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PHARM!!! Exam 2 Flashcards

1
Q

Complications of Birth Control Pills

A

Abdominal pain
Chest pain (SOB)
Headaches
Eye problems
Severe Leg Pain

Blood clot
HTN

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2
Q

Ethinyl Estradiol &
Drospirenone

(Yasmin)

A

(kind of like spirolactone)

*Prevent pregnancy
*Reduce fluid retention
*Reduce risk for ovarian cancer, benign breast disease, and ovarian cysts
*Reduce risk for PIC

Adverse Reactions:
-Thromboembolism!
-HyPERkalemia
-HTN
-Uterine bleeding
-Increased growth of breast malignancies

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3
Q

Ethinyl Estradiol &
Drospirenone

(Yasmin)

Administration

A

-Make sure to verify pt is not pregnant
-Use back up BC through first cycle
-take at same time each day
-take missed does next day with other pill, if missed 2 days, take 3. After 3 missed bills use back up

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4
Q

Ethinyl Estradiol &
Drospirenone

(Yasmin)

Education

A

REPORT:
-Leg or chest pain
-Leg edema
-Sudden change in vision
-Severe headache
-SOB
-Palpitations
-Paresthesia
-weakness
-abdominal cramps

Do NOT smoke!

Stop taking 4 weeks before surgery that could increase risk of DVT.

Monitor BP

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5
Q

Estrogen HRT:

Conjugated Equine Estrogen (Premarin)

Transdermal Estradiol

Intravaginal Estradiol

A

*Relief of severe menopausal symptoms
*Relief of vulvar and vaginal atrophy
*Prevent postmenopausal osteoporosis

Adverse Reactions:
-Thromboembolism
-Thrombophlebitis
-PE
-Stoke / CVA
-MI
-HTN
-Endometrial hyperplasia, ovarian cancer, breast cancer
-Nausea

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6
Q

Estrogen HRT:

Conjugated Equine Estrogen (Premarin)

Transdermal Estradiol

Intravaginal Estradiol

Client Instructions

A

Report:
-leg or chest pain
-leg edema
-sudden change in vision
-severe headache
-SOB
-persistent vaginal bleeding

-Do not smoke

-Stop taking within 4 weeks of surgery that could cause DVT

-Take with food
-Exercise regularly
-low-fat diet

-regular blood checks

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7
Q

Estrogen plus progesterone HRT

Conjugated Estrogen and Medroxyprogesterone Acetate

Transdermal Estradiol

Norethindrone

A

*Relief of postmenopausal symptoms
*Relief of vulvar and vaginal atrophy
*Prevention of postmenopausal osteoporosis

Adverse Reaction:
-Thromboembolism
-HTN
-Breast cancer
-Break through bleeding and other menstrual irregularities
-Edema
-Nausea

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8
Q

Estrogen plus progesterone HRT

Conjugated Estrogen and Medroxyprogesterone Acetate

Transdermal Estradiol

Norethindrone

Client Instructions

A

Report:
-leg or chest pain
-leg edema
-sudden change in vision
-severe headache
-SOB
-persistent vaginal bleeding

-Do not smoke

-Stop taking within 4 weeks of surgery that could cause DVT

-Take with food
-Exercise regularly

*take at bedtime

*Get mammogram and blood work done

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9
Q

GnRH Agonist

Leuprolide (Lupron)

A

*Treats endometriosis
*treatment of advanced prostate cancer in males

Adverse Reactions:
-bone loss
-hot flashes
-vaginal dryness
-headache

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10
Q

GnRH Agonist

Leuprolide (Lupron)

Client instructions

A

-perform weight-bearing exercise daily
-Consume adequate calcium and vitamin D
-avoid hot flash triggers (consuming glucose)
-use vaginal lubricants
-report headache, dizziness, or paresthesia
-take analgesics for headache

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11
Q

Progesterone

Medroxyprogesterone Acetate (Provera)

A

*Endometriosis
*treat dysfunctional uterine bleeding
*treatment of endometrial carcinoma

Adverse Reactions:
-Thromboembolism
-Breast Cancer
-breakthrough bleeding and menstrual irregularities
-Nausea
-Edema

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12
Q

Progesterone

Medroxyprogesterone Acetate (Provera)

Client instructions

A

Report:
-leg or chest pain
-leg edema
-sudden change in vision
-severe headache
-SOB
-persistent vaginal bleeding

-Do not smoke

-Stop taking within 4 weeks of surgery that could cause DVT

-Take with food
-Exercise regularly

*take at bedtime

*Get mammogram and blood work done

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13
Q

LH & FSH Stimulant:

Clomiphene (Clomid)

