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
aspirin is an
antiplatelet
anticoagulants have
Have no direct effect on a blood clot that is already
formed
anticoagulant goal
Goal is to thin blood to prevent thrombus
forming
Heparin & low-molecular-weight heparins action
Turnoff coagulation pathway & prevent clot formation
Warfarin (Coumadin®) Mechanism of action (at war with vitamin K) and blocks what factors?
inhibiting Vitamin K synthesis by bacteria in gut, which blocks
production of factors – 2, 7, 9 & 10
Low–molecular-weight heparins do not require
Do not require laboratory monitoring*
how long for theraputic effect of warafin?
2-7 days
Urokinase (anticoagulant) antidote (cape cod stops uro bleeding)
aminocaproic acid
Fibrinolytic Agents (fibrin is severe)
Bleeding occurring with these agents is more
severe than with anticoagulants and can be
difficult to control
Thrombolytic Drugs - adverse (thrombo lyses my hearto)
Cardiac dysrhythmias; can be dangerous
Thrombolytics (lysing and busting) - order of operation (ptt, hep, ptt, coum)
PO ASA, Check PTT lab, start Heparin, check PTT labs Q 6
hours, start coumadin in PM
c for acute
colchicine
cloptrogel (plavix) (antiplatelet) adverse affects
excessive bleeding (hemorrhage), chest pain, edema, abdominal pain, D/N, headache, fatigue, epistaxis (nose bleed), pruritus.
stroke - BEFAST
BEFAST→ Balance issue, eye sight change, facial drooping, arm weakness, speech difficulty, time to call for help.
HIT and ITP signs and symptoms (the same) what you memorized for skills final
spontaneous bleeding, nose, mouth, gums, any line or puncture sites. Nausea, vomiting, abdominal cramps, thrombocytopenia, & others
ITP (IT is attacking my platelets)
IdiopathicThrombocytopenia Purpura{ITP}
immune system attacks Platelets
mentropin (Pergonal) - what does it do? and where does it come from? (men stimulate ovulation and sperm after menopause)
🞑 Stimulates development of ovarian follicles, leading to ovulation
🞑 May also be given to men to stimulate spermatogenesis
🞑 From urine of post menopausal women
PT normal and therauputic ranges - warfarin (PT in heaven at 11)
Normal PT = 11-15 sec
Therapeutic PT = 1.5x normal
PTT normal and theraputic ranges - warfarin (Pitt at war around 25 to 35, and at peace at 45 - 70)
Ptt normal = 25-35 sec
Ptt therapeutic = 45-70 sec
depo-provera long-acting form of (just progesterone)
medroxyprogesterone.
clomiphene (clomp out the estrogen and I’m ovulating) side effects (clomping makes me sweaty and bloated)
Hot Flashes.
Bloating and Abdominal Discomfort. …
Weight Gain. …
Mood Swings. …
Nausea and Dizziness. …
Breast Tenderness.
chrionic gonadotropin alpha - side effects (too many babies)
TAchycardia,phlebitis, DVT (Sharpie moment)
CNS→Dizziness, headache, flushing, depression, anxiety, nervousness, fatigue,
GI→nausea, bloating, constipation
Other→ Urticaria, ovarian hyperstimulation, multiple pregnancy, blurred visions (blood pressure, microclot can get caught in eye) breast pain
bph treatment (alpha 5 prostate)
5-alpha reductase inhibitor and Alpha -Adrenergic Blockers
5-alpha reductase inhibitor examples (alpha in finland with a duster)
Finasteride (Proscar, Propecia®) and Dutasteride (Avodart®)
Alpha -Adrenergic Blockers -what doses for treatment of what? (adrene bald at 1, and prostate at 5)
1mg= Alopecia
5mg= BPH
saw palmetto - American DwarfPal - inhibits what? (the dwarf beats the alpha and testosterone wins)
(Sabal minor, commonly known as the dwarf palmetto)
Inhibits 5-Alpha reductase (DHT) - this shrinks or enlarges the prostate
phosphodiasterase examples (Phil on viagra is a disaster)
1- sildenafil (Viagra®) : First oral drug for tx of ED.
Longer Duration
2- vardenafil (Levitra®).
