Pharmacology Review: Reproductive and Genitourinary Systems (Lecture Notes)

Course Overview and Instructors

• Four instructors greeted the class; female pediatric-focused nursing faculty with extensive clinical backgrounds.
  • Miss Costello: background in pediatrics; teaches pharmacology; first year teaching in pharmacology but confident after experience.
  • Doctor Moe: nurse for 44 years; 31 years at UCA; nearing retirement; neonatal ICU experience; long nursing career with diverse roles; emphasizes patient-centered care (we don’t take care of drugs, we take care of people).
  • Dr. Hall: transitioning out; introducing new opportunities for others; supporting role in course leadership.
  • Ms Crafton: course lead; handles accommodations and testing logistics with CRNs; coordinates with other staff and tutoring resources.
• Class culture and expectations:
  • Be on time; professional courtesy.
  • Accommodations: schedule tested accommodations through the course team; testing accommodations rotate with exams; plan to be back after exams for content review.
  • Office hours and tutoring: stop by on the Fourth Floor; tutoring available; Ms Freeman also available to help with extra support.
• Course focus and philosophy:
  • Course description: classifications of drugs; foundation built for pharmacology across clinical courses.
  • Emphasis on understanding how drugs affect people, not just memorizing drug names.
  • ATI quizzes and materials used as study aids, not just for points.
  • Professional practice emphasis: aim to connect pharmacology to safe patient care.

Syllabus, Accommodations, and Scheduling Details

• Course components and structure:
  • Course description and objectives focus on drug classifications and prototypes; foundational for nursing across clinical areas.
  • Assessments include objective tests and some in-class activities; quizzes (ATI quizzes) used for learning and review.
  • Policies on punctuality, attendance, and grading thresholds.
• Grading and progression:
  • Minimum grade to progress to clinical courses: a C or higher, i.e., a numeric score of at least 70
  • 69.9 is not sufficient to progress.
  • Medication math exam: must score 80 ext{%} (previous summers had 70% but this semester requires 80 ext{%}}; next semester increases to 90% due to reduced margin for error.
  • Exam weights:
  • Exam 1: 12 ext{%}
  • Exams 2–4: 15 ext{%} each
  • Final exam: 18 ext{%}
  • ATI in-class activities: 15 ext{%}
  • Homework/quizzes: variable (mostly quizzes in ATI content)
  • ATI-based assessments and proctored exams:
  • Two practice exams (practice A and practice B) with focused reviews after each
  • Proctored proctoring via ATI; the focus is on predicting performance and driving targeted review, not just raw percentage.
  • Proctored ATI score is reported in levels: Level 3 → 100, Level 2 → 90, Level 1 → 70; generally does not change final grade but helps focus study.
• Scheduling notes:
  • Labor Day schedule noted; one class session rescheduled (Tuesday instead of Monday for that week).
  • Math study sessions: scheduled for 10:00 and 10:15 in some weeks; dedicated math quiz after exam 3 (10/29).
  • If first math exam score < 80%, there is a retest opportunity the Monday before Thanksgiving.
  • Attendance roster: students must initial the roster; no points deducted for absence, but a pattern of absence prompts outreach from instructors.
• Study resources and study habits:
  • Study guides provided this year; general rather than hyper-specific to encourage broad study.
  • ATI resources include drug tables that students can print, highlight during lectures, and refer to during study.
  • Emphasis on using ATI materials and pre-class quizzes for learning rather than chasing points.
  • Schedule emphasizes two 50-minute study breaks to maintain engagement and prevent fatigue.
• Content delivery approach:
  • Weekly content is structured by the presenting instructor; ask the presenter about topic-specific questions.
  • Textbook is not required; ATI Pharmacology 5.0 Made Easy is recommended as a learning aid.
  • Emphasis on reading ATI modules before class and using the drug tables during lectures.
• Practical tips and study culture:
  • Build a study group; nursing is collaborative: explaining concepts out loud helps retention.
  • Use memory tricks and short YouTube videos in the study tool folder to aid memory (e.g., bethanechol vs. digoxin challenges).
  • AI tools are encouraged as study aids for NCLEX-style questions and memory tricks.
  • The instructor emphasizes ethical, efficient, and responsible use of AI for study and practice questions.

