Pharm final Flashcards
Depo-PROvera action (pro-vera NOT pro FSH and LH)
: has effects similar to those of progesterone;
inhibits secretion of Pituitary Gonadotropins thus prevents
ovulation
depo PROvera use (PRO bleeding, endometrosis, and renal cancer)
treat absent or irregular menstrual periods,
abnormal uterine bleeding. Also used to decrease
the risk of endometrial hyperplasia & renal cancer
depo provera precautions (not pro sun)
melasma. don’t use if pregnant.
Megestrol (Megace) progestogen (mega appetite for pregnancy, cancer and HIV)
Adjunct therapy for treatment of breast and
endometrial cancers
🞑 Management of anorexia, cachexia, or unexplained
weight loss in AIDS patients
🞑 To stimulate appetite and promote weight gain in
cancer patients
🞑 Female infertility
fertility drugs - adverse effects (too many kids fast HR, phlebitis and DVTs)
Tachycardia, phlebitis, DVT
Dizziness, headache, flushing, depression,
anxiety, nervousness, fatigue
Nausea, bloating, constipation, others
Ovarian hyperstimulation, multiple pregnancies,
blurred vision, breast pain, others
mentropins (Pergonal®- fertility drug) - Standardized mixture of (men like fish and lh)
FSH and LH (makes ovaries develop)
fertility drug - chronionic (Ovidrel®) - just recombinant
Chorionic gonadotropin alfa
🞑 Recombinant form of human chorionic gonadotropin (FSH and LH)
fertility drugs - used primarily - but ALSO…
Used primarily to induce ovulation in anovulatory
patients
Also may be used to promote spermatogenesis in
infertile men
uterine stimulants (only oxy stimulates)
Also called oxytocics -oxytocin hormone secreted from
Posterior lobe of Pituitary gland.
oxytocin (oxys help with…)
Used to induce labor at or near full-term gestation,
and to enhance labor when contractions are weak and
ineffective
Other uses
🞑 Prevent or control postpartum uterine bleeding
🞑 Complete an incomplete abortion (after miscarriage)
🞑 Promote milk ejection during lactation
Uterine Relaxants: Tocolytics (stop the tocos after 20 weeks) (it’s not my time toco)
Stop Labor “To-cease-labor”
Used to stop labor that begins before term to prevent
premature birth
Generally used after 20th week of gestation (5 mon)
uterine relaxants adverse effects (relax uterus, but speed up heart - sugar also)
Palpitations, tachycardia, Hypertension, others
Tremors, anxiety, insomnia, headache, dizziness,
others
Nausea, vomiting, anorexia, bloating, diarrhea,
constipation
Hyperglycemia, hypokalemia
Dyspnea, hyperventilation
Vaginal Ring (NuvaRing)
hormonal
vaginal ring duration
The standard way to use the ring is you leave it in for 21 days, then remove it and have a 7-day ring-free break
vaginal ring care
mild soap and lukewarm water anytime you take it out of your vagina and before you put it back in
smoking and estrogen (throm my smoke)
Thrombolytic events are most serious adverse effects, smoking increases chances of thrombus
Review how to administer anticoagulant to prevent DVT
Heparin DVT Prophylaxis : 5000U SQ BID-TID
Use of 1/2 - 5/8 -gauge syringe at 90-degree angle SQ injection
Ensure that SC doses are given SC, not IM- never
SC doses should be given in areas of deep subcutaneous fat, and sites rotated
Check order before giving : ½ life is 1-2 hours
DO NOT massage
Not within 2 inches of umbilicus, abdominal incisions, open wounds, scars, drainage, tubes, stomas
Warfarin INR normal and therapeutic ranges (Theraputic INR War is as easy as 1,2,3)
Warfarin normal INR: 1
Warfarin therapeutic : 2-3.5
Review what LMWH is and reason to administer drug (low hep stops my DVTs)
(Lovenox & Fragmin)
SQ- stops factors in clotting cascade and prevents new clot formation ( DVT prophylaxis)
Review clopidrogel (Plavix) action (P for platelet) (plavix must die-phosphate)
Antiplatelet Drug
Action: ADP inhibitor, reduces the risk of thrombotic stroke(prophylaxis TIA- transient ischemic attacks)
-Heparin IV: OPD (IV is short and sweet)
Onset: immediate
Peak: immediate
duration: 2-6 hours
-Heparin SQ: OPD (Hep was 20, peaked at 24, and came back to 12)
Onset: 20-30 min
Peak: 2-4 hrs.