A

*Promote ovulation
*Treatment of infertility

Adverse Reactions:
-Hot flashes
-Breast engorgement
-Nausea
-Abdominal discomfort
-Blurred vision
-Flashes of light
-dizziness
-Ovarian hyperstimulation
-Multiple gestation -

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14
Q

LH & FSH Stimulant:

Clomiphene (Clomid)

Client Instructions

A

-Expect Hot flashes
-Apply COLD compresses if needed
-Take NSAID
-Wear supportive bra
-take drug with food
-Report any visual disturbances
-Do not engage in dangerous activities if symptoms occur
-Report pelvic pain
-Be aware of possible multiple babies

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15
Q

Ovulation Stimulant:

Human Chorionic Gonadotropin (hCG) (Pregnly)

A

*Promotes of ovulation
*Treatment of infertility w/ meds for follicular maturation

Adverse Reaction:
-Ovarian hyperstimulation
-Ovarian cyst rupture
-CNS effects: irritability, headache, fatigue, restlessness

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16
Q

Ovulation Stimulant:

Human Chorionic Gonadotropin (hCG) (Pregnly)

Client Instructions

A

Seek medical care ASAP for pelvic or lower abdominal pain or pressure, unusual weight gain or swelling.

Take analgesics PRN

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17
Q

Hyperprolactinemia Inhibitor:

Cabergoline

A

*Correction of amenorrhea from excessive secretion of prolactin
*treat infertility

Adverse Reactions:
-Nausea
-Headache, dizziness
-Pulmonary fibrosis
-Pericardial fibrosis
-valvular disorders and retroperitoneal fibrosis

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18
Q

Hyperprolactinemia Inhibitor:

Cabergoline

Client Instructions

A

-take with food
-report headache / dizziness
-do not engage in dangerous activities
-take analgesics

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19
Q

Oxytocin (Pitocin)

A

*Uterine Stimulation
*Induction or enhancement of labor near or post term
*treatment of postpartum hemorrhage

Adverse Reactions:
-Uterine Hyperstimulation
-Hypertensive crisis
-Water intoxication

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20
Q

Oxytocin (Pitocin)

Client Instructions

A

-Report increasing duration or strength of contractions
-report headaches, palpitations, nausea, or chest pain
-Report drowsiness or headache

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21
Q

When do you stop Pitocin?

A

When contractions are lasing > 90 seconds, <2 minutes apart, and with fetal pattern of late decelerations.

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22
Q

Ergot Alkaloids:

Methylergonovine (Methergine)

A

*Prevention and treatment of postpartum and post-abortion hemorrhage

Adverse Reactions:
-Hypertension
-Nausea / vomiting
-Cramps
-Arrhythmias
-Seizures

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23
Q

Ergot Alkaloids:

Methylergonovine (Methergine)

Client instructions

A

-report nausea, headache, weakness, or palpitations

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24
Q

Synthetic Prostaglandins:

Dinoprostone Vaginal Insert (Cervidil)

Gel (Prepidil)

A

*Promotion of cervical ripening
*stimulation of uterine contractions after cervical ripening

Adverse Reaction:
-Amniotic fluid embolism
-Uterine Rupture
-headache
-Chills
-HyPOtension
-N/V/D

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25
Q

Synthetic Prostaglandins:

Dinoprostone Vaginal Insert (Cervidil)

Gel (Prepidil)

Client Instructions

A

-Report increased duration or strength of contractions
-Report N/V/D
-Increase clear fluid intake as needed
-Report fever

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26
Q

Beta2 Adrenergic Agonists: Terbutaline

A

*To stop preterm labor

Adverse Reaction:
-Respiratory effects (pulmonary edema, dyspnea, cough, tachypenea)

-Cardiac effects (tachycardia, MI, chest pain, palpitations)

-HyPOtension
-HyPOkalemia
-HyPERglycemia

Fetal Effects: Hypotension, tachycardia, hyperinsulinemia/hypoglycemia, hyperbilirubienmia, hypocalcemia

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27
Q

Beta2 Adrenergic Agonists: Terbutaline

Client instructions

A

Report:
-SOB
-Dyspnea
-cough
-palpitations
-chest pain
-weakness
-Nausea
-paresthesia
-3P’s

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28
Q

Glucocorticoids

Betamethasone

A

*Increase production of lung surfactant in a fetus (24-34 weeks gestation)
*Reduce risk of respiratory depress syndrome, bronchopulmonary, dysplasia, intraventricular hemorrhage and neonatal death

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29
Q

Glucocorticoids

Betamethasone

Client Instructions

A

Report
-SOB
-cough
-increased sputum
-3P’s
-headache and dizziness

30
Q

Anticonvulsant:

