Drugs for Osteoporosis and Hormonal Problems
Drugs for Osteoporosis and Hormonal Problems
Chapter Overview
This document discusses drugs related to osteoporosis and various hormonal problems affecting women's and men's health, focusing on treatments available as of 2022.
Page 1: Female Reproductive Functions
Female Sex Steroid Hormones:
Estrogens
Progesterone
Pituitary Gonadotropin Hormones:
Follicle-Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Page 2: Estrogenic Drugs
Common Estrogen Drugs:
Conjugated Estrogens: Premarin
Esterified Estrogens: Estratab
Transdermal Estradiol: Estraderm, Climara, Vivelle
Estradiol Cypionate: Depo-Estradiol, DepoGen
Estradiol Valerate: Delestrogen
Ethinyl Estradiol: Estinyl
Vaginal Dosage Forms: Vagifem, Estrace Vaginal Cream
Estrogen Types: Estrone (Aqueous), Estropipate (Ogen, Ortho-Est)
Page 3: Estrogens - Indications
Used for treatment or prevention of conditions linked to estrogen deficiency, including:
Atrophic vaginitis
Hypogonadism
Oral contraception (combined with progestin)
Uterine bleeding
Vasomotor spasms of menopause ("hot flashes")
Osteoporosis (treatment and prophylaxis)
Palliative treatment for breast or prostate cancer
Ovarian failure or after removal of ovaries
Page 4: Estrogens - Contraindications
Contraindications to Estrogens:
Previous drug allergy
Any estrogen-dependent cancer
Undiagnosed abnormal vaginal bleeding
Pregnancy
Active thromboembolic disorders or history thereof
Page 5: Estrogens - Adverse Effects
Most Serious Event: Thromboembolic events
Common Side Effects:
Nausea
Hypertension
Edema
Vomiting, diarrhea, constipation, abdominal pain
Photosensitivity, chloasma, amenorrhea, breakthrough uterine bleeding, breast tenderness
Fluid retention, headaches
Page 6: Estrogens - Drug Interactions
Significant Drug Interactions:
Oral anticoagulants: Decreased activity
Rifampin: Decreased effect
St. John’s Wort
Tricyclic antidepressants
Smoking increases effects
Page 7: Estrogens - Use Recommendations
Use Methodology:
Always initiate at the smallest effective dosage to relieve symptoms or prevent conditions.
Page 8: Progestins - Mechanisms of Action
Mechanisms:
Induce secretory changes in the endometrium
Increase basal body temperature
Thicken the vaginal mucosa
Relax uterine smooth muscle
Stimulate mammary tissue growth
Feedback inhibition of pituitary gonadotropins release
Page 9: Common Progestins
Most Commonly Used Progestins:
Hydroxyprogesterone (Hylutin)
Levonorgestrel (Plan B)
Medroxyprogesterone (Provera, Depo-Provera)
Megestrol (Megace)
Norethindrone acetate (Aygestin)
Norgestrel (Ovrette, Ovral)
Progesterone (Prometrium)
Etonogestrel implant (Implanon)
Page 10: Progestins - Indications
Clinical Indications for Progestins:
Treat functional uterine bleeding from hormonal imbalances, fibroids, or cancers
Treat primary and secondary amenorrhea
Adjunctive and palliative treatments for cancers and endometriosis
Page 11: Progestins - Additional Indications
Can be combined with estrogens for:
Contraceptive purposes
Prevention of miscarriage
Symptoms relief from premenstrual syndrome
Page 12: Progestins - Contraindications
Like Estrogens: Contains similar contraindications to estrogens, including liver dysfunction, thromboembolic disorders, nausea, vomiting, amenorrhea, and weight changes.
Page 13: Progestins - Adverse Effects
Most Common Effects:
Nausea, vomiting, amenorrhea, spotting
Edema, weight changes
Page 14: Medroxyprogesterone (Provera, Depo-Provera)
Effects:
Inhibits pituitary gonadotropins secretion to prevent ovulation.
Stimulates mammary tissue growth.
Has antineoplastic actions against endometrial cancer.
