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Pharmacology ATI > Genitourinary and Reproductive > Flashcards

Genitourinary and Reproductive Flashcards

1
Q

Why is progesterone included with estrogen for treating menopause?

A

It protects from increased risk of endometrial cancer
(estrogen only is fine if prior hysterectomy)

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2
Q

Estrogen hormone replacement therapy

Prototype

A

conjugated equine estrogen (Premarin)
transdermal Estradiol (FemPatch, Estraderm, Climara)
estradiol cream (Estrace)
estradiol intravaginal tabs (Vagifem)

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3
Q

Estrogen hormone replacement therapy

MOA

A

Binds to estrogen receptors in breasts, genitals, hypothalamus and pituitary gland
Provides small, stable amount of estrogen to prevent menopause symptoms

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4
Q

Estrogen hormone replacement therapy

Adverse Effects

A

Nausea
HTN (increased angiotensin and aldosterone)
Water retention
Endometrial hyperplasia (increased risk of endometrial and ovarian cancers)
Thromboembolic events

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5
Q

Estrogen hormone replacement therapy

Teaching

A
  • Quit smoking
  • Monitor for pain, redness, and swelling in leg, dypsnea, chest pain
  • Stop 4 weeks before surgery due to thromboembolic event risk
  • Monitor vaginal bleeding (may indicate cancer)
  • Nausea goes away with time
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6
Q

Estrogen hormone replacement therapy

Admin

A

Continuous use and at same time daily to avoid bleeding
Cream or intravag tabs at bedtime

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7
Q

Estrogen hormone replacement therapy

Contraindications

A
  • hx of thromboembolic events
  • Breast, ovarian, endometrial, or vaginal cancer
  • Undiagnosed vag bleeding
  • Liver disease
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8
Q

Estrogen hormone replacement therapy

Common interactions

A

Decreased effect with St. John’s Wort, anticonvulsants, some antibiotics
Reduces effectiveness of warfarin and diabetes meds
Increase levels of diazepam, chlordiazepoxide, TCAs, and theophylline

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9
Q

Estrogen and progesterone hormone replacement therapy

Indication

A

Severe menopause symptoms: hot flashes and vaginal atrophy
Prevents menopausal osteoporosis

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10
Q

Estrogen and progesterone hormone replacement therapy

Prototype

A

conjugated estrogen and medroxyprogestrone acetate (Prempro)
transdermal estradiol and norethindrone (CombiPatch)

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11
Q

Estrogen and progesterone hormone replacement therapy

MOA

A

Estrogen binds to target tissues to prevent menopause symptoms.
Progesterone antagonizes tissue growth in endometrium caused by estrogen

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12
Q

Estrogen and progesterone hormone replacement therapy

Adverse effects

A

Even greater risk of thromboembolic event
Increased risk for vaginal bleeding, weight gain, breast cancer

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13
Q

GrH agonist

Prototype

A

Leuprolide (Lupron)
Nafarelin (Synarel)

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14
Q

GrH agonist

classification

A

Gonadotropin releasing hormone antineoplastic

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15
Q

GrH agonists

MOA

A

Stimualates secretion of FSH and LH from pituitary gland, which increases estrogen and progesterone.
After several weeks, FSH and LH drop drastically to the point of monopausal hormone levels
This allows endometrium to shrink

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16
Q

GrH agonists

Indication

A

Endometrial hyperplasia
Endometriosis

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17
Q

GrH agonists

Adverse effects

A

Hot flashes
Headache
Vaginal dryness
Bone loss

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18
Q

GnRH agonists

Interventions

A
  • Therapy limited to 6 mo to prevent osteoporosis
  • Bone density scanning if must last longer
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19
Q

GnRH agonists

Admin

A

Intramuscular injection

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20
Q

GnRH agonists

Instructions

A
  • Perform weight bearing exercises daily and take calcium and vit D
  • Lube for vaginal dryness
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21
Q

GnRH agonists

Contraindications

A

Pregnancy
Abnormal vag bleeding
Metastatic brain cancer
Allergy to benzoyl alcohol

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22
Q

Progesterone

Prototype

A

medroxyprogesterone acetate (Provera)
norethindrone (Micronor)

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23
Q

Progesterone

Indication

A

Endometriosis
Abnormal bleeding
Palliative tx for advanced uterine cancer

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24
Q

Progesterone

MOA

A

Antagonizes estrogen from causing endometrial growth

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25
Q

LH and FSH stimulants

Prototype

A

clomiphene (Clomid)

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26
Q

LH and FSH stimulants

Class

A

Ovulatory stimulants

27
Q

LH and FSH stimulants

MOA

A

Inhibits estrogen receptors on pituitary and increases GnRH release from the hypothalamus
GnRH stimulates LH and FSH release, causing more follicle maturation and ovulation

28
Q

LH and FSH stimulants

Adverse effects

A

Vasomotor effect (hot flashes)
Breast engorgement
GI upset
Visual disturbance
Ovarian enlargement
Multiple gestation

29
Q

LH and FSH stimulants

Instructions

A
  • cold compresses for hot flashes
  • report pelvic pain
  • report vision changes
30
Q

