Week 1: Intro to Pharm Flashcards
1
Q
Characteristics of an Ideal Drug
A
- Effective
- Selective
- Reversible
- Predictable
- No harmful side effects
- No drug/food interactions
- Inexpensive
- Easy to administer
- Chemically stable
- simple name
*There currently are NO ideal drugs
2
Q
Objective of drug treatment
A
Maximum Benefit with minimum harm
3
Q
Education to Patient and family about Medications
A
- Medication name
- expected respone; possible side effects
- dosage and administration schedule
- route of administration
- duration of drug use
- drug storage
4
Q
Pharmacokinestics:
define/the 4 steps
A
- How drugs can move through the body
1) Absorption
2) Distribution
3) Metabolism
4) Excretion
5
Q
Pharmacotherapeutics:
The use of drugs to….
A
1) Diagnose
2) Prevent disease
3) Treat disease
4) Prevent pregnancy
6
Q
5 Rights to give medication
A
1) Right drug
2) Right dose
3) Right time
4) Right patient
5) Right route
7
Q
Pharmacokinetics:
Absorption
A
- from site of administration into bloodstream.
- rate determines how soon effects occur
- amount determines intensity of effects
- effecting: ph, had food or not, pain, stress, rate of gastric empyting
8
Q
Lipid soluable drugs tend to be _______ and hang around _________ than water soluable drugs
A
stored in fat, longer
9
Q
Passive absorption
A
diffusion…higher to lower concentration..no energy needed
10
Q
Active Absorption
A
needs carrier or enzyme to move across membrane
11
Q
Pinocytosis
A
cell engulfs particles of drug
12
Q
disintegration
and
dissolution
A
disintegration- brode down into small particles
dissolution- dissolving into smaller particles
13
Q
Factors affecting drug absorption
A
1) Rate of dissolution
2) Surface area
3) blood flow
4) lipid solubility
5) Food or fluids taken along with drugs (some meds will be slowed down with food and drink while some need it)
14
Q
Routes of Administration
A
1) Enteral– gut,mouth, peg tube, gtube, rectal (Absorbed through oral or gastric mucosa, small intestine or rectum)
2) Topical
3) Parenteral –IV, IM, SQ
15
Q
Distribution
Define/distribution effected by:
A
-How it moves/gets through the body..movement of drug throughout the body through the circulatory system
effected by:
-bloodflow to tissues
- ability of drug to exit the vascular system
- ability of drug to enter cells
_*determined by how well med can enter the cells*_
16
Q
Drug diffuses out of blood to ___________
A
the site of action
17
Q
blood brain barrier
A
- tight junction between cells of capillary walls in the CNS
- only drugs that are lipid soluable or have a transport system can cross through the capillary walls to the CNS
- Benefits: very specific on what crosses, can protect the brain from drugs and harmful substances
- Disadvantage: obsticale treating seizures, cancers in brain or parkinsons
18
Q
Protein Binding
A
- Type of drug storage system
- Drugs form reversible bonds with protein
- drugs NOT bound to protein are a FREE state and are still active
- drugs bound to protein are NOT active
- As free drug acts on cells, there is a decrease in plasma drug levels
- need to know pts albumin level
- two highly bound protein bound drugs will compete and one will become toxic
19
Q
highly protein bound
moderately protein bound
low protein bound
A
- 80-90%
- 50%
- 10-20%
20
Q
Metabolism
A
- “Biotransformation”
- converting a drug to a form more easily removed from the body
- Almost all occurs in liver
- Hepatic microsomal enzyme or P450
21
Q
Conjugates
A
make drugs more water soluble and more easily excreted by the kidneys
22
Q
P450
A
- a way that a drug is metabolized
- enzyme from the liver which aid in metabolism of many drugs
- Initiate drugs, accelerate excretion
23
Q
Drug to drug interations involving P450
A
- inhinitor works against enzyme
- inducer makes more enzymes available
24
Q
Factors Influencing rate of metabolism
A
- age
- nutritional status
- liver disease
- induction of drug-metabolizing enzymes
- first pass effect
25
First Pass effect:
\*\*Changes how much of the drug is available for the body to use
\*A strong first pass = increase in dose given to body
1. drug absorbed
2. drugs enter hepatic portal circulation--go to liver
3. hepatic microsomal enzymes metabolize drug to inactive form
4. drug conjugates--leaving liver
5. drug distributed to general circulation
26
Excretion
- elimination of drugs from the body
- eliminate non protein bound drugs...had to be eliminated by protein first to be eliminated
- primarily through kidneys
**-rate of excretion determines the meds concentration in the bloodstream and tissue.**..concentration determines the duration of action
27
Excretion:
Glomerular Filtration
filtration moves drugs from blood to urine...protein bound drugs are not filtered
28
Excretion:
Passive Reabsorption
lipid soluble drugs move back into the blood (polar and ionized drugs remain in the urine)
29
Excretion:
Active Transport
Tubular "pumps" for organic acids and bases move drugs from blood to urine
30
Drug Half Life
- time for amount of drug to decrease 50%
- amount of time it takes fro half the drug concentration to be eliminated
- most drugs eliminated over 4 half lives
- the greater the half life, the longer it takes the medicine to be excreted
ex. ...asprin 650 mg/ half life 3 hrs...pt takes it at 7:00. 3 hrs later, half the drug has been excreted. Leaving 325mg in system....3 hrs later, half of 325mg will be left.
