Ph. Ch.40 Drugs Used in Men's and Women's Health Study Guide Flashcards
What Drugs cause toxic effects with Antiandrogen agents?
Dutasteride (Avodart)
Action: reduces the hyperplastic cell growth associated with BPH.
Drugs that enhance toxic effects:
- Ketaconazole
- Itraconazole
- Ritonavir
- Diltiazem
- Verapamil
- Cimetidine
- Ciprofloxacin
**abovementioned drugs inhibit the metabolism of dutasteride and should be given with extreme caution to men taking any of these medications
What are nursing instructions, warnings, patient education and the drug Interactions for patients on Viagra?
Drug therapy for Erectile Dysfunction
Drug class: Phosphodiesterase Inhibitors
-Sildenafil (Viagra)
Nursing Instructions:
- Taken from 30 mins to 4 hrs before sex
- Approved for use in pulmonary arterial hypertension
Warnings:
- Common adverse effect: Headache, flushing of face & neck, color vision impairment
- Serious adverse effect: Hypotension, dizziness & angina, loss of vision/hearing, priapism
Patient Education:
- Sexual stimulation is required for erection
- NOT an aphrodisiac; It does NOT increase sexual desire;
- Does not affect sperm count and do NOT reduce fertility
Drug Interactions:
- Nitroglyerin patches/ointment, amyl nitrate
- Cimetidine, erythromycin, ketoconazole, itraconazole, ritonavir, indinavir, saquinavir
- Alcohol
- Alpha-adrenergic blocking agents (tamsulosin, alfuzosin, terazosin, doxazosin, prazosin)
- Rifampin
What are nursing interventions with a Antibiotic regiment?
- When infections are present, abstain from sexual intercourse to prevent reinfection.
- For women, should remain in recumbent position for 30 minutes to allow time for drug absorption
- For men and women – teach that both partners must take meds
- Tetracycline and doxycycline are alternatives to Penicillin
What is the mechanism of action of Estrogen, and Progestin?
-Estrogen blocks pituitary release of FSH preventing the ovaries from developing a follicle from which the ovum is released.
-Progestin inhibit pituitary release of LH, the hormone responsible for releasing an ovum from a follicle.
**Both alter cervical mucus by making it thick and viscious, inhibiting sperm migration.
What are nursing instructions for patients on BCPs and Penicillins?
Antibacterial agents (e.g., penicillins, tetracyclines, rifampin, isoniazid, griseofulvin) alter metabolism of hormones in the gut, making the contraceptive less effective.
What is prescribed and what is the treatment of ED?
Drug therapy for Erectile Dysfunction
Drug class: Phosphodiesterase Inhibitors
-Sildenafil (Viagra)
Nursing Instructions:
- Taken from 30 mins to 4 hrs before sex
- Approved for use in pulmonary arterial hypertension
Warnings:
- Common adverse effect: Headache, flushing of face & neck, color vision impairment
- Serious adverse effect: Hypotension, dizziness & angina, loss of vision/hearing, priapism
Patient Education:
- Sexual stimulation is required for erection
- NOT an aphrodisiac; It does NOT increase sexual desire;
- Does not affect sperm count and do NOT reduce fertility
Drug Interactions:
- Nitroglyerin patches/ointment, amyl nitrate
- Cimetidine, erythromycin, ketoconazole, itraconazole, ritonavir, indinavir, saquinavir
- Alcohol
- Alpha-adrenergic blocking agents (tamsulosin, alfuzosin, terazosin, doxazosin, prazosin)
- Rifampin
What are the uses/indications/contraindications of
Phosphodiesterase inhibitor: Sildenafil, Vardenafil, Avanafil, Tadalafil?
Drug class: Phosphodiesterase Inhibitors
- Sildenafil
- Vardenafil
- Tadalafil
- Avanafil
Uses:
- Causes smooth muscle relaxation that allows blood inflow to fill many small sinusoidal spaces resulting in erection.
