DCA Hormones/ DM 1-10

sildenafil brand name

Viagra, Revatio

sildenafil therapeutic class

Erectile Dysfunction Agent, Pulmonary Hypertension Agent

sildenafil dosage form

"- Tablet
- Suspension
- Injectable"

sildenafil indications

"- Erectile dysfunction
- Pulmonary HTN"

sildenafil efficacy

"- Improvement in sexual function
- Improvement in respiratory status/functional status"

sildenafil mechanism of action

Inhibition of phosphodiesterase type 5 (PDE5) by sildenafil increases the amount of cyclic guanosine monophosphate (GMP) enhancing erectile function and pulmonary vasculature relaxation. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum and vasodilation in the pulmonary bed.

sildenafil counseling

"- Take 30 min-4 hrs prior to anticipated sexual activity
- Do not take more frequently than once q24h for erectile dysfunction"

sildenafil adverse effects

"Common (>10%): flushing, nausea, headache, visual disturbances
Rare but Serious (

sildenafil toxicity

- Seek medical attention if chest pain, erection lasting >4 h, tinnitus, dizziness, or SOB "

sildenafil drug interactions

α-Adrenergic agents: additive hypotension
Nitrates: additive hypotension, potentially severe
Protease inhibitors: increased concentration of sildenafil and increased risk of toxicity"

sildenafil counterindications

"- Hypersensitivity to phosphodiesterase inhibitors
- Concurrent HIV protease inhibitors when used for treating pulmonary HTN
- Concurrent guanylate cyclase stimulators"

sildenafil dosing

"Erectile dysfunction: 25-100 mg 1 h prior to anticipated sexual activity
Pulmonary HTN: 5-20 mg TID"

sildenafil pharmacology

"Dose adjustment RENAL:
- CrCl

tadalafil brand name

Cialis

tadalafil therapeutic class

Erectile Dysfunction Agent, Pulmonary Hypertension Agent

tadalafil dosage form

- Tablet "- Erectile dysfunction
- Benign prostatic hyperplasia
- Pulmonary HTN"

tadalafil efficacy

- Improvement in sexual function, BPH symptoms, or respiratory symptoms

tadalafil mechanism of action

Inhibition of phosphodiesterase type 5 (PDE5) by tadalafil enhances erectile function by increasing the amount of cyclic GMP enhancing erectile function and pulmonary vasculature relaxation. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum and vasodilation in the pulmonary bed.

tadalafil counseling

"- If taking as needed, take 30 min prior to anticipated sexual activity
- Do not take more frequently than q24h
- Seek medical attention if chest pain, erection lasting >4 h, tinnitus, dizziness, or SOB"

tadalafil adverse effects

"Common (>10%): flushing, nausea, myalgia, headache
Rare but Serious (

tadalafil toxicity

- Seek medical attention if chest pain, erection lasting >4 h, tinnitus, dizziness, or SOB

tadalafil drug interactions

α-Adrenergic agents: additive hypotension
Nitrates: additive hypotension, potentially severe"

tadalafil counterindication

"- Hypersensitivity to phosphodiesterase inhibitors
- Concurrent nitrates
- Concurrent guanylate cyclase stimulators"

tadalafil dosing

"Erectile dysfunction: 2.5-5 mg daily or 10-20 mg as needed
BPH: 5 mg daily
Pulmonary HTN: 40 mg daily"

tadalafil pharmacology

"Dose adjustment RENAL:
- CrCl < 50 mL/min, reduce dose
Dose adjustment HEPATIC:
- avoid use"

estradiol brand name

Estrace

estradiol therapeutic class

Estrogen

estradiol dosage form

"- Tablet
- Injectable
- Vaginal ring"

estradiol indication

"- Abnormal vasomotor function
- Atrophic vulva or vagina
- Breast cancer
- Carcinoma or prostate
- Decreased estrogen level
- Postmenopausal osteoporosis"

estradiol efficacy

"- Improvement in menopause symptoms
- Improved BMD for postmenopausal osteoporosis
- Routine Cancer and laboratory screening"

estradiol mechanism of action

Estradiol and other estrogens produce characteristic effects on specific tissues (such as breast), cause proliferation of vaginal and uterine mucosa, and increase calcium deposition in bone.