Used in various treatments like uterine bleeding, secondary amenorrhea, and as a contraceptive.
Page 15: Contraceptive Drugs - Overview
Purpose: Medications to prevent pregnancy. Most oral contraceptives are estrogen-progestin combinations.
Page 16: Alternative Contraceptive Forms
Available Forms:
Long-acting injectable medroxyprogesterone
Transdermal contraceptive patch
Intravaginal contraceptive ring
Implantable rods
Page 17: Contraceptive Drugs - Mechanism of Action
Mechanisms:
Prevent ovulation through gonadotropin inhibition and increasing uterine mucus viscosity.
Leads to reduced sperm movement and fertilization.
Might prevent implantation of fertilized eggs.
Page 18: Contraceptive Drugs - Other Effects
Benefits:
Improve cycle regularity
Reduce blood loss during menstruation
Decrease occurrences of functional ovarian cysts and ectopic pregnancies.
Page 19: Contraceptive Drugs - Drug Interactions
Drugs Decreasing Oral Contraceptive Effectiveness:
Antibiotics (especially penicillins and cephalosporins)
Barbiturates, isoniazid, rifampin
Drugs with Potential Interactions: Beta blocker, warfarin, tricyclic antidepressants, vitamins, hypnotics, anticonvulsants, theophylline, antidiabetics.
Page 20: Uterine Stimulants - Overview
Purpose: Medications to alter uterine contractions for:
Labor promotion
Prevention of premature labor
Reduce postpartum hemorrhage risk.
Page 21: Uterine Stimulants - Types
Also known as oxytocics:
Examples: Oxytocin (Pitocin), Prostaglandins, Ergot derivatives, mifepristone (RU-486).
Page 22: Oxytocin (Pitocin) - Uses
Synthetic Uses:
Induce labor near full term, enhance weak contractions.
Other Uses: Prevent/control postpartum bleeding, complete incomplete abortions, promote lactation by aiding milk ejection.
Page 23: Ergot Alkaloids - Uses
Mechanism: Increase uterine contraction strength and frequency.
Used post-delivery to prevent atony and hemorrhage (e.g., Methylergonovine - Methergine).
Page 24: Uterine Relaxants - Overview
Purpose: Medications to stop or prevent premature labor beginning before term, after the 20th week of gestation.
Definition: Uterine contractions between 20 and 37 weeks are considered premature labor.
Page 25: Nonpharmacologic Measures
Recommended measures include bed rest, sedation, and hydration to manage premature labor.
Page 26: Uterine Relaxants
Examples of Drugs:
Indomethacin: Inhibits prostaglandin activity
Nifedipine: Blocks calcium influx, inhibiting myometrial activity
Page 27: Corticosteroids in Preterm Labor
Administered when uterine relaxants fail in ongoing delivery.
Drugs Used: Betamethasone or dexamethasone help to promote fetal lung maturity between 24 and 34 weeks.
Page 28: Osteoporosis - Overview
Characterized by:
Low bone mass and increased fracture risk.
Affects women more significantly, with 40% of women over 50 developing fractures.
Also affects 20% of men with this condition.
Page 29: Osteoporosis - Risk Factors
Factors Increasing Risk Include:
European or Asian descent
Slender body build
Early estrogen deficiency
Smoking
Alcohol consumption
Low-calcium diet
Sedentary lifestyle
Family history of osteoporosis.
Page 30: Drug Therapy for Prevention of Osteoporosis
Women at high risk may be advised to take calcium and vitamin D can be protective against osteoporosis, particularly for those aged over 60 years.
Page 31: Major Classes of Osteoporosis Drugs
Include:
Bisphosphonates:
Alendronate (Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel)
Zoledronic acid (Reclast)
Selective Estrogen Receptor Modifiers (SERMs):
Raloxifene (Evista)
Tamoxifen (Nolvadex)
Hormones:
Calcitonin (Calcimar)
Teriparatide (Forteo): stimulates bone formation
Denosumab (Prolia): prevents bone resorption
Page 32: Bisphosphonates - Mechanism of Action
They work by inhibiting osteoclast-mediated bone resorption, increasing bone mineral density. Clinical evidence shows bisphosphonates can reverse bone mass loss and reduce fracture risk.
