Exam 1 Flashcards
Menarche
The start of menstruation, ends at menopause
What does estrogen do in CHC
Prevents: Formation of dominant follicle, ovulation, LH surge
Stabilizes uterine endometrium
Inhibits proliferation and secretory changes
Decreases irregular/heavy menstruation
Where is mestranol used in CHC
Used in older products or ones with high concentrations of estrogen (higher doses only in certain cases)
Preferrable dose of estrogen
What are other doses associated with (3)
What is preferred
Low!
Higher doses are associated with MI, VTE, and strokes
Low estrogen products with estradiol are preferred
Progestin
Natural or synthetic with progesterone-like effects
Most are derivatives of testosterone
Balance estrogen effects
Make endometrium less favorable for implantation
Suppress LH surge, prevent ovulation and pregnancy
Progesterone
Naturally occurring hormone produced in the ovaries
Progestin in CHC (1st gen 3 examples and what to remember)
Norethindrone, norethindrone acetate, ethynodiol
ETHIN or ETHYN
Progestin in CHC (2nd gen example)
Norethisterone and levonorgestrel (LNG)
MOST COMMON
Progestin in CHC (3rd gen 3 examples, perks, and what to remember)
Desogestrel, gestodene, norgestimate
Higher efficacy, fewer effects on lipids and carb metabolism, fewer androgenic side effects
ESO or EST
SE of increased estrogen in CHC (5)
cyclic breast changes (soreness and tenderness)
dysmenorrhea
menorrhagia (increased bleeding)
chloasma (hyperpigmentation of skin)
VTE (clots)
SE of decreased estrogen in CHC (2)
Amenorrhea
Spotting
SE of increased progestin in CHC (4)
Weight gain, depression, fatigue, decreased libido
SE of decreased progestin in CHC (2)
breakthrough bleeding (between cycles)
headaches
How can CHC be administered
Orally (most common)
Transvaginal and transdermal (not used for high-risk patients, but there is less N/V, heart and circulatory risks, and easier compliance?)
Effectiveness of oral CHC
99.3% if completely correct
92% with typical use
Advantages of oral CHC
Decreases blood loss, cramps, less pain on ovulation (mittelschmerz)
Reduction of ovarian cysts, benign breast disorders, pelvic inflammatory disease, ectopic pregnancy, endometrial and ovarian CA
Monophasic (non-phasic) CHC
Fixed ratio of estrogen:progesterone
Biphasic CHC and example
Fixed amount of estrogen but less progestin in beginning of cycle: this allows for normal physiologic process of menstruation without ovulation
Ex: ortho-novum
Triphasic CHC, perk and 1 example
Low estrogen and progestin, ratios change during 3 phase in the cycle
LEAST SIDE EFFECTS BC LOW HORMONES
Ex. Ortho tri-cyclenLo (Also for acne)
Four phasic CHC
Ratios change 4 times in cycle
Yasmin
Monophasic pill with ethinyl estradiol and drospirenone (K+ sparing, hyperkalemia, vfib and v-tach)
Yasmin contraindications
Contraindicated in liver, kidney, or adrenal insufficiency, NSAIDS, k+ sparing meds, ACE, ARBS
Oral CHC pack
21 or 28 day packs (in the 28 day, 7 of them are empty or inactive)
Last 7 days are decreasing estrogen to cause withdrawal bleeding (not true menses)
what does Loestrin FE do
Gives iron during withdrawal bleeding to prevent anemia
Mircette
2 days of Fe and 5 days low-dose estrogen to help prevent HA from estrogen withdrawal
Extended cycle products and 3 examples
shortened period of inactive pills reduces number of withdrawal bleeding days
Ex. Loestrin 24, YAZ, beyaz
YAZ and 24 because 24 hours in a day and days are long so it’s a longer period of active pills idk
Continuous dosing products
Seasonale (jolessa): 91 days with 84 active days and 7 inactive. Withdrawal bleeding only 4x/year
Lybrel: 28 days with no withdrawal bleeding
Ortho-evra transdermal patch (where and how is it worn, advantages)
Worn on stomach, buttocks, outer arm, upper torso (fatty areas)
Worn for 3 weeks, 1 week off for withdrawal bleeding
Similar advantages to oral
