Quiz 3 Non-diabetes endocrine and supplements Flashcards
Cholecalciferol Brand Name
Vitamin D3, Adrovance
Cholecalciferol Class
Vitamin D analogs (Nutriceutical Nutritive Agent)
Cholecalciferol Indications
Vitamin D deficiency
Refractory rickets (or vitamin D resistant rickets), hypoparathyroidism, and familial hypophosphatemia
Cholecalciferol General Mechanism of Action
Vitamin D3 regulates both the calcium and phosphate as well as citric acid metabolism, promotes the intestinal absorption of calcium and controls the incorporation of calcium into the organic bone matrix [13]. Vitamin D mediates intestinal calcium absorption by an active transport mechanism and also promotes normal bone formation [14].
Cholecalciferol Pregnancy Category
Fetal risk cannot be ruled out
Cholecalciferol Contraindications
Hypersensitivity, Hypercalcemia, Hypervitaminosis D, Hyperlipidemia, Hyperphosphatemia, Liver disease, renal impairment, renal osteodystrophy, sarcoidosis, arteriosclerosis, cardiac conditions, concurrent use of calcium-containing preparations, other vitamin D-containing preparations or vitaman D analogs, or thiazide diuretics
Cholecalciferol Black Box Warning
N/A
Cholecalciferol Key Counseling Points
Warn patient to report symptoms of hypercalcemia. Side effects with excessive use may include nausea, anorexia, weight loss, constipation, polyuria, polydispsia, hypertension, weakness, and muscle aches or stiffness. Instruct patient to maintain adequate intake of calcium with drug. Avoid additional vitamin D supplements.
Calcium; Cholecalciferol Class
Antacid, calcium containing
Calcium; Cholecalciferol Indication
Vitamin deficiency
Calcium; Cholecalciferol Pregnancy Category
NONE
Calcium; Cholecalciferol Contraindication
- Hypercalcemia
- Hypervitaminosis D
Calcium; Cholecalciferol Black Box Warning
NONE
Calcium; Cholecalciferol Counseling
- Overdose symptoms may include nausea, loss of appetite, thirst, urinating more or less than usual, body aches, stiffness, confusion, or irregular heartbeats.
- Ask a doctor or pharmacist before taking any multivitamins, mineral supplements, or antacids while you are taking cholecalciferol.
Cyanocobalamin Brand Name
Cobolin-M
Cyanocobalamin Class
Essential B Vitamin (B12)
Cyanocobalamin Indications
Cobalamin deficiency, normal absorption //
Cobalamin deficiency, malabsorption
Cyanocobalamin MoA
B12 is required for the synthesis of the amino acid methionine from homocysteine. A deficiency of B12 results in hyperhomocysteinemia and a decrease in methionine. Since methionine is required for DNA synthesis, B12 deficiency also results in decreased DNA synthesis, which presents clinically as macrocytic anemia when red blood cells are unable to extrude their nucleus
Cyanocobalamin Pregnancy Category
Pregnancy Compatible
Cyanocobalamin Contraindication
Hypersensitivity to cyanocobalamin or colbat
Cyanocobalamin Black Box Warning
N/A
Cyanocobalamin Key Counseling Points
May require several weeks for maximum effect. Take extended-release products with food. Avoid alcohol as it inhibits the absorption of B12.
Ergocalciferol Brand Name
Drisdol
Ergocalciferol Class
Vitamins, Fat-Soluble. Vitiman D analog
Ergocalciferol Indications
- hypoparathyroidism
- Refractory rickets (vitaman D resistant rickets)
- familial hypophosphatemia
Ergocalciferol MoA
After the activation of the vitamin D receptor, some of the biological changes produced by ergocalciferol include mobilization and accretion of calcium and phosphorus in the bone, absorption of calcium and phosphorus in the intestine, and reabsorption of calcium and phosphorus in the kidney
Ergocalciferol Contraindications
Hypercalcemia, malabsorption syndrome, abnormal sensitivity to the toxic effects of vitamin D, and hypervitaminosis D.
Ergocalciferol Black Box Warning
N/A
Ergocalciferol Counseling Points
Take by mouth as directed. Best absorbed when taken after a meal, but may be taken with or without food. If using liquid form of this medication, measure the dose using a special measuring device/spoon. Certain medications (bile acid sequestriants) can decrease the absorption of Vitamin D. Take your doses of these medications as far as possible from your doses of Vitaman D - at least 2 hours if possible.
