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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
Synthetic Prostaglandins: Dinoprostone Vaginal Insert (Cervidil) Gel (Prepidil) Client Instructions
-Report increased duration or strength of contractions -Report N/V/D -Increase clear fluid intake as needed -Report fever
26
Beta2 Adrenergic Agonists: Terbutaline
*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
27
Beta2 Adrenergic Agonists: Terbutaline Client instructions
Report: -SOB -Dyspnea -cough -palpitations -chest pain -weakness -Nausea -paresthesia -3P's
28
Glucocorticoids Betamethasone
*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
29
Glucocorticoids Betamethasone Client Instructions
Report -SOB -cough -increased sputum -3P's -headache and dizziness
30
Anticonvulsant: Magnesium Sulfate
*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
Anticonvulsant: Magnesium Sulfate Client Instructions
-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
Testosterone: Androderm Delatestryl
*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
Testosterone: Androderm Delatestryl Client Instructions
-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
5-Alpha Reducase Inhibitor Finasteride (Proscar)
*Treatment of BPH *Treatment for male pattern hair loss Adverse reactions: -reduced libido and ejaculate volume -reduce PSA -Gynecomastia
35
5-Alpha Reductase Inhibitor Finasteride (Proscar) Client instructions
-Expect decreases in libido and ejaculate volume -undergo regular prostate screenings -report breast enlargement
36
Alpha-Adrenergic Receptor Antagonisits Tamsulosin
*Treatment of BPH Adverse Reactions: -Reduced ejaculation volume -reduced ejaculation failure -retrograde ejaculation -headache & dizziness -hyPOtension -Fainting
37
Alpha-Adrenergic Receptor Antagonisits Tamsulosin Client Instructions
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
PDE-5 Inhibitor: Slidenafil
*Treat ED Adverse reactions: -Priapism -headache -Hypotension, fainting, dizziness -Sudden loss of hearing -Irreversible loss of vision (rare)
39
PDE-5 Inhibitor: Slidenafil Client Instructions
-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
Anticholinergics: Oxybutynin Chloride (Ditropan)
*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
Anticholinergics: Oxybutynin Chloride (Ditropan) Client education
-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
Cholinergic: Bethanechol
*Treatment of urinary retention Adverse reactions: -Hypotension -Bradycardia -Excessive gastric acid and salivation -Diarrhea, fecal incontinence -Bronchoconstriction -Dizziness, fainting
43
Cholinergic: Bethanechol Client Instructions
-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
What is the nephron?
The functional unit of the kidney
45
70% of filtration happens where?
Proximal tubule
46
What are loop diuretics?
They are the most protenant (strongest) diuretics Furosemide Bumetanide Torsemide They block reabsorption of sodium and chloride preventing water reabsorption (this promotes diuresis)
47
Why give a loop diuretic?
-Fast! Within an hour -Take pressure off the heart!! -Pulmonary edema -Edema (related to liver, renal, or cardiac) -HTN -Hypercalcemia
48
What are adverse effects of loop diuretics
***Ototoxicity ***monitor lipid panel AND glucose levels! Obvious ones: Dehydration Hyponatremia Hypochloremia Hypotension Hypokalemia Hyperglycemia hyperuricemia Hypocalcemia Hypomagnesemia Decreased HDL, increased LDL
49
What are contraindications for loop diuretics?
Pregnancy Anuria Meds *dig, lithium, ototoxic meds, NSAIDS, antihypertensives Comorbidities: *DM, Cardiac disease, gout, dehydration, electrolyte issues
50
What is osmotic diuretic?
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
When would you give mannitol ?
In ACUTE renal failure IV, Rapid acting, more of an emergency med
52
What are adverse reactions to mannitol (osmotic diuretic)
-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
What are contrandications to mannitol (osmotic diuretic)
-Someone with intracranial bleed (bc it vasodilates and would increase bleed) -anuria -dehydration, renal failure
54
What are potassium sparing diuretics?
***Spironolactone Block aldosterone resulting in K+ retention, but excretion of H2O and Na
55
When would you use K Sparing diuretics?
-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
What are complications Spironolactone
-Endocrine type issues *deep voice *impotence *irregular menses Be careful with ACEi as they also spare K+
57
What are Thiazide Diuretics ?
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
What is the first line medication for HTN ?
Thiazides *used with other meds such as ACEi
59
What are complications for thiazides?
dehydration hyponatremia hypokalemia hypochloremia Hypoerglycemia Hyperuricemia Hypomag Increase LDL **no Ototoxicity unless mixed with Dig or Lithium
60
When are thiazides contraindicated?
pregnancy no renal impairment dm gout dehydration meds *dix, lithium, ototoxic meds, NSAIDS, antihypertensive
61
What are the main labs for someone needing diuretics
BUN Creatinine GFR Renal / Liver function
62
What are erythropoietic drugs?
Help encourage red blood cell production by stimulating red blood cell development -Anemia -HIV/AIDS
63
When are erythropoietic adverse reactions
-HTN: increase blood volume -blood clots (MI, stroke, DVT) -headache / bone pain, muscle aches
64
What are SERMS (selective estrogen receptor modulators)
Raloxifene Used for: Breast cancer Osteoporosis controls bone loss, high cholesterol and coagulation
65
What are Biphosphnates
Aldendronate decrease bone loss (osteoporosis) **i can asued
66
special instructions regarding aldendronate
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
What is calcitonin
Calcitonin salmon Used for osteoporosis *taken as an INHILATION (stored in fridge) *do not take if fish allergy
68
What is a 5-alpha reductase
Finesteride Used for BPH - shrinks prostate and increases ability to urinate also used for male pattern baldness
69
What can finesteride casues?
-gynecomastia -decreased libido -ED
70
What are alpha blockers
tamsulosin vasodilator used for BPH or urinary retention Adverse reactions: hypotension dizzy nasal congestion
71

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