Ortho-evra transdermal patch disadvantages and who shouldn’t use it
skin irritation, menstrual cramps, change in vision or inability to wear contact lenses, not as effective in women over 198 lbs, weight gain or loss, nausea
Increased risk of VTE
Do not use women >35, smoke bc of constricted arteries and clots easily form
NuvaRing
2 inch indwelling ring with estrogen/progesterone
Inserted during first 5 days of menstruation
Indwelling for 3 weeks, removed for 1 for withdrawal bleeding
NuvaRing considerations
1st 7 days after insertion, use backup method
If it falls out, must be put in within 3 hours. If not, use backup for 7 days
Increased risk for: VTE, vaginal irritation, discharge or infection
Risks increased if pt smokes
Who uses progestin-only pills
Used for women who can’t take estrogen:
History of VTE
Heart disease
Breast feeding (estrogen can be excreted in breast milk)
Smokers (Spasms of blood vessels)
Over 35
HTN
Or those who experience HA, chloasma, Lipid changes
Progestin pill side effects (5)
Higher incidence of irregular bleeding
Fatigue
Decreased libido
Depression/mood changes
Weight gain
Routes of progestin only (4)
Oral, IM, SQ, implantable
3 oral progestin only
Micronor, nor QD, aygestin
NOR or ends in estin just like progestin
injectable progestin only rules
depo-provera (depo=deep like an injectable)
Injected every 11-13 weeks (negative test needed for next injection)
Suppresses ovulation
If late injection, 13 weeks and one day must be ruled out for pregnancy
Progestin only considerations (injectable)
Stop after 2 continuous years (risk of decreased bone density)
Increase intake of Ca and vit d
Implantable progestin only
Nexplanon similar to implanon
Inserted for up to 3 years
Nexeplon contains barium which shows up on X-rays, US, CT, and MRI
Not used in women with BMI>30
What to do with 1-3 missed doses of BC
Missed 1: take as soon as you remember
Missed 2: take 2 when you remember and 2 the next day
Missed 3: discard pack, use backup, and restart
What hormone is in plan B
Progestin only
What does a copper-releasing IUD do
prevents implantation, not fertilization
Perimenopause S&S
Cycles can become longer or shorter, irregular, insomnia, hot flashes, irritability, H/A, memory lapse, decreased libido, vaginal dryness, joint aches and pain
Premarin
Conjugated estrogens
Indications of premarin and MOA
HRT for menopause symptoms
Mod-severe vasomotor symptoms of menopause, vaginal dryness/atrophy
MOA: develops and maintains female genital system, breasts, and secondary sex characteristics
Contraindications of premarin
Known drug allergy
Any estrogen dependent cancers
Undiagnosed abnormal vaginal bleeding
Pregnancy, lactation
Active thrombolytic disorder (Stroke, thrombophlebitis, hypercoagulable states, CVD, smokers)
Adverse effects of premarin
Most serious: thromboembolic events
Common: N/V/D/C, photosensitivity, HTN/thrombophlebitis, amenorrhea/breakthrough bleeding, chloasma/hirsutism/alopecia, tender breasts/fluid retention/HA
Interactions of premarin
Decreased activity of oral anticoagulants
Concurrent use of rifampin and St. John’s wort can decrease effectiveness
Use with tricyclic antidepressants (TCA) can cause toxicity of TCA
Smoking can increase risk of thrombosis
SSRI for menopause
Reduce severity of vasomotor symptoms, reduce depression, may relieve irritability, and mood changes
Clonidine for menopause
reduces vasomotor symptoms, sedative effect, must monitor BP (antihypertensive)
Gabapentin for menopause
May relieve vasomotor symptoms, should be limited to those who can not take HRT, may cause drowsiness
Soy, red clover, black cohosh for menopause
caution in who (2)
Helps decrease hot flashes. Caution with women who have breast cancer and liver disease
11 therapies for menopause
SSRI, clonidine, gabapentin, soy, red clover, black cohosh, Vit E, primrose, St. John’s wort, ginseng, melatonin
WHI and their opinion on HRT
