ATI PHARMACOLOGY DRUGS Reproductive and Genitourinary System Drugs

What administration considerations apply to ethinyl estradiol and drospirenone?

Confirm negative pregnancy status before starting therapy.Use an additional method of contraception during the first cycle.Take pills at the same time each day.Take according to the precise dosing schedule, typically 21 days of a drug-containing pill and 7 days of an inactive pill.Follow the manufacturer’s instructions for missed pills, typically taking one missed pill with the next pill, two pills for 2 consecutive days after 2 missed days, and after 3 missed days starting a new cycle 7 days later with alternative contraception in the interim.

What administration considerations apply to conjugated equine estrogen, transdermal estradiol, and intravaginal estradiol?

Oral:Take according to the precise dosing schedule, typically continuously to avoid monthly bleeding.Take pills at the same time each day.Transdermal estradiol patches:Apply patches at the recommended interval, typically once or twice per week.Apply to clean, dry, intact skin on the abdomen or trunk (not breasts or waistline) and press firmly for 10 seconds.Do not use the same site more than once per week.Intravaginal estradiol hemihydrate tablets (Vagifem) or vaginal cream (Estrace vaginal cream):Use according to the precise dosing schedule, typically tablets are inserted once daily for 2 weeks, then twice per week.Insert tablet using provided applicator at bedtime.Vaginal cream is applied using a reusable applicator to measure the precise dose; insert into vagina at bedtime.

What administration considerations apply to conjugated estrogen and medroxyprogesterone acetate, transdermal estradiol and norethindrone?

Oral:Take according to the precise dosing schedule, typically continuously to avoid monthly bleeding.Take pills at the same time each day. Transdermal:Apply patches at the recommended interval, typically every 3 to 4 days.Apply to clean, dry, intact skin on the abdomen or trunk (not breasts or waistline) and press firmly for 10 seconds.Do not use the same site more than once per week.

What administration considerations apply to leuprolide?

Give via IM injection monthly or give depot form IM every 4 months.Rotate injection sites.Refrigerate unopened vials.Expect amenorrhea and other menstrual irregularities.

What administration considerations apply to medroxyprogesterone acetate?

Give orally daily or cyclically or via IM injection.Expect amenorrhea and other menstrual irregularities.

What administration considerations apply to clomiphene?

Take orally, beginning 5 days after menstruation onset and continuing therapy for 5 days. (With amenorrhea, begin any time.)Repeat the 5-day course at 30-day intervals as prescribed, depending on the occurrence of ovulation and conception.Take the drug at the same time each day.For a missed dose, take it as soon as possible. Double the next dose if not remembered until then. For two missed doses, consult the provider.Stop taking the drug for any suspicion of pregnancy.

What administration considerations apply to human chorionic gonadotropin?

Confirm follicular maturation with clomiphene (Clomid), menotropins, or follitropins before administration.Give via IM injection after reconstituting powder with the supplied diluent.When used with clomiphene, give 7 to 9 days after the previous dose of clomiphene.When used with menotropins or follitropins, give 1 day after the previous dose.

What administration considerations apply to cabergoline?

Take orally twice per week on the same days of the week.Take with or without food.Discontinue when prolactin levels are within the expected reference range.

What administration considerations apply to oxytocin?

Administer IV via infusion pump.Gradually increase the flow rate by 1 to 2 milliunits/min every 30 to 60 min until contractions last 1 min or less every 2 to 3 min.Monitor blood pressure and pulse rate.Monitor for uterine hyperstimulation (contractions lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20 mm Hg). Stop the infusion and report hyperstimulation immediately.Monitor fetal heart rate and rhythm, and report signs of fetal distress.Stop the infusion for serious alterations in fetal heart rate or rhythm.

What administration considerations apply to methylergonovine?

Check blood pressure before administration. Do not give if B/P exceeds parameters set by providerGive orally for 2 to 7 days or IM every 2 hr as needed.Give the drug IV only for emergency control of severe hemorrhage.Administer IV doses slowly (over 1 min to minimize adverse effects).Administer after the delivery of the placenta.Monitor vital signs and uterine response.Tell clients to expect some cramping.