31
Drug Actions
- Cellular processes involved in drug and cell interactions
- Onset, peak, duration
32
Onset
time it takes for drug to elicit therapeutic response
(ex. IV vs. PO)
33
Peak
time it takes for drug to reach maximum therapeutic response
high concentration of drug
34
Duration
time that drug concentration is sufficient to elicit therapeutic response....lowest concentration of drug
35
Pharmacodynamics
-what drugs do to the body and how they do it
36
Drug Mechanisms of Action
- 3 basic ways that drugs can act to produce therpeutic effects
1) receptor interaction
2) enzyme interaction- deactivate or activate drugs
3) Nonspecific interactions
37
Receptor Interaction:
Agonist
mimics actions of endogenous regulatory molecules
(ex. Insulin)
Sympathetic agonist = increase HR
38
Receptor Interaction:
Antagonist
prevents or inhibits action of agonist
(ex. beta blockers)
39
Receptor Interaction:
Agonist-Antagonist
exerts some agonist and some antagonist action
40
Enzyme Interaction
- drugs can inhibit action of a specific enzyme
- enzyme binds to drug instead of normal target cell
41
Non specific Interactions
Sites of action include cell membrances and metabolism
ex. penicillin breaks down bacteria cell wall...no lock and key enzyme
42
Receptor Interaction
A. Tissue receptor
B. Poor receptor fit, no response likely
C. Some drug-receptor fit, some response likely
D. Excellent receptor fit...good response likely
43
Drug Process and Resources
- Food and Drug Administration
- Controlled substances
- Drug Names (All have two...)
Generic: Ibuprofen
Brand: Advil
44
Cultural Considerations
- heritage
- communication
- family organization
- nutrition
- spiritual
- herbs
45
Herbal Therapies
Herbs: a botanical without any woody tissu such as stems or bark
common herbs used:
aloe vera, chamomile, Dong quai, echinacea, garlic, ginkgo, st. johns wort
46
Autonomic Nervous System:
What is the central Nervous system?
Brain and spinal cord
-it revieves signals and sends them back out
47
The peripheral nervous system
- The Autonomic nervous system
- The somatic nervous system
48
The Automatic nervous system is \_\_\_\_\_\_\_\_\_
Involuntary -- smooth muscle and glands
49
The Somatic Nervous system is \_\_\_\_\_\_\_\_
Voluntary -- skeletal muscle
50
THE NERVOUS SYSTEM CHART
51
The sypathetic and parasympathetic cause opposite effects to provide \_\_\_\_\_\_\_\_
Homeostasis
52
The sympathetic effects from the spinal cord
Eyes: dilate pupils
lung: dilate bronchioles
heart: increase HR
blood vessels: constrict them
gastro: relaxes
bladder: relaxes it
uterus: relaxes
53
Alpha 1 receptor
Blood vessels, eyes, bladder, prostate
Blood vessels: causes vasoconstriction. increased BP, and increased contractibility of the heart
eyes: pupil dilation
bladder: contraction
prostate: contraction
54
Alpha 2 receptor
blood vessels and smooth muscle (GI tract)
blood vessels: decreased BP ( reduced norepinepherine)
smooth muscle (GI): decreased GI tone and motility
55
Beta 1 receptor
Heart\*, kidneys
heart: increased HR, and increased heart contraction
kidneys: increased renin secretion, increased angiotensin, increased BP
56
Beta 2 receptors
smooth mucle (GI), lungs, uterus, liver
smooth musle (GI): decreased GI tone and motility
lungs: bronchodilation
uterus: relaxation of uterine smooth muscle
liver: activation of glycogenolysis, increased blood sugar
57
Parasympathetic Nervous system
recepotors and neurotransmitters
what do Acetylcholine and acetylcholinesterase do?