Some ppl are having bad reactions so lets completely get rid of HRT. Oh wait, there’s a pattern with the people who had bad reactions, ok nvm only SOME people get HRT
What do the testes do
produce male sex hormones
What happens in the seminiferous tubules
Spermatogenesis (mature sperm cells are produced)
Androgens
Primarily testosterone which is an anabolic steroid
Controls the development and maintenance of male primary and secondary sex characteristics
Decreases fat mass, helps with hair placement
Testosterone
Produced from interstitial cells between the seminiferous tubules
Androgenic activity
Anabolic activity
Involved in development of bone and muscle tissue
Inhibition of protein catabolism
Erythropoietic effects (produces RBCs)
Synthetic derivatives of testosterone
Improves pharmacokinetics/dynamics of endogenous hormone
Combined esters with testosterones, poor PO absorption
Uses of synthetic derivatives of testosterone
Decreased libido and fatigue due to low levels
Examples of synthetic derivatives of testosterone
Testosterone propionate: oily solution lasting 2-3 days, administered every 2-4 weeks
Methyltestosterone/fluoxymesterone: effective with oral administration, buccal tablet, or injectable
Transdermal forms: Gel and skin patches
Anabolic steroids
Possess high anabolic activity
Not used in US a lot bc of potential for misuse in muscle people
Indications of anabolic steroids
Anemia, hereditary angioedema, metastatic breast cancer, wasting syndrome due to HIV
Four products available in the US
Schedule III drug: can lead to psychological or physical dependence (DEA number needed)
4 names of anabolic steroids
Anadrol-50
Oxandrin
Winstrol
Nandrolone
Indications of testosterone (androgen)
Primary and secondary hypogonadism
Treatment of oligospermia
Inoperable breast cancer in women (relieving symptoms, not a cure)
Why are androderm and testoderm patches used
to mimic natural circadian cycles in males
Where are andro and testoderm patches applied
Androderm: not scrotal skin
testoderm: scrotal skin
Who shouldn’t touch androderm patches and why
Children
Inappropriate enlargement of genitalia, premature development of pubic hair, advanced bone aging, increased libido, aggressive behavior
Nursing considerations of androderm patches
Baseline lab testing BUN/Cr, LFT, CE/s, lipids (MI or CVA)
Watch for weight gain or electrolyte disturbances
What do androgens maintain
Secondary health characteristics
When does BPH process start
30
MOA of 5-Alpha reductase inhibitor (Proscar) finasteride
Reduces prostate size by inhibiting the enzyme that converts testosterone to 5-alpha dihydrotestosterone (DHT)
Eases the passage of urine
What is 5-Alpha reductase inhibitor (Proscar) finasteride used for
BPH
Additional effects of 5-Alpha reductase inhibitor (Proscar)
May increase hair growth in men
teratogenic in pregnant women and children (Don’t touch)
Indications of 5-Alpha reductase inhibitor (Proscar)
Androgenic alopecia in men
BPH shrinks prostate in 3-6 months
Contraindications of 5-Alpha reductase inhibitor (Proscar) (2)
Hypersensitivity
Pregnant women, category X
Examples and pattern of erectile dysfunction medications
Sildenafil (viagra), vardenafil (levitra), tadalafil (cialis)
Ending -afil
What does sildenafil (viagra) do
Inhibits the enzyme phosphodiesterase, causing the buildup of guanosine monophosphate, causing the relaxation of smooth muscle in the penis and permits inflow of blood
Nitric oxide is released inside the corpora cavernosa during sexual stimulation and contributes to the erectile effect
Indications of sildenafil (viagra)
Take 1 hour before intercourse
Contraindications of sildenafil (viagra)
Hypersensitivity
Can potentiate hypotensive effects of nitrates, avoid concurrent use
NO NITROGLYCERINS because of significant hypotension (vasodilator)
Adverse effects of sildenafil (viagra)
Hypotension
headache