Pharmacology Focus: Reproductive and Genitourinary Drugs

General principles

• Core nursing perspective when teaching pharmacology:
  • Always relate drugs to people, considering age, comorbidities, and broader health goals.
  • Understanding classifications and prototype drugs first, then consequences and nursing actions.
• Key pharmacologic ideas:
  • Contraceptive hormones broadly work by suppressing FSH and LH to prevent ovulation; they also thicken cervical mucus and thin the endometrium to prevent implantation.
  • Some contraceptives block aldosterone receptors, potentially reducing premenstrual bloating for some patients.
  • Hormonal contraceptives are used for contraception and, in some cases, relief of severe premenstrual syndrome (PMS) symptoms.
  • NCLEX and ATI often list generic drug names; trade names are provided for familiarity.
• Major safety concerns:
  • Thromboembolism risk is the highest concern with hormone contraceptives.
  • Symptoms of thromboembolism include asymmetric leg pain, swelling, redness; chest pain or shortness of breath; sudden vision changes or severe headache.
  • Smokers, older adults, obesity, diabetes, autoimmune diseases, and other cardiovascular risks increase thromboembolism risk.
  • Hyperkalemia (high potassium) symptoms: palpitations, paresthesias, weakness, abdominal cramps.
  • Drug interactions: antibiotics (e.g., some oral antibiotics) can reduce contraceptive effectiveness; enzyme-inducing drugs like rifampin can alter levels of hormones; some combinations may be contraindicated.
  • When starting a hormonal contraceptive, use a non-hormonal method for the first cycle to ensure contraception during the transition.
• Adverse effects and important considerations:
  • Abnormal uterine bleeding, breast tenderness or enlargement, weight gain, headaches, reduced libido, breast cancer risk (especially with BRCA1 mutations).
  • Hypertension and potential hyperkalemia; regular physical exams every 6–12 months are advised for those on contraceptives.
• Different delivery methods and their practical implications:
  • Depo-Provera (depo) injectable: every 3 ext{ months}; advantages include less frequent dosing (good for memory issues); disadvantages include clinic visits and potential scarring or breakthrough bleeding.
  • Intrauterine device (IUD): lasting 3-8 ext{ years} depending on type; suitable for those completed with childbearing plans.
  • Vaginal ring: worn for 3 ext{ weeks}, removed for 1 ext{ week}; mimics cycle.
  • Transdermal patch: worn for 1 ext{ week} and replaced weekly for three weeks, then off for a week; mimics cycle.
  • Hormonal implants (subcutaneous): long-acting; typically several years.
• Emergency contraception: Plan B
  • High-dose hormonal contraceptive intended to delay ovulation or prevent implantation; effective within 72 ext{ hours} of unprotected intercourse; effectiveness decreases with time.
  • BMI considerations: BMI > 30 may reduce effectiveness; not effective if unprotected sex occurred more than 5 ext{ days} earlier.
  • Counseling: not a substitute for regular contraception; discuss alternatives if BMI is a concern.
• Menopause and Hormone Replacement Therapy (HRT)
  • HRT is for symptom relief (hot flashes, night sweats, vaginal dryness) rather than reversing menopause; average menopausal symptom duration is about 7 ext{ years}.
  • Long-term HRT was associated with increased cardiovascular disease and breast cancer risk in older studies, leading to revised recommendations.
  • Current guidelines favor short-term HRT for healthy women with treated risk factors; not a universal solution.
  • Women with a uterus require combined estrogen plus progesterone; women after hysterectomy may receive estrogen alone.
  • Delivery methods for HRT are varied (patches, pills, vaginal creams, or suppositories).
  • Side effects mirror contraceptives: thromboembolism, abnormal uterine bleeding, breast symptoms, etc.
• Endometriosis and GnRH-related therapies
  • Leuprolide (Lupron) is a GnRH agonist; paradoxically stimulates initial GnRH effects but ultimately suppresses ovarian hormone production, placing the patient in a hypoestrogenic state to shrink endometrial tissue.
  • This can cause menopausal-like symptoms and bone density loss; calcium and vitamin D supplementation recommended; weight-bearing exercise advised.
  • Injectable dosing schedules include monthly or every four months.