3- Tadalafil (Cialis®)
viagra generic name (viagra on the slide)
sildenafil
Levitra® generic name (parden varden, levitra)
vardenafil
Cialis® generic name (just a tad of cia)
Tadalafil
phosphodiasterase inhibitors - no what? (nitrates would be a disaster)
- No Nitrates cause severe Hypotension, may not respond to Tx.
phosphodiasterase inhibitors - nursing considerations? (abuse is a disaster)
- Nursing considerations: Assess patient knowledge, drug-drug interactions, the potential for abuse
syphilis 2ndary stage (2nd in 2nd week)
Secondary: 2-8 weeks after chancre appears; hematogenous dissemination of spirochetes
Rash-whole body includes palms/soles, mucous patches, fever, swollen lymph nodes, sore throat, HA, wt loss, fatigue, muscle aches, condylomata lata-highly infections, constitutional symptoms
syphilis - tierary stage (3 gums)
Tertiary: Neurosyphilis: tabes dorsalis
If not diagnosed/detected: cardiac involvement, gummatous lesions,
general paresis(muscle weakness)
Chlamydia trachomatis - manifestations (Clap is inflammed and has PID)
Mostly asymptomatic
🞑 cervicitis, urethritis, proctitis, lymphogranuloma venereum, and pelvic inflammatory disease
chlamydia complications (C for chlamydia and conjuncivitis)
Conjunctivitis, pneumonia
** Before birth, most women are tested for STI’s
Gonorrhea - males - symptoms and what percentage asymptomatic?
Urethritis– male Painful Urination
🞑 Sx: Dysuria and urethral discharge (5% asymptomatic)
Gonorrhea - females - incubation period and when do symptoms appear? (female gone in 10 days)
Endocervical canal primary site; UA culture
🞑 70-90% also colonize urethra
🞑 Incubation: unclear; sx usually in l0 d
gonhorrhea - Extra-genital infection mostly
asymptomatic!!
gonhorrhea general
Painful urination, Abd d/c penis & vagina
Men- testicular pain
Women- Abdominal pain
Sometimes “NO SYMPTOMS!!”
Mushroom Odor
Pus d/c drip white/yellow or green
ex of adreneric blockers (adrene has the flu)
ex. tamsulosin (Flomax®)
Review pediatric within normal limit (WNL) dosages for Tylenol
ACETAMINOPHEN (Tempra, Panadol, Generic)
Dosage: 15 mg / kg every 4-6 hours as needed.
oral anti-diabetic drugs - Metformin / Glucophage
Metformin / Glucophage - decrease production of glucose by the liver -
HgA1C levels
A normal A1C level is below 5.7 %
-a level of 5.7 % to 6.4 % indicates prediabetes,
and a level of 6.5 % or more indicates diabetes.
thyroid drug interactions (thyroid at WAR with the toins, antacids, and salt)
phenytoin, fosphenytoin, cholestyramine, antacids, calcium, salts, iron, estrogen, WARFARIN
trichomoniasis treatment (only the met can cure trick)
Metronidazole 500mg PO, BID X 7D
Men: 2 gm Metronidazole PO X 1 dose
Tinidazole 2 g orally in a single dose
trichomoniasis treatment (only tin and met can cure trick)
Tinidazole 2 g orally in a single dose
Review nadir neutrophil cell count and appropriate interventions
Neutrophil counts generally start to drop about a week after each round of chemotherapy begins. Neutrophil levels reach a low point about 7 to 14 days after treatment. This is called the nadir. At this point, you are most likely to develop an infection. (less than 500)
dwarf pal interactions (Just contraception)
Potential drug Rx= NSAD, estrogen replacement, oral contraception
what should pt get before using dwarf pal?
Pt should get a PSA (prostate screening test) test, and digital rectal exam before Tx – Baseline
oral anti-diabetic - Sulfonylureas and Glinides (so funny you stimulate insulin from my beta cells)
stimulate insulin secretion from the beta cells of the pancreas
oral antidiabetic - Thiazolidinediones (even insulin isn’t resistant to thia)
(TZD) - decrease insulin resistance
Review objective of therapy for HIV pts and CD4 cell within normal limit (WNL)
count -CD4 count:
500-1600: Normal
200-500: Beginning of HIV Illness
<200: AIDS
-Goal is to find the regimen that will best control the infection with a tolerable adverse effect profile. -Medication regimens change during the course of the illness.
STDs curable (stage C for cure)
syphilis, gonorrhoea, chlamydia and trichomoniasis.
incurable STDs (the Hs)
hepatitis B, herpes simplex virus (HSV), HIV and human papillomavirus (HPV).