Page 33: Selective Estrogen Receptor Modulators (SERMs)
Function by stimulating estrogen receptors on bone to increase bone density.
Page 34: Calcitonin - Mechanism of Action
Directly inhibits osteoclastic bone resorption.
Page 35: Teriparatide - Mechanism of Action
Unique Action: The only drug that stimulates bone formation, acting similarly to natural parathyroid hormone (PTH).
Page 36: Denosumab (Prolia) - Mechanism of Action
Monoclonal antibody that blocks osteoclast activation, thus preventing bone resorption. Administered via subcutaneous injection every six months, along with daily calcium and vitamin D.
Page 37: Drug Therapy for Osteoporosis - Indications
Primary Uses:
Raloxifene for postmenopausal osteoporosis
Bisphosphonates for both prevention and treatment
Teriparatide for patients at highest risk of fractures, especially those with prior fracture history.
Page 38: Drug Therapy for Osteoporosis - Contraindications
Bisphosphonates: Allergies, hypocalcemia, esophageal dysfunction, inability to remain upright for 30 min post-dosing.
SERMs: Known allergies, pregnancy, current venous thromboembolic disorders or history thereof.
Calcitonin: Drug allergy or salmon allergy.
Teriparatide: Drug allergy.
Denosumab: Hypocalcemia, renal impairment/failure, risk of infections.
Page 39: Drug Therapy for Osteoporosis - Adverse Effects
SERMs: Hot flashes, leg cramps, increased risk of venous thromboembolism, teratogenic effects, leukopenia.
Bisphosphonates: Headaches, GI upset, joint pain, esophageal burns (if lodged in esophagus), osteonecrosis of the jaw, incapacitating bone/joint/muscle pain.
Page 40: Calcitonin - Adverse Effects
Flushing of the face, nausea, diarrhea, reduced appetite.
Teriparatide: Chest pain, dizziness, hypercalcemia risk, nausea, arthralgia.
Denosumab: Potential for infections.
Page 41: Alendronate (Fosamax) - Overview
Description: Oral bisphosphonate; first non-estrogen, non-hormonal option for preventing bone loss. Inhibits osteoclast-mediated bone resorption, with indications for:
Prevention and treatment of osteoporosis in men and postmenopausal women, glucocorticoid-induced osteoporosis in men, and Paget disease in women.
Page 42: Raloxifene (Evista) - Overview
Class: SERM
Use: Primarily for prevention of postmenopausal osteoporosis.
Adverse Effects: Hot flashes.
Page 43: Nursing Implications - General
Assess baseline vital signs, weight, blood glucose, renal and liver function, smoking history, history of drug interactions, including contraindications like pregnancy.
Page 44: Uterine Stimulants - Nursing Implications
Assess mother's vital signs and fetal heart rate before administration.
Uterine relaxants should be used when preterm labor occurs between weeks 20 and 37.
Page 45: Bisphosphonates - Nursing Implications
Ensure patients have no esophageal abnormalities and can maintain an upright position for 30 minutes after dosing.
Page 46: Bisphosphonates - Administration Instructions
Recommended to take medication each morning with a full glass of water, 30 minutes before eating, and remain upright for at least 30 minutes following.
Page 47: SERMs - Nursing Implications
Requires discontinuation of medication 72 hours prior to and throughout periods of prolonged immobility (surgery or long trips).
Page 48: Men's Health Overview
Androgens: Male sex hormones such as testosterone.
Functions include development, maintenance of male characteristics, bone and muscle development, metabolic process inhibition, and stimulation of blood cell production.
Page 49: Anabolic Steroids - Overview
Definition: Enhance tissue synthesis and increase formation.
Classified as Schedule III due to potential for misuse.
Examples: Oxymetholone (Anadrol-50), Oxandrolone (Oxandrin), Nandrolone (Deca-Durabolin).