estradiol counseling

"- Report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder
- Do not smoke during therapy, as this increases the risk of thromboembolic events"

estradiol adverse effects

"Common (>10%): none known
Rare but Serious (

estradiol toxicity

- Annual physical examination including cervical cytology (PAP smear) and breast exam, BP, serum triglycerides

estradiol counterindications

"- Hypersensitivity to estradiol
- History of thromboembolic disorders, breast cancer, any estrogen-dependent neoplasm
- Known or suspected pregnancy"

estradiol black box warning

- Endometrial and breast cancer risk

estradiol dosing

"Abnormal vasomotor function and atrophic vulva or vagina: 1-2 mg daily (3 wk on, 1 wk off)
Breast cancer: 10 mg TID x 3 months
Carcinoma of prostate: 1-2 mg TID
Decreased estrogen levels: 1-2 mg daily
Postmenopausal osteoporosis: 0.5 daily x 23 d followed by 5 d off"

estradiol pharmacology

- Dose adjustments not required

estradiol pearls

"- Estrogens increase the risk of endometrial cancer - monitor for abnormal vaginal bleeding
- Increased risks of MI, stroke, invasive breast cancer, pulmonary emboli, and DVT in postmenopausal women have been reported
- Estrogens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration possible"

estradiol (transdermal patch) brand name

Vivelle-Dot, Estraderm

estradiol (transdermal patch) therapeutic class

Estrogen

estradiol (transdermal patch) dosage form

"- Transdermal Patch (once or twice weekly)
- Various topical formulations (gel, cream, aerosol spray)"

estradiol (transdermal patch) indications

"- Abnormal vasomotor function or atrophic vagina or vulva
- Postmenopausal osteoporosis"

estradiol (transdermal patch) efficacy

"- Improvement in menopause symptoms
- Improved BMD
- Decreased postmenopausal osteoporosis"

estradiol (transdermal patch) mechanism of action Estradiol and other estrogens produce characteristic effects on specific tissues (such as breast), cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, and accelerate epiphyseal closure after initial growth stimulation.

estradiol (transdermal patch) counseling

"- Report abnormal vaginal bleeding or signs/symptoms of a thromboembolic disorder
- Do not smoke during therapy, as this increases the risk of thromboembolic events
- Place patch on clean, dry skin, preferably on the lower abdomen, upper quadrant of buttock, or outer aspect of hip - do not apply to the breasts or waistline
- Rotate sites of application with 1 wk allowed between applications to a particular site"

estradiol (transdermal patch) adverse effects

"Common (>10%): edema, application site irritation
Rare but Serious (

estradiol (transdermal patch) toxicity monitoring

- Annual physical examination including cervical cytology (PAP smear) and breast exam

estradiol (transdermal patch) counterindications

"- Hypersensitivity to estradiol
- History of thromboembolic disorders, breast cancer, any estrogen-dependent neoplasm
- Pregnancy"

estradiol (transdermal patch) black box warning

- Endometrial and breast cancer risk

estradiol (transdermal patch) dosing

"- 0.014 - 0.0375 mg/d
- Adjust dose as necessary based on response"

estradiol (transdermal patch) pharmacology

- Dose adjustments not required

estradiol (transdermal patch) pearls

"- Estrogens increase the risk of endometrial cancer - monitor for abnormal vaginal bleeding
- Increased risks of MI, stroke, invasive breast cancer, pulmonary emboli, and DVT in postmenopausal women have been reported
- Estrogens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration possible
- Patch contain metal - remove prior to MRI
- Do not cut patch"

conjugated estrogens brand name

Premarin

conjugated estrogens therapeutic class

Estrogen hormone

conjugated estrogens dosage form

"- Tablet
- Injectable
- Vaginal cream"

conjugated estrogens indication

"- Abnormal vasomotor function
- Atrophy of vagina or vulva
- Postmenopausal osteoporosis
- Female hypogonadism syndrome
- Primary ovarian failure"

conjugated estrogens efficacy

"- Resolution of clinical signs of abnormal bleeding, hot flashes, or other symptoms
- Prevention of osteoporosis"

conjugated estrogens mechanism of action

Estrogens act through binding to nuclear receptors in estrogen-responsive tissues. Circulating estrogens modulate the pituitary secretion of the gonadotropins, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), through a negative-feedback mechanism

conjugated estrogens counseling

- Discuss potential long-term adverse effects of hormone therapy including MI, stroke, DVT, PE, and breast cancer

conjugated estrogens adverse effects

"Common (>10%): weight change, headache, migraine, depression, disorder of menstruation, breast pain
Rare but Serious (

conjugated estrogens toxicity

"
- Conduct diagnostic evaluation to rule out malignancy in the event of persistent or recurring vaginal bleeding"

conjugated estrogens counterindications

"- Hypersensitivity
- Undiagnosed abnormal genital bleeding
- History of estrogen- or progesterone-dependent neoplasia
- Active or history of DVT or PE
- Severe liver dysfunction
- Known or suspected pregnancy"

conjugated estrogens black box warning

"- Breast cancer
- Cardiovascular disease
- Endometrial cancer"

conjugated estrogens dosing

"- 0.3 mg daily (continuously or cyclically)
- 1.25 mg cyclically (3 wk on, 1 wk off)
- Adjust dose to individual response"

conjugated estrogens pharmacology

"Dose adjustment HEPATIC:
- avoid in severe liver dysfunction
- Half-life of 26 hours"

conjugated estrogens pearls

"
- Increased risk of MI, stroke, invasive breast cancer, PE, and DVT has been shown in postmenopausal women
- Estorgens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual women
- In postmenopausal women with a uterus, a progestin should be added to estrogen to reduce the risk of endometrial cancer
- Also available in combination with bazedoxifene (Duavee) for osteoporosis prevention and vasomotor symptoms"

oral contraceptive - monophasic brand name

Ortho-Novum, Yaz

oral contraceptive - monophasic therapeutic class

Oral Contraceptive

oral contraceptive - monophasic dosage form

- Tablet

oral contraceptive - monophasic indications

"- Contraception
- Acne" "
- Improvement in acne
- Improvement in menstrual symptoms"

oral contraceptive - monophasic mechanism of action

As contraceptives, estrogens suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to inhibit ovulation, cause edematous endometrial changes that are hostile to implantation of the fertilized ovum, accelerate ovum transport, and produce degeneration of the corpus luteum (luteolysis). Progestins inhibit ovulation by suppression of LH, inhibit sperm capacitation, slow ovum transport, produce a thinning endometrium that hampers implantation, and cause cervical mucus changes that are hostile to sperm migration.

oral contraceptive - monophasic counseling

"- Take this drug at approximately the same time each day
- If spotting occurs and no doses have been missed, continue to take tablets even if spotting continues
- Report immediately if new severe or persistent headache, blurred or loss of vision, SOB, severe leg, chest, or abdominal pain, or any abnormal vaginal bleeding occur"

oral contraceptive - monophasic adverse effects

"Common (>10%): weight change, breast tenderness, breast swelling
Rare but Serious (

oral contraceptive - monophasic toxicity

- Annual physical examination including cervical cytology (PAP smear) and breast exam

oral contraceptive - monophasic drug interaction

Antibiotics: alters intestinal flora which reduces the enterohepatic circulation of estrogen metabolites resulting in decreased efficacy of contraceptive

oral contraceptive - monophasic counterindications

"- Hypersensitivity to ethinyl estradiol or progestin component
- History or risk of thromboembolic disorders
- Breast or endometrial cancer
- Uncontrolled HTN
- Hepatic disease
- Known or suspected pregnancy
- Thrombogenic cardiac value or rhythm disease
- Smoking or migraine headache if >35 y of age"