Estradiol Brand Name
Estrace
Estradiol Class
Estrogen
Estradiol Indication
- Abnormal vasomotor function (moderate to severe)
- Atrophic vulva or vagina (moderate to severe), menopause
- Breast cancer, metastatic for palliation only
- Carcinoma of prostate, advanced, androgen-dependent, for palliation only
- Decreased estrogen level, secondary to hypogonadism, castration or primary ovarian failutre
- Postmenopausal osteoporosis, prophylaxis
Estradiol MoA
Estradiol (17β-estradiol; E2) is the most potent of the naturally occurring estrogens and the major estrogen secreted during the reproductive years. Estradiol and other estrogens produce characteristic effects on specific tissues (such as breast), cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, and accelerate epiphyseal closure after initial growth stimulation.
Estradiol Pregnancy Category
Contraindicated
Estradiol Contraindication
Hypersensitivity to estradiol; history of thromboembolic disorders, breast cancer, any estrogen-dependent neoplasm, known or suspected pregnancy
Estradiol Black Box Warning
Endometrial and breast cancer risk, dementia risk; should not be used to reduce CV risk; secondary exposure risk (transdermal solution)
Estradiol Counseling Points
Report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder. Do not smoke during therapy, as this increases the risk of thromboembolic events.
Ethinyl Estradiol; Desogestrel Class
Contraceptive, Estrogen
Ethinyl Estradiol; Desogestrel Indication
- Contraception
Ethinyl Estradiol; Desogestrel MoA
The contraceptive effect of desogestrel/ethinyl estradiol is based on interaction of various factors, the most important of which is ovulation inhibition and changes in cervical secretion [467]. Desogestrel/ethinyl estradiol is a combination of oral contraceptives that acts by suppressing gonadotropins. This activity leads to inhibition of ovulation, changes in cervical mucus and endometrium, thus, preventing fertilization and implantation [3]. Ethinyl estradiol is a well-known synthetic estrogen. Desogestrel is a synthetic progestogen. After oral administration it has a strong ovulation-inhibiting activity, a strong progestational and anti-estrogenic activity, no estrogenic activity, very weak androgenic/anabolic activity
Ethinyl Estradiol; Desogestrel Pregnancy Category
Contraindicated (I would hope so)
Ethinyl Estradiol; Desogestrel Contraindication
Blood pressure 160mm Hg or greater systolic or 100 mmHg or greater diastolic, persistent. Carcinoma of the breast, known or suspected, or personal history. Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia. Cerebral vascular or coronary artery disease, current or history.Cholestatic jaundice of pregnancy or jaundice with prior hormonal contraceptive use.Concomitant hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. Deep vein thrombophlebitis or thromboembolic disorders, past history. Diabetes with vascular involvement. Genital bleeding, undiagnosed abnormal. Headaches with focal neurological symptoms. Smoke, if over age 35. Heavy cigarette smoking. Hepatic adenomas or carcinomas or active liver disease. Hepatocellular disease with abnormal liver function. Hypersensitivity to any component of these products. Hypertension, severe. Major surgery with prolonged immobilization. pregnancy, known or suspected. Thrombophlebitis, valvular heart disease. inherited or acquired hypercoagulopathies
Ethinyl Estradiol; Desogestrel Black Box Warning
Oral: Smoking is not advised in women using oral contraceptives. Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age
Tablet: Ortho-Cept(R): Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. This risk increases with age and with the number of cigarettes smoked and is quite marked in women over 35 years of age. Use of combination oral contraceptives is not recommended in women who are over 35 years of age that smoke [5].
Velivet(TM): Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use oral contraceptives should be strongly advised not to smoke [9].
