Drugs Affecting the Reproductive System Flashcards
Enlarged prostate which leads to urinary stasis, obstruction, and infection - obstructs urinary flow
Clinical manifestations: difficult initiation of urine stream, incomplete bladder emptying, overflow incontinence, at risk for frequent UTI’s
Common condition of aging - see lot pats taking meds to treat BPH
Pharmacologic therapy goal: either shrink prostate or relax smooth muscle of urinary tract to increase ability to urinate; increase quality of life
Common prob
Review BPH
Blocks testosterone; shrinks prostate
- 5-alpha reductase inhibitor: prototype: finasteride (Proscar)
Blocks testosterone; shrinks prostate
MoA: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)
Benign prostatic hypertrophy (BPH)
Indication: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)
Reduced libido, hypotension - not lot AE that readily experience
AE: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)
Teach: symptom improvement in 3-6 months - not overnight; takes time to shrink prostate; time to interfere processes that enlarges prostate and reverse them so takes awhile for symp improvement
Women wear gloves when handling medication (really harmful to women)
DO NOT HANDLE medication while pregnant (category X - never take it) - to developing fetus; no reason to take it and know causes harm
Men: DO NOT donate blood while on medication or father a child - get anybody pregnant because how med works and how excreted in fluids
Nursing: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)
Blocks alpha-1 adrenergic receptor in smooth muscle of prostate, relaxes bladder neck and urethra allows urine flow; target alpha-1 receptors of SNS and blocking those receptors to cause relaxation of smooth muscle surrounding prostate gland in urinary sys; trying to relax everything/smooth muscle around prostate in UT so can urinate easier reducing symp of BPH
MoA: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
Benign prostatic hypertrophy
Indications: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
Oral; extended release
Route: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
heart failure or CAD
Contraindications/cautions: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
antihypertensive drugs - working to lower BP; if put on another med that also lowers BP so BP may get extremely low
Drug/drug: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
Tachycardia, hypotension- targets other blood vessels so get this, syncope, GI upset, sexual dysfunction
Adverse Effects: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
Monitor closely for hypotension; Do not crush or chew extended-release formulations; Monitor for symptom improvement of BPH
Nursing: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)
cause prolonged smooth muscle relaxation- allowing flow of blood into corpus cavernosum and facilitating erection; not that admin lot med because pats take before sex; not do in hospital lot times; in play make sure adequately understands what med for and affects can have so self-monitor effects when at home taking med
MoA: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
penile erectile dysfunction
Indications: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
Oral prior to sexual stimulation
Route: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
numerous – check drug resource prior to admin.
Contraindications: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
No organic nitrates (ex. nitro tablets) within previous 24 hours - causes vasodilation so high risk for hypotension; or alpha-adrenergic blockers
Drug/Drug: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
Headache, dizziness, hypotension (biggest AE because smooth muscle relaxation; monitor for s/s: dizzy, syncope, light-headed)
Adverse Effects: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
Teach: caution with nitrates to avoid hypotension; know how monitor for hypotension and report s/s of hypotension; is affected by grapefruit juice: alters hepatic enzyme sys - sys less effective so more med can stay in bloodstream - make sure not drink grapefruit juice 24-48 hrs before/after so best to avoid
Nursing: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)
Most meds contain estrogen
used for variety things/Indications:
sev diff Routes:
Female hormones: estrogens
Atrophic vaginitis
Hypogonadism
Oral contraception
Ovarian failure
Uterine bleeding
Breast or prostate cancer
Osteoporosis
Vasomotor symptoms of menopause (hot flashes) - treat symptoms of menopause
used for variety things/Indications:
Oral
Transdermal
Topical
sev diff Routes:
Many symptoms of menopause attributed to decreased estrogen levels experienced - trying to minimize effects pat experiencing; sometimes can be sig and interfere with daily living and quality of life depending on what it is
Smallest effective dose - hard know amount and what do
May be combined with progestins (intact uterus)
Individualized plan based on benefit vs. risk - discuss with doc; amount and how long
Hormone replacement therapy: using the Estrogens
Osteoporosis
Hot flashes
Atrophic vaginitis