What administration considerations apply to dinoprostone vaginal insert or gel ?

Gel:Administer intracervically using a syringe prefilled with the drug in gel form and an endocervical catheter.Have clients lie supine during instillation and remain supine for 30 min.Repeat dosing every 6 hr, twice, if the desired therapeutic effect has not occurred.Monitor uterine activity and fetal heart rate.Monitor uterine hyperstimulation (contractions lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20 mm Hg). Report hyperstimulation immediately.Begin oxytocin 6 to 12 hr after the last dose. Vaginal insert:Insert the pouch containing the drug into the posterior fornix of the vagina.Have clients lie supine for 2 hr while the pouch gradually releases the drug.Remove the pouch using the attached tape when active labor begins or 12 hr later.Follow the monitoring precautions listed above.

What administration considerations apply to terbutaline?

Confirm preterm labor and gestation between 20 and 36 weeks.Usually administered subcutaneously (lateral deltoid area)every 20 minup to 3 hrno longer than 48 hrLess often administered by IV infusionMonitor fetal heart rate and rhythm, and report signs of maternal or fetal distress.Stop the infusion for serious alterations in fetal heart rate (above 180 beats/min) or rhythm (nonreassuring).

What administration considerations apply to betamethasone?

betamethasone (Betaject) 12 mg IM for 2–3 doses 24 hr apartDexamethasone 6 mg IM for four doses 12 hr apartGive deep IM in ventral gluteal or vastus lateralis muscle

What administration considerations apply to magnesium sulfate?

Loading dose of 4 to 6 g magnesium sulfate intermittent IV bolus as a secondary infusion over 15 to 30 min. Use a volumetric pump to ensure accuracy of dose.Administer maintenance dose by continuous infusion at 2 g/hr.Monitor blood levels to maintain therapeutic level at 4 to 7 mEq/L.

What administration considerations apply to androderm, delatestryl?

Transdermal (Androderm)Apply the patch to the upper arm, back, abdomen, or thigh.Apply once per day.Rotate sites; do not use the same site more often than once per week.A gel is also available (AndroGel, Testim). If used, wash hands after applying and cover the site of application, then do not shower or swim for several hours.Underarm liquid: Use the metered-dose pump to apply liquid into applicator and then apply to axilla. Buccal (Striant)Apply to gums above an upper incisor.Apply external pressure with a finger for 30 seconds to promote adhesion.Alternate sides of the mouth.Tell clients to expect a bitter taste and changes in taste.Tell clients the tablets are not affected by eating, drinking, brushing the teeth, or chewing gum. Subcutaneous (implantable pellets) (Testopel)Using local anesthesia, the provider implants pellets under the skin of the abdomen.Two to six pellets are implanted every 3 to 4 months. IM (Delatestryl)Long-acting formulations are injected every 2 to 4 weeks.Serum testosterone levels will vary; tell clients to expect changes in mood, energy, and libido.

What administration considerations apply to finasteride?

Take orally, with or without food.Crush the tablets if needed.Expect drug therapy to be lifelong.Ensure that women do not handle the drug, especially if crushed, due to the possibility of transdermal absorption.Expect therapeutic effects to take 6 to 12 months.

What administration considerations apply to tamsulosin?

Take orally once a day.Take at the same time each day, 30 min after the same meal (such as breakfast).Swallow the capsules whole; do not crush or chew them.

What administration considerations apply to sildenafil?

Take orally 1 hr before sexual activity – limit to once daily.Take with or without food (but high-fat foods delay effects and reduce peak effects: sildenafil and vardenafil [Levitra], not tadalafil [Cialis]).Expect effects to last up to 4 hr.Do not take within 24 hr of using nitrates.Do not take more than one dose in a 24-hr period.

What administration considerations apply to oxybutynin chloride?

Take orally (either short-acting syrup or tablets) two to four times a day.Take the extended-release (ER) tablets once a day.Swallow ER tablets whole; do not crush or chew them.Expect excretion of the insoluble shell of the ER tablets in stool.Apply the transdermal patch twice a week to dry and intact skin on the abdomen, hip, or buttocks.Rotate patch adhesion sites.