Desogen(R): Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs are contraindicated in women who are over 35 years of age, and smoke
Ethinyl Estradiol; Desogestrel Key Counseling Points
Report upcoming elective surgeries, prolonged periods of immunocilization, or recent childbirth as this may increase the risk of blod clots. Side effects may include nausea, vomiting, breakthrough bleeding, weight gain, breast tenderness, headache, and migraine. Caution patient to report symptoms of blood clots, liver tumors, or high blood pressure. Report persistent bleeding. Counsel patient to report changes in vision or difficulty with contact lens wear. Advise patient to report symptoms of fluid retention. Take drug at the same time every day and do not allow mroe than 24 hours between doses. Use a non-hormonal backup form of contraception for the first 7 days. Do not smoke during baby .Encourage to patient not smoke during therapy. Instruct patient that if a single active dose is missed take the tablet as soon as possible and resume a normal schedule. If more than one active dose is missed, contact a physician for instructions. Use of additional nonhormonal methods of contraception may be necessary
Ethinyl Estradiol; Drospirenone Class
Contraceptive, Contraceptive combination
Ethinyl Estradiol; Drospirenone Indication
- Acne (Moderate) - contraception
- Contraception
- Contraception - Premenstrual dysphoric disorder
Ethinyl Estradiol; Drospirenone MoA
The contraceptive effect of drospirenone/ethinyl estradiol is based on interaction of various factors, the most important of which is ovulation inhibition and changes in the endometrium [485]. Drospirenone/ethinyl estradiol is an combination oral contraceptive (COC) that works primarily by suppressing ovulation. Additionally, COC agents cause cervical mucus changes that block sperm penetration and endometrial changes that reduce the chance of implantation [482][483]. Although the exact mechanism of action in acne is unknown, drospirenone and ethinyl estradiol increase sex hormone binding globulin and decrease free testosterone, which may play a role
Ethinyl Estradiol; Drospirenone Pregnancy
Contraindicated
Ethinyl Estradiol; Drospirenone Contraindication
A) Adrenal insufficiency
B) Breast cancer or other estrogen or progestin-sensitive cancer, current or past history
C) Cerebrovascular disease
D) Concomitant use with hepatitis C drug combinations containing ombitasvir, paritaprevir/ritonavir, with or without dasabuvir
E) Coronary artery disease
F) Deep vein thrombosis or pulmonary embolism, current or past history
G) Diabetes mellitus with vascular disease
H) Headaches with focal neurological symptoms or migraine headaches with or without aura if over age 35 years
I) Hepatic dysfunction
J) Hepatic tumors, benign or malignant
K) Hypercoagulopathies, inherited or acquired
L) Hypertension, uncontrolled
M) Pregnancy
N) Renal insufficiency
O) Smoking and over age 35 years
P) Thrombogenic valvular or thrombogenic rhythm diseases of the heart (eg, subacute bacterial endocarditis with valvular disease or atrial fibrillation)
Q) Uterine bleeding, undiagnosed, abnormal
Ethinyl Estradiol; Drospirenone Black Box Warning
Cigarette Smoking and Serious Cardiovascular Events
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke [6][7].
Ethinyl Estradiol; Drospirenone Counseling
Patients over 35 years of age should not smoke during therapy, as this increases the risk of serious cardiovascular side effects. [6][7]
Advise patient to practice safe sex. Drug does not prevent disease transmission. [6][7]
Discuss potential long-term adverse effects of hormone therapy including myocardial infarction, stroke, thrombophlebitis, dementia, venous thromboembolism (VTE), pulmonary embolism, and breast cancer. Inform patient that risk of VTE is greatest after initially starting therapy or restarting therapy after a 4-week or greater pill-free interval. [6][7]
Drug may cause premenstrual syndrome, headache/migraine, breast pain/tenderness/discomfort, nausea/vomiting, fatigue, abdominal pain/tenderness/discomfort, weight gain, and mood changes. [6][7]
Instruct patient to report signs/symptoms of serious cardiovascular events, such as myocardial infarction, stroke, and arterial or venous thrombosis. [6][7]
Patient should report new headaches that are persistent, severe, or recurrent, abnormal vaginal bleeding, amenorrhea of 2 or more consecutive cycles, or jaundice. [6][7]
Patients should report any unexplained partial or complete loss of vision. In addition, patients who wear contact lenses should report visual changes or changes in lens tolerance. [6][7]
This drug should be taken every day, at the same time each day, in the exact order noted on the packaging. [6][7]
Advise patient to use a nonhormonal back-up form of contraception for the first 7 days if a Sunday-start regimen is initiated or if drug is started postpartum but before menstruation resumes. [6][7]
Advise patient that certain drugs may cause oral contraceptives to be less effective and backup contraception may be necessary. Consult healthcare professional prior to new drug use. [6][7]
Review with the patient the procedure for handling missed doses. It is very important that the patient follow carefully missed-dose instructions for the particular brand or formulation prescribed in order to prevent pregnancy. [6][7]
Ethinyl Estradiol; Levonorgestrel Class
Contraceptive, Contraceptive combination
Ethinyl Estradiol; Levonorgestrel Indication
- Contraception
Ethinyl Estradiol; Levonorgestrel MoA
Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus) and the endometrium (which reduce the likelihood of implantation) [480][481].
