Reproductive System Flashcards
ethinyl estradiol & drospirenone (Yasmin): Class
Oral contraceptives - combination estrogen/progesterone
ethinyl estradiol & drospirenone (Yasmin): other medications
ethinyl estradiol & norethindrone (Ortho-Novum 1/35)
ethinyl estradiol & drospirenone (Yasmin): EPA
Suppresses secretion of FSH & LH, thus preventing ovulation. Progesterone thickens cervical mucus; Prevents endometrium thickening. Drospirenone works similarly to spironolactone thereby decreasing ankle edema & treating PMS symptoms
ethinyl estradiol & drospirenone (Yasmin): Use
Pregnancy prevention; PMS symptoms; Stabilize menses; Prophylactic uterine/ovarian cancer, PID, ovarian cysts
ethinyl estradiol & drospirenone (Yasmin): ADRs
thromboembolism; abnormal uterine bleeding; promote growth of existing breast cancer; potential risk for HTN; hyperkalemia (drospirenone)
ethinyl estradiol & drospirenone (Yasmin): Contraindications
Pregnancy – teratogenic
BRCA1 gene mutation
ACE inhibitors
Many drug interactions: Rifampin, anti-seizure, & antifungal dec effectiveness
ethinyl estradiol & drospirenone (Yasmin): RN Intervention
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 & amt of uterine bleeding
D/C if any indication of breast cancer
levonorgestrel (Mirena) (same as Plan B): class
Contraceptives - Intrauterine Device (IUD)
levonorgestrel (Mirena): Use
Pregnancy prevention; Tx PMS symptoms and heavy periods; emergency contraception (120 hours after unprotected sex); endometriosis; Fibroids
levonorgestrel (Mirena): ADRs
acne, migraines, vaginitis, ovarian cysts, hair loss, decreased libido, menstrual pattern changes, unwanted hair growth; Pelvic inflammatory disease (PID); ectopic pregnancy (MEDICAL EMERGENCY); uterine perforation
levonorgestrel (Mirena): EPA
thins uterine lining, thickens cervical mucus to prevent sperm from entering, inhibits sperm from reaching/fertilizing the egg
levonorgestrel (Mirena): Contraindication
Pregnancy – teratogenic
PID
Past or current breast, cervical, or uterine cancer
< 6 weeks post partum
levonorgestrel (Mirena): RN Intervention
- Confirm absence of pregnancy FIRST
- Avoid smoking
- Monitor pattern & amt of uterine bleeding
- Teach client to feel for IUD strings with a clean finger once/month after menses: Call provider if strings seem shorter or longer than usual/can’t locate string/unable to feel IUD
- Report any sudden abdominal pain/cramping/vaginal bleeding, abnormal discharge, fever
How does Plan B work?
take within 72 hours of unprotected sex and it works by delating ovulation
conjugated estrogen & medroxyprogesterone acetate (Prempo): Class
Estrogen & Progesterone Hormone Replacement Therapy (HRT)
conjugated estrogen & medroxyprogesterone acetate (Prempo): other medications
transdermal combination of estradiol & norethindrone (CombiPatch)
conjugated estrogen & medroxyprogesterone acetate (Prempo): 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.
conjugated estrogen & medroxyprogesterone acetate (Prempo): use
Relieves symptoms of menopause
conjugated estrogen & medroxyprogesterone acetate (Prempo): ADRs
Nausea is very common; HTN; vaginal bleeding, edema, weight gain, possibly breast cancer. Risk for thromboembolic disorders increases w/addition of progesterone
conjugated estrogen & medroxyprogesterone acetate (Prempo): Contraindications
- History of thromboembolic events
- Suspect/confirmed breast, vaginal, cervical, endometrial cancer
- Many drug-on-drug interactions
conjugated estrogen & medroxyprogesterone acetate (Prempo): RN Interventions
Monitor BP
Monitor for s/sx of DVT/PE/MI/Stroke
Avoid smoking
Stop at least 4 weeks prior to surgery
Apply intravaginal/transdermal @ bedtime
Monitor pattern & amt of uterine bleeding
Report persistent vaginal bleeding
D/C if any indication of breast cancer
conjugated equine estrogen (Premarin): Class
estrogen hormone replacement therapy (HRT)
conjugated equine estrogen (Premarin): other medications
transdermal estradiol (Estraderm); estradiol intravaginal tablets (Vagifem); estradiol cream (Estrace)
conjugated equine estrogen (Premarin): EPA
Binds to estrogen receptors and substitutes the fluctuating amounts of estrogen into a more stable amount of estrogen to prevent symptoms
conjugated equine estrogen (Premarin): Use
relieves symptoms of menopause
conjugated equine estrogen (Premarin): ADRs
Nausea is very common; HTN; endometrial hyperplasia - increase risk for endometrial/ovarian cancer; thromboembolic disorders
conjugated equine estrogen (Premarin): Contraindication
- History of thromboembolic events
- Suspect/confirmed breast, vaginal, cervical, endometrial cancer
- Many drug-on-drug interactions
conjugated equine estrogen (Premarin): RN Intervention
Monitor BP
Monitor for s/sx of DVT/PE/MI/Stroke
Avoid smoking
Stop at least 4 weeks prior to surgery
Apply intravaginal/transdermal @ bedtime
Monitor pattern & amt of uterine bleeding
Report persistent vaginal bleeding
D/C if any indication of breast cancer
testosterone (Androderm): class
hormone: Androgen - Testosterone
testosterone (Androderm): Use
- Treatment of male hypogonadism, delayed puberty, and testicular failure
- Treatment of breast cancer in females
- Hormone therapy for transgender males (assigned female at birth)
testosterone (Androderm): EPA
synthetic testosterone
testosterone (Androderm): administration
PO, IM, Intranasal, Transdermal patch (rotate sties each week), Buccal upper gums (pressure for 30 seconds, change taste), Subcutaneous
testosterone (Androderm): ADR
virilization - development of male physical characteristics (increased muscle bulk, body hair, deep voice), hypertension, increased growth undiagnosed prostate cancer, edema/ weight gain, gynecomastia, hepatotoxic, abnormal bone growth (premature epiphyseal closure in children), neuropsychiatric symptoms with abuse
testosterone (Androderm): RN Interventions
educate on virilization, prostrate cancer screening, periodical monitoring of weight and sodium levels, monitor in children, monitor LFTs, may experience changes in mood, energy, libido
testosterone (Androderm): contraindications
teratogenic, breast/prostate cancer, urinary obstruction from BPH, HTN
testosterone (Androderm): interactions
increase action of insulin/ antidiabetic medications, increases effect of Warfarin
finasteride (Proscar): class
5-alpha Reductase Inhibitor
finasteride (Proscar): Use
BPH (benign prostatic hyperplasia), male pattern baldness (Propecia)
finasteride (Proscar): 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.