- Cholinergic receptors are NICOTINIC and MUSCARINIC
- Neurotransmitter is: ACETYLCHOLINE: which stimulates receptors to produce a response
- The enzyme ACETYLCHOLINESTERASE can inactivate acetylcholine before it reaches receptors
58
Drugs that mimic these systems will produce response \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Opposite to each other in the same organ
59
sympathomimetic
mimic neurotransmitter norepinephrine
adrenergics
60
Parasympathomimetic
Mimic nerurotransmitter acetylcholine
cholingergics
61
The Parasympathetic nervous system from the spinal cord effects:
Eyes: constrict pupils
Lungs: cpmstroct bronchioles amd increase secretions
heart: decreased HR
blood vessels: dilate
GI: increase peristalsis and secretions
bladder: contracts
salivary glands: incraesed salivation
62
The sympathetic Nervous system:
-ADRENERGIC
Neurotransmitter is NOREPINEPHRINE: which is released from terminal nerve endings to stimulate cell receptors to produce response
63
The Adrenergic receptors are
Alpha 1, Alpha 2, Beta 1, beta 2
Beta-1: one heart
Beta 2- two lungs
Alpha 1: blood vessels
64
Both Pediatrics and Geriatric Patients are:
- more sensitive to drugs
- greater individual variation
- increased risk for adverse drug reactions
65
Pediatrics
Pharmacokinetic differences
- everything moves faster for kids
- absoprtion, distribution, metabolism, excretion
66
Pediatric Adverse drug reactions
Peds pts are subject to unique adverse reactions to certain meds:
examples include:
- growth suppression
- discoloration of teeth
67
Med administration:
to an Infant
- give PO in cheek and make sure it has all gone down
- droppers in ears, eyes, nose, mouth
- suppositories have to hold butt cheeks together for 5-10 mints
-they lack developed muscle mass so use smaller needles for IM or IV
(swap legs for giving injections)
68
Med Administration:
to a Toddler
- IM injections given into the vastus lateralis
- IVS in scalp or feet
- After child has walked for about a yr. can use the VENTROGLUTEAL site for IM b/c less pain
- NO more scalp for IV access
69
Med Administration:
Preschool range
- same as toddler group
- can give oral meds better now
70
Med administration:
School aged
- rapid physical, metal, and social developement occurs
- chew tablets okay now
- VENTROGLUTEAL site best for IM injections and muscles
71
Geriatrics:
Complicated drug therapy
- Altered pharmacokinetics
- multiple and severe illnesses
- increased risk for drug interaction b/c of POLYPHARMACY
- poor compliance
72
Geriatric:
Polyoharmacy
taking of multiple drugs conccurently, most seen with patients who visit multiple physicians
73
Possible causes of ineffective management of health care regimen
- extended therapy for chronic illness causes pt to become discouraged
- troublesome adverse reactions
- lack of understanding of the purpose for the drug
- forgetfulness
- misunderstanding of oral or written instructions on how to take the drug
- A weak pt-nurse relationship
- lack of funds to obtain drug
- mobility problems
- lack of family support
- confnitive deficits
- visual or hearing defects
- lack of motivation
74
Geriatric Adverse drug reactions:
Factors predisposing the elderly
- some from polypharmacy
- some predictable b/c aging
- degeneration og organ systems
- multiple/severe illnesses
- unreliable compliance
75
Measures for reduction of geriatric Adverse drug reactions
- thorough drug history (inclusing OTC and herbal)
- initiate therapy with low doses
- monitor pt responses and plasma drug levels closely
- simple regimen
- encourage pt to dispose of old meds
- promote compliance
76
Geriatric Adults:
Absoprtions
-slower in older adults due to diminished gastric motility and decreased bloodflow to digestive organs
77
Geriatric:
distribution
- increase body fat in geriatric pts provide larger storage compartment for lipid-soluble drugs
- decreased plasma levels
- decreased body water
78
geriatric:
metabolism
- decreased in the enzyme production in the liver
- visceral blood flow diminished
- increased half life in drugs
79
Geriatrics:
excretion
reduced renal blood flow, glomerular filtration rate, active tubular secretion and nephron function
80
drugs given in high doses are absorped _____ and have a more rapid \_\_\_\_\_
faster, onset of action
81
high fat meals affect absorption how?