Page 50: Anabolic Steroids - Approved Uses
Indicated for promoting weight gain post-surgery, trauma, chronic diseases, anemia, hereditary angioedema, and metastatic breast cancer.
Page 51: Anabolic Steroids - Misuse Risks
Common among athletes and bodybuilders; potential serious side effects include sterility, cardiovascular diseases, liver cancer, psychological dependency.
Page 52: Androgen Inhibitors - Overview
Types: 5-alpha reductase inhibitors such as Finasteride and Dutasteride, utilized for benign prostatic hyperplasia (BPH).
Page 53: Prostate Shrinkage - Timeline
Clinical effects of 5-alpha reductase inhibitors may take up to 6 months.
Page 54: Finasteride - Further Details
Prevents DHT-induced hair thinning, treatment options for male pattern baldness, and teratogenic effects, particularly in pregnant women. Gloves are necessary when handling.
Page 55: Doxazosin and Other Alpha1-Adrenergic Blockers
Indicated for alleviating obstruction from BPH, other examples include Tamsulosin (Flomax), Terazosin (Hytrin), Alfuzosin (Uroxatral), Silodosin (Rapaflo).
Page 56: Erectile Dysfunction Drugs
Phosphodiesterase (PDE) Inhibitors: Examples include Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), Avanafil (Stendra).
Their function involves smooth muscle relaxation in the corpora cavernosa, promoting blood inflow to treat ED, and are used for pulmonary hypertension.
Page 57: Contraindications for Erectile Dysfunction Drugs
Contraindicated in patients with known androgen-responsive tumors and major cardiovascular disorders (especially those using nitrate medications).
Page 58: Adverse Effects of Androgen Drugs
Common effects include fluid retention and risk of thromboembolic disorders. Anabolic steroids can lead to liver issues and severe adverse effects like heart attack.
Page 59: Common Androgen-side Effects
Both ED drugs and anabolic steroids may cause priapism, requiring urgent medical attention due to excessive responses.
Page 60: PDE Inhibitors - Specific Risks
Risks include unexplained visual loss, gynecomastia, libido loss, and myopathy with finasteride.
Page 61: Drug Interactions in Men's Health
Androgens can alter anticoagulation effects significantly. Risks of hypotension occur with PDE inhibitors and nitrates.
Page 62: Alpha Blockers - Interactions
Additive Effects: Increased hypotension when combined with antihypertensives, risk potentiation with azole antifungals, erythromycins, cardiac drugs.
Page 63: Administration Techniques for Androgens
Specific instructions for sublingual, buccal, oral forms. Transdermal patches should be applied as directed to either scrotal or body skin (depending on type).
Page 64: Patient Education on Hormonal Drugs
Pregnant women should avoid crushed or broken hormone medications. Education on administration and monitoring for adverse effects is crucial.
Page 65: Endocrine Drugs Overview
Function: Maintain physiological stability for and across all body functions through hormones that act as the body's chemical messengers.
Page 66: Neuroendocrine System Overview
The Hypothalamus (part of the CNS) and Pituitary Gland (anterior and posterior) control body functions through hormone release and negative feedback mechanisms.
Page 67: Negative Feedback Loop in Endocrine System
Regulates hormone activity based on ongoing bodily needs, highlighting a feedback mechanism necessary for sustaining homeostasis.
Page 68: Anterior Pituitary Drugs
Hydrocortisone (Cortef):
Drug form of cortisol aiding in anti-inflammatory responses.
Cosyntropin (Cortrosyn):
Stimulates cortisol release and is used for diagnosing adrenocortical insufficiency and aids in renal sodium retention.
Page 69: Anterior Pituitary (Cont'd)
Somatropin/Somatrem: Recombinantly produced growth hormone stimulating skeletal growth in deficiencies.
Octreotide (Sandostatin): Reduces severe diarrhea from carcinoid tumors secreting vasoactive intestinal polypeptide (VIP).
Page 70: Posterior Pituitary - Vasopressin
Vasopressin and Desmopressin mimic antidiuretic hormone effects, useful in treating diabetes insipidus and manage severe bleeding.
