Reproductive and Genitourinary drugs Flashcards
oral contraceptives - combination estrogen/progesterone prototype and other drug names
ethinyl estradiol and drospirenone (Yasmin)
Others: ethinyl estradiol and norethindrone (Ortho-Novum 1/35)
combo oral contraceptives EPA
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
combo oral contraceptives administration
PO at the same time every day
combo oral contraceptives therapeutic use
pregnancy prevention; PMS symptoms; stabilize menses; prophylactic uterine/ovarian cancer, PID, ovarian cysts
combo oral contraceptives ADRs
thromboembolism, abnormal uterine bleeding, promote growth of existing breast cancer, potential risk for HTN, hyperkalemia (drospirenone)
combo oral contraceptives contraindications and interactions
Pregnancy - teratogenic
BRCA1 gene mutation
ACE inhibitors
Many drug interactions: Rifampin, anti-seizure, and antifungal decreased effectiveness
combo oral contraceptives RN intervention and client education
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
contraceptives IUD prototype
levonorgestrel (Mirena) same drug as Plan B
estrogen and progesterone HRT prototype and other drug names
conjufated estrogen and medroxyprogesterone acetate (Prempo)
Others: transdermal combination of estradiol and norethindrone (CombiPatch)
estrogen and progesterone HRT EPA
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
estrogen and progesterone HRT adminsitration
PO, vaginally, transdermal (CombiPatch)
estrogen and progesterone HRT therapeutic use
relieves symptoms of menopause
estrogen and progesterone HRT ADRs
nausea is very common, HTN, vaginal bleeding, edema, weight gain, possibly breast cancer. Risk for thromboembolic disorders increases w/ addition of progesterone
estrogen and progesterone HRT contraindications and interactions
History of thromboembolic events
suspect/confirmed breast, vaginal, cervical, endometrial cancer
Many drug interactions
estrogen and progesterone HRT RN intervention and client education
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
estrogen HRT prototype and other drug names
conjugated equine estrogen (Premarin)
Others: transdermal estradiol (Estraderm); estradiol intravaginal tablets (Vagifem), estradiol cream (Estrace)
estrogen HRT EPA
binds to estrogen receptors and substitutes the fluctuating amounts of estrogen into a more stable amount of estrogen to prevent symptoms
estrogen HRT administration
PO and many other routes
estrogen HRT therapeutic use
relieves symptoms of menopause
estrogen HRT ADRs
nausea is very common, HTN, endometrial hyperplasia - inc risk for endometrial/ovarian cancer, thromboembolic disorders
estrogen HRT contraindications and interactions
History of thromboembolic events
suspect /confirmed breast, vaginal, cervical, endometrial cancer
Many drug interactions
estrogen HRT RN intervention and client education
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
hormone: androgen - testosterone prototype
testosterone (Androderm)
testosterone therapeutic uses
Treatment of male hypogonadism, delayed puberty, and testicular failure
Treatment of breast cancer in females
Hormone therapy for transgender males (AFAB)
EPA: synthetic testosterone
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
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
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
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
5-alpha reductase inhibitors prototype
finasteride (Proscar)
5-alpha reductase inhibitors therapeutic use
BPH. Also, male pattern baldness (propecia)
Reduces risk of prostate cancer
5-alpha reductase inhibitors administration
PO
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
5-alpha reductase inhibitors ADRs
reduced libido, ejaculate volume, and gynecomastia
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
5-alpha reductase inhibitors contraindications and interactions
Women, children, pregnancy. Caution with additional obstructive urinary disorder and liver impairment
alpha 1 - adrenergic blockers prototype and other drug names
tamsulosin (Flomax)
Others: silodosin, alfuzosin, terazosin, doxazosin (nonspecific)
alpha 1 - adrenergic blockers therapeutic use
treats BPH and improves urination. Initial monotherapy
alpha 1 - adrenergic blockers administration
PO, once daily - take 30 min after eating a meal/same time each day. Do not crush or chew
alpha 1 - adrenergic blockers EPA
blocks alpha 1 adrenergic receptors = smooth muscle relaxation in the prostate and outlet of the bladder - increased urinary flow
alpha 1 - adrenergic blockers ADRs
ejaculation irregularities, HA, dizziness
Other non specific alpha antagonists = hypotension/fainting
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
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
phosphodiesterase type 5 (PDE5) inhibitors prototype and other drug names
sidenafil (Viagra)
Others: vardenafil (Levitra), tadalafil (Cialis)
PDE5 inhibitors therapeutic use
erectile dysfunction
PDE5 inhibitors administration
PO, do not take more than 1 a day
PDE5 inhibitors EPA
blocks PDE5 - which normally ends an erection
PDE5 inhibitors ADRS
priapism, HA, hypotension, fainting, and dizziness. Rare ones are hearing loss and vision loss
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
PDE5 inhibitors contraindications and interactions
Nitrates
Caution w/ recent cardiovascular events
CYP3A4 inhibitors increase effects (grapefruit juice, other meds)
Interaction w/ Tamsulosin = hypotension
anticholinergic/urinary antispasmodics prototype
oxybutynin (Ditropan)
anticholinergic/urinary antispasmodics therapeutic use
spastic bladder conditions (neurogenic bladders), overactive bladders: incontinence, urgency, frequency
anticholinergic/urinary antispasmodics administration
PO, XR tablet, transdermal
anticholinergic/urinary antispasmodics EPA
blocks muscarinic receptors in the detrusor muscle = bladder relaxation and contraction of internal sphincter
anticholinergic/urinary antispasmodics ADRs
anticholinergic = DRY
Dry mouth, constipation, blurred vision, mydriasis (dilated pupils), dry eyes, decreased sweating = increased temp. HA, dizziness, and drowsiness
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
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
cholinergic/urinary stimulant prototype
bethanechol (Urecholine)
cholinergic/urinary stimulant therapeutic use
non-obstructive urinary retention
cholinergic/urinary stimulant administration
PO, empty stomach
cholinergic/urinary stimulant EPA
actrivates muscarinic receptors in the detrusor muscle that lines the bladder = bladder contraction. Also relaxes internal sphincter
cholinergic/urinary stimulant ADRs
cholinergic = wet - salivation, lacrimation, diarrhea (GI secretions - excess acid). Hypotension and bradycardia! dizziness/faining. Bronchoconstriction. Watch for cholinergic crisis
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
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