LH and FSH stimulants

Admin

A

PO once daily for 5 days after start of menses
Take at same time every day

31
Q

LH and FSH stimulants

Contraindications

A

Pregnancy (teratogenic)
Primary ovarian failure
Uterine bleeding
Liver disease
Uncontrolled thyroid disease
Thrombophlebitis

32
Q

Ovulation Stimulant

Prototype

A

human chorionic gonadotropin (Pregnyl)

33
Q

Ovulation Stimulant

Indication

A

Infertility

34
Q

Ovulation Stimulant

MOA

A

Causes ovulation by stimulating secretion of LH

35
Q

Ovulation Stimulant

Adverse effects

A

Ovarian rupture from hyperstimulation
CNS symptoms: irritable, headache, fatigue

36
Q

Ovulation Stimulant

Interventions

A
  • Monitor for hyperstimulation: abdominal pain and swelling
  • Monitor for ovarian rupture: sudden, sharp pelvic pain, nausea, vomiting, weakness
37
Q

Ovulation Stimulant

Admin

A
  • Confirm maturation of the follicle via intravaginal sonography
  • Reconstitute and admin via IM
  • Give 7-9 days after last dose of clomiphene if taking
38
Q

Ovulation Stimulant

Contraindications

A

Pituitary tumor
Dysfunctional uterine bleeding
Adrenal insufficiency
Uncontrolled thyroid disease

39
Q

Antihyperprolactinemia

Prototype

A

cabergoline
bromocriptine (Parlodel)

40
Q

Antihyperprolactinemia

Indication

A

Infertility

41
Q

Antihyperprolactinemia

MOA

A

Increases available dopamine, which causes the pituitary gland to secrete less prolactin
Less prolactin increases secretion of HcG, which stimulates LH and FSH to produce ovulation

42
Q

Antihyperprolactinemia

Adverse effects

A

Pulmonary fibrosis
Pericardial fibrosis
Valvular disorders
Retroperitoneal fibrosis
Nausea, dizziness, headache

43
Q

Antihyperprolactinemia

Interventions

A

Monitor serum prolactin levels monthly until reach a normal level

44
Q

Antihyperprolactinemia

Contraindications

A

Uncontrolled hypertension

45
Q

Oxytocin

Class

A

uterine stimulants

46
Q

Oxytocin

prototype

A

oxytocin (Pitocin)

47
Q

Oxytocin

MOA

A

Mimics natural oxytocin released by the pituitary
Causes uterine contraction and milk ejection

48
Q

Oxytocin

adverse effects

A

Uterine hyperstimulation = uterine rupture and death
Hypertensive crisis
Water intoxication (ADH effect)

49
Q

Oxytocin

Interventions

A
  • Monitor length, strength, and frequency of contractions
  • Monitor FHR
  • Monitor BP
  • Monitor I&Os for water intoxication
  • Monitor for nausea, headache
  • If contractions longer than 1 minute or are more frequent than every 2 min, or resting uterine pressure is greater than 15-20 mmHg = turn on side, stop infusion, administer oxygen, prepare uterine relaxant
50
Q

Oxytocin

Admin

A
  • IV infusion
  • Increase by 1-2 mL/min every 30-60 min until contractions last up to 1 min and occur every 2-3 min.
  • Cervic should be dilated 2-3 cm and effaced before admin
51
Q

Oxytocin

Contraindications

A
  • Unripe cervix
  • Placental abnormalities
  • Herpes
  • Fetal distress
  • Fetal lung immaturity
  • Breech or transverse
  • Umbilical cord prolapse
  • Cephalopelvic disproportion
52
Q

Ergot alkaloids

Prototype

A

methylergonovine (Methergine)

53
Q

Ergot alkaloids

Indication

A

Prevent and treat postpartum hemorrhage

54
Q

Ergot alkaloids

MOA

A

Stimulate smooth muscle in uterus

55
Q

Ergot alkaloids

Adverse effects

A

rare: hypertension, stroke, nausea, cramps, arrhythmias, seizures

56
Q

Ergot alkaloids

Interventions

A

Monitor BP, HR, and seizures

57
Q

Ergot alkaloids

Admin

A
  • Check BP prior to admin
  • IM every 2 hours or orally for 2-7 days
  • IV over 1 min
  • Assess slowing of vaginal bleeding
58
Q

Ergot alkaloids

Contraindications

A

Induced labor
Threatened miscarriage
Hypertension

59
Q

Synthetic prostaglandins

Indication

A

Promotes softening, dilating, and effacement of the cervix

60
Q

Synthetic prostaglandins

Prototype

A

dinoprostone (Cervidil)
misoprostol (Cytotec)

61
Q

Synthetic prostaglandins

MOA

A

Activates collagenase, which breaks down collegan complex that keeps cervix firm and closed
Softens the cervix and allows contractions to start

62
Q

Synthetic prostaglandins

Adverse effects

A

Amniotic fluid embolism
Uterine rupture
Chills
Hypotension
Nausea

63
Q

Synthetic prostaglandins

Admin

A
  1. Gel in prefilled syringe administered through cervix with endocervical catheter with pt lying supine (pillow under hip) for 30 min. Start oxytocin 6-12 hours after last dose
  2. Pouch contained drug placed at cervix while pt lies supine for 2 hours. Pouch removed with attached tape when active labor begins
64
Q
A

Pharmacology ATI (19 decks)

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