Ethinyl Estradiol; Levonorgestrel Pregnancy Category
Contraindicated
Ethinyl Estradiol; Levonorgestrel Contraindication
A) Acute viral hepatitis, or severe (decompensated) cirrhosis [6]
B) BMI greater than or equal to 30 kg/m(2)
C) Carcinoma of the breast, known, suspected, or personal history
D) Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia
or progestin-sensitive cancer, current or past
E) Cerebrovascular or coronary artery disease, current or past history
F) Cholestatic jaundice of pregnancy or jaundice with prior pill use
G) Concomitant hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
H) Deep vein thrombophlebitis or thromboembolic disorders (eg, pulmonary embolism), current or history of
I) Diabetes with vascular disease
J) Diabetes mellitus and are over age 35, diabetes mellitus with hypertension or other end-organ damage, or diabetes mellitus of greater than 20 years duration
K) Genital bleeding, undiagnosed, abnormal
L) Headaches with focal neurological symptoms
M) Hepatic adenomas or carcinomas or other liver tumors, benign or malignant
N) Hypersensitivity to any of the product components
O) Liver disease, active
P) Major surgery with prolonged immobilization
Q) Migraines with aura
R) Migraines with or without aura and older than 35 years
S) Pregnancy, known or suspected Smoking and older than 35 years
U) Thrombogenic rhythm disorders
V) Thrombophilias, hereditary or acquired
W) Thrombophlebitis or thromboembolic disorders
X) Uncontrolled hypertension or hypertension with vascular disease
Y) Undiagnosed abnormal uterine bleeding
Z) Valvular heart disease with thrombogenic complications
Ethinyl Estradiol; Levonorgestrel Black Box Warning
Oral (Tablet)
a) Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. This risk increases with age, particularly in women older than 35 years, and with the number of cigarettes smoked. Women who use oral contraceptives should be strongly advised not to smoke
2) Transdermal (Patch, Extended Release)
a) Warning: Cigarette Smoking and Serious Cardiovascular Events and Contraindicated in Women with BMI greater than or equal to 30 kg/m(2)
Cigarette Smoking and Serious Cardiovascular Events
Cigarette smoking increases the risk of serious cardiovascular events from combined hormonal contraceptive (CHC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, CHCs, including levonorgestrel/ethinyl estradiol, are contraindicated in women who are over 35 years of age and smoke.
Contraindicated in Women with a BMI greater than or equal to 30 kg/m(2)
Levonorgestrel/ethinyl estradiol is contraindicated in women with a BMI greater than or equal to 30 kg/m(2). Compared to women with a lower BMI, women with a BMI greater than or equal to 30 kg/m(2) had reduced effectiveness and may have a higher risk for venous thromboembolism events (VTEs)[6].
Ethinyl Estradiol; Levonorgestrel Counseling
Inform patient of serious long-term adverse effects of hormone therapy including myocardial infarction, stroke, deep vein thrombosis, pulmonary embolism, dementia, and breast or endometrial cancer [6][19].
Advise patient to report symptoms of pregnancy, including amenorrhea that occurs in 2 or more consecutive cycles, and to discontinue use if pregnancy is confirmed
Oral side effects may include elevated blood pressure, headache, migraines, enlarged or tender breasts, dizziness, mood changes, nausea and pancreatitis [19].
Transdermal side effects may include application site disorders, nausea, headache, dysmenorrhea, and increased weight.
Tell patient to report persistent or prolonged vaginal bleeding.
Instruct patient to report any unexplained partial or complete loss of vision and patient who wears contact lenses to report visual changes or changes in lens tolerance.
Advise patient to use a non-hormonal backup form of contraception for the first 7 days of use.
Counsel patient to take oral tablets at the same time each day.
Instruct patient using transdermal patch to avoid frequent or prolonged water exposure and large amounts of body lotions or oils and to check for partial or complete detachment once daily and also after water exposure.