What administration considerations apply to bethanechol?

Take orally three to four times a day.Take 1 hr before or 2 hr after meals.

What are adverse drug reactions associated with ethinyl estradiol and drospirenone?

ThromboembolismHyperkalemia (due to the drospirenone in this drug)Hypertension (less likely with ethinyl estradiol and drospirenone than with other combination oral contraceptives)Uterine bleedingIncreased growth of breast malignancies

What are adverse drug reactions associated with conjugated equine estrogen, transdermal estradiol, and intravaginal estradiol?

NauseaThromboembolism: thrombophlebitis, pulmonary embolism, stroke, myocardial infarctionHypertensionEndometrial hyperplasia, endometrial and ovarian cancer

What are adverse drug reactions associated with conjugated estrogen and medroxyprogesterone acetate, transdermal estradiol and norethindrone?

Thromboembolism; even greater risk with addition of progesterone than with estrogen aloneNauseaHypertensionBreast cancerBreakthrough bleeding and other menstrual irregularitiesEdema

What are adverse drug reactions associated with leuprolide?

Bone lossVasomotor instability (hot flashes)Vaginal drynessHeadache

What are adverse drug reactions associated with medroxyprogesterone acetate?

ThromboembolismBreast cancerBreakthrough bleeding and other menstrual irregularitiesNauseaEdema

What are adverse drug reactions associated with clomiphene?

Vasomotor instability (hot flashes)Breast engorgementNausea, abdominal discomfortBlurred vision, flashes of light, dizzinessOvarian hyperstimulationMultiple gestation

What are adverse drug reactions associated with human chorionic gonadotropin?

Ovarian hyperstimulationOvarian cyst ruptureCNS effects: irritability, headache, fatigue, restlessness

What are adverse drug reactions associated with cabergoline?

NauseaHeadache, dizzinessPulmonary fibrosis, pericardial fibrosis, valvular disorders and retroperitoneal fibrosis.

What are adverse drug reactions associated with oxytocin?

Uterine hyperstimulationHypertensive crisisWater intoxication (rare at therapeutic doses)

What are adverse drug reactions associated with methylergonovine?

Rare with PO or IM administration – more common when administered IVHypertensionNausea, vomiting (rare with oral administration)CrampsArrhythmiasSeizures

What are adverse drug reactions associated with dinoprostone vaginal insert or gel ?

Amniotic fluid embolism, uterine rupture, headache, chills or hypotension.Nausea, vomiting, diarrhea

What are adverse drug reactions associated with terbutaline?

Respiratory effects: pulmonary edema, dyspnea, cough, tachypneaCardiac effects: tachycardia, myocardial ischemia, chest pain, palpitations, hypotensionHypokalemiaHyperglycemiaFetal effects: hypotension, tachycardia, hyperinsulinemia/hypoglycemia, hyperbilirubinemia, hypocalcemia

What are adverse drug reactions associated with betamethasone?

Pulmonary edema (if given with beta-adrenergic medications)Hyperglycemia (if client has pregestational or gestational diabetes)Hypertension

What are adverse drug reactions associated with magnesium sulfate?

Flushing, diaphoresisDrowsiness, muscle weaknessMaternal hypotension, bradycardia, bradypneaDepressed/absent deep tendon reflexes (DTRs)Altered level of consciousnessDecreased urine outputMagnesium toxicityReduced variability of fetal heart rate

What are adverse drug reactions associated with androderm, delatestryl?

Virilization (females, children)Increased growth of existing (undiagnosed) prostate cancerEdema/weight gainLiver toxicity (17-alpha-alkylated androgens only)Premature epiphyseal closure in young clients who have not reached full heightGynecomastia (males)

What are adverse drug reactions associated with finasteride?

Reduced libido and ejaculate volumeReduced prostate-specific antigen (PSA) levelsGynecomastia (males)

What are adverse drug reactions associated with tamsulosin?