SLOW STOMACH MOTILITY AND DELAY ABSORPTION
82
acids and bases
absorption
acids are absorped in acides
and bases are absorped in bases
83
Hormone functions:
Estrogen and Progesterone
- regulate development and maintenance of female reproductive system and secondary sex characteristics
- also affect metabolism
- estrogens produce effects on tissues with estrogen receptors: female genitalia, breasts, pituitary, hypothalamus
- regular menstrual cycle
- control fertility (prevent pregnancy)
84
Estrogen
the maturation of the female reproductive organs and appearance of secondary sex organs
-Replacement:
(Menopause signs and symptomes, bone loss, cardiac protection)
Often used to treat disorders caused by estrogen deficiency
- Prevent actions of hormones (prevent pregnancy) with oral contraceptives, parenteral, transdermal contraception
- Assist actions of hormones (fertility treatments) from ovarian failure
- other uses: dysmenorrhea, atrophic vaginitis
85
Progesterone
- Increases basal body temp, changes vaginal epithelium, relaxes uterine smooth muscle, stimulates breast tissue growth, produces withdrawal bleeding in presence of estrogen
- Affects pituitary, uterus, vaginal mucosa, and mammary glands
- Uses: uterine bleeding: amenorrhea, dysmenorrhea, contraception, endometriosis, infertility, and to prevent miscarriage
86
Menopause
the permanen end of menstration cause by a decrease in ovarian function
- no periods for 1 year
- trigger unknown
- age range of 45-55 and can also happen after surgical removal of the ovaries
- signs and symptoms are caused by a decrease in estrogen:
Irregular bleeding, vaginal dryness, hot flashes, night sweats, sleep problems, mood changes, weight gain, thinning of hair, loss of breast fullness
87
Hormone replacement:
**Conjugated estrogens**
(ex. Premarin, and Prempro)
- promote growth and developement of female sex organs and the maintenence of secondary sex characteristics
- resoration of hormonal balance in treatment of hormone sensitive tumors.
- Side effects: headache, edema, HTN, nause, weight changes, increased appetite, jaundice, vomitting
onset-repid
peak-unknown
duration- 24 hr
88
Hormone replacement:
**Estradial**
(ex. Estrace, Estraderm)
- promote growth and development of female sex organs
- metabolic effects include reduced blood cholesterol, protein synthesis and sodium/water retention
- restoration of hormonal balance in menopause
-side effects:
headache, edema, HTN, nausea, amenorrhea, hypergylcemia
- onset/peak/duration unkown
- po, im, SQ. vaginal, topical, implants
89
Contraception:
Estrogen companents
decrease release of FSH, so no ovum released
preventing ovulation b/c ovarian follicle cant mature, no release
most common
90
Contraception:
Progesterone Components
decrease release of LH, prevent implantation
prevent fertilization by inhibiting ovulation
91
Benefits of contraception
imprves regularity of menstrual cycle and decreases blood loss
92
Contraception definition
prevent ovulation by inhibiting release of gonadotropins and increasing uterine mucous viscosity resulting in decreased sperm movement and fertilization of ovum and possible inhibition of fertilized egg implantation
93
Contraception:
Combination
**Monophasic**
fixed level of E & P throughout cycle
94
Contraception:
Combination
**Biphasic**
E constant/ P varied, low in 1st half, high in 2nd half
increase @ end to nourish the uterine lining
95
Contraception:
Combination
**Triphasic**
E & P levels vary to mimic normal cycle
96
Nuva ring
vaginal ring containing estrogen and progesterone
inserted for 3 weeks then removed
97
Progesterone ONLY contraception
mini pills, depo-vera, implanon
mini-pills:
less risk than with combination pills, does not suppress ovulation, increased risk for break through bleeding (menstrual irrregularities), may have less contraceptive effectiveness, stay on schedule!!!!