ITP treatment (idiopathic thrombocytopenia) (kill IT with steroids)
steroids or Immune globulin
HIT treatment***(hit the leprachaun and arganot)
lepriudin and argatroban
Conjugated estrogens= (prim and conjugated)
Premarin (Enjuvia, Premarin)
THREE MAJOR ENDOGENOUS ESTROGENS: (dial, tone, tried all)
Estradiol (principle and most active), Estrone, Estriol
estrogen indications (estrogen can help cancer)
Atrophic vaginitis- thinning, drying & inflammation of vaginal walls
🞑 Hypogonadism
🞑 Oral contraception (given with a progestin)
🞑 Dysmenorrhea
🞑 “Hot f lashes” of menopause (vasomotor symptoms) 🞑
🞑 Breast & Prostate Cancer
🞑 Osteoporosis
estrogen indications
Treatment or prevention of disorders that result from estrogen deficiency
🞑 Uterine bleeding
🞑 Palliative treatment of advanced breast & prostate cancer 🞑 Osteoporosistreatment and prophylaxis
🞑 Many other indications
estrogen contraindications
Pregnancy, smoking, Any estrogen-dependent cancer
Undiagnosed abnormal vaginal bleeding Pregnancy
Active thromboembolic disorder or history of stroke, venous blood clot
estrogen adverse affects
thrombolytic events (most serious), Nausea (most common), Chloasma (hyperpigment of facial skin)-photosensitivity
progestin indications (pros can stop the miscarriage)
Treatment of functional uterine bleeding caused by:
🞑 Hormonal imbalance, fibroids, or uterine cancer
Treatment of primary and secondary amenorrhea,
palliative cancer & endometriosis
Prevent conception
Palliative treatment of some cancers and endometriosis
Prevention of threatened miscarriage- relaxing uterine smooth muscles
Alleviation of PMS symptoms
Premarin (Enjuvia, Premarin) (Prim during menopause)
Action: replace estrogen deficit
Classification: conjugated estrogens
Use: For symptoms of menopause. (Hot flashes,
vaginal dryness,etc.)
Also, for osteoporosis prevention and sometimes
part of cancer treatment in men and women
How supplied: Topicals, creams, tablets, rings and injections
premarin (Enjuvia) estrogen - precautions - (heart disease is not prim and proper)
Precaution: Not for pts w/ heart disease, abnormal vaginal bleeding, hormone dependent cancer - Side Effects: SOB, leg cramps, palpitations and bleeding
nuvaring
lasts for up to 5 weeks.You do not need to remove the vaginal ring during sexual or other activities unless you are more comfortable doing so. Within the 90-day dosage period, you may remove the vaginal ring, rinse it with clean lukewarm (not hot or boiling) water, and re-insert the ring as needed.
Men with trichomoniasis symptoms (trick men into epidymitis)
sometimes have symptoms of urethritis, epididymitis (inflammation at back of testicle), or prostatitis
women with trichomoniasis (tricks women with strawberries)
sometimes have vaginal discharge, which can be diffuse, malodorous, or yellow-green with or without vulvar irritation, and might have a strawberry-appearing cervix, which is observed more often on colposcopy than on physical examination
HPV vaccine (guard the HPV 24/7)
Gardasil 2/4 and Gardasil 9
virus that can cause cervical, oral, penile, and anal cancers -
Oncogenic HPV infection
metronidazole (Flagyl) adverse effects (seizure and low WBC at the met)
-seizures, peripheral neuropathy, prolong QT interval, candidiasis, transient leukopenia, neutropenia,
stomatitis, vaginitis, genital pruritus, dysmenorrhea, decrease libido DDI:
metronidazole drug interactions (war and the met don’t mix)
- Disulfiram - acute psychosis/confusion. - Cimetidine - risk of metronidazole toxicity - Busulfan - busulfan toxicity - Warfarin - increase anticoagulant effects, risk of bleeding
metronizadole teaching
- Sexual partners simultaneously treated to prevent reinfection (trichomoniasis) - Avoid alcohol during treatment and 3 days after - Metallic taste and dark/red-brown urine may occur - Report s/s of candidal overgrowth and a/e especially neurologic symptoms - Inform prescriber if pregnant or may become pregnant
contraceptive interactions***(ceph and penelope fought with birth control)
penicillin and Cephalosporins
oxytocin is what antagonist?
progesterone antagonist
Progesterone antagonist*- Politically charged
“ Abortion Pill” (misty is an antagonist)
Stimulates uterine contractions to induce abortion - mi-fe-pristone (Mifeprex®)
progesterone vs. progestin (IN = in the lab)
Progesterone is the naturally occurring hormone in the body, which originates from the ovaries and has various duties in the reproduction and menstruation cycles. Progestin is a synthetic, lab created hormone that is meant to mimic progesterone and act as it does in the body
uterine relaxants - what side?