Tell patient to avoid smoking cigarettes during therapy.
Instruct patient to avoid St. John’s Wort during therapy.
Counsel patient to contact healthcare professional for instructions if a dose is missed and that additional contraception may be required in the event of a missed dose.
Ethinyl Estradiol: Norethindrone Class
Contraceptive, Estrogen
Ethinyl Estradiol: Norethindrone Indication
Contraception
Ethinyl Estradiol: Norethindrone MoA
Combined oral contraceptives suppress gonadotropins to prevent pregnancy. Inhibition of ovulation is the primary mechanism by which pregnancy is prevented. Gonadotropin suppression also changes the cervical mucus, increasing the difficulty of sperm entry into the uterus, and altering the endometrium to reduce the likelihood of implantation
Ethinyl Estradiol: Norethindrone Pregnancy Category
Contraindicated
Ethinyl Estradiol: Norethindrone Contraindication
A)Blood pressure 160 mmHg or greater systolic or 100 mgHg or greater, persistent
B) Carcinoma of the breast, known or suspected, or personal history of breast cancer
C) Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia
D) Cerebral vascular or coronary artery disease, current or history
E) Cholestatic jaundice of pregnancy or jaundice with prior pill use
F) Concomitant hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
G) Deep vein thrombophlebitis or thromboembolic disorders, past history
H) Diabetes with vascular involvement
I) Genital bleeding, undiagnosed abnormal
J) Headaches with focal neurological symptoms
K) Hepatic adenomas or carcinomas
L) Hepatocellular disease with abnormal liver function, acute or chronic
M) Hypersensitivity to any component of the product
N) Hypertension, uncontrolled
O) Major surgery with prolonged immobilization
P) Pregnancy, known or suspected
Q) Thrombophlebitis, thromboembolic disorders, or known thrombophilic conditions
R) Valvular heart disease with complications
Ethinyl Estradiol: Norethindrone Black Box Warning
1) Oral (Tablet)
Modicon(R), Ortho-Novum(R):
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, combination oral contraceptives, including norethindrone/ethinyl estradiol, should not be used by women who are over 35 years of age and smoke.
Ovcon 35(R):
Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with the extent of smoking (in epidemiologic studies, 15 or more cigarettes per day was associated with a significantly increased risk) and is quite marked in women over 35 years of age. Women who use oral contraceptives should be strongly advised not to smoke.
Ethinyl Estradiol: Norethindrone Counseling Points
Advise patient to practice safe sex. Drug does not prevent disease transmission.
Discuss potential long-term adverse effects of hormone therapy including myocardial infarction, stroke, thrombophlebitis, dementia, pulmonary embolism, or breast cancer.
This drug may cause chloasma, change in weight, bloating, nausea, stomach cramps, vomiting, migraine, depression, amenorrhea, breakthrough bleeding, breast tenderness or swelling, or nipple discharge.
Tell patient to report persistent/recurrent abnormal vaginal bleeding.
Patients should report any unexplained partial or complete loss of vision. In addition, patients who wear contact lenses should report visual changes or changes in lens tolerance.
This drug should be taken every day, at the same time each day with not more than 24 h between doses.
Advise patient to use a non-hormonal backup form of contraception for the first 7 days if a Sunday-start regimen is initiated.
Patients should not smoke during therapy, as this increases the risk of serious cardiovascular side effects.
Review with the patient the procedure for handling missed doses. It is very important that the patient follow carefully missed-dose instructions for the particular brand or formulation prescribed in order to prevent pregnancy. In many cases, this will necessitate the use of a back-up method of contraception until the regular schedule has been reestablished.
If patient is still unsure of what to do in the event of a missed dose, patient should use a back-up form of contraception and contact healthcare professional for instructions.