Depo-vera
(Medroxyprogesterone)
Im injection: every 3 months
Implanon: new progestin implant...effective for 3 years
98
**Depo-provera**
Medroxyprogesterone
class, how it works, uses, onset/peak/duration, side effects
Class: progestin
-fixed dosage of estrogen/progestin. Ovulation inhibited by supression of FSH and LH
(prevents penetration of sperm/implantation of egg)
- Uses: prevent pregnany, regulate pd, emergency contraceptive, acne
- side effects: depression, cerebral hemmorhage, thrombosis, pulmonary embolism, edema, HTN, abdominal cramps, bloating
onset- 1 month
peak- 1 month
duration- 1 month
99
other uses for oral contraception
dysmenorrhea
(produce cyclic withdrawal bleeding for pts with dysmenorrhea and irregular pds.
treat endometriosis
ortho tri-cyclen can be used to treat acne
100
Emergency Contraception
Yupze regimen, Plan B, Copper IUD
1)Yupze reguman:
(large dose of estrogen taken as soon after intercourse as possible and another 12 hrs later) aka: morning after pill, important to follow up with HCP to rule out pregnancy
2) Plan B: taking a levonorgesterel in 2 hrs, 12 hrs apart.
(Progestin only) large 1 dose or 2 time dose, 95% effective if done within 24 hours
-will NOT terminate a preg if implantation had already occured
3)Copper IUD within 5 days of intercourse
101
Adverse effects: Estrogen
- N/V most common
- fluid retention, weight gain, breast enlargement
- abnormal vaginal bleeding
- HTN
-Thrombophlebitis/Thrombotic Conditions
(increased risk for smokers over 35)
- Myocardial infarction, CVA
- elevated serum calcium
- hyperglycemia
102
Precautions: Estrogen
- Caution with smokers and woman over 35
- Contraindicated with breast CA, pregnancy, thromboembolic disorder, undx vaginal bleeding
- use with caution in pts with history of migraines or asthma. family hx of breast cancer
- unopposed estrogen therapy associated with increased risk of endometrial hyperplasia
103
Adverse effects: Progesterone
- N/V (not as bad as with estrogen)
- elevated blood pressure
- weight gain
- visual changes
- migranes
- thrombophlebitis/thrombolic events
- liver dusfunction
104
Pt teaching: Estrogen and Progesterone
- Take PO with food or milk to minimize GI upset
- BSE, routine pap smears
- report any weight gain greater than 5 ib per week
- sun precautions
- DO NOT SMOKE
105
amenorrhea
absence of menstration
106
endometriosis
abnormal location of endometrial tissue
107
oligomenorrhea
infrequent menstration
108
Pt teaching for birth control pills
- other drugs can decrease effectiveness
- use other forms of contracetion when using antibiotics, rifampin, phenytoin/phenobarbita, steriods
- take pills as directed
- make up missed pills ASAP
- report any pain/headaches/depression/dizziness/blurred vision/resp distress
109
Endometriosis
-Abnoral location of endometrial tissu outside the uterus
(implants on ovaries, uterus, uterosacral, broad ligaments and bowel. Displaced tissue still responds to hormonal control so bleeds during menstration
-Causes: inflammation, scar tissue, adhesions, infertility, pain, bleeding
-most pt asymptommatic
(severe lower back pain, pelvic pain worse during period.
-give Danazol (Danocrine)
110
**Danazol (Danocrine)**
class, how it works, what it does, side effects
Class: androgens
- suppresses and atrophies uterine tissue, supresses FSH production, which shuts down extopic and normal edometrial activity
- given PO
- treats endometriosis
- Side effects: hot flashes, weight gain
111
Osteoporosis
**Alendronate (Fosamax)**
class, how it works, what it does, side effects, onset/peak.duration
- Class: biphosphonate, bone reabsorption inhibitor
- lowers serum alkaline phosphatase
- used for prevention/treatment of osteoporosis in post menopausal women
- Take in AM with glass of water, do not lay flat for 30-1 hr.