Page 71: Special Uses of Desmopressin
Increases plasma levels of antihemophilic factor, beneficial for nocturnal enuresis management.
Page 72: Nursing Implications for Posterior Pituitary Drugs
Monitor blood glucose, instruct patients on administration techniques, avoid abrupt discontinuation of medications.
Page 73: Thyroid Hormones Overview
The Thyroid Gland secretes T3, T4, and Calcitonin, crucial for metabolic regulation, located strategically near the parathyroid glands.
Page 74: Hypothyroidism Basics
Occurs from thyroid gland defects or dysfunctions in pituitary or hypothalamus leading to hormone deficiency. Classification includes congenital, myxedema, and goiter.
Page 75: Hashimoto's Disease
A chronic autoimmune condition leading to reduced thyroid hormone, highly influenced by genetic factors.
Page 76: Common Symptoms of Hypothyroidism
Include thickened skin, hair loss, constipation, lethargy, and anorexia.
Page 77: Hyperthyroidism Overview
Caused by disease states leading to excess thyroid hormones with severe systemic implications, including weight loss, increased appetite, nervousness, and heat intolerance.
Page 78: Treatments of Hyperthyroidism
Management includes radioactive iodine and antithyroid drugs to suppress hormone production or remove affected tissues.
Page 79: Thyroid Replacement Drugs
Levothyroxine (Synthroid): Synthetic T4 for hypothyroidism.
Liothyronine (Cytomel): Synthetic T3.
Liotrix (Thyrolar): Combined T3 and T4.
Page 80: Thyroid Replacement Drugs - Mechanism and Indications
Replace hormone deficiency to achieve euthyroid status, indicated for hypothyroidism, preventing goiters, and after gland removal.
Page 81: Thyroid Replacement Drugs - Adverse Effects
Cardiac dysrhythmia: Most significant. May also include hypertension, insomnia, tremors, and weight loss.
Page 82: Levothyroxine - Special Instructions
Best taken at 0600 on an empty stomach; dosing in micrograms.
Page 83: Antithyroid Drugs Overview
Used to manage hyperthyroidism and prevent surges during treatments.
Page 84: Antithyroid Drugs - Mechanism of Action
Methimazole and propylthiouracil inhibit iodine incorporation essential for T3, T4 synthesis, with PTU also preventing T4 to T3 conversion.
Page 85: Antithyroid Drugs - Indications and Adverse Effects
Used for hyperthyroidism. Adverse effects include liver and bone marrow toxicity.
Page 86: Propylthiouracil (PTU)
Antithyroid agent with delayed symptom improvement (~2 weeks).
Page 87: Nursing Implications for Antithyroid Drugs
Assess allergies, vital signs, and cautions in patients with pre-existing cardiac conditions or pregnant women.
Page 88: Special Considerations During Pregnancy
Hypothyroidism treatment should continue to prevent fetal growth retardation; monitor and adjust dosages regularly.
Page 89: Monitoring and Educating Patients
Patients should remain compliant with medication times and brands to prevent inconsistencies in treatment.
Page 90: Hyperthyroid Crisis Management
Assess for exacerbation causes such as stress or infection, be cautious of drug interactions.
Page 91: Patient Education on Emergency Signs
Instruct patients to report unusual symptoms and cautions against over-the-counter medications without healthcare provider consulting.
Page 92: General Monitoring Guidelines
For thyroid treatments, monitor therapeutic responses and adverse effects, ensuring improved energy levels and reduction in hyperthyroid symptoms.
Page 93: Comparison of Hypothyroid and Hyperthyroid Symptoms
Hyperthyroidism Symptoms: Weight loss, increased appetite, heat intolerance, tachycardia, diarrhea, anxiety, and more.
Hypothyroidism Symptoms: Weight gain, decreased appetite, cold intolerance, bradycardia, fatigue, hair loss, and others.
Page 94: Concluding Homework Instructions
Suggested to read chapters and familiarize with key concepts and details discussed throughout the material.
This exhaustive study guide synthesizes all the information from the provided transcript, clearly outlining medications, their mechanisms, indications, contraindications, nursing implications, and associated risks across various discