Pharm II Exam II (Reproductive And Urinary Drugs)

ethinyl estradiol and drospirenone (Yasmin)

• suppresses FSH and LH - preventing ovulation

• promotes thickening of cervical mucua - preventing passage of sperm

• prevents thickening of endometrium - prevents implantation

• may block aldosterone receptors - preventing retention of sodium and water

side effects of Yasmin

• risk for thromboembolism

• abnormal uterine bleeding

• decreased libido

• risk for breast cancer - BRACA1+

• HTN

• hyperkalemia

client teachig for Yasmin

• recognize S/S of thromboemboli

• avoid smoking/vaping

• signs of hyperkalemia (palpitations, paresthesia, abdominal cramping)

• take pills at same time each day

  • take one missed pill with the next pill

  • two pills for 2 consecutive days after 2 missed days

  • after 3 missed days, start new cycle (and another form of contraception)

drug interactions with Yasmin

• antibiotic therapy

• phenytoin

• rifampin

administration routes of Yasmin

• injection

• implantation into arm

• intrauterine device

• transdermal patch

• tablet/pill

Hormone Replacement Therapy Uses

• short term relief of menopausal symptoms

• feminization of transgender women

• (high risk for cardiac disease and contribution to breast cancer; with proper follow up, can be safely used)

Adverse Reactions of HRT

• thromboembolism

• abnormal uterine bleeding

• growth of existing breast cancer

• HTN

• hyperkalemia

Interactions with HRT

• anti seizure drugs

  • HC and HRT less effective

• warfarin and oral hypoglycemics

  • HC and HRT decrease effects

Endometriosis Symptoms

• pelvic pain that worsens over time

• excessive bleeding

• painful bowel movements or painful urination during menstrual periods

• infertility

• uterine lining proliferates outside of the uterus

• attaches to fallopian tubes, colon, ovaries, and causes pelvic pain that worsens over time; creates scar tissue

Expected Side Effects of GnRH Agonist - leuprolide (Lupron)

• cessation of menstrual periods

• emotional lability

• osteoporosis

• menopausal symptoms

Client Teaching for GnHR Agonist - leuprolide (Lupron)

• consume adequare calcium and Vitamin D

• encourage weight-bearing exercise

• requires monthly or q4 month IM injections

• alternative therapies to manage side effects

Action of Clomiphene (Clomid) for infertility

• stimulates follicle to mature

Patient Teaching and Side Effects for clomiphene (Clomid)

• oral - begin 5 days after menses begins and take for 5 days

• Expected Side Effects - breast tenderness, hot flashes

• Increased potential for multiple birth

• RED FLAG: pelvic pain

Action of Human chorionic gonadotropin (Pregnyl) for infertility

• stimulates ovulation

Patient Teaching and SIde effects of Human chorionic gonadotropin (Pregnyl)

• IM instructions- reconstitute with diluent provided, timing dependent on follicle maturation

• Monitoring for ovarian hyperstimulation - via ultrasound

• RED FLAG: pelvic pain, unusual weight gain

Action of cabergoline (Parlodel) for infertility

• corrects amenorrhea by decreasing prolactin levels

Patient Teaching for cabergoline (Parlodel)

• oral - twice a week on same days

• monitor prolactin levels

• monitor blood pressure

Action of oxytocin (Pitocin) for L&D

• uterine stimulant during labor

Adverse Effects for oxytocin (Pitocin)

• uterine hyperstimulation (contractions over 2 minutes)

  • stop infusion - priority

  • administer oxygen

Action of methylergonovine (Methergine) for L&D

• used postpartum to stop bleeding

Adverse Effects of methylergonovine (Methergine)

• HTN

  • monitor V/S

Action for dinoprosterone (Cervidil) for L&D

• softens cervix and stimulates labor

Adverse Effects for dinoprosterone (Cervidil)

• fluid embolism, uterine rupture, headache, hypotension

  • turn client on side

  • remove drug

  • administer oxygen

  • notify provider

Action of beta-adrenergic agonists (Brethine) for L&D

• stops contractions

Adverse Effects for Terbutaline (also Brethine)

• pulmonary edema, dyspnea, cough, tachypnea

  • restrict fluids

  • monitor V/S, SaO2, ECG, blood glucose

Action of betamethasone for L&D

• stimulates fetal lung maturity

Adverse Effects of betamethasone

• pulmonary edema

  • monitor respiratory status

  • monitor glucose

Action of magnesium sulfate for L&D

• prevents seizures due to preeclampsia/eclampsia

Adverse Effects of magnesium sulfate

• magnesium toxicity (hypotension, bradycardia, depressed DTR’s, altered LOC)

  • monitor kidney function - strict I&O

  • antidote - calcium gluconate

Testosterone Uses

• hypogonadism in males

• delayed puberty in males

• suppression of female secondary sex characteristics and masculinization for transgender males

• androgen replacement in testicular failure or menopause

• anemia not responsive to traditional therapy

• postmenopausal breast cancer

• muscle wasting in males with AIDS

Adverse Effects of Testosterone

• virilization

• epiphyseal closure

• cholestatic hepatitis

• hypercholesterolemia

• growth of prostate cancer

• polycythemia

• edema from salt and water retention

• potential for misuse

• hypercalcemia

• hypoglycemia

Administration of Testosterone

• transdermal patch

• cream

• injection

• pills

• buccal

Administration of sildenafil (Viagra)

• 1 hour before sexual activity

• limit to once daily

• do not take within 24 hours of using nitrates

Adverse Reaction for sildenafil (Viagra)

• priapism - medical emergency

• MI or sudden death

• hypotension

• headache

• sudden hearing loss (rare)

• sudden vision loss (rare)

Uses of 5-Alpha Reductase Inhibitor finasteride (Propecia)

• benign postrate hypertrophy

• male pattern hair loss

Administration of finasteride (Propecia)

• oral tablets

• OK to take with or without food

• OK to crush tablet

• therapy lifelong

• therapeutic effects may take 12 months

• Caution - women on childbearing age should not handle

Adverse Effects of finasteride (Propecia)

• decreased libido and ejaculate volume

• gynecomastia

• decreased PSA

Uses of Alpha-Adrenergic Receptor Antagonists - tamsulosin (Flomax)

• urinary retention related to BPH

• relaxation of smooth muscle

  • increased urine flow

  • decreased BPH symptoms

Adverse Reactions of tamsulosin (Flomax)

• orthostatic hypotension

• dizziness and headaches

• reduced ejaculate volume

• ejaculation failure

• retrograde ejaculation

Action of oxybutynin (Ditropan)

• drug therapy for urinary incontinence/Overactive bladder (urgency, frequency, incontinence)

• anticholinergic

• blocks muscarinic receptors in detrusor muscle

• relaxes the bladder

• contraction of the internal sphincter of the bladder

Side Effects of Anticholinergic drugs

• can’t see

• can’t spit

• can’t pee

• can’t poop

Action of bethanechol (Urecholine)

• drug therapy for urinary retention related to bladder “atony” cholinergics

• activates the muscarinic receptors in the detrusor muscle

• bladder contracts

• internal sphincter relaxes

Adverse Reactions for bethanechol (Urecholine)

• hypotension

• bradycardia

• sweating

• excessive gastric secretions, salivation, diarrhea