- Side effects: N/D, constipation, hypocalcemia, hypophos., patho fractures if taken more than 3 months
onset: 3-6 weeks
peak: 3-6 months
duration: 12 weeks or more
112
Osteoporosis:
**Ibandronate Sodium (Boniva)**
class, what it does, how it works, side effects, onset/peak/duration
- Class: biphosphonates
- inhibits resorption of bones by inhibiting osteoclast activity
- for reversal/prevention of osteoporosis
- side effects: diarrhea, dysppsie, gastric ulcers
- Take AM with water, do not lay flat for 30 mints-1 hr
onset: unknow
peak: 0.5-2 hrs
duration: up to 1 month
113
Fertility Medications:
**Clomiphene Citrate (Clomid)**
- Class: Estrogen antagonist
- stimulates hypothalamus and thus ovaries to develop ovarian follicle which will stimulate ovulation
- can also treat menstrual abnormalities
- Side effects: ovarian hyperstimulation-cysts, multiple pregnancies, hot flashes, abdominal discomfort, GI distress, depression, weight gain, hair loss, dizziness, blurred vision, birth defects
114
Infertility causes
1) pelvic infections
2) obstruction of uterine tubes
3) lack of ovulation
(preg. can not occur unless ovarian follicles recieve hormonal signal to mature each month
115
Nursing Considerations for fertility meds
- pt much have normal liver function and estrogen levels
- inform pt of optimal time for intercourse
- strict treatment regimen (take same time everyday)
- take basal temp 4-10 days after treatment to determine if ovulation occured
- monitor for abdominal pain that could indicate ovarian cyst or rupture of cyst
- report visual symptomes such as blurring
- multiple births common
116
Obstetric Medications
- Prenatal Meds: multivitamins, iron, folic acids
- Meds for pregnancy discomfort: N/V, heartburn, constipation, pain
117
Pregnancy
- normal pregnancy is 40 weeks
- any birth less than 27=premature
- a loss prior to 20 weeks gestation is considered miscarriage
118
Pregnancy or labor complications
diabetes, HTM, preeclampsia, labor not pregressing, fetal intolerance, post partum hemorrhage
119
Reasons to induce:
fetal or maternal well being, diabetes, preeclampsia, infection, reptured membrances
120
**Terbutaline (Brethine)**
class, how it works, side effects, onset/peak/duration
- prevent pretern labor after 20 weeks gestation
- delay preterm delivery so that seroids can be given
- inhibits the release of mediators
- Side effects: tachycardia, tremors, nervousness, headache, GI distress, anxiety, arrhythmis, hyperglycemia, hypokalemia, pulmoney edema
- given SQ, PO, or pump
onset: 60-120 mint.
peak: 2-3 hrs
duration: 4-8 hrs
121
**Magnesium sulfate**
class, what it does, how it works, side effects, onset/peak/duration
- Class: Calcium antagonist, CNS depressant
- for preeclampsie and eclampsia, prenatal, intrapartal and post partum
- Side effects: flushing, diaphoresis, dizziness, nausea, HA, hypotension, lethary, decreased fetal HR, lethary in neonate
- Monitor serum mag levels, deep tendon relfexes, uterine reponse and urine output
onset: 60 mint
peak: unknown
duration: 3-4 hr
122
**Nifedipine
(Procardia)**
Class, what it does, side effects, onset/peak/duration
- Class: Calcium channel blockers
- most often used for long term control of preterm labor
- inhibits calcium transport into myocardial and vascular smooth muscle cells leading to inhibition of excitation contraction
- Side effects: headache, anxiety, flushing, constipation, diarrhea, weight gain, steven johnson syndrome
onset: 20 min
Peak: uknown
duration: 6-8 hrs
123
**Oxytocin**
and Synthetic **Pitocin**
what it does, side effects, onset/peak/duration
- secreted by the post. pituitary gland, stimulates smooth muscle of uterus and mammary gland
- stimulates uterine contraction to promote induction of labor
- stimulate by breastfeeding or nipple stim
- has a short half life and able to stom immediately
onset: immediate
peak: unknown
duration: 1 hr
