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Reproductive and Genitourinary drugs Flashcards

1
Q

oral contraceptives - combination estrogen/progesterone prototype and other drug names

A

ethinyl estradiol and drospirenone (Yasmin)
Others: ethinyl estradiol and norethindrone (Ortho-Novum 1/35)

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2
Q

combo oral contraceptives EPA

A

suppresses secretion of FSH and LH, thus preventing ovulation. Progesterone thickens cervical mucus; prevents endometrium thickening. Drospirenone works similarly to spironolactone thereby decreasing ankle edema and treating PMS symptoms

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3
Q

combo oral contraceptives administration

A

PO at the same time every day

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4
Q

combo oral contraceptives therapeutic use

A

pregnancy prevention; PMS symptoms; stabilize menses; prophylactic uterine/ovarian cancer, PID, ovarian cysts

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5
Q

combo oral contraceptives ADRs

A

thromboembolism, abnormal uterine bleeding, promote growth of existing breast cancer, potential risk for HTN, hyperkalemia (drospirenone)

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6
Q

combo oral contraceptives contraindications and interactions

A

Pregnancy - teratogenic
BRCA1 gene mutation
ACE inhibitors
Many drug interactions: Rifampin, anti-seizure, and antifungal decreased effectiveness

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7
Q

combo oral contraceptives RN intervention and client education

A

Confirm absence of pregnancy FIRST
Additional method of birth control during 1st cycle of pills
Avoid salt substitutes (drospirenone)
Monitor K+ due to potential for hyperkalemia (drospirenone)
Monitor BP
Monitor for s/sx of DVT/PE/MI/Stroke
Avoid smoking
Monitor pattern and amount of uterine bleeding

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8
Q

contraceptives IUD prototype

A

levonorgestrel (Mirena) same drug as Plan B

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9
Q

estrogen and progesterone HRT prototype and other drug names

A

conjufated estrogen and medroxyprogesterone acetate (Prempo)
Others: transdermal combination of estradiol and norethindrone (CombiPatch)

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10
Q

estrogen and progesterone HRT EPA

A

binds to estrogen receptors and substitutes the fluctuating amounts of estrogen into a more stable amount of estrogen to prevent symptoms. Adding in progesterone suppresses tissue growth in the uterus thereby preventing hyperplasia of uterine lining

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11
Q

estrogen and progesterone HRT adminsitration

A

PO, vaginally, transdermal (CombiPatch)

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12
Q

estrogen and progesterone HRT therapeutic use

A

relieves symptoms of menopause

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13
Q

estrogen and progesterone HRT ADRs

A

nausea is very common, HTN, vaginal bleeding, edema, weight gain, possibly breast cancer. Risk for thromboembolic disorders increases w/ addition of progesterone

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14
Q

estrogen and progesterone HRT contraindications and interactions

A

History of thromboembolic events
suspect/confirmed breast, vaginal, cervical, endometrial cancer
Many drug interactions

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15
Q

estrogen and progesterone HRT RN intervention and client education

A

Monitor BP
Monitor for s/sx of DVT/PE/MI/stroke
Avoid smoking
Stop at least 4 weeks prior to surgery
Apply intravaginal/transdermal at bedtime
Monitor pattern and amount of uterine bleeding
Report persistent vaginal bleeding
D/C if any indication of breast cancer

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16
Q

estrogen HRT prototype and other drug names

A

conjugated equine estrogen (Premarin)
Others: transdermal estradiol (Estraderm); estradiol intravaginal tablets (Vagifem), estradiol cream (Estrace)

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17
Q

estrogen HRT EPA

A

binds to estrogen receptors and substitutes the fluctuating amounts of estrogen into a more stable amount of estrogen to prevent symptoms

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18
Q

estrogen HRT administration

A

PO and many other routes

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19
Q

estrogen HRT therapeutic use

A

relieves symptoms of menopause

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20
Q

estrogen HRT ADRs

A

nausea is very common, HTN, endometrial hyperplasia - inc risk for endometrial/ovarian cancer, thromboembolic disorders

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21
Q

estrogen HRT contraindications and interactions

A

History of thromboembolic events
suspect /confirmed breast, vaginal, cervical, endometrial cancer
Many drug interactions