  • Additional therapies may include progesterone to antagonize estrogen-driven tissue growth.
  • Alternative/adjunct therapies include managing hot flashes and sleep disturbances; lifestyle adjustments are emphasized.
• Infertility drugs
  • Clomiphene citrate (Clomid): oral agent to stimulate follicle maturity; cycles are timed and monitored with ultrasound; risks include ovarian hyperstimulation and multiple gestations.
  • Human chorionic gonadotropin (HCG, Pregnyl): injectable; used to trigger ovulation when follicles reach maturity.
  • Cabergoline or Bromocriptine (parlodel): dopamine agonists used for amenorrhea due to low prolactin; stabilize prolactin levels to restore ovulatory cycles.
  • Monitoring often requires daily ultrasounds to assess follicle development; multiple injections and precise timing are critical.
• Labor and delivery pharmacology
  • Oxytocin (Pitocin): stimulates uterine contractions; used to induce or augment labor.
  • Methergine (ergot alkaloid): postpartum to reduce hemorrhage by increasing uterine tone after delivery.
  • Dinoprostone (Cervidil): prostaglandin (vaginal insert) to soften the cervix and initiate labor in term pregnancies.
  • Betamethasone: corticosteroid given to mothers at risk of preterm birth to accelerate fetal lung maturity.
  • Terbutaline: beta-adrenergic agonist used to stop preterm contractions; associated with pulmonary edema risk; hospitalization and close monitoring required.
  • Magnesium sulfate: seizure prophylaxis in preeclampsia; high-alert drug with toxicity signs including decreased deep tendon reflexes; antidote is calcium gluconate.
  • Side effects and monitoring: differentiate between common side effects and significant adverse effects; maintain vigilant fetal/metalomonitoring during labor induction and augmentation.
• Drugs affecting the male reproductive system
  • Testosterone therapy: various delivery forms (topical patches, subcutaneous pellets, buccal gels, and injections); used for delayed puberty, hypogonadism, gender transition, and other noted indications.
  • Finasteride (Propecia): 5α-reductase inhibitor for benign prostatic hyperplasia (BPH) and male pattern hair loss; onset of therapeutic effects may take up to 12 ext{ months}; potential side effects include decreased libido, reduced ejaculate volume, gynecomastia; women of childbearing age should not handle crushed Propecia tablets.
  • Alpha-1 blockers for BPH: Tamsulosin (Flomax) relaxes smooth muscle of the bladder outlet to ease urination; common adverse effect is orthostatic hypertension; safety when rising from lying or sitting positions is emphasized.
  • Phosphodiesterase-5 inhibitor for erectile dysfunction: Sildenafil (Viagra); used about one hour before sexual activity; limited to once daily; contraindicated with nitrates due to risk of severe hypotension; adverse risks include rare events like myocardial infarction in those with cardiovascular disease, and rare reports of sudden hearing or vision loss; high-fat meals can delay onset of action.
• Hormones and gender-transition care
  • Hormone management aligns with social and health care goals: estrogen for transgender women and testosterone for transgender men.
  • Leuprolide and other GnRH-modulating drugs may be used to pause puberty or manage transition care; these agents can impact bone health and other hormone-sensitive systems.
  • General teaching includes how to handle transcare medications safely (e.g., skin-to-skin transfer risk with gels; need for gloves for patients handling testosterone gels).
• Urinary and neurogenic bladder drugs
  • Ditropan (oxybutynin): anticholinergic used for urgency-frequency incontinence; notable anticholinergic side effects summarized as: you can't see, you can't pee, you can't spit, you can't poop (drying effects on eyes, urinary flow, saliva, and bowels).
  • Interventions to mitigate anticholinergic effects: encourage fluids, fiber, activity; monitor for blurred vision and safety concerns, especially if glaucoma risk exists.
  • Uracoline (bethanechol): cholinergic drug used to promote bladder contraction in neurogenic bladder and urinary retention.
  • Side effects for cholinergic drugs include sweating, salivation, nausea, diarrhea; hypotension and bradycardia may occur with some cholinergic agents.
• Men’s health and pregnancy transition considerations
  • Emphasize safe handling of topical medications and skin absorption risks for testosterone gels, with proper PPE when applicable.