Magnesium Sulfate

A

*Prevent and treat seizure in pt with preeclampsia or eclampsia

Adverse Reactions:
-Flushing
-diaphoresis
-drowsiness
-muscle weakness
-maternal hyPOtension
-BRadycardia
-Bradypnea
-Depressed DTR
-Altered LOC
-Decreased Urine output
-Magnesium toxicity
-reduced variability of FHR

31
Q

Anticonvulsant:

Magnesium Sulfate

Client Instructions

A

-Report adverse effects
-Comfort measures
-change positions slowly
-Measure I/O
-Explained used to prevent seizures (but can be toxic)
-Monitor Respiratory and FHR

32
Q

Testosterone:

Androderm Delatestryl

A

*Treatment of male hypogonadism
*delayed puberty
*testicular failure
*treatment for breast cancer

Adverse Reactions:
-Virilization (hair in women)
-increased growth of existing prostate cancer
-Edema/wt gain
-liver toxicity
-premature epiphyseal closure in those who have not reached full height
-Gynecomastia

33
Q

Testosterone:

Androderm Delatestryl

Client Instructions

A

-If drug is being used for breast cancer for woman * expect Virilization
-report body hair growth, acne, and changes in voice and menstruation
-report changed in urination
-pain while ejaculating
-hemauria

-Check prostate levels
-Monitor Wt twice per week
-report wt gain or swelling of legs
-undergo liver function tests
-report jaundice, fatigue, nausea, loss of appetite (s/s of liver failure)
-obtain hand and write xrays
-report breast enlargement

34
Q

5-Alpha Reducase Inhibitor

Finasteride (Proscar)

A

*Treatment of BPH
*Treatment for male pattern hair loss

Adverse reactions:
-reduced libido and ejaculate volume
-reduce PSA
-Gynecomastia

35
Q

5-Alpha Reductase Inhibitor

Finasteride (Proscar)

Client instructions

A

-Expect decreases in libido and ejaculate volume
-undergo regular prostate screenings
-report breast enlargement

36
Q

Alpha-Adrenergic Receptor Antagonisits

Tamsulosin

A

*Treatment of BPH

Adverse Reactions:
-Reduced ejaculation volume
-reduced ejaculation failure
-retrograde ejaculation
-headache & dizziness
-hyPOtension
-Fainting

37
Q

Alpha-Adrenergic Receptor Antagonisits

Tamsulosin

Client Instructions

A

expect adverse reactions (decrease in ejaculation volume and ejaculation failure)
-Report headache is not relieved by analgesics
-Check BP
-Slow movements
-report dizziness or fainting
-do not engage in dangerous activities

-Drugs are to be taken lifelong

38
Q

PDE-5 Inhibitor:

Slidenafil

A

*Treat ED

Adverse reactions:
-Priapism
-headache
-Hypotension, fainting, dizziness
-Sudden loss of hearing
-Irreversible loss of vision (rare)

39
Q

PDE-5 Inhibitor:

Slidenafil

Client Instructions

A

-Go to Doc if erection is longer than 4 hrs
-report headache
-take analgesics
-Report dizziness or fainting
-Check BP
-Stop taking if hearing loss
-Seek care ASAP if vision changes

40
Q

Anticholinergics:

Oxybutynin Chloride (Ditropan)

A

*treat urinary urge incontinence caused by overactive bladder
*treatment of neurogenic bladder

Adverse Reactions:
-Dry mouth
-constipation
-Urinary retention
-Mydriasis (pupil dilation)
-Dry eyes
-blurred vision
-headache
-dizziness
-drowsiness
-fever
-head exhaustion

41
Q

Anticholinergics:

Oxybutynin Chloride (Ditropan)

Client education

A

-suck on hard candy
-sip water
-increased fluid and fiber
-increase activity levels
-Report any undesirable changes
-use lubricating eye drops
-Regular eye checks
-report dizziness or fainting
-no dangerous activities
-seek medical attention for fever and signs of heat exhaustion (muscle cramps, dizziness, N/V

42
Q

Cholinergic:
Bethanechol

A

*Treatment of urinary retention

Adverse reactions:
-Hypotension
-Bradycardia
-Excessive gastric acid and salivation
-Diarrhea, fecal incontinence
-Bronchoconstriction
-Dizziness, fainting

43
Q

Cholinergic:
Bethanechol

Client Instructions

A

-Report dizziness
-Increase fluid intake to maintain hydration
-report dyspnea
-Report dizziness or fainting
-do not engage in dangerous activities
-sit down or lie down if feeling dizzy

44
Q

What is the nephron?

A

The functional unit of the kidney

45
Q

70% of filtration happens where?

A

Proximal tubule

46
Q

What are loop diuretics?