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22
Q

estrogen HRT RN intervention and client education

A

Monitor BP
Monitor for s/sx of DVT/PE/MI/stroke
Avoid smoking
Stop at least 4 weeks prior to surgery
Apply intravaginal/transdermal at bedtime
Monitor pattern and amount of uterine bleeding
Report persistent vaginal bleeding
D/C if any indication of breast cancer

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23
Q

hormone: androgen - testosterone prototype

A

testosterone (Androderm)

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24
Q

testosterone therapeutic uses

A

Treatment of male hypogonadism, delayed puberty, and testicular failure
Treatment of breast cancer in females
Hormone therapy for transgender males (AFAB)
EPA: synthetic testosterone

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25
testosterone administration
PO IM - gluteal muscle Intranasal Transdermal patch: Apply to upper arm, back, abdomen, thigh, Once daily, Rotate sites. Gel - cover - do not get wet for several hours. Underarm liquid Buccal upper gums: Pressure w/ finger x30 sec, Alternate sides of gums, Bitter taste, changes in taste Subcutaneous - implantable or injection
26
testosterone ADRs
Virilization - development of male physical characteristics (increased muscle bulk, body hair, deep voice), in females/children Hypertension - increased risk of cardiovascular events Increased growth of undiagnosed prostate CA edema/weight gain Gynecomastia 17-alpha-alkylated androgens (PO) are hepatotoxic (methyltestosterone, oxandrolone) Abnormal bone growth - premature epiphyseal closure in children Neuropsychiatric symptoms w/ abuse: increased irritability/aggression
27
testosterone RN interventions and client education
Educate on virilization effects - reversible with discontinuation w/discontinuation Prostate CA screening Periodical monitoring of weight, sodium levels w/ children and young adults monitor height, x rays 2x per year Monitor LFTs - educate on s/sx of liver fx Monitor for/educate on gynecomastia May experience changes in mood, energy, and libido
28
testosterone contraindications and interactions
Teratogenic! Males w/ breast, prostate CA, or urinary obstruction from BPH. Black box warning for HTN Increase action of insulin/antidiabetic meds Increase effects of warfarin
29
5-alpha reductase inhibitors prototype
finasteride (Proscar)
30
5-alpha reductase inhibitors therapeutic use
BPH. Also, male pattern baldness (propecia) *Reduces risk of prostate cancer*
31
5-alpha reductase inhibitors administration
PO
32
5-alpha reductase inhibitors EPA
inhibits 5-alpha reductase, the enzyme responsible for converting testosterone to 5-alpha DHT = inhibits metabolism of testosterone, causing decreased proliferation of prostatic cells - reducing the enlargement of the prostate gland and mechanical obstruction of the urethra Can take 6-12 months for prostate reduction and symptom improvement
33
5-alpha reductase inhibitors ADRs
reduced libido, ejaculate volume, and gynecomastia
34
5-alpha reductase inhibitors RN intervention and client education
Hazardous drug precautions: Pregnant caregivers, nurses, or pharmacists should not handle (especially if crushed) the drug, which can be absorbed and harmful to a male fetus Monitor for and educate pt on the adverse effects Baseline PSA, monitor periodically Cancer screening
35
5-alpha reductase inhibitors contraindications and interactions
Women, children, pregnancy. Caution with additional obstructive urinary disorder and liver impairment
36
alpha 1 - adrenergic blockers prototype and other drug names
tamsulosin (Flomax) Others: silodosin, alfuzosin, terazosin, doxazosin (nonspecific)
37
alpha 1 - adrenergic blockers therapeutic use
treats BPH and improves urination. Initial monotherapy
38
alpha 1 - adrenergic blockers administration
PO, once daily - take 30 min after eating a meal/same time each day. Do not crush or chew
39
alpha 1 - adrenergic blockers EPA
blocks alpha 1 adrenergic receptors = smooth muscle relaxation in the prostate and outlet of the bladder - increased urinary flow
40
alpha 1 - adrenergic blockers ADRs
