fever, increase clear fluid intake |
| contraindications for synthetic prostaglandins | acute pelvic inflammatory disease, acute cardiac disease, acute lung disease, liver or kidney impairment, fetal malpresentation, previous uterine surgery |
| interactions with synthetic prostaglandins | oxytocic agents |
| drug therapy that stops uterine contractions includes | Beta2 Adrenergic Agonists (terbutaline (Brethine)) |
| indications for beta2 adrenergic agonists | preterm labor inhibitor (off label use) |
| prototype beta2 adrenergic agonist drug | terbutaline (Brethine) |
| action of beta2 adrenergic agonists | stop labor by decreasing the availability of myosin light chain kinase |
| adverse effects of beta2 adrenergic agonists | pulmonary edema, dyspnea, cough, tachypnea, tachycardia, chest pain, palpitations, hypotension, hopykalemia, hyperglycemia |
| interventions for beta2 adrenergic agonists | monitor respiratory status, fluid restrictions if indicated, obtain baseline vitals, prepare to administer propanolol to counteract adverse effects, initiate fluid or electrolyte replacement as indicated, monitor blood glucose levels |
| administration of beta2 adrenergic agonists | confirm preterm labor and between 20-35 weeks gestation, subcutaneously every 20 minutes for up to 3 hours but no longer than 48 hours, stop if fetal heart rate above 180 or rhythm nonreassuring |
| instructions for beta2 adrenergic agonists | report shortness of breath and difficulty breathing, weakness, nausea, chest pain, polydipsia, polyuria, and polyphagia |
| contraindications for beta2 adrenergic agonists | cardiac disease, hypertension, preeclampsia, hyperthyroidism, uncontrolled diabetes, MAOIs within 14 days, glaucoma |
| interactions with beta2 adrenergic agonists | hypoglycemic drugs, MAOIs, TCAs |
| drug therapy to accelerate fetal lung maturity includes | betamethasone (Celestone) |
| administration of betamethasone (Celestone) | deep IM, ventral gluteal or vastus lateralis muscles, course of antenatal glucocorticoids |
| adverse effects of betamethasone (Celestone) | pulmonary edema, hyperglycemia, hypertension |
| contraindications for betamethasone (Celestone) | allergies, systemic infection |
| cautions with betamethasone (Celestone) | administer lowest possible dose because of adverse effects |
| interactions with betamethasone (Celestone) | vaccines |
| drug therapy to prevent and treat seizure activity includes | magnesium sulfate (a tocolytic drug) |
| indications for magnesium sulfate | prevention & treatment of seizures |
| administration of magnesium sulfate | loading dose 4-6 grams over 15-30 minutes, use infusion pump, maintenance dose by continuous infusion, monitor therapeutic levels (4-7), patient on left side |
| adverse effects of magnesium sulfate | burning at IV site, flushing, diaphoresis, N/V, headache, drowsiness, blurred vision, depressed deep tendon reflexes, decreased urine output, magnesium toxicity, hypotension, bradycardia, pulmonary edema |
| interventions for magnesium sulfate | monitor for adverse effects |
| education for magnesium sulfate | purpose of frequent monitoring, purpose of strict I&O |
| contraindications for magnesium sulfate | myasthenia gravis, kidney failure, hypocalcemia |
| interactions with magnesium sulfate | neuromuscular blocking agents |
| drug therapy for androgen (testosterone) replacement therapy include | Testosterone |
| indications for testosterone | hypogonadism, delayed puberty, testicular failure, breast cancer in females |
| prototype testosterone drugs | testosterone (Androderm, Androgel, Axiron), implantable tables (Testopel), buccal tablets (Striant), testosterone enanthate (Delatestryl) |
| action of testosterones | produce proteins that cause adrogenic and anabolic effects of testosterone on the body |
| adverse effects of testosterones | virilization, increased growth of existing prostate cancer, edema & weight gain, gynecomastia, premature epiphyseal closure |
| interventions for testosterones | -monitor I&O, weight, and sodium levels -females: changes in hair growth distribution, deepening of voice, acne, menstrual changes -males: screening for prostate cancer, breast enlargement children: monitor height, xray hands and wrists |
| administration of testosterones | transdermal: upper arm/back/abdomen/thigh, rotate sites, wash hands after gel application and cover site buccal: gums above upper incisor, alternate sides of mouth, not affected by food/drinking/teeth brushing |
| administration of testosterones contd. | subcutaneous: pellets surgically implanted under skin of abdomen every 3-4 months IM: injected every 2-4 weeks, changes in mood, energy, and libido |
| contraindications of testosterones | pregnancy category X, breast cancer in males, prostate cancer, hypertension |
| interactions with testosterones | insulin, antidiabetic drugs, anticoagulants, cyclosporine |
| drug therapy for benign prostatic hypertrophy and outflow disorders include | 5 alpha reductase inhibitor (finasteride (Propecia, Proscar)), Alpha adrenergic receptor antagonists (tamsulosin (Flomax)) |
| indications for 5 alpha reductase inhibitors | benign prostatic hypertrophy, male pattern hair loss |
| prototype 5 alpha reductase inhibitor drug | finasteride (Propecia, Proscar) |
| adverse effects of 5 alpha reductase inhibitors | reduced libido and ejaculate volume, breast enlargement in males, reduced prostate specific antigen (PSA) levels |
| interventions for 5 alpha reductase inhibitors | possible reduced libido and ejaculate volume, baseline PSA level, PSA levels will decline with therapy, increased PSA may indicate prostate cancer, monitor for body image concerns (breast enlargement) |