Indications:
- Improve erectile function and overall sexual satisfaction
- Tadalafil can be used to reduce symptoms and improve urinary flow associated with BPH
- Sildenafil (Revatio) and Tadalafil (Adcirca) have been approved for use in arterial HTN
Contraindications:
- Nitroglycerin patches
- Cimetidine, Erythromycin, Ketoconazole, Itraconazole, Ritonavir, Indinavir, Squinavir
- Alcohol
- Alpha- adrenergic blocking agents
- Rifampin
Nursing Instructions:
Sildenafil
- taken from 30 mins to 4 hrs before sex
- approved for use in pulmonary arterial hypertension
Vardenafil
- Taken from 30 mins to 4 hrs before sex
Avanafil
- Taken 15 mins before sex
Tadalafil
- Starts working within 30 mins & may last up to 36 hrs
- approved for once-daily dose and treatment for BPH
- approved for use in pulmonary arterial hypertension
Common adverse effect:
-Headache
-Flushing of face & neck
-Color vision impairment
Serious adverse effect:
-Hypotension
-Dizziness & angina
-Loss of vision/hearing
-Priapism
Patient Education:
- Sexual stimulation is required for erection
- NOT an aphrodisiac; It does NOT increase sexual desire;
- Does not affect sperm count and does NOT reduce fertility
- Should not be taken more than once every 24 hours
Drug Interactions:
- Nitroglyerin patches/ointment, amyl nitrate
- Cimetidine, erythromycin, ketoconazole, itraconazole, ritonavir, indinavir, saquinavir
- Alcohol
- Alpha-adrenergic blocking agents (tamsulosin, alfuzosin, terazosin, doxazosin, prazosin)
- Rifampin
What are pre-assessment and nursing interventions in estrogen therapy?
Premedication assessment:
-Review medical history for Obesity, smoking, HTN, gallbladder disease, diabetes, severe varicose veins, seizure disorders, oligomenorrhea or amenorrhea, rheumatic heart disease, thromboembolic disease, stroke, malignancy of breast or reproductive system, renal or liver disease, severe mental depression, suspected pregnancy or repeated contraceptive failure.
-Take baseline body weight, BP in supine and sitting positions
-Ensure pregnancy test has been given and patient is not pregnant
Interventions:
-Start the first pill on the first Sunday after mens begins. Take one pill at the same time until the pack is gone
- If using a 21-day pack, wait 1 week and restart on the next Sunday
- If using a 28-day pack, start a new pack the day after finishing the last pack
- Full protection by the pill may not occur on the first month so use an additional form of BC
- If diarrhea or vomiting occur within 3 to 4 hours after taking an active tablet, it’s considered a missed pill
What are the Dangers and contraindications with Phosphodiesterase inhibitors (Viagra)?
Common adverse effect:
-Headache
-Flushing of face & neck
-Color vision impairment
Serious adverse effect:
-Hypotension
-Dizziness & angina
-Loss of vision/hearing
-Priapism
Contraindications:
- Nitroglycerin patches
- Cimetidine, Erythromycin, Ketoconazole, Itraconazole, Ritonavir, Indinavir, Squinavir
- Alcohol
- Alpha- adrenergic blocking agents
- Rifampin
What are the Preventive methods against both STIs and Pregnancy?
- When infections are present, abstain from sex
- If having a sex partner with unknown status or one with HIV or STI, use condoms
- Both partners should get tested for STIs including HIV before first sexual encounter
- Practice safe sex if not abstinence. Use latex condoms
- Arrange follow up appointments or referrals for counselling as needed
- Importance of documentation of all sexual partners
What Herbal supplement intersects with oral contraceptives therapy?
St. John’s Wort may increase the liver’s metabolism of oral contraceptive hormones, resulting in decreased contraceptive effect.