ejaculation irregularities, HA, dizziness Other non specific alpha antagonists = hypotension/fainting
41
alpha 1 - adrenergic blockers RN intervention and client education
Educate on altered ejaculation - Reduced volume, possible failure, retrograde If taking non-specific (alfuzosin, terazosin, doxazosin) educate on orthostatic hypotension - Monitor BP - Change positions slowly - Do not drive if dizziness occurs
42
alpha 1 - adrenergic blockers contraindications and interactions
Erectile dysfunction meds (sildenafil) Female and children Caution in patients with hypotension (non selective meds) - any drugs causing hypotension
43
phosphodiesterase type 5 (PDE5) inhibitors prototype and other drug names
sidenafil (Viagra) Others: vardenafil (Levitra), tadalafil (Cialis)
44
PDE5 inhibitors therapeutic use
erectile dysfunction
45
PDE5 inhibitors administration
PO, do not take more than 1 a day
46
PDE5 inhibitors EPA
blocks PDE5 - which normally ends an erection
47
PDE5 inhibitors ADRS
priapism, HA, hypotension, fainting, and dizziness. Rare ones are hearing loss and vision loss
48
PDE5 inhibitors RN intervention and client education
If prolonged erection (>4 hrs) go to ER Monitor for adverse effects: Mild analgesic for HA, Monitor BP if dizzy, Stop if hearing or vision loss occurs Take 1 hr prior to sexual activity High fat foods decrease effects of dildenafil and vardenafil DO NOT take within 24 hrs of nitrates
49
PDE5 inhibitors contraindications and interactions
Nitrates Caution w/ recent cardiovascular events CYP3A4 inhibitors increase effects (grapefruit juice, other meds) Interaction w/ Tamsulosin = hypotension
50
anticholinergic/urinary antispasmodics prototype
oxybutynin (Ditropan)
51
anticholinergic/urinary antispasmodics therapeutic use
spastic bladder conditions (neurogenic bladders), overactive bladders: incontinence, urgency, frequency
52
anticholinergic/urinary antispasmodics administration
PO, XR tablet, transdermal
53
anticholinergic/urinary antispasmodics EPA
blocks muscarinic receptors in the detrusor muscle = bladder relaxation and contraction of internal sphincter
54
anticholinergic/urinary antispasmodics ADRs
anticholinergic = DRY Dry mouth, constipation, blurred vision, mydriasis (dilated pupils), dry eyes, decreased sweating = increased temp. HA, dizziness, and drowsiness
55
anticholinergic/urinary antispasmodics RN intervention and client education
Monitor for anticholinergic effects/crisis Urinary retention can cause overdistended bladder and UTIs (w/lack of sensation) Caution in high heat, excessive temperatures - risk for hyperthermia Drink lots of water Increase fiber intake
56
anticholinergic/urinary antispasmodics contraindications and client interaction
Closed angle glaucoma, myasthenia gravis, GI/GU obstruction CYP3A4 inhibitors (grapefruitjuice, other meds - antibiotics/antifungals) = increased toxicity CYP3A4 inducers (phenytoin, rifampin, carbamazepine) decrease effectiveness
57
cholinergic/urinary stimulant prototype
bethanechol (Urecholine)
58
cholinergic/urinary stimulant therapeutic use
non-obstructive urinary retention
59
cholinergic/urinary stimulant administration
PO, empty stomach
60
cholinergic/urinary stimulant EPA
actrivates muscarinic receptors in the detrusor muscle that lines the bladder = bladder contraction. Also relaxes internal sphincter
61
cholinergic/urinary stimulant ADRs
cholinergic = wet - salivation, lacrimation, diarrhea (GI secretions - excess acid). Hypotension and bradycardia! dizziness/faining. Bronchoconstriction. Watch for cholinergic crisis
62
cholinergic/urinary stimulant RN intervention and client education
Monitor BP, HR, resp status Monitor for urinary output: Bedpan, urinal nearby, call bell within reach, bed alarm on Educate regarding s/sx of hypotension - sit/lie down if dizzy - Do not drive
63
cholinergic/urinary stimulant contraindications and interactions
Hypotension, hyperthyroidism, asthma, GI ulcers, obstructive urinary retention Cholinesterase inhibitors worsen cholinergic effects Promcainamide, quinidine, atropine, epinephrine interfere with therapeutic efffects

Pharm (13 decks)

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