Reproductive, GI, and Immune Flashcards
Nuva Ring
(ovulation suppressant)
intravaginal contraceptive ring
Yaz
(ovulation suppressant)
taken po
traditional 28 day pill
Loestrim
(ovulation suppressant)
taken po
traditional 28 day pill
Ortho Novum
po
28 day pill
Ovulation suppressants
- synthetic estrogen and/or progestin
- block the follicle stimulating hormone & luteinizing hormone
- increase vaginal mucus viscosity
Use:
- prevention of pregnancy
- treat endometriosis
- hypermenorrhea
- post-coital (plan b)
Types of ovulation suppressants
- traditional 28 day pill
- extended cycle pill (4x/year period)
- transdermal patch - weekly/monthly
- intravaginal contraceptive ring
Adverse effects of ovulation suppressants
- HTN/ blood clots, MI, HA, N/V, anorexia, and weight gain.
- breakthrough bleeding (when first getting started on extended)
Nursing implications of ovulation suppressants
- caution women 35+ who smoke
- educate against possible stroke
- missed dose = pregnancy can occur
- weight gain
Drug interactions of ovulation suppressants
- antibiotics
- TB drugs
(Premarin) Conjugated estrogen
(estrogen)
- hormone replacement therapy/menopause
- oral contraceptive
- prostate cancer in men
Nursing implications of estrogen
- female characteristics in men
- check BP
- advise against smoking
- only take p.r.n.
Estrogen
- HRT/ menopause
- treat prostate cancer in men
- oral contraceptive
*individualized dosing
Risk/adverse effects of estrogen
thromboembolism
Ovulation stimulants
- same effects as natural hormones - enhance or enable reproduction
- treat infertility
clomiphene (Clomid)
(ovulation stimulant)
treats infertility
bromocriptine mesylate (Parlodel)
treats infertility
Adverse effects of ovulation stimulants
- deep vein thrombosis
- ovarian hyperstimulation – leaks fluid, tender stomach
- multiple pregnancies
medroxy progesterone (Depo-Provera)
- inhibit gonadotropin
- decrease endometrial tissue proliferation
oral or IM
Progestins
- inhibit gonadotropin
- decrease endometrial tissue proliferation
Contraceptive
uterine bleeding
Adverse effects of progestins
- deep vein thrombosis, liver dysfuntion, N/V
Forms of progestins
oral or long acting IM – one shot every 3 months
testosterone (Depo-testosterone)
(androgen)
used in delayed puberty
androgens
- maintain muscular and skeletal proteins
- used in delayed puberty
antacids
- alkaline substances that neutralize stomach acids
- aluminum, magnesium, calcium
- OTC
adverse effects of antacid
- Magnesium - diarrhea
- Aluminum - constipation
- Calcium - intestinal gas, constipation, and acid rebound
Nursing implications of antacids
- interferes with many drugs by binding in GI tract
- assess pain, check sugar contents for diabetes
- Calcium most effective for heartburn
Magnesium:
- not given with renal insufficiency
- acts rapidly, highly neutralizing, long duration
Histamine-2 receptor antagonist
- po or IV
- suppress the secretion of gastric acid and decrease pepsin in the stomach
- GERD - peptic ulcers
ranitidine (Zantac)
(Histamine-2 receptor antagonist)
for GERD - peptic ulcers
famotidine (Pepcid)
(Histamine-2 receptor antagonist)
for GERD - peptic ulcers
cimetidine (Tagamet)
*prototype
(Histamine-2 receptor antagonist)
treat GERD, peptic ulcers, gastric reflux
*may cause infections in elderly
omeprazole (Prilosec)
(proton pump inhibitor)
- po
for: erosive gastritis, symptomatic GERD, and ulcers
lansoprazole (Prevecid)
(proton pump inhibitor)
- po
for: erosive gastritis, symptomatic GERD, and ulcers
pantoprazole (Protonix)
(proton pump inhibitor)
- IV
- stress ulcer prophylaxis for hospitalized patients
Proton pump inhibitors
- Inhibits gastric acid secretions
- prevent pumping of gastric acid from parietal cells
Nursing implications of proton pump inhibitor
- ulcers heal in 4-8 weeks
- swallow whole
- give most before food
Helicobactor pylori agents
Treatment combination of:
- 2 antimicrobials (amoxicillin, clarithromycin, metronidazole, or tetracycline)
- 1 proton pum inhibitor and/or
- 1 histamine-2
7-14 days of treatment
treat peptic GI ulcers caused by H. Pylori bacteria
misoprostol (Cytotec)
synthetic prostaglandin given with NSAIDs to protect gastric mucosa
sucralfate (Carafate)
4x/day
acts locally to protect gastric mucosa
mineral oil
(lubricant laxative)
softens dry/hard feces
lubricant laxatives
soften dry/hard feces
stimulant cathartics
- po or glycerine suppository