oral contraceptive - monophasic black box warning

"- Cigarette smoking
- age >35 years"

oral contraceptive - monophasic dosing

- 1 tablet daily

oral contraceptive - monophasic pharmacology

"Dose adjustment HEPATIC:
- contraindicated in hepatic disease"

oral contraceptive - monophasic pearls

"- Patients wit thrombogenic mutations should not receive oral contraceptives
- Patients should not smoke during therapy, as this increases the risk of serious cardiovascular side effects
- Multiphasic product have a lower total steroid dose than monophasic products and may have lower adverse effect rates, but treatment is usually initiated with monophasic products
- Extended cycle dosing (84 on/7 off, continuous) is safe, reduces or eliminates monthly menstrual bleeding, may increase efficacy and reduce hormonal withdrawal symptoms"

oral contraceptive - triphasic brand name

Ortho Tri-Cyclen, Ortho-Novum 7/7/7

oral contraceptive - triphasic therapeutic class

Oral Contraceptive

oral contraceptive - triphasic dosage forms

- Tablet

oral contraceptive - triphasic indications

"- Contraception
- Acne" "
- Improvement in acne
- Improvement in menstrual symptoms"

oral contraceptive - triphasic mechanism of action

As contraceptives, estrogens suppress follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to inhibit ovulation, cause edematous endometrial changes that are hostile to implantation of the fertilized ovum, accelerate ovum transport, and produce degeneration of the corpus luteum (luteolysis). Progestins inhibit ovulation by suppression of LH, inhibit sperm capacitation, slow ovum transport, produce a thinning endometrium that hampers implantation, and cause cervical mucus changes that are hostile to sperm migration.

counseling

"- Take this drug at approximately the same time each day
- If spotting occurs and no doses have been missed, continue to take tablets even if spotting continues
- Report immediately if new severe or persistent headache, blurred or loss of vision, SOB, severe leg, chest, or abdominal pain, or any abnormal vaginal bleeding occur"

oral contraceptive - triphasic adverse effects

"Common (>10%): weight change, breast tenderness, breast swelling
Rare but Serious (

oral contraceptive - triphasic toxicity

- Annual physical examination including cervical cytology (PAP smear) and breast exam

oral contraceptive - triphasic drug interactions

"Antibiotics: alters intestinal flora which reduces the enterohepatic circulation of estrogen metabolites resulting in decreased efficacy of contraceptive

oral contraceptive - triphasic counterindications

" "- Hypersensitivity to ethinyl estradiol or progestin component
- History or risk of thromboembolic disorders
- Breast or endometrial cancer
- Uncontrolled HTN
- Hepatic disease
- Known or suspected pregnancy
- Thrombogenic cardiac value or rhythm disease
- Smoking or migraine headache if >35 y of age"

oral contraceptive - triphasic black box warning

"- Cigarette smoking
- age > 35 years"

oral contraceptive - triphasic dosing

- 1 tablet daily

oral contraceptive - triphasic pharmacology

"Dose adjustment HEPATIC:
- contraindicated in hepatic disease"

oral contraceptive - triphasic pearls

"- Patients wit thrombogenic mutations should not receive oral contraceptives
- Patients should not smoke during therapy, as this increases the risk of serious cardiovascular side effects
- Multiphasic product have a lower total steroid dose than monophasic products and may have lower adverse effect rates, but treatment is usually initiated with monophasic products
- Extended cycle dosing (84 on/7 off, continuous) is safe, reduces or eliminates monthly menstrual bleeding, may increase efficacy and reduce hormonal withdrawal symptoms"

levothyroxine brand name

Synthroid, Levoxyl, Levothroid

levothyroxine therapeutic class

Thyroid supplement

levothyroxine dosage forms

"- Tablet
- Capsule"

levothyroxine indications

"- Hypothyroidism
- Thyroid-stimulating hormone suppression"

levothyroxine efficacy

"- Serum TSH, T3, and T4 levels
- Resolution of symptoms of hypothyroidism, fatigue, edema, hair loss, cold intolerance, and lethargy"