Reduced ejaculate volume, ejaculation failure, retrograde ejaculation (tamsulosin and silodosin)Headache and dizzinessHypotension, fainting, (nonselective alpha blockers, not tamsulosin)

What are adverse drug reactions associated with sildenafil?

Priapism (persistent erection)HeadacheHypotension, fainting, dizzinessSudden loss of hearing (rare)Irreversible loss of vision (rare)

What are adverse drug reactions associated with oxybutynin chloride?

Dry mouthConstipationUrinary retentionMydriasis (pupil dilation), dry eyes, blurred visionHeadacheDizziness, drowsinessFever, heat exhaustion

What are adverse drug reactions associated with bethanechol?

Hypotension, bradycardiaExcessive gastric acid and salivation, diarrhea, fecal incontinenceBronchoconstrictionDizziness, fainting

What instructions should be provided for a client taking ethinyl estradiol and drospirenone?

Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath.Do not smoke.Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events.Report palpitations, paresthesia, weakness, or abdominal cramps.Obtain regular blood pressure checks.Report any unusual breakthrough bleeding or spotting or changes in menstrual patterns.Perform breast self-examination every month.

What instructions should be provided for a client taking conjugated equine estrogen, transdermal estradiol, and intravaginal estradiol?

Take oral forms with food.Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath.Do not smoke.Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events.Exercise regularly and follow a healthy, low-fat diet.Take, apply, or instill at bedtime.Obtain regular blood pressure checks.Report persistent or recurrent vaginal bleeding.

What instructions should be provided for a client taking conjugated estrogen and medroxyprogesterone acetate, transdermal estradiol and norethindrone?

Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath.Do not smoke.Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events.Exercise regularly and follow a healthy, low-fat diet.Take oral forms with food.Take pill or apply transdermal patch at bedtime.Obtain regular blood pressure checks.Perform breast self-examination every month.Obtain a mammogram and breast examination at the recommended intervals.Report vaginal bleeding or spotting to the provider.Advise client to report edema to provider.

What instructions should be provided for a client taking leuprolide?

Perform weight-bearing exercise daily.Consume adequate calcium and vitamin D.Identify and avoid conditions that trigger hot flashes, such as fluctuations in glucose levels.Consider alternative therapies with the provider’s prescription.Use vaginal lubricants if indicated.Report headache, dizziness, or paresthesia.Take over-the-counter analgesics to relieve headache.

What instructions should be provided for a client taking medroxyprogesterone acetate?

Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath.Do not smoke.Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events.Perform breast self-examination every month.Obtain a mammogram and breast examination at the recommended intervals.Report any unusual breakthrough bleeding or spotting or changes in menstrual patterns.Take oral forms with food.Take at bedtime.

What instructions should be provided for a client taking clomiphene?

Expect hot flashes as a side effect of this therapy.Apply cold compresses as needed and if helpful.Take over-the-counter anti-inflammatory drugs as needed.Wear a supportive bra.Take the drug with food.Report any visual disturbances. Do not engage in dangerous activities if symptoms occur.Report pelvic pain.Be aware of the possibility of twins.

What instructions should be provided for a client taking human chorionic gonadotropin?

Seek medical care immediately for pelvic or low abdominal pain or pressure, unusual weight gain, or swelling.Report pelvic or abdominal pain.Take over-the-counter analgesics as needed for headache.

What instructions should be provided for a client taking cabergoline?

Take the drug with food if GI symptoms persist.Report headache or dizziness.Do not engage in dangerous activities if dizziness occurs or tends to recur.Take over-the-counter analgesics to relieve headache.

What instructions should be provided for a client taking oxytocin?

Report increasing duration or strength of contractions.Report headache, palpitations, nausea, or chest pain.Report drowsiness or headache.

What instructions should be provided for a client taking methylergonovine?

Report any nausea.Report headache.Report any weakness or palpitations.

What instructions should be provided for a client taking dinoprostone vaginal insert or gel ?

Report increasing duration or strength of contractions.Report nausea, vomiting, and diarrhea.Increase clear fluid intake as needed.Report fever.