- can lead to dependance
- induce intestinal paristalsis
biscodyl (Dulcolax)
(stimulant cathartic)
- po or glycerine suppository
- can lead to dependance
- induce intestinal peristalsis
magnesium citrate
(saline cathartic)
bowel prep
saline cathartics
- increase osmotic pressure
- draws H2O into colon
- watery stools
docusate sodium (Colace)
(surfactant laxative)
- stool softener
surfactant laxative
facilitate passage of water and lipids into the fecal mass, which softens the stool
- do not cause the patient to defecate
- prevent straining
psyllium (Metamucil)
(bulk forming laxative)
- can be used long term
- use water to retain natural & synthetic cellulose derivatives
- increase water absorption
- produce normal formed stools
- OTC
- also an antidiarrheal
Bulk-forming laxatives
- can be used long term
- use water to retain natural & synthetic cellulose derivatives
- increase water absorption
- produce normal formed stools
- OTC
Cathartics
- most abused
- strong effect to eliminate loose stool
- irritate the GI mucosa and pull water into the bowel lumen, as a result, the feces moves through the bowel too rapidly to allow water absorption so watery stool is eliminated
laxatives
mild effect to eliminate soft formed stools
Use of laxatives and cathartics
- relieve constipation
- prevent straining
- empty bowel
- eliminate toxic substances
Contraindications of laxatives/cathartics
- undiagnosed abdominal pain
- intestinal obstruction
Nursing implications of laxatives/cathartics
- Impaction (all the stool may not be coming out)
- Abuse
- increase fluids and fibers
Bismuth-salts pepto bismol
- antidiarrheal
- caution in kids (aspirin)
diaphenovylate (Lomotil)
- synthetic opiate antidiarrheal
- acts on smooth muscle of the GI tract
- no analgesic activity
- abuse/physical dependance can occur
loperamide (Imodium)
- opiate antidiarrheal
- OTC
antiemetics
- prevent/treat N/V
ondansetrone (Zofran)
(antiemetic)
- serotonin blocker
- post-op N/V (started out as drug for N/V associated with chemotheraphy)
- po/IV
metoclorpramide (Reglan)
(antiemetic)
- prokinetic agent
- used to treat delayed gastric emptying
- used for GERD & antiemetic
- can have EPS symptoms especially with young adults
phenothazine
- anti-psychotic (migraine): Compozine and Phenergan
- used to treat N/V
- heavily sedative (Phenergan)
- EPS symptoms and cognitive impairment can occur
- Phernergan can be given IV - is caustic - have good site
Syrup of Ipecac
- emetic: induces vomiting
* can be used in accidental poisoning cases IF APPROPRIATE
orlistat (Xenical)
- obesity drug
- fat blocker
- diarrhea/bowel movement
Drugs affecting vitamin absorption
- laxatives and antibiotics
- decrease fat soluble absorption
Nursing implications of Vitamins
- warn against mega doses
- administer separate from laxatives
- natural vs synthetic (no big differences)
- eat a well balanced diet
Minerals/Electrolytes
- essential to bone, teeth, cell membrane, connective tissue and enzymes
- varied well balanced diet provides sufficient minerals
Iron
- used to treat/prevent iron deficiency anemia
iron dextran injection (InFeD)
- IV
- iron deficiency anemia
ferrous sulfate (Feosol)
- iron deficiency anemia
- common treatment
Nursing Implications for Iron
- can cause black stools
- take with meals or after with full glass of water
- GI upset
- take liquid with straw
Potassium
- K+ and Cl- deficiencies occur together (KCl is taken)
- replacement for use with diuretic, poor diet, GI losses
- po or IV
Nursing Implications for Potassium
- IV dose diluted and given slowly (Can be mixed wit Lidocaine)
- po dose with at least 4oz fluid because its caustic
- best absorbed on empty stomach
Hyperkalemia
- can be treated with cation exchange resin
Na+ polystyrene sulfonate (Kayexalate)
- po or rectal
- acts in colon to release Na+ and combine with K+ and eliminate in feces
Nursing Implications for Hyperkalemia
- stop all forms of K+
- cardiac monitoring
- each gram of resin will decrease K+ approx. 1 mEq
- retain enema for 1 hour
- may need dialysis
- also may use IV regular insulin and D50
magnesium sulfate
- IM/IV
- for low Mg levels
magnesium oxide
- po
- for low Mg levels
Magnesium
- used to control convulsions associated with eclampsia (IV push)
aldesleukin (Proleukin)
(Interleukins)
- activates cellular immunity, inhibits tumor growth, prevents rapid growth of malignant cells.