Many symptoms of menopause attributed to decreased estrogen levels experienced - trying to minimize effects pat experiencing; sometimes can be sig and interfere with daily living and quality of life depending on what it is
Many are combination of estrogen and progesterone - variety of routes; most contain estrogen; some progesterone only
Some are progestin only
Since Most drugs contain estrogen treat similarly
Prevent pregnancy
Do not prevent against sexually transmitted infections including HIV
Contraceptive drugs
Oral: norethindrone/ethyl estradiol (Loestrin)
Transdermal: norelgestromin/ethyl estradiol
Intravaginal: etonogestrel-ethyl estradiol (NuvaRing)
Many are combination of estrogen and progesterone - variety of routes; most contain estrogen; some progesterone only
BBW: loss of bone mineral density
Some are progestin only
Pregnancy/lactation (Category X) - trying prevent pregnancy with lot meds so making uterus inhabitable for child and if pregnant causes lot probs
Hx of cardiovascular disease related to clotting (DVT, MI, CVA) - blood clots reoccuring thing; excess estrogen effect on body that makes higher propensity to form blood clots
Smoking – increased risk of thrombus formation; risk substantially increased; imp part pat teaching
Antibiotics – make contraceptives less effective, make sure to use other method to prevent pregnancy; d-d interaction
Black box warning: - risks very high/detrimental to that happen
Female hormones: Contraindications and Warnings
Increased risk of cardiovascular events (DVT, PE, MI, ischemic CVA) - can be life threatening
Increased risk of endometrial and breast cancer
Black box warning: - risks very high/detrimental to that happen
Sev diff effects that can happen
Breakthrough bleeding/menstrual irregularities - effect menstrual cycles; not post-menopausal
Changes in libido
Fluid retention (edema, headaches, dizziness)
GI effects (nausea/vomiting, abdominal cramps, bloating)
Thromboembolism (DVT/PE/CVA) - risk blood clots
Female hormones: adverse effects
B = Breakthrough bleeding
E = Edema
G = GI effects
E = Embolism
L = Lost libido
(S) = Stop smoking - counsel to do this because increases risk of blood clot
C = contraceptives less effective with antibiotics
C = cardiovascular events, increased risk
Acronym for Female Hormones: BEGEL(S) with Cream Cheese for AE
Assess:
Interventions:
Nursing action for female hormones
Gen assessment
Pay special attention to anything relating woman’s health
Age, lifestyle, menstrual cycle like; (pre/post menopausal), child-bearing status, wellness exams (staying up), cancer screenings; change in hormones
Risk for cardiovascular events, especially thromboembolism (increased risk or not)
Assess:
Counsel tobacco smokers on smoking cessation - risk higher with those who smoke in having CV events
Educate route, timing, adverse effects - if not want get pregnant need take effectively
May take with food if GI distress occurs
Interventions:
Oral contraception: pill must be taken at the same time each day; missed dose follow package directions and use alternate form of contraception for 7 days to not get pregnant
Contraceptives less effective when taking antibiotics; use alternate
Educate route, timing, adverse effects - if not want get pregnant need take effectively
Bone mineral density decreases - puts pat at higher risk for fractures
Review Osteoporosis
Increases bone mineral density without stimulating the endometrium; modulates effects of endogenous estrogen at specific receptor sites to help increase bone mineral density
MoA: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)
Prevention and treatment of osteoporosis in postmenopausal women
Indications: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)
Pregnancy/lactation, hx. DVT or smoking
Contraindications: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)
Venous thromboembolism, vaginal bleeding - Not have all same effects as estrogen in entire body but mimics effects - most imp is causes risk for blood clots
AE: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)
Commonly seen
Slows bone resorption
MoA: - Bisphosphonates: Prototype: alendronate (Fosamax)
Osteoporosis
Indications: - Bisphosphonates: Prototype: alendronate (Fosamax)
Oral daily or weekly
Route/dose: - Bisphosphonates: Prototype: alendronate (Fosamax)
Esophageal or gastric ulcer, esophagitis
Contraindications: - Bisphosphonates: Prototype: alendronate (Fosamax)
Nausea, diarrhea, esophageal erosion (biggest AE to esophagus - very hard on lining of GI tract - biggest prob is causes this but can do lot things to minimize effect on pat), headache
Adverse effects: - Bisphosphonates: Prototype: alendronate (Fosamax)
Teach-take in AM with full glass water 30 min prior to food or drink, sit upright for at least 30 minutes after admin - minimize risk reflux back into esophagus - no food because minimizes absorption; limit use to 5 years (really long half-life) then take off med for at least another 5 years/longer because med keeps working to prevent or keep working on osteoporosis; imp to know how take med correctly to min esophageal erosion that can occur
Nursing: - Bisphosphonates: Prototype: alendronate (Fosamax)