Practical and Clinical Implications, Safety, and Monitoring

• Counseling and consent:
  • Thorough patient history is essential (breast cancer risk, BRCA1 status, cardiovascular history, thromboembolism risk, weight, smoking status).
  • Women with uterus on HRT or contraceptives require careful monitoring for thromboembolic risk and breast health; adjust therapy based on history.
• Drug interactions and coverage considerations:
  • Antibiotics and rifampin can reduce effectiveness of oral contraceptives; some antiseizure drugs can either reduce or increase effectiveness of hormone contraceptives depending on interactions.
  • When starting or combining therapies, assess interactions and consider alternate methods or adjustments.
• Dosing, timing, and patient education:
  • For missed oral contraceptives: if one pill missed, take the missed dose with the next pill; if two consecutive days missed, take two pills for two days; if three days missed, restart with a new cycle and use a backup method.
  • For labor and obstetric medications, timing relative to cervical maturation and fetal status is critical (e.g., dinoprostone placement timing, HCG trigger timing, etc.).
• Diet and lifestyle integration:
  • Calcium and vitamin D intake are emphasized with medications that affect bone density (e.g., Lupron, menopause therapies) to mitigate bone loss.
  • Dietary planning includes foods rich in calcium (e.g., dairy products, fortified foods) and sources of vitamin D (sun exposure, fortified foods), balanced with sun safety.
• Ethical and real-world relevance:
  • Emphasis on evidence-based practice; historical studies have shaped current guidelines (e.g., risks identified with long-term hormone replacement therapy leading to revised recommendations).
  • Consider equity of access (cost of long-acting methods vs. daily pills; insurance coverage considerations for implants, IUDs, etc.).
  • Public health implications of emergency contraception access and education.
• Practical math and dosing skill development
  • IV infusion calculations example to reinforce safe practice: converting flow rate with drip factor.
  • Example problem: Give 200 ext{ mL} over 60 ext{ min} with a drip rate of 15 ext{ drops/min}. The required drops per minute are calculated as:
  • 200 ext{ mL} / 60 ext{ min} imes 15 = 50 ext{ drops/min}
  • Round to the nearest whole drop; use a leading zero when applicable; do not use trailing zeros.
  • In real practice, infusion pumps are common, but understanding drops-per-minute helps in settings without pumps.
  • Practice problems with focus reviews are used to guide targeted study and reduce calculation errors on exams.

Content-Specific Details: Quick Reference by Drug Category

Hormonal Contraceptives (general)

• Mechanism: suppress FSH and LH to prevent ovulation; thickens cervical mucus; reduces endometrial thickening; may block aldosterone receptors for PMS symptoms.
• Common formulations (examples discussed): ethinyl estradiol + drospirenone (Yasmin is one example);
• Key safety concerns: thromboembolism risk; monitor for leg pain, redness, swelling, vision changes, chest pain, shortness of breath.
• Risk factors for thromboembolism: smoking; older age; obesity; diabetes; autoimmune disease; cardiovascular disease.
• Side effects: abnormal uterine bleeding, breast changes, weight gain, headaches, decreased libido, risk for breast cancer (BRCA-related considerations).
• Important reminders: sometimes antibiotics or anti-seizure meds alter effectiveness; if starting antibiotics, use another contraception method during the course.
• Missed pills protocol: as described above.
• Alternative formulations: Depo-Provera, IUD, vaginal ring, patch, implants; each with pros/cons (e.g., adherence vs. clinic visits, long-term effects).