- renal cancer, melanoma, HIV, and Kaposi sarcoma
- monitor VS, neuro status
- report bleeding
cyclophosphamide (Cytoxan)
- alkylating agent - developed from mustard gas
- interfere with cell division and structure of DNA during all phases of cell cycle
- Taken on empty stomach and increase fluids
- may cause cystitis
cisplatin (Platinol)
- alkylating agent - developed from mustard gas
- used for both hemotological and solid cancers
- N/V, nephrotoxicity, ototoxicity
- check renal function
doxorubicin (Adriamycin)
- leukemia
- breast/lung/ovarian cancer
- may turn urine red
Interferons alfa 2a/2b
(Roferon-A or Intron-A)
- inhibits viral replication by reprogramming virus
- prevents rapid growth of malignant cells
- increase activity of other cells
- increase cytotoxic activity of natural killer cells
Use: Kaposi’s sarcoma, hairy cell leukemia, and chronic hepatitis
filgrastin G-CSF (Neupogen)
- Colony stimulating agents
- promotes proliferation, differentiation, and activation of cells that make granulocytes
- prevent infections and stimulate arteriole growth
- give 24 hours after chemo
- avoid infections
- Side effects: bone pain, redness at injection site
epoetin alfa (Epogen)
- hematopoetic
- not given unless hemoglobin is less than 12
- athletically abused
- check blood count/BP
vincrintine (Oncovin)
(plant alkaloid)
- Vinca genus plant - cell cycle specific - stops mitosis
- Hodgkin’s lymphoma
- acute lymphoblastic leukemia
- can cause severe tissue damage with infiltrate
- peripheral nerve toxicity
may become toxic with patients with hepatic impairment
fluorouracil (5-FU)
(antimetabolite)
- cell cycle specfic
- drink plenty of fluids
cyclosporin (Sandimmune)
- prevention of organ rejection
- arthiritis
- Irritable bowel syndrome
infliximab (Remicade)
(monoclonal antibody)
- rheumatoid arthiritis
- Crohn’s disease
- Black box warning: infections
Side effects:
- headache, dizziness, fatigue, anxiety, fever and rash
Nursing Imp:
- administer immediately after reconstitution, do not breastfeed, watch for blood in stools, monitor for TB, and may be premedicated with acetaminophen or diphenhydramine
methotrexate (Rheumatrex)
(antimetabolite)
- rheumatoid arthiritis
- avoid alcohol, sunlight, and aspirin
- pee it out!
Adverse effects of Interferons
- flu like symptoms, depression and suicide
Nursing Implications of Interferons
- read label (for appropriate dose)
- refrigerate
- photosensitive
- do not shake
Hematopoeitic drugs
- used to prevent anemia (Epogen)
- given subQ or IV
- used in renal failure, cancer or HIV
Adverse and Nursing Imp of Interleukins
- MI
- Capillary leak syndrome
- monitor VS, neuro status
- stop drug with life threatening adverse reactions
- report bleeding
Adverse effects of Immunosuppressants
- tremors
- HA
- oral candidias
- seizures
side effects of immunizing agents
- pain at injection site
- fever, malaise, muscle ache
- anaphylaxis
- serum sickness
antineoplastic agents
- interfere with cell replication, with supply of nutrients and genetics in nucleus
- specific percentage of kills
- drug resistance
- harmful to rapid healthy cells
antimeabolites
- effective against rapidly growing tumors
- toxic effects: bone marrow suppression, mucositis, GI ulcerations, alopecia
Nursing Imp of plant alkaloid
- prepare patient for side effects
- start anti-emetics before and on a schedule
- eat!
- alopecia - wigs/shampoo
- mucositis (stomatitis) - soft tooth brush, rinse, drink fluids, systematic analgesics
- bleeding