Ethinyl Estradiol: Norgestimate Class
Contraceptive, Endocrine-Metabolic Agent
Ethinyl Estradiol: Norgestimate Indication
Acne - Contraception
Contraception
Ethinyl Estradiol: Norgestimate MoA
Ethinyl estradiol, an estrogen, and norgestimate, a progestin, are a combination product that reduces the possibility of pregnancy primarily via suppression of ovulation; although, other mechanisms may include changes in cervical mucus that inhibit sperm penetration and in the endometrium that reduce the chances of implantation. The exact mechanism involved in the treatment of acne is not established, but may be related to increase of sex hormone-binding globulin and reduction of free testosterone
Ethinyl Estradiol: Norgestimate Pregnancy Category
Contraindicated
Ethinyl Estradiol: Norgestimate Contraindication
A)Arterial or venous thrombotic diseases, patients at high risk
B) Breast cancer or other estrogen-or progestin-sensitive cancer, history of or current
C) Cerebrovascular disease
D) Concomitant hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir
E) Coronary artery disease
F) Diabetes mellitus with vascular disease
G) DVT or pulmonary embolism, history of or current
H) Headaches with focal neurological symptoms
I) Hypercoagulopathies, inherited or acquired
J) Hypertension, uncontrolled
K) Liver disease or liver tumors, benign or malignant
L) Migraine headaches in patients older than 35 years
M) Migraine headaches with aura
N) Pregnancy
O) Smoking, women older than 35 years
P) Thrombogenic valvular or thrombogenic rhythm diseases of the heart (eg, atrial fibrillation or subacute bacterial endocarditis with valvular disease)
Q) Uterine bleeding, undiagnosed abnormal
Ethinyl Estradiol: Norgestimate Black Box Warning
1) Oral (Tablet)
Cigarette Smoking and Serious Cardiovascular Events
Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use.
This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked.
For this reason, combination oral contraceptives are contraindicated in women who are over 35 years of age and smoke
Ethinyl Estradiol: Norgestimate Counseling Points
Warn patient to report symptoms of venous or arterial thrombosis.
Instruct patient to report symptoms of gallbladder disease or jaundice.
Counsel patient to report any irregularities in vaginal bleeding.
Side effects may include headache, migraine, abdominal pain, flatulence, vaginal infection, genital discharge, breast discharge, breast pain or enlargement, mood disorders, nervousness, chloasma, and weight changes.
Advise patient to take tablet at the same time every day.
Instruct patient that if a single active dose is missed, including vomiting or diarrhea within 3 to 4 hours after the active dose, take the tablet as soon as possible and resume a normal schedule. If more than one active dose is missed, contact a physician for instructions. Use of additional nonhormonal methods of contraception may be necessary.
Ferrous Sulfate Class
Iron Supplement, Mineral Supplement
Ferrous Sulfate Indication
Iron deficiency
Ferrous Sulfate MoA
Ferrous sulphate contains iron and most of the iron in the body is present as haemoglobin. The remainder is present in the storage forms ferritin or hemosiderin, in the reticuloendothelial system or as myoglobin with smaller amounts occurring in haem-containing enzymes or in plasma bound to transferrin
Ferrous Sulfate Pregnancy Category
None
Ferrous Sulfate Contraindicated
Specific Indications have not been
1) anemia other than iron-deficiency anemia
2) hemochromatosis
3) hemosiderosis
4) hypersensitivity to iron products
Ferrous Sulfate Black Box
Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately
Ferrous Sulfate Counseling Points
Works best when taken on an empty stomach. If there is a stomach ache, try with food. Most people feel better after taking it for 1 week. May take up to 4 weeks to feel full effect. Common side effects include feeling or being sick, constipation, and diarrhoea
Do not chew or crush - administer with a full cup of water or juice on an empty stomach. If we miss a dose, take it as soon as you remember. But if it’s close to your next dose, skip it and take it when you are usually suppose to
Folic Acid Brand Name
FA-8
Folic Acid Class
Essential B Vitamin
Folic Acid Indication
Folic acid deficiency
Folic Acid MoA
Folic acid is required for the conversion of deoxyuridylate to thymidylate, which is a rate-limiting step in DNA synthesis. Folic acid deficiency presents clinically as macrocytic anemia when red blood cells are unable to extrude their nucleus.
Folic Acid Pregnancy Category
None
Folic Acid Contraindication
Hypersensitivity
Folic Acid Black Box Warning
N/A
Folic Acid Counseling Points
May require several weeks for maximum effect. Avoid alcohol as it inhibits the absorption of folic acid.
Levothyroxine Brand Name
Synthroid
Levothyroxine Class
Thyroid supplements
Levothyroxine Indication
- Hypothyroidism
- Thyroid-stimulating hormone suppression, pituitary
Levothyroxine MoA
Levothyroxine sodium is a synthetic thyroid hormone. The endogenous thyroid hormones, T3 and T4, diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. This hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins.