What instructions should be provided for a client taking terbutaline?

Report shortness of breath, difficulty breathing, or cough.Report palpitations or chest pain.Report weakness, nausea, palpitations, or paresthesia.Report polyphagia, polydipsia, and polyuria.

What instructions should be provided for a client taking betamethasone?

Instruct client to report shortness of breath, cough, and increased production of sputum.Tell the client to report polyphagia, polydipsia, or polyuria.Instruct client to report headache and dizziness.

What instructions should be provided for a client taking magnesium sulfate?

Tell the client to report adverse effects.Provide comfort measures.Instruct the client to change positions slowly from supine to upright and to sit until dizziness resolves.Assist the client as needed to promote safety.Explain the purpose of strict measurement of oral intake and urinary output.Explain that magnesium sulfate is used to prevent seizures.Explain to the client the importance of frequent monitoring of respiratory status.Explain to the client the importance of frequent monitoring of fetal heart rate.

What instructions should be provided for a client taking androderm, delatestryl?

Expect virilization if being treated for breast cancer (women).Report body hair growth, acne, and changes in voice and menstruation.Report changes in urination, pain with ejaculation, or blood in the urine.Undergo regular prostate cancer screenings.Check weight twice a week.Report weight gain and swelling in the legs.Undergo liver function tests at recommended intervals.Report jaundice, fatigue, nausea, or loss of appetite.Obtain hand and wrist x-rays at recommended intervals.Report breast enlargement.

What instructions should be provided for a client taking finasteride?

Expect decreases in libido and ejaculate volume.Undergo regular prostate cancer screenings.Report breast enlargement.

What instructions should be provided for a client taking tamsulosin?

Expect decreases in ejaculate volume and ejaculation failure.Report headache not relieved with an over-the-counter analgesic.Have blood pressure checked regularly.Rise slowly from a reclining or sitting position.Report dizziness or fainting.Do not engage in dangerous activities if dizziness occurs or tends to recur.Advise client this drug will need to be taken lifelong.

What instructions should be provided for a client taking sildenafil?

Seek medical care immediately for an erection lasting more than 4 hr.Report headache.Take over-the-counter analgesics to relieve headache.Report dizziness or fainting.Have blood pressure checked regularly.Stop taking the drug if hearing loss is suspected; further evaluation should be done by provider.Seek medical care immediately for changes in vision.

What instructions should be provided for a client taking oxybutynin chloride?

Suck on hard candy.Sip water.Increase fluid and fiber intake.Increase activity levels.Report any undesirable changes in urinary elimination (retention, infection).Use over-the-counter lubricating eye drops.Obtain regular eye examinations (potential for glaucoma).Report headache not relieved by over-the-counter analgesics.Report dizziness or fainting.Do not engage in dangerous activities if dizziness occurs or tends to recur.Avoid becoming overheated.Seek medical attention for fever and signs of heat exhaustion (muscle cramps, dizziness, nausea, vomiting).

What instructions should be provided for a client taking bethanechol?

Report dizziness.Increase fluid intake to maintain hydration.Report any difficulty breathing.Report dizziness or fainting.Do not engage in dangerous activities if dizziness occurs or tends to recur.Sit or lie down if feeling dizzy.

What contraindications are there for the use of ethinyl estradiol and drospirenone?

Pregnancy-has teratogenic effectsHistory or other risk for thromboembolic eventsSuspected or confirmed breast cancerAltered liver functionAltered renal or adrenal function (estradiol and drospirenone)Smokers older than 35 years

What contraindications are there for the use of conjugated equine estrogen, transdermal estradiol, and intravaginal estradiol?

History of or other risk for thromboembolic eventsSuspected or confirmed breast, vaginal, cervical, or endometrial cancerLiver diseaseUndiagnosed vaginal bleeding

What contraindications are there for the use of conjugated estrogen and medroxyprogesterone acetate, transdermal estradiol and norethindrone?

History of or other risk for thromboembolic eventsSuspected or confirmed breast, vaginal, cervical, or endometrial cancerLiver diseaseUndiagnosed vaginal bleeding

What contraindications are there for the use of leuprolide?

