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Pharmacology Mod 7

Reproductive and Genitourinary

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