How long does it take for prostate reduction and symptoms improvement take place?
6 - 12 months
finasteride (Proscar): ADRs
reduced libido, ejaculate volume, and gynecomastia
finasteride (Proscar): RN Interventions
- 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 baseline PSA (prostate specific antigen)
- cancer screening
finasteride (Proscar): contraindications
women, children, pregnancy, caution with obstructive urinary disorder and liver impairments
tamsulosin (Flomax): Class
Alpha1 - adrenergic blockers
tamsulosin (Flomax): other medications
silodosin, alfuzosin, terazosin, doxazosin (nonselective alpha antagonists)
tamsulosin (Flomax): Use
Treats BPH and improves urination.
Initial monotherapy
tamsulosin (Flomax): administration
PO, once daily - take 30 minutes after eating a meal/same time each day. Do not crush/chew.
tamsulosin (Flomax): EPA
blocks alpha1-adrenergic receptors = smooth muscle relaxation in the prostate and outlet of bladder - increased urinary flow
tamsulosin (Flomax): ADRs
ejaculation irregularities, headache, dizziness, nonspecific: hypotension/fainting
tamsulosin (Flomax): RN Interventions
educate on altered ejaculation (reduced volume, failure, retrograde), educate on orthostatic hypotension
tamsulosin (Flomax): contraindications
contraindicated with erectile dysfunction drugs (sildenafil), females/children, hypotension (non-selective meds) – any drugs causing hypotension
sildenafil (Viagra): class
phosphodiesterase type 5 (PDE5) Inhibitors
sildenafil (Viagra): other medications
vardenafil (Levitra), tadalafil (Cialis)
sildenafil (Viagra): Use
Erectile dysfunction
sildenafil (Viagra): administration
PO, do not take more than once a day!
sildenafil (Viagra): EPA
blocks PDE5 that normally ends an erection
sildenafil (Viagra): ADRs
priapism, headache, hypotension, fainting, dizziness, rare: hearing loss, vision loss
sildenafil (Viagra): RN Intervention
if erection more than 4 hours go to ER, take 1 hour prior to sexual activity, high fat foods decrease effects, DO NOT take within 24hrs of nitrates (Nitroglycerin) - used to treat angina: live threatening hypotension
sildenafil (Viagra): contraindication
Nitrates, caution with recent cardiovascular events, CYP3A4 inhibitors increase effects (grapefruit juice), interactions with Tamsulosin - hypotension
oxybutynin (Ditropan): class
anticholinergic/ urinary antispasmodics
oxybutynin (Ditropan): use
spastic bladder conditions (neurogenic bladders), overactive bladders: incontinence, urgency, frequency
oxybutynin (Ditropan): EPA
blocks muscarinic receptors in the detrusor muscle = bladder relaxation + contraction of internal sphincter
oxybutynin (Ditropan): ADR
anticholinergic = DRY, Dry mouth, constipation, blurred vision, mydriasis (dilated pupils), dry eyes, decreased sweating = increased temperature. HA, dizziness, drowsiness.
oxybutynin (Ditropan): RN Interventions
Monitor for anticholinergic effects/crisis,
Urinary retention can cause overdistended bladder and UTI,
Caution in high heat, excessive temperatures - risk for hyperthermia, Drink lots of H20!, Increase fiber intake
oxybutynin (Ditropan): contraindication
- closed-angle glaucoma, myasthenia gravis, GI/GU obstruction.
- CYP3A4 inhibitors (grapefruit juice, other meds- antifungals/antibiotics) = increased toxicity
- CYP3A4 inducers (phenytoin, rifampin, carbamazepine) decrease effectiveness
bethanechol (Urecholine): Class
Cholinergic/ Urinary Stimulant
bethanechol (Urecholine): Use
non-obstructive urinary retention
bethanechol (Urecholine): administration
PO, empty stomach
bethanechol (Urecholine): EPA
activates muscarinic receptors in the detrusor muscle that lines the bladder = bladder contraction. Also relaxes internal sphincter.
bethanechol (Urecholine): ADRs
- Cholinergic = wet - salivation, lacrimation, diarrhea (GI secretions – excess acid)
- Hypotension and Bradycardia! Dizziness/fainting
- Bronchoconstriction
- Watch for cholinergic crisis!
bethanechol (Urecholine): RN Interventions
monitor RP, HR, and respiratory status, monitor for urinary output, educate regarding hypotension
bethanechol (Urecholine): Contraindication
- hypotension, hyperthyroidism, asthma, GI ulcers, obstructive urinary retention.
- Cholinesterase inhibitors worsen cholinergic effects
- Procainamide, quinidine, atropine, epinephrine interfere with therapeutic effects.