A

They are the most protenant (strongest) diuretics

Furosemide
Bumetanide
Torsemide

They block reabsorption of sodium and chloride preventing water reabsorption (this promotes diuresis)

47
Q

Why give a loop diuretic?

A

-Fast! Within an hour
-Take pressure off the heart!!
-Pulmonary edema
-Edema (related to liver, renal, or cardiac)
-HTN
-Hypercalcemia

48
Q

What are adverse effects of loop diuretics

A

**Ototoxicity
**monitor lipid panel AND glucose levels!

Obvious ones:
Dehydration
Hyponatremia
Hypochloremia
Hypotension
Hypokalemia

Hyperglycemia
hyperuricemia

Hypocalcemia
Hypomagnesemia
Decreased HDL, increased LDL

49
Q

What are contraindications for loop diuretics?

A

Pregnancy
Anuria

Meds
*dig, lithium, ototoxic meds, NSAIDS, antihypertensives

Comorbidities:
*DM, Cardiac disease, gout, dehydration, electrolyte issues

50
Q

What is osmotic diuretic?

A

Mannitol

works along entire nephron

pulls fluid into tubule, but not a ton of Na.

Causes vasodilatation

**only can be given IV WITH a filter!!! Lives in the warmer

51
Q

When would you give mannitol ?

A

In ACUTE renal failure

IV, Rapid acting, more of an emergency med

52
Q

What are adverse reactions to mannitol (osmotic diuretic)

A

-Heart failure (if you give it and they can’t pee)
-Fluid overload (if you give it and they can’t pee)
-pulmonary edema
-rebound ICP
-fluid / electrolyte imbalance
-Metabolic acidosis (related to K+ and Na level)

53
Q

What are contrandications to mannitol (osmotic diuretic)

A

-Someone with intracranial bleed (bc it vasodilates and would increase bleed)

-anuria

-dehydration, renal failure

54
Q

What are potassium sparing diuretics?

A

***Spironolactone

Block aldosterone resulting in K+ retention, but excretion of H2O and Na

55
Q

When would you use K Sparing diuretics?

A

-combined with other diuretics for HTN
-heart failure
-hyperaldosteronism
-Oral med

**best for HTN and cardiac protective for pts with heart failure

**helps prevent remodeling in heart after damage is done

56
Q

What are complications Spironolactone

A

-Endocrine type issues
*deep voice
*impotence
*irregular menses

Be careful with ACEi as they also spare K+

57
Q

What are Thiazide Diuretics ?

A

HCTZ

Promotes diuresis when renal function is intact

-works in distal tubule of kidney

-blocks reabsorption of Na and Chloride and inhibits H2O reabsorption

*Kidneys need to be functional

58
Q

What is the first line medication for HTN ?

A

Thiazides

*used with other meds such as ACEi

59
Q

What are complications for thiazides?

A

dehydration
hyponatremia
hypokalemia
hypochloremia

Hypoerglycemia
Hyperuricemia
Hypomag
Increase LDL

**no Ototoxicity unless mixed with Dig or Lithium

60
Q

When are thiazides contraindicated?

A

pregnancy
no renal impairment
dm
gout
dehydration
meds
*dix, lithium, ototoxic meds, NSAIDS, antihypertensive

61
Q

What are the main labs for someone needing diuretics

A

BUN
Creatinine
GFR
Renal / Liver function

62
Q

What are erythropoietic drugs?

A

Help encourage red blood cell production by stimulating red blood cell development

-Anemia
-HIV/AIDS

63
Q

When are erythropoietic adverse reactions

A

-HTN: increase blood volume

-blood clots (MI, stroke, DVT)

-headache / bone pain, muscle aches

64
Q

What are SERMS (selective estrogen receptor modulators)

A

Raloxifene

Used for:
Breast cancer
Osteoporosis
controls bone loss, high cholesterol and coagulation

65
Q

What are Biphosphnates

A

Aldendronate

decrease bone loss
(osteoporosis)

**i can asued

66
Q

special instructions regarding aldendronate

A

It can cause esophageal burns so

30/30/30
Take on empy stomach
sit up for 30 minutes after
wait 30 minutes before taking any other drugs

67
Q

What is calcitonin

A

Calcitonin salmon

Used for osteoporosis

*taken as an INHILATION (stored in fridge)

*do not take if fish allergy

68
Q

What is a 5-alpha reductase

A

Finesteride

Used for BPH - shrinks prostate and increases ability to urinate

also used for male pattern baldness

69
Q

What can finesteride casues?

A

-gynecomastia
-decreased libido
-ED

70
Q

What are alpha blockers

A

tamsulosin

vasodilator used for BPH or urinary retention

Adverse reactions:
hypotension
dizzy
nasal congestion

71
Q
A

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