Duration: 8-12 hours
Rivaroxaban PO: OPD (river is 2 and 4, and died at 24)
Onset: 2hrs
Peak: 2-4 hrs.
duration: 24 hrs
- Warfarin PO: OPD (long days during war)
Onset: 1-3 days
Peak: 2-7 days
duration: 2-5 days
Review what is the priority of assessing a stroke patient
With a stroke patient you want to find out the time that they were last normal in order to ID the therapy window.
Will start antithromblytics if w/in 3-4 hrs, if longer will just treat symptoms.
Review sequent of priority of treatment for starting anticoagulation
b
Which anticoagulant drug does not have a therapeutic effect and why (alt please, the TSA is not theraputic)
TPA and Alteplase, because of short half life:5-10 minutes. Don’t need to monitor PT.
Objective of anticoagulant therapy
To prevent clot formation or thin blood to prevent thrombus forming
HIT - 2 types (Hit fast or slow?)
HIT = Heparin induced thrombocytopenia
2 types:
1. slow decrease in Plt
2. acute reduction > 50% of Plts
Review what lab test Factor Xa drug level is tested for
Heparin is monitored by activated partial thromboplastin times (aPTT) and Factor Xa
What is the risk of giving Vitamin K too fast (vitamin K is the heart) and how fast to administer?
It can cause anaphylactic shock or cause cardiac arrest
Should be diluted and administered over 30 minutes.
Warfarin resistance will also occur for 7 days
thrombolytics do what? (throm-lytics lyse and bust)
Thrombolytic drugs lyse the clot
Objective of anticoagulant therapy
To prevent clot formation or thin blood to prevent thrombus forming
What is important to know about NOT giving Heparin and LMWH
Together
it is a deadly/lethal dose
What are appropriate sites to give LMWH - you already know this
What are appropriate sites to give LMWH
Subcutaneous locations (SQ): abdomen, back of arms, dorsogluteal
NEVER IM. SQ doses should be given in areas of deep SQ fat and sited rotated.
Do not give SQ doses within 2 inches of the umbilicus, abdominal incisions, or open wound, scars, drainage tubes, stomas.
Do not aspirate SQ injections or massage injection sites. May cause hematoma formation.
INR normal range and theraputic range - warafin (theraputic war is as easy as 1,2,3)
Normal INR = 1
Therapeutic INR = 2-3.5
Review medication that is given as 1 shot for 3 months contraceptive coverage
Depo-Provera= 1 shot IM coverage for 3 months. Caution for under 24 years of age due to bone density. B/c can take calcium out of bones.
Clomiphene (Clomide, others) → Nonsteroidal ovulation stimulant (clomp out the estrogen and I’m ovulating)
Blocks estrogen receptors in the uterus and brain, resulting in a false signal of low estrogen levels. Increase production of Gonadotropin Releasing hormones (Gn-RH), FSH and LH. As a result, maturation of ovarian follicles is stimulated leading to ovulation and increased chance on conception:
Chorionic gonadotropin alfa (Ovidrel) MOA and where does it come from? (cryogenics rupture)
MOA:Causes rupture and ovulation of mature ovarian follicle and maintenance of corpus luteum. Used to stimulate ovulation. From pregnant female urine.
Naegele’s Rule (+1-3+7) year, month, day
Ex: last day of menstrual cycle was on June 20, 2020
LDM: 6/20/2020 + 1 year = 6/20/2021
Subtract 3 months: 6/20/2021 - 3 months = 3/20/2021
Add 7 days: 3/20/2021 + 7 days = 3/27/2021 (Baby Due Date)
Review BPH and surgery (prostate surgery is for twerps)
Benign prostatic hyperplasia (BPH) Nonmalignant (noncancerous) enlargement of the prostate gland. Also called benign prostatic hypertrophy.
symptoms: obstructed urinary outflow. Although surgical treatment by transurethral resection of the prostate (TURP) is a common strategy
5-alpha reductase inhibitor - moa and also treats what? (alpha and omega can stop testosterone) AND treats what else?