Bed rest (be on left side - to keep flow of blood going), sedation, hydration
Magnesium sulfate IV***IT’s not my time (don’t need to know anything else on this slide)
Magnesium sulfate IV also used to stop labor**must have Ca-Glucanate to tx Mag toxic
Androgen Inhibitors (the alphas and gonad)
5-Alpha-reductase inhibitors
Alpha1-adrenergic blockers
Androgen receptor blockers
Gonadotropin-releasing hormone (Gn-RH)
Analogs
dont use what with erectile dysfunction?
nitrates
Pregnant women should not handle crushed or
broken finasteride tablets,
can cause
teratogenesis
veinous is
hot, arterial is cold
2 types of anti-platelets at the same time?
yes you can, can’t take 2 of the same kind.
Anticoagulants - C for
cascade
Ginko-Garlic-Ginger-Ginseng
can interfere and cause more clotting
never give any of these meds with an…
epidural
heparin monitored by…
APPT time. normal is within 30 - 40 seconds. Therauputic is 60 - 80. Just double it.
heparin test is
APTT
Vitamin K actual name
Phytonadione
Drug therapy with enoxaparin (Lovenox) must
be closely monitored with activated partial
thromboplastin times (aPTTs) lab tests.
false
LMWH examples - (The enox and dalton are low weight on mars)
enoxaparin (Lovenox®) and dalteparin (Fragmin®) (don’t need to monitor PTT)
Fibrinolytic Agents - bleeding is…(fibrins burn more)
more
severe than with anticoagulants and can be difficult to control
patient arrived in the emergency department 2
hours after a stroke & was given an
intravenous (IV) injection of Alteplase®. It is
most important for the nurse to monitor what?
(Select all that apply.)
- Bleeding
- Vital signs
- PT levels
- Allergic reactions
- Electrocardiogram
everything except 3 and 4
herpes, syphilis will have
sores
Syphilis treatment
penicillin, and retest after 3-6 months. may not be cured.
Trichomoniasis Vaginalis complication***(the trick is not have a premature birth)
premature birth
gram negative test
gonorrhea
Chorionic is what? (creepy cryogenics)
fertility drug
clomiphene does what? (don’t clomp my ovulation!)
induces ovulation
Antifibrinolytics do what? (Anti - key word)
Antifibrinolytics/ Hemostatic Drugs will cause/promote coagulation
clopidrogel trade name (gel for my plavix)
Plavix
(phosphodiasterase) Viagra generic name (slide into viagra, phil)
sildenafil
gonhorrhea - symptoms in women (you know this, ER) BUT the majority are…
Sx: majority asymptomatic; may have vaginal discharge,
dysuria, urination, labial pain/swelling, abdominal pain
complications of gonhorrea - women
Complications; Infertility, PID,joint & tissue
gonhorrea - males - incubation period (Gonorrhea for boys at 14)
🞑 Incubation: 1-14 d (usually 2-5 d)
gonhorrea males - complications (same as women)
Complications; Infertility, sterility, joint & tissue
pediatric WNL ibuprofen dose (IB is smaller)
IBUPROFEN (Motrin,® Advil®) *Not recommended under six months. Dosage: 10 mg / kg every 6-8 hours as needed.
malignant hypothermia antidote
dantrolene
HIT is slow or fast?
Heparin induced thrombocytopenia 1. Slow decrease in ptt
ex of fibrilolytic (fibrin is severe) agents (fiber ends in your ase)
alteplase, anistreplase, reteplase, streptokinase, tenecteplase, and urokinase
is chylamdia usually symptomatic, or asymptomatic?
asymptomatic
is herpes usually symptomatic, or asymptomatic?
asymptomatic
is BV usually symptomatic, or asymptomatic?
50% asymptomatic
is gonhorrea in women usually symptomatic, or asymptomatic?
asymptomatic
metronidazole (Flagyl) contraindications (liver at the met)
Hepatic disease, renal impairment, alcohol, 1st trimester
metronidazole (Flagyl) side effects
seizures, peripheral neuropathy, prolong QT interval, candidiasis, transient leukopenia, neutropenia
metronidazole increases the effects of what drug? (the war gets bigger at the met)
warfarin bleeding
Premarin (Enjuvia®, Premarin®)
replace estrogen deficit
Rivaroxaban (The river flows)
anticoagulant
how fast does chancre resolve? (take a chance in 1 - 5 weeks)
chancre resolves in 1-5 weeks