Pregnancy – teratogenic effectsAllergy to benzyl alcoholAbnormal vaginal bleedingMetastatic cerebral lesions

What contraindications are there for the use of medroxyprogesterone acetate?

Pregnancy: teratogenicHistory of or high risk for thromboembolic eventsUndiagnosed vaginal bleedingLiver diseaseCervical, uterine, vaginal, or breast cancer

What contraindications are there for the use of clomiphene?

Pregnancy – teratogenicPrimary ovarian failureUndiagnosed uterine bleedingLiver diseaseUncontrolled thyroid diseaseThrombophlebitis

What contraindications are there for the use of human chorionic gonadotropin?

Pituitary tumorDysfunctional uterine bleedingUncontrolled thyroid diseaseAdrenal insufficiency

What contraindications are there for the use of cabergoline?

Uncontrolled hypertensionPregnancy-induced hypertension

What contraindications are there for the use of oxytocin?

Unripe cervixPlacental abnormalitiesActive genital herpesUterine surgeryFetal distressLung immaturityCephalopelvic disproportionMalpresentationProlapsed umbilical cord

What contraindications are there for the use of methylergonovine?

Induction of laborThreatened spontaneous abortionHypertension

What contraindications are there for the use of dinoprostone vaginal insert or gel ?

Acute pelvic inflammatory diseaseActive cardiac diseaseActive lung diseaseLiver or kidney impairmentFetal malpresentationNonreassuring fetal heart rate patternUterine scarring from previous surgery

What contraindications are there for the use of terbutaline?

Known sensitivity

What contraindications are there for the use of betamethasone?

Hypersensitivity to betamethasone or any componentSystemic fungal infections

What contraindications are there for the use of magnesium sulfate?

AnuriaHypermagnesemiaHeart blockHypocalcemia

What contraindications are there for the use of androderm, delatestryl?

Pregnancy – teratogenicBreast cancer in malesProstate cancer or obstruction benign prostatic hypertrophyHypertensionSerious cardiac, renal, or hepatic diseaseNote: Using androgens to improve athletic performance is illegal.

What contraindications are there for the use of finasteride?

Pregnancy (teratogenic)Female, children

What contraindications are there for the use of tamsulosin?

Concurrent use of erectile dysfunction drugs such as sildenafil (Viagra)Females, children

What contraindications are there for the use of sildenafil?

Concurrent use of nitroglycerin or other nitratesChildren

What contraindications are there for the use of oxybutynin chloride?

Angle-closure glaucomaMyasthenia gravisGastrointestinal obstructionGenitourinary obstructionActive cardiac dysfunction

What contraindications are there for the use of bethanechol?

HypotensionHyperthyroidismLow cardiac outputAsthma, chronic obstructive pulmonary diseaseGastric ulcersUrinary tract obstruction or bladder wall weaknessIntestinal obstructionRecent intestinal surgery

What are potential interactions for ethinyl estradiol and drospirenone?

ACE inhibitors and other drugs that can elevate serum potassium can cause hyperkalemia (due to drospirenone).Rifampin (Rifadin), ritonavir (Norvir), phenobarbital (Luminal), carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John’s wort can reduce the effectiveness of oral contraceptives.Oral contraceptives can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs.Oral contraceptives can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants.

What are potential interactions for conjugated equine estrogen, transdermal estradiol, and intravaginal estradiol?

Rifampin, ritonavir (Norvir), phenobarbital, carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John’s wort can reduce the effectiveness of estrogens.Estrogens can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs.Estrogens can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants.

What are potential interactions for conjugated estrogen and medroxyprogesterone acetate, transdermal estradiol and norethindrone?

Rifampin (Rifadin), ritonavir (Norvir), phenobarbital, carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John’s wort can reduce the effectiveness of hormone replacement therapy.HRT can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs.HRT can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants.Ketoconazole may increase the adverse effects of progesterone.

What are potential interactions for leuprolide?

Antiandrogens such as megestrol and flutamide can increase antineoplastic effects.Increased risk of seizures if administered concurrently with bupropion or SSRIs.