- Psychosocial influences vs adverse effects with BCPs
Psychosocial influences: - STIs cause a high degree of anxiety; explain confidentiality policy of the facility before asking about sexual partners
Common adverse effects: - Nausea, weight gain, spotting, change in menstrual flow, missed period, chloasma (facial pigmentation), depression, mood changes and headaches
- Patients at Risks for BCPs
- Risks increases with age and heavy smoking (over 35 years old and smoker
What is the drug Tamsulosin?
Drug Therapy for BPH
Drug class: Alpha-1 Adrenergic Blocking Agents
- Alfuzosin, Silodosin, Tamsulosin
Uses:
- used to reduce mild to moderate urinary obstruction manifestations in men with BPH
- Symptoms show improvement after 1 week of therapy, but 2 to 3 months of continued therapy are required to assess full effect.
- Not used to treat Hypertension
Actions:
- Blocks alpha-1 receptors on the prostate gland and certain areas of the bladder neck causing muscle relaxation and allowing greater urinary outflow in men with enlarged prostate gland.
- Alpha-1 blocking agents DO NOT reduce prostate size or inhibits testosterone synthesis nor affect PSA levels
Patient Teaching:
- Initial dose may cause dizziness and hypotension with tachycardia and fainting. Give first dose with food. Lie down immediately if symptoms develop.
What are Intravaginal Contraceptives?
Intravaginal Hormonal Contraceptives
Example: NuvaRing, EluRyng and Annovera
Action: inhibits ovulation
Patient education:
- Insert for 3 weeks and removed for 1 week
- Cigarette smoking increases risk for serious cardiovascular effects in persons who smoke and use combination contraceptives
- Nuvaring: place used ring in the foil pouch and discard in waste receptacle out of reach of children and pets. Insert a new ring on day 7
- Annovera: after removal, wash with warm water and mild soap, dry with a clean cloth. Reinsert the same ring on day 7
- Serious adverse effects to be reported asap: severe headaches, dizziness, blurred vision, leg pain, SOB, chest pain and acute abdominal pain
Intravaginal NonHormonal Contraceptives
Example: Phexxi (vaginal gel)
Action: lowers pH to prevent pregnancy
Patient education:
- One prefilled single-dose applicator up to 1 hour before sex. An additional applicatorful should be inserted if intercourse does not occur within 1 hour of initial insertion.
- Phexxi should not be used with vaginal ring contraceptives
- Common adverse effects include burning sensation, pruritus, UTI, BV, dysuria, discomfort and pain.
Premedication assessment essential before Initiating finasteride or dutaseride, Administer transdermal and intravaginal contraceptives and Mini-pills/Combination Pills.
- Initiating finasteride (Proscar) or Dutasteride (Avodart)
-Obtain a baseline PSA blood level. - Admin transdermal and intravaginal contraceptives
- Review medical history
If there is a history of obesity, smoking, HTN, gallbladder disease, diabetes, severe varicose veins, seizure disorders, oligomenorrhea or amenorrhea, rheumatic heart disease, thromboembolic disease, stroke, malignancy of breast or reproductive system, renal or liver disease, severe mental depression, sustained pregnancy or repeated contraceptive failure. - Take baseline blood pressure in supine & sitting positions
- Ensure that a pregnancy test has been given and patient is not pregnant
- Mini pills and combination pills
- Review medical history.
If there is a history of obesity, smoking, HTN, gallbladder disease, diabetes, severe varicose veins, seizure disorders, oligomenorrhea or amenorrhea, rheumatic heart disease, thromboembolic disease, stroke, malignancy of breast or reproductive system, renal or liver disease, severe mental depression, sustained pregnancy or repeated contraceptive failure. - Take baseline body weight measurement, blood pressure in supine and sitting positions
- Ensure that pregnancy test has been given and patient is not pregnant
What is the Relationship of Contraceptives with Metrorrhagia, Amenorrhea, Menorrhagia, Dysmenorrhea?
- Metroragia, Amenorrhea, Menorrhagia, Dysmenorrhea are common adverse effects of contraceptives