Dyspepsia
Priapism (erection for >4 hours)
Visual loss
Oxytocin (Pitocin) use and mode of action
Use: To induce labor
MOA: increases uterine contractility
SE and AR of oxytocin (pitocin)
SE: HTN, dysrhythmias, hypercontraction of uterus
AR: Seizures, water intoxication
Terbutaline use and SE
Use: Decreases uterine contractions to stop preterm labor
SE: tachycardia in mother and fetus, SOB
Magnesium sulfate
Can be used for preterm labor to decrease contractions
may be safer than terbutaline because it increases blood flow to uterus (less tachy)
Can also be used for preeclampsia (high BP and proteinuria)
Cholinergic drugs (which part of the CNS)
Parasympathetic (rest and digest)
neurotransmitter of PNS
acetylcholine
CHOLINE for CHOLINErgic drugs
Direct acting cholinergic drugs
Stimulate postsynaptic nerve cell release of acetylcholine at the receptor site (agonists)
Indirect acting cholinergic drugs
has something helping it
inhibits acetylcholinesterase (breaks down acetylcholine)
cholinergic stimulation (GI and urinary)
frequent gastric secretions, mobility, urinary frequency (bladder contracts, sphincter relaxes)
Cholinergic stimulation (miosis)
constriction of pupil, opening of canal of schlemm, decreased intraocular pressure
cholinergic stimulation (cardiovascular)
decreased HR, vasodilation
cholinergic stimulation of lungs
increased secretion and restriction
cholinergic stimulation (skeletal)
increased contraction (nicotonic)
Bethanechol (urecholine) use
cholinergic
Direct acting
post-op and post-partum non obstructive urinary retention
urinary retention r/t neurogenic atony of the bladder
Routes of bethanechol
PO/SQ
IV and IM contraindicated
contraindications of bethanechol
intestinal or urinary obstruction
bradycardia
hypotension
peptic ulcer bc of increased GI secretions
active bronchial asthma and COPD (bc of bronchoconstriction)
parkinsonism (bc we want a DECREASE in acetylcholine, not in increase)
side effects of bethanechol
N/V/D
abd cramps, salivation, sweating, frequent urination, blurred vision, miosis
adverse effects of bethanechol
orthostatic hypotension, bradycardia, muscle weakness, heart block/cardiac arrest, acute asthma attacks
drug interactions of bethanechol
Decreased effect of bethanechol with antidysrhythmics, ganglionic blocking agents cause significant hypotension, atropine counteracts
nursing considerations of bethanechol
ambulation and increased fluid intake
monitor VS, urine output >1500ml
atropine antidote
change position slowly, 1 hr before or 2hrs after meals
cholinergic crisis: muscular weakness and increased salivation
pilocarpine
cholinergic
reversible cholinesterase inhibitors
produce pupillary constriction in glaucoma
cholinergic
cholinesterase
breaks down into acetylcholine
small amount needed
cholinergic effects
smooth muscle stimulation
Physostigmine (antilirium) what is it and indications
anticholinesterase (indirect-acting)
myasthenia gravis, reversal of anticholinergic drug effects
Physostigmine (antilirium) contraindications
known drug allergy, prior severe cholinergic reactions, asthma gangrene, hypothyroidism, CAD, mechanical obstruction of GI or GU tracts
adverse reactions of Physostigmine (antilirium)
GI upset, excessive salivation
interactions and routes of Physostigmine (antilirium)
anticholinergics (opposites)
IM or IV
parasympatholytics
opposite of parasympathetic
anticholinergic
sympathetic nervous system
Cardio effects of anticholinergics
increased HR, dysrhythmias (used for symptomatic brady)
CNS effects of anticholinergics
restlessness, irritability, disorientation, hallucinations, delirium
Eye effects of anticholinergics
dilates pupils, decreased visual accommodation, increased intraocular pressure
GI and GU effects of anticholinergics
GI: decreased salivation, gastric secretions, and motility
GU: increased retention
glandular and resp effects of anticholinergics