What are potential interactions for medroxyprogesterone acetate?

Rifampin (Rifadin), ritonavir (Norvir), phenobarbital (Luminal), carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John’s wort can reduce the effectiveness of progesterones.Progesterones may require adjustments in the dosage of hypoglycemic drugs.

What are potential interactions for clomiphene?

Tricyclic antidepressants, phenothiazines, and methyldopa (Aldomet) increase prolactin concentrations, thus interfering with fertility.

What are potential interactions for human chorionic gonadotropin?

Concurrent use with tricyclic antidepressants, butyrophenones, phenothiazines, and methyldopa may impair fertility

What are potential interactions for cabergoline?

Taken with phenothiazines, butyrophenones, thioxanthenes, or metoclopramide (Reglan), cabergoline and the other drug lose effectiveness.Concurrent use with antihypertensives can increase risk of hypotensionIncreased effects of SSRIs and serotonin agonists

What are potential interactions for oxytocin?

Vasopressors, can cause hypertension

What are potential interactions for methylergonovine?

Other ergot alkaloids, vasopressors, and triptans increase the risk of hypertension.Protease inhibitors and itraconazole (Sporanox) increase the risk of toxicity.Smoking increases vasoconstrictive effects.Grapefruit juice increases blood levels of drug.

What are potential interactions for dinoprostone vaginal insert or gel ?

Oxytocic agents increase the risk of uterine hyperstimulation.

What are potential interactions for terbutaline?

Hypoglycemic (antidiabetes) drugs require increased dosing due to hyperglycemic effects.Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risks of hypertension, tachycardia, and angina.

What are potential interactions for betamethasone?

Glucocorticoids can decrease antibody responses to vaccines and can increase the risk of infection from live vaccines.Immunizations should be avoided while glucocorticoids are in use.

What are potential interactions for magnesium sulfate?

Decreased absorption of tetracyclinesCa channel blockers – increases antihypertensive effects

What are potential interactions for androderm, delatestryl?

Androgens may reduce insulin or antidiabetic drug requirements.Androgens may increase or decrease the effects of oral anticoagulants.Androgens increase the risk of cyclosporine toxicity.

What are potential interactions for tamsulosin?

Drugs that lower blood pressure can increase hypotensive effects of nonselective alpha blockers.Erythromycin, itraconazole (Sporanox), nefazodone (Serzone), and HIV protease inhibitors increase levels of nonselective alpha blockers.Cimetidine (Tagamet) may worsen orthostatic hypotension.

What are potential interactions for sildenafil?

Nitrates (nitroglycerin) increase the risk of life-threatening hypotension.CYP3A4 inhibitors (grapefruit juice, ketoconazole, erythromycin, itraconazole [Sporanox], cimetidine [Tagamet], and others) increase plasma levels and the risk of adverse effects.Alpha-adrenergic antagonists such as doxazosin (Cardura) and drugs used to treat benign prostatic hypertrophy can cause orthostatic hypotension.Rifampin (Rifadin) can decrease drug levels.

What are potential interactions for oxybutynin chloride?

CYP3A4 inhibitors (grapefruit juice, ketoconazole, erythromycin, itraconazole [Sporanox], plus others) may increase toxicity.CYP3A4 inducers (phenytoin [Dilantin], rifampin [Rifadin], carbamazepine [Tegretol], plus others) decrease effectiveness.

What are potential interactions for bethanechol?

Cholinesterase inhibitors worsen cholinergic effects and increase the risk of toxicity.Mecamylamine (Inversine) worsens abdominal symptoms and hypotension.Procainamide (Pronestyl), quinidine, atropine, and epinephrine interfere with therapeutic effects.

What interventions should be planned for a client taking ethinyl estradiol and drospirenone?

Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident.Encourage clients who smoke to quit.Monitor potassium levels and electrocardiogram periodically.Monitor blood pressure.Monitor the pattern and amount of any reported bleeding.Recommend mammograms and breast examinations at appropriate intervals.Discontinue the drug for any indications of breast cancer.