Sythetic: Pitocin used for labor induction, stimulate increased contractions during labor, prevent and control postpartum bleeding, and partial birth abortions after 20 week gestation
124
Prostagladins
- used to induce labor
- local hormone that act directly at the site where they are secreted
- In uterus...cause smooth mucsle contraction
- In carboprost used to control post pardum hemmorage
125
Labor Induction:
**Dinoprostone (Prostin E2, prepidil)**
class, what they do, onset/peak/duration, side effects
- Prostaglandin to induce softening of cervix prior to inducing labor or for incomplete aborstions
- produce contractions by stimulating the myometrium
- Class: oxytocic, prostagladins
Inset:
onset: rapid
peak: 30-40 mints
duration: 12 hrs
- side effects: uterine abnormalities, fever, uterine rupture, back pain, Hypotension/hyper., UTI
126
Labor Induction:
**Misoprostol (Cytotec)**
class, what it does, side effects, onset/peak/duration
- Class: Prostaglandins
- soften cervix and labor induction
-given PO
Onset: 30 mint
Peak: unknown
duration: 3-6 hrs
- Side effects: N/V/D, uterine rupture, abdominal pain, uterine bleeding
127
Labore Induction:
**Methylergonovine Maleate (Methergine)**
class, what it does, side effects, onset/peak/duration
- Class: ergot alkaloids
- given PO or IM, IV if emergent
- stimulate uterine and vascular smooth muscle uterine contraction
Onset: 5-15 mints
Peak: unknown
duration: 3 hours
- Side effects: hypotension, cramps, N/V, allergic reactions
128
Labor Induction:
Carboprost (hemabate)
-caution with asthma pts
-side effects:
N/V/D, uterine cramping, headache, chills
129
Testosterone
- constant secretion by testes in men..increased in pubirty and decreased in adulthood
- feedback: testosterone levels get to high in blood, feedback to pituitary that shuts off secretion of LH and FSH
130
Androgens
male sex hormones that mediate normal growth and developement and maintenance of primary and secondary male sex characteristics
131
Pharmacothery with
**Testosterone**
-promotes synthesis of erythropoietin...and increases crit compared to women
-Adverse effects:
enhanced secondary sex characteristics, continuous erection, prolonged use can produce gynecomastia and halt spermatogenesis, N/V, insomnia, GI disturbances, libido changes
- IM better absorbed
onset: unknown
peak: unknown
duration: 1 to 3 days
132
Benign prostate hyperplasia
enlargement of the prostate gland that decreases outflow of urine by obstructing the urethra
133
Prostatic Hypertrophy treatment
- minimize urinary obstruction
- prevent complication
- treat symptoms
- give Finasteride (Proscar)
134
**Finasteride (Proscar)**
- Class: 5 alpha reductase inhibitor
- Inhibits 5-alpha reductase
-treatment of behign prostatic hyperplasia (BPH)
and reduces prostate size and improves urine flow
- pregnant women should not handle tablets
- Side effects: loss of libido, loss of erection, ejaculatroy dysfunction, myopathy...stimulates hair growth...so some people use this for male pattern baldness
Onset: 3-6 months
Peak: 1-2 hours
duration: 5-7 hrs
135
Prostatic Hypertrophy:
**Doxazosin (Cardura)**
- Class: peripherally acting antiadrenergics
- Alpha-adrenergic antagonist
- Treatment of BPH as well as HTN
- reduces contraction of smooth muscles in bladder, neck and prostate gland
- watch for orthostatic hypotension, dizziness, reflex tachcardia
onset: 1-2 hrs
peak: 2-6 hrs
duration: 24 hrs
136
Erectile dysfunction
- consistant inability to either obtain an erection or to sustain erection long
treatment: Viagra
could be R/T:
- arthrosclerosis
- diabetes
- kidney disease
- stoke
- HTN
- Smoking
137
Erectile dusfunction:
**Sildenafil citrat (Viagra)**
- Class: phosphodiesterase
- enhances flow of blood into corpus cavernosum by relaxing the smooth mucsle
- last about 4 hours
- Does not caus automatic erection, responds to stimulationg: NO EFFECT IN ABSENCE OF SEXUAL STIMULATION
onset: 20-60 min
peak: 30-130 min
duration: 24 hr
138
Precaution with Viagra and Cialis