Emergency Contraception (Plan B)

• Indication: higher dose hormonal product to prevent ovulation or implantation after unprotected intercourse.
• Timing: effective within 72 ext{ hours}; after that, effectiveness declines.
• BMI considerations: BMI > 30 may reduce effectiveness; if BMI remains high and unprotected sex occurred recently, discuss alternatives with a health care provider.
• Availability: over-the-counter in many states; some states require prescription; cost varies by location.

Menopause and Hormone Replacement Therapy (HRT)

• Indications: relief of vasomotor symptoms (hot flashes, night sweats), vaginal dryness, sleep disturbances; not intended to reverse aging.
• Duration: average menopausal symptoms last about 7 ext{ years}; long-term use has risks.
• Risks historically identified in large studies led to more cautious use; current practice emphasizes short-term, lowest effective dose in healthy women with proper risk assessment.
• Hormone delivery differences: women with uterus require estrogen + progesterone; women post-hysterectomy may receive estrogen alone.
• Drug interactions and comorbidity considerations: interactions with drugs like warfarin, hypoglycemics; higher risk in patients with preexisting conditions.

Endometriosis and GnRH-related Therapies

• Leuprolide (Lupron): GnRH agonist; creates a hypoestrogenic state to shrink endometrial tissue; used short-term due to bone density implications.
• Additional monitoring: calcium and vitamin D supplementation; increased calcium intake and weight-bearing exercise recommended.
• Progesterone adjuncts: can antagonize estrogen-driven tissue growth.
• Practical teaching: educate about diet and calcium/vitamin D to support bone health during therapy.

Infertility Treatments

• Clomiphene (Clomid): oral agent to stimulate follicular maturation; cycling with ultrasound monitoring; risk of multifollicular development and multiple gestations.
• HCG (Pregnyl): injectable; triggers ovulation when follicles mature; precise timing is essential.
• Parlodel/Cabergoline: dopamine agonists to correct amenorrhea due to low prolactin levels.
• Monitoring: daily ultrasound; close clinical follow-up for ovulation timing and safety concerns.

Labor and Delivery Drugs

• Oxytocin (Pitocin): induce/augment labor; monitor uterine contractions to avoid overstimulation and fetal distress.
• Methergine: postpartum to reduce bleeding by increasing uterine tone; monitor blood pressure due to hypertension risk.
• Dinoprostone (Cervidil): vaginal prostaglandin to soften cervix and stimulate labor; risk includes rare fluid embolus and uterine rupture; hospital monitoring required.
• Terbutaline: tocolytic (beta-adrenergic agonist) to stop preterm contractions; monitor for pulmonary edema; hospitalization and careful fluid management.
• Betamethasone: fetal lung maturity in preterm birth; monitor maternal glucose and respiratory status due to potential hyperglycemia and edema.
• Magnesium sulfate: seizure prophylaxis in preeclampsia; toxicity signs include decreased reflexes; antidote is calcium gluconate.

Drugs Affecting the Male Reproductive System

• Testosterone therapies: multiple formats (patches, pellets, gels, injections) for delayed puberty, hypogonadism, gender-affirming care, and other conditions.
• Finasteride (Propecia): 5α-reductase inhibitor for BPH and hair loss; may take up to 12 ext{ months} for effect; potential side effects include decreased libido, erectile changes, gynecomastia; precaution for women of childbearing potential.
• Alpha-1 blockers (Flomax/Tamsulosin): ease urinary flow in BPH by relaxing bladder outlet; watch for orthostatic hypotension.
• Sildenafil (Viagra): PDE-5 inhibitor for erectile dysfunction; time-to-effect about 1 ext{ hour}; avoid nitrates due to risk of severe hypotension; watch for rare adverse events like MI, sudden hearing/vision loss; high-fat meals can delay peak effect.