| administration of 5 alpha reductase inhibitors | give with or without food, can crush, lifelong drug therapy, full therapeutic effects in 12 months, pregnant women cannot handle pills due to risk of transdermal absorption |
| instructions for 5 alpha reductase inhibitors | undergo regular prostate cancer screenings, report breast enlargement |
| indications for alpha adrenergic receptor antagonists | benign prostatic hypertrophy |
| prototype alpha adrenergic receptor antagonists drug | tamsulosin (Flomax) |
| action of alpha adrenergic receptor antagonists | relaxation of smooth muscle in prostate gland & outlet of bladder, increased urine flow and decreased BPH symptoms |
| adverse effects of alpha adrenergic receptor antagonists | reduced ejaculate volume, ejaculation failure, headache, hypotension, fainting, dizziness |
| interventions for alpha adrenergic receptor antagonists | educate about altered ejaculation, OTC analgesic for headache, monitor BP, report systolic pressure drop or a heart rate increase when rising from sitting to standing |
| administration of alpha adrenergic receptor antagonists | orally once daily same time each day 30 minutes after the same meal, swallow whole |
| instructions for alpha adrenergic receptor antagonists | expect decreased ejaculation volume and possible failure, report headache unrelieved by OTC analgesic, have BP checked daily, rise slowly, report dizziness, plan on lifelong drug therapy |
| contraindications for alpha adrenergic receptor antagonists | use of erectile dysfunction drugs, females, children |
| interactions with alpha adrenergic receptor antagonists | drugs that lower BP, erythromycin, itraconazole, nefazodone, HIV protease inhibitors, cimetidine |
| drug therapy for erectile dysfunction includes | PDE5 Inhibitors (sildenafil (Viagra)) |
| indication for PDE5 inhibitors | erectile dysfunction |
| prototype PDE5 inhibitors drug | sildenafil (Viagra) |
| action of PDE5 inhibitors | PDE5 makes an erection subside, sildenafil inhibits PDE5 within the pensi |
| adverse effects of PDE5 inhibitors | persistent erection (more than 4 hours, could result in permanent damage), headache, hypotension, fainting, dizziness |
| interventions for PDE5 inhibitors | tell about risk of impotence following persistent erection, monitor for side effects |
| administration of PDE5 inhibitors | orally 1 hour prior to sexual activity, high fat foods reduce effects, effects can last 4 hours, only 1 dose per 24 hour period, dont take within 24 hours of taking nitrates |
| instructions for PDE5 inhibitors | medical care for erection lasting more than 4 hours, OTC analgesic for headache, regular BP checks, stop taking if loss of vision or hearing occurs |
| contraindications for PDE5 inhibitors | taking nitrates, children |
| interactions with PDE5 inhibitors | nitrates, grapefruit juice, alpha adrenergic antagonists, rifampin |
| drug therapy for urinary incontinence & over active bladder includes | Anticholinergics (oxybutynin (Ditropan)) |
| indications for anticholinergics | urinary incontinence due to overactive bladder, neurogenic bladder |
| prototype anticholinergics drug | oxybutynin (Ditropan) |
| action of anticholinergics | relaxes bladder, contracts internal sphincter |
| adverse effects of anticholinergics | dry mouth, constipation, pupil dilation, dry eyes, blurred vision, headache, dizziness, drowsiness, fever, heat exhaustion, urinary retention, distended bladder |
| interventions for anticholinergics | monitor bowel and urinary patterns for constipation and retention, periodic eye exams, use caution in hot weather |
| administration of anticholinergics | two - four times daily, or extended release once daily, excretion of extended release shell in stool, transdermal patch twice weekly, rotate patch sites (abdomen, hip, butt) |
| instructions for anticholinergics | hard candy, sip water, increase fluid and fiber intake, increase activity levels, report undesirable changes in urinary elimination, regular eye exams, report headache not relieved by OTC analgesic, avoid becoming overheated |
| contraindications for anticholinergics | glaucoma, myasthenia gravis, GI obstruction, genitourinary obstruction, active cardiac dysfunction |
| interactions with anticholinergics | grapefruit juice, ketoconazole, erythromycin, phenytoin, rifampin, carbamazepine |
| drug therapy for urinary retention includes | Cholinergics (bethanechol (Urecholine)) |
| indications for cholinergics | urinary retention |
| prototype cholinergics drug | bethanchol (Urecholine) |
| action of cholinergics | contract bladder, relaxes internal sphincter |
| adverse effects of cholinergics | hypotension, bradycardia, excessive gastric acid secretion and salivation, diarrhea, bronchoconstriction, dizziness, fainting |
| interventions for cholinergics | monitor BP/HR/respirations, monitor bowel elimination patterns |
| administration of cholinergics | 3-4 times per day, 1 hour before or 2 hours after meal |
| instructions for cholinergics | increase fluid intake, sit if dizzy, report difficulty breathing and fainting |
| contraindications for cholinergics | hypotension, hyperthyroidism, low cardiac output, asthma, copd, gastric ulcers, urinary tract obstruction, intestinal obstruction |
| interactions with cholinergics | cholinesterase inhibitors, mecamylamine, procainamide, quinidine, atropine, epinephrine |
Created by:
twohlers
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