Levothyroxine Pregnancy Category
Compatible
Levothyroxine contraindication
Hypersensitivity, nontoxic diffuse goiter or nodular thyroid disease, thyrotoxicosis, AMI, treatment of obesity or weight loss, uncorrected adrenal insufficiency; may precipitate acute adrenal crisis
Levothyroxine Black Box
Not for weight reduction
Levothyroxine Counseling points
May require 6-8 wk for symptomatic improvement. Avoid abrupt discontinuation. Take on an empty stomach, with water at least 30 min before food. Avoid antacids and iron within 4 h of dose.
Methimazole Brand Name
Tapazole
Methimazole Class
Thionamides, Antithyroid Agents
Methimazole Indication
- Hyperthyroidism
- Graves disease, Thyrotoxicosis
- Patients with toxic multinodular goiter who are poor candidates for surgery or radioactive iodine therapy.
- Thyrotoxicosis, Drug-induced
Methimazole MoA
It is used to treat overactive thyroid (hyperthyroidism). It prevents the thyroid gland from making too much thyroid hormone. It interferes with the step that causes the iodination of tyrosine residues in thyroglobulin, mediated by the enzyme thyroid peroxidase, thus preventing the synthesis of thyroxine (T4) and triiodothyronine(T3)
Methimazole, a thyroid hormone synthesis inhibitor, is used in the treatment of hyperthyroidism. Its actions are similar to propylthiouracil although it does not inactivate the existing thyroxine and triiodothyronine stored in the thyroid or in the blood
Methimazole Pregnancy Category
Fetal risk cannot be ruled out
Methimazole Contraindication
Hypersensitivity
Methimazole Black Box
N/A
Methimazole Counseling Points
Immediately report any symptoms of agranulocytosis. Prompty report symptoms of vasculitis (e.g. new rash, hematuria, decreased urine output, dyspnea, or hemoptysis). Side effects may include urticaria, nausea, vomitting, epigastric distress, arthralgia, paresthesia, loss of taste, abnormal loss of hair, myalgia, headache, pruritus, drowsiness, neuritis, edema, vertigo, and skin pigmentation. Instruct patient to report symptoms of hepatotoxicity, hypothyroidism, drug fever, a lupus-like syndrome, or insulin autoimmune syndrome
Norethindrone Brand Name
Errin, Camila, Golivette, Lyza, Nora-BE, Nor-QD, Ortho Micronor
Norethindrone Class
Contraceptive, Progestin
Norethindrone Indication
- Pregnancy Prevention (oral contraceptive)
- Women with secondary amenorrhea (absence of menstral period in women who have previously had a menstrual period who are not pregnant), endometriosis, and irregular menstrual periods cause dby hormonal imbalance
Northindrone MoA
Norethindrone is a progestin contraceptive that prevents ovulation, inhibits sperm penetration by thickening the cervical mucus, reduces the midcycle luteinizing hormone and follicle-stimulating hormone peaks, delays the movement of ovum through the fallopian tube, and alters the endometrium lining [4]. Norethisterone has progestational action similar to those of progesterone, but is a more potent inhibitor of ovulation and has weak oestrogenic and androgenic properties. It is used to treat a number of disorders of the menstrual cycle
Northindrone Pregnancy Category
Contraindicated
Northindrone Contraindication
Abnormal and diagnosed genital bleeding, acute liver disease, benign or maligant liver tumors. Carcinoma of the breast, hypersensitivitity to any component of the product, pregnancy.
Northindrone Black Box Warning
N/A
Northindrone Counseling Points
Side effects include nausea, dizziness, headache, breast, tenderness, or irregular periods. Tell patient to report persistent or recurrent abnormal vaginal bleeding, amenorrhea, or severe abdominal pain. Advise patient to take drug every day, at the same time of day, with no more than 24 hours between doses, including durin bleeding episodes. Avoid smoking during therapy as this increases the risk of heart attack or stroke. Use an alternative non-hormonal or back-up method of contraception while taking St. John’s wort and for 28 days after discontinuing St. John’s wort. If a dose is missed by 3 hours or more, take the missed pill as soon as remembered, then resume normal schedule, and use a backup method (eg, condom and spermicide) for 48 hours
Potassium Chloride Brand Name
Klor-Con
Potassium Class
Electrolyte, potassium
Potassium Indication
Hypokalemia, Hypokalemia, prophylaxis
Potassium MoA
Potassium is an electrolyte required for maintenance of the excitatory properties of neuromuscular tissues, and the resting membrane potential of cells is related to potassium concentrations, varying directly with the ratio of intracellular to extracellular potassium level.