Urinary/Neurogenic Bladder Drugs

• Ditroplan oxybutynin (Ditropan): anticholinergic for urgency-frequency incontinence; significant anticholinergic side effects (dry mouth, constipation, blurred vision, urinary retention).
• Interventions to mitigate anticholinergic effects: hydration, dietary fiber, mobility; monitor eye health due to glaucoma risk.
• Uracoline (bethanechol): cholinergic to improve bladder emptying in neurogenic bladder or urinary retention.
• Cholinergic side effects: sweating, salivation, diarrhea, bradycardia; monitor vitals and fluid status.

Gender Transition and Hormonal Care (Overview)

• Hormone management reflects patient goals: estrogen for trans women; testosterone for trans men; GnRH modulators (like Lupron) may be used in puberty suppression contexts.
• Safety considerations include skin absorption risk with gels (require gloves for handling), monitoring for thromboembolism, and maintaining bone and cardiovascular health.

Teaching, Safety, and Nursing Practice Implications

• Patient education and safety:
  • Emphasize smoking cessation for those on contraceptives due to thromboembolism risk.
  • Regular blood pressure and metabolic monitoring (for hypertension/hyperkalemia risk) are important.
  • Educate about drug interactions and the need for alternate contraception during certain therapies (e.g., antibiotics, enzyme-inducing drugs).
• Assessment and monitoring:
  • Vigilant assessment for signs of thromboembolism, uterine overstimulation during labor induction, and signs of magnesium sulfate toxicity.
  • Monitor for surgical contraindications and potential interactions with warfarin or antidiabetic medications in HRT use.
• Clinical judgment and ethics:
  • Use of prophylaxis and monitoring tailored to age, comorbidities, and risk profile.
  • Discuss patient values and goals, especially around long-term therapies like HRT, infertility treatments, and transition-related care.

Practice Tools and Exam Readiness

• Study tools and memory aids:
  • Supplemental YouTube videos and memory tricks available in the study tool folder.
  • ATI drug tables and modules should be reviewed prior to class; highlight relevant sections during lectures.
• Using AI responsibly:
  • AI can be used to generate NCLEX-style questions, memory tricks, and targeted practice content; use ethically and avoid overreliance.
• Study strategies:
  • Join or form a study group; explain concepts aloud to reinforce learning.
  • Use pre-class quizzes and practice tests as learning tools, not just as grade opportunities.
  • Practice small, focused study sessions rather than cramming; interleave practice questions with content review.

Summary of Key Values and Takeaways

• The course emphasizes people-centered nursing care in pharmacology, not just memorization of drug names.
• A structured assessment system blends exams, ATI practice, and proctored tests with predictive scoring to guide improvement.
• Knowledge of drug classifications, routes of administration, and monitoring parameters is essential for safe patient care in obstetric, reproductive, pediatric, and adult populations.
• Ethical practice includes considering risk factors, patient education, and collaborative learning strategies to improve outcomes.
• Practical skills (e.g., IV drip calculations) are reinforced with problem-solving steps and explicit rounding rules to ensure safe administration.

Note on Formulas and LaTeX Formatting

• Follicle-stimulating hormone and luteinizing hormone are central to ovulation control: ext{FSH}, ext{LH}
• Example exam weights (as given): 12 ext{%}, 15 ext{%}, 15 ext{%}, 18 ext{%}, 15 ext{%}
• Medication math example: 200 ext{ mL}
  ightarrow 60 ext{ min}; ext{drip rate} = 15rac{ ext{drops}}{ ext{min}}
  ightarrow 50rac{ ext{drops}}{ ext{min}}
• Dosing durations and windows formatted as: 3 ext{ months}, 3 ext{–}8 ext{ years}, 1 ext{ week}, 3 ext{ weeks}, etc.
• Symptom durations and risk windows: 72 ext{ hours} for Plan B effectiveness; 7 ext{ years} typical menopausal symptom duration; 12 ext{ months}$$ for finasteride onset of effect.

End of Notes