Inhibits enzyme converting testosterone to DHT more potent form of testosterone stimulates prostate growth
- Block the effects of endogenous androgens (testosterone)
-Used to treat benign prostatic hyperplasia (BPH)
May also be used for treatment of male-pattern baldness
Alpha -Adrenergic Blockers and BPH (adrene just eases BPH - smooth)
Used for symptomatic relief of obstruction caused by BPH*
Inhibits smooth muscle contractions – tx Htn & BPH
Serenoa repens, sabal serrulata (this is saw palmetto) (Serena loves BPH and alopecia)
Used for treatment of BPH and alopecia
Review Saw Palmetto - adverse affects (saw my headache, bladder, and back pain and I’ll raise you one)
Serenoa repens, sabal serrulata
Adverse effects: GI upset, Headache, Back pain, Dysuria.
The use of saw palmetto for the treatment of mild benign prostatic hyperplasia has been supported by scientific studies.
- True
- False: The answer is false.
Review if Testosterone requires tapering off and for how long (teste for a few weeks)
Gradually reducing your testosterone intake over several weeks may be the safest way to end treatment without as many negative drawbacks.
Testosterone - best absorption method/route and OPD (teste at age 30, peaked at 24, and 24 again)
pharmacokinetics : Testosterone gel:
Best route : Topical
Onset of action: 30 - 60 min
Peak plasma concentration: 2-4h
Elimination half life: 10- 100 min
Duration of action: 24h
Phosphodiesterase inhibitors - side effects (P - Phosphodiesterase = P - priapism)
Phosphodiesterase Inhibitors action of enzyme phosphodiesterase
- Precautions: common side effects include headache, congestion, and flushing. Serious side effects include priapism and hypotension. HA, dizziness, muscle pain, CP, HTN or Hypotension, N/V/D
- Prolonged erection >4 hrs= medical emergency
Review normal PSA value and what it can indicate (PSA tour at 2:30 and 3)
The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood.
Normal value: 2.5 – 3 ng/mL
Review rationale why priapism can be a medical emergency and the time frame.
Priapism = a painful prolonged erection of the penis.
Priapism or abnormally prolonged penile erection is a relatively uncommon, but possible, adverse effect of both the erictile disfunction drugs and the androgens. This condition is a medical emergency and warrants urgent medical attention. It is simply due to an excessive therapeutic drug response. Phosphodiesterase inhibitors can also cause unexplained visual loss.
> 4 hrs= medical emergency
Review what peliosis of the liver is and possible drug that can cause it (only one that has to do with liver)
Peliosis is a liver condition charecterized blood filled spaces due to the use of anabolic steroids.
Review virus that can cause cervical, oral, penile, and anal cancers
HPV: Oncogenic HPV infection
Approx 150 different types of HPV, majority asymptomatic
** No treatment, ONLY PREVENTION! (HPV vaccine)
is a chancre is painful and in what stage of syphilis does it present? % of patients that notice it?
Painless, Primary stage, unnoticed in 15-30% of pts
Syphilis - Primary stage - incubation period! (it’s primary by chance)
Primary: Incubation 10-90 days; HIGHLY INFECTIOUS,
Single Painless lesion or chancre: raised margins indurated 1-2 cm diameter, no exudate
Early: macule, papule Late: clean, painless, indurated ulcer with smooth firm borders
Syphilis treatment: (Phylis on millions of benzos and penicillin)
tx= Benzathine penicillin G 2.4 million units IM single dose
Chlamydia treatment - (100 docs to treat chlamydia) and is it asymptomatic?
can be asymptomatic in females and males
tx= Doxycycline 100mg PO two times per day for 7 days
Gonorrhea treatment (tria to treat gonhorrhea, a gram just this once)
tx= ceftriaxone 500mg IM single dose for persons<150kg
persons>150kg= 1gm cetriaxone
Syphilis treatment (Phylis) and how is it administered?