Potassium Pregnancy Category
Compatible
Potassium Contraindication
Hypersensitivity to potassium, acute renal failure, structural, pathologic, or pharmacologic causes that delay tablet passage through the GI tract, hyperkalemia, Addison disease, acute dehydration
Potassium Black Box
N/A
Potassium Counseling Points
Take with food. Take the powder, granule, or oral liquid only after mixing in 4 oz of water or juice. Crush or break only specifically designed extended-release formulations. Capsules may be opened, sprinkled on apple sauce, and ingested immediately. Completely dissolve effervescent tablets in liquid and sip slowly over a 5-10 min period.
Progesterone Brand Name
Prometrium
Progesterone Class
Progestin Hormone
Progesterone Indication
- Prevention of estrogen-induced endmetrial hyperplasia
- Secondary physiologic amenorrhea
- Assisted reproduction for infertile women
Progesterone MoA
Progesterone transforms proliferative endometrium into secretory endometrium. Parenterally administered progesterone inhibits gonadotropin production, which in turn prevents follicular maturation and ovulation.
Progesterone Pregnancy Categories
Weight risks and benefits
Progesterone Contraindication
Abnormal vaginal bleeding, history of estrogen- or progesterone-dependent neoplasia, active or history of DVT or PE, known or suspected pregnancy (oral only)
Progesterone Black Box Warning
Cardiovascular disorders, breast cancer, dementia risk, risk versus benefits
Progesterone Counseling Points
Menstrual bleeding should occur 3-7 d after last dose. Report if menstruation does not occur within 7 d after last dose. For vaginal formulation, avoid using other vaginal drugs within 6 h before or 6 h after using progesterone.
Testosterone Brand Name
AndroGel
Testosterone Class
Androgen, C-III
Testosterone Indication
Hypogonadism
Testosterone MoA
Testosterone is an endogenous androgen. Androgens are responsible for normal growth and development of male sex organs. Testosterone is involved in the growth and maturation of the prostate, seminal vesicles, penis, and scrotum; development of male hair distribution; laryngeal enlargement; vocal cord thickening; alterations in body musculature; and fat distribution.
Testosterone Pregnancy Category
Contraindicated
Testosterone Contraindication
Hypersensitivity to testosterone; men with breast or prostate cancer; women who are pregnant, who may become pregnant, or who are breast-feeding
Testosterone Black Box Warning
Secondary Exposire
Testosterone Counseling Points
Gel to be applied to clean, dry, intact skin of the shoulders and upper arms and/or abdomen but should not be applied to genitals. Gel should be allowed to dry well; swimming and showering should be avoided for 5-6 h after application. Patients should keep application site covered, as direct skin contact can transfer drug to others. Virilization has been reported in children who were secondarily exposed to testosterone gel (coming in contact with bare skin around gel application site). Male patients should report too frequent or persistent erections. Female sexual partners of patients using drug should report male-like changes. Do not use higher doses than you have been prescribed, or combine with other anabolic steroids, serious adverse effects can occur. Seek medical attention if chest pain, shortness of breath, signs of stroke, or behavioral changes.
Thyroid Brand Name
Armour Thyroid
Thyroid Class
Thyroid supplements
Thyroid Indication
Hypothyroidism
Thyroid MoA
Thyroid hormone is a naturally derived thyroid replacement containing both levothyroxine (T4) and liothyronine (T3). The endogenous thyroid hormones, T3 and T4, diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. This hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins.
Thyroid Pregnancy Category
Compatible
Thyroid Contraindication
Hypersensitivity to thyroid, nontoxic diffuse goiter or nodular thyroid disease, thyrotoxicosis, AMI, treatment of obesity or weight loss, uncorrected adrenal insufficiency; may precipitate acute adrenal crisis
Thyroid Black Box Warning
Ineffective and potentially toxic when used for weight loss
Thyroid Key Counseling Points
May require 6-8 wk before symptoms improve. Do not stop using this medicine suddenly without asking your doctor; may need to slowly decrease dose before stopping it completely. Take on an empty stomach, with water.