glandular: sweating
resp: decreased secretions
atropine indications
bradycardia (bradycardia ends in A)
pre-op control of secretions, treatment of insecticide poisoning
code or rapid response
contra of atropine
closed angle glaucoma
adhesions between iris and lens
certain types of asthma
severe hepatic and renal dysfunction
reflux esophagitis
intestinal atony
hiatal hernias
obstructive GI or GU conditions
severe ulcerative colitis
side effects of atropine
dry mouth, nausea, headache, constipation, dry skin, blurred vision, palpitations, urinary retention
adverse effects and life threatening of atropine
AE: tachy and hypotension
LT: v-fib, stevens johnson, coma
Dicyclomine (Bentyl) use
antispasmodic cholinergic blocker
treatment of IBS, colic and enterocolitis in infants
contraindications of Dicyclomine (Bentyl)
KDA
angle closure glaucoma
GI tract obstruction
myasthenia gravis
paralytic ileus
GI atony
toxic megacolon
indications of Cogentin
anticholinergic
decreases rigidity, tremors of parkinson
inhibits release of acetylcholine
side effects of Cogentin
dry mouth, dry secretions, urinary retention, constipation, blurred vision, increased HR, restlessness, confusion
life threatening and contra of Cogentin
LT: paralytic ileus
contra: glaucoma
indications of Oxybutynin (ditropan)
overactive bladder, antispasmodic for neurogenic with spinal injuries
contra of Oxybutynin (ditropan)
KDA, GI/GU retention, uncontrolled angle-closure glaucoma
Oxybutynin (ditropan) nursing considerations
PATCH!
and take 1 hr before meals or 2 hours after w fluids
Tolterodine (detrol) indications
urinary frequency, urgency, urge incontinence caused by bladder overactivity
Used more often bc less dry mouth since it’s more specific to bladder
Tolterodine (detrol) contra
angle-closure glaucoma, urinary retention, decreased hepatic function
what to do if Tolterodine (detrol) is taken with cytochrome P-340 3A4 (ketoconazole, erythromycin)
start with 1mg 2x day (1/2 normal dose)
how to take Tolterodine (detrol) and side effects
PO without food and no grapefruit juice
SE: dry mouth, eyes and skin, HA, dizziness, vertigo, nervousness, N/V/D/C, abdominal pain, urinary retention
anticholinergic for motion sickness and side effects
scopolamine
-patch behind ear or wrist band
-Used for 3 days
Dramamine, antivert, marzine
SE: dry mouth, blurred vision, constipation, urinary retention
nursing considerations for anticholinergics
assess urinary output (bc it causes retention)
check hx (contra of glaucoma)
monitor VS (HR increases)
bowel sounds (decreased peristalsis)
mouth care (dry)
What do agonists of a drug do
increase activity
neurotransmitters of sympathetic nervous system
norepinephrine, epinephrine, dopamine
Beta 1
heart
beta 2
lungs
dopaminergic receptors
arterial dilation, increasing blood flow to organs
sympathomimetic drugs indirect acting
causes a release of catecholamine from storage site in nerve endings, then binds to receptors
sympathomimetic drugs mixed acting
acts directly by binding to receptor site and then indirectly by stimulating release of neurotransmitters
+ inotrope
increases contractility, increases CO
(-) inotrope
decreases contractility and CO
+ chronotrope
HR increases
(-) chronotrope
HR decreases
alpha-1 locations and responses (3)
pupils: dilation
GU: constriction of bladder
vessels: constriction
beta 1 locations and responses (4)
cardiac: increased contractility (+ inotrope)
AV node: increased HR (+ chronotrope)
SA node: increased HR
kidney
beta-2 locations and responses (2)
lungs: vasodilation
bronchial muscles: dilation
alpha-1 beta-1 location and response
GI muscle: decreased motility (relaxation of muscle)
alpha-1 beta-2 location and response
liver: glycogenolysis
Dobutamine (dobutrex) class and indication
class: beta-1 adrenergic
cardiac decompensation (increases)
dobutamine (dobutrex) MOA and AE
MOA: increases CO by increasing contractility (+ inotrope), increases SV and perfusion to kidneys
AE: H/A, restlessness, HTN, tachy, palpitations, dysrhythmias
dopamine (inotropin) use (low vs high dose)
beta-1 adrenergic
low dose dilates vessels in kidneys, brain, heart, mesentery, increasing blood flow
high dose increases contractility and CO
dopamine (inotropin) indications, contra and antidote
indications: shock, cardiopulmonary arrest
contra: catecholamines secreting tumor of adrenal gland
if extravasation: phentolamine (alpha blocker)
epinephrine (adrenaline) use
acts on receptors by the SNS, strengthens cardiac contraction, bronchodilation, increased HR and CO
beta-1 (increased HR), beta-2 (bronchodilation)
epinephrine (adrenaline) indications
anaphylaxis, cardio shock, severe hypotension, cardiac arrest
epinephrine (adrenaline) side and adverse effects and LT
SE: anorexia, N/V, nervousness, tremors, agitation, HA, weakness, pallor, sweating, dizziness
AE: palpitations, tachy, HTN, dyspnea, necrosis (vasoconstrictor), gangrene if infiltration
LT: vfib and pulmonary edema
epinephrine (adrenaline) interactions
Increased effect with TCA, MAOI, decreased effects with BB, methyldopa, digoxin may cause dysrhythmias
Norepinephrine (levophed)
Beta-1
not used during allergic reaction, for hypotensive states
Neo-synepherine (phenylephrine)
alpha adrenergic
hypotension and SVT
alpha-1 (vasoconstrictor)
more pressure=decreased secretions
albuterol (proventil, ventolin)
beta-2 adrenergic agonist
treats bronchospasm, asthma, bronchitis, COPD
contra of albuterol
dysrhythmias, CAD
caution, SE, AR, LT of albuterol
caution: cardiac disease, HTN, hyperthyroidism, DM, renal dysfunction, elderly, pregnancy
SE: tremor, nervousness, dizziness, restlessness, sweating, blurred vision, flushing, HA, hoarseness, insomnia
AR: palpitations, tachy, HTN, hallucinations, seizures, hyperglycemia
LT: increased effects w sympathomimetics, TCA, MAOI, decreased BB
2 centrally acting alpha 2 agonists
clonidine and methyldopa (both for HTN) bc alpha 2 is a vasodilator
alpha 1, alpha 2, beta 1, beta 2
alpha 1: vasoconstrictor
alpha 2: vasodilator
beta 1: heart
beta 2: lungs
adrenergic blockers
blocks effects of receptors (and SNS at alpha 1 receptors)
vasodilation, reduced BP, miosis (pupil constrict), reduced muscle tone
indications of alpha-adrenergic blockers
HTN, BPH, raynauds
endings of alpha blockers
-zosin
tamsulosin (flomax)
treats BPH
not used with ED drugs, alpha blockers, or Ca+ blockers
beta blockers for glaucoma?
yes!
beta blockers ending
-olol
selective vs non selective BB
selective just for one part
beta-1 selective
beta-1 and 2 for non selective
alpha blockers use
HTN except flomax
beta and alpha blockers
vasodilate to lower BP, decrease HR, contractility, CO, release of renin
indications of BB
MI, angina, dysrhythmias, HTN, heart failure
prevents migraines
contra of BB
KDA, uncompensated HF, shock, heart block, brady, pregnancy, pulmonary disease, raynauds
SE of BB and acute withdrawal
SE: mild and transient brady, AV block, hypotension, bronchoconstriction, mask hypoglycemia, inhibit glycogenolysis
acute withdrawal: HTN crisis, angina, MI
African americans and BB
don’t respond well bc low renin
asian americans and BB
works very well
indian americans and BB
resistance
salt amount for HTN
<2g/day
stages of HTN
normal: 90/60-119/79
pre: 120/80-139-89
stage 1: 140/90-159/99
stage 2: >160/100
6 types of antihypertensives
diuretics
sympatholytics
vasodilators
ACE
ARBS
Ca+ blocker
hydrochlorothiazide
diuretic for HTN
avoid in renal insufficiency
alpha and beta for HTN
beta-adrenergic blockers
centrally acting alpha 2
alpha adrenergic
adrenergic neuron blockers
alpha 1 beta 1 blockers
beta blockers
used for HTN and also decreases HR
for asthma pts, use selective BB
metoprolol (lopressor, toprol)
decreases CO
decompensated HF don’t use
beta-1 blocker
not for pregnant women
taper down