- tx= Benzathine penicillin G 2.4 million units IM single dose
Treatment is Penicillin G, administered parenterally, in all stages of syphilis - The preparation, dosage, and length of treatment will depend on the stage and clinical manifestations of the disease
- Treatment for late latent syphilis (greater than a year) and tertiary syphilis require longer duration because organisms are dividing more slowly
-Longer treatment for people with unknown duration to ensure they are treated adequately
Genital herpes treatment (Cure herpes with a big bicycle for 400)
Acyclovir: 400mg PO, TID/7days
or
Famciclovir or Valacyclovir
Pelvic Inflammatory Disease treatment (piddy tria only once; she has dox at the met)
Ceftriaxone 500mg IM x 1 dose
PLUS Doxycycline 100mg PO BID X 14 days
PLUS Metronidazole 500mg po BID x 14d
BV treatment - (Bev at the met with clind at 7, 5, 7 and cream!)
Metronidazole: 500 mg orally 2 times/day for 7 days
or
Metronidazole gel 0.75%: one full applicator (5 g) intravaginally, once daily for 5 days
or
Clindamycin cream 2%: one full applicator (5 g) intravaginally at bedtime for 7 days
chorionic - Ovidrel® PreFilled Syringe is administered when (cryogenics syringe when fish is ready)
monitoring of the patient indicates that sufficient follicular development has occurred in response to FSH
treatment for ovulation induction.
🞑 From pregnant female urine
uterine relaxants - Not my time - I= Indomethacin (I for indomethacin, I for anti - inflammatory)
I= Indomethacin-anti/inflammatory
uterine relaxants - It’s not my time - N= Nifedipine- (nifty, it also blocks calcium)
CCB calcium channel blocker
uterine relaxants - It’s Not My Time Yet M= Mag Sulfate (maggie relaxes)
relax smooth uterine muscle to prevent it from contracting
uterine relaxants - Not my time (T) Terbutaline (slows turbulant contractions)
BB, dec uterine contraction
female steroid hormones
estrogen and progestins
female pituitary gonadatropin hormones (fish for estrogen)
FSH (stimulate ovaries to produce estrogen) and LH (releases egg - ovulation)
Di-ethyl-stil-bestrol (Die ethyl, you’re toxic)
No longer available in U.S- used to prevent miscarriages but caused fetal death and toxemia
treatment for endometriosis (pro endometrosis)
progestins
progesterone - what does it do? (pro-gesterone is NOT pro-fsh, lh, or ovulation)
inhibits secretion of Pituitary Gonadotropins (FSH and LH) thus prevents ovulation
what to do if you miss a dose of provera?
If a dose is missed, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to the regular dosing schedule. Do not take 2 doses at once
🞑 If miss 2 active pill in 3 weeks or miss 3 or more in a
row. Instruct pt to throw out rest of pack and Start a new
pack that day.
oral contraceptives (phasics 1,2, and 3)
Monophasic, biphasic, and triphasic forms.
Oral contraceptive - Triphasic form (Tri to be normal)
most closely duplicates the normal hormonal levels of the female cycle*
contraceptives do what?
Decreased sperm movement and fertilization of
the ovum
🞑 Possible inhibition of implantation of a fertilized egg (zygote)
corpus luteum
a hormone-secreting structure that develops in an ovary after an ovum has been discharged but degenerates after a few days unless pregnancy has begun.
main purpose of fertility drugs
to produce ovulation
arterial clot formation 3 steps (art dinner)
Platelets initiate process.
Fibrin formation occurs.
RBCs are trapped in fibrin mesh.
venous clot formation (same as art dinner)
Platelet aggregation with fibrin that attaches to RBCs
Antiplatelet agents - just stop platelet formation - and used to treat what? just one thing
Inhibit platelet aggregation
Used to treat and prevent ischemic events
Anticoagulants (anti cascade)
Interfere with clotting factors in the clotting cascade
Therapy is primarily prophylactic ***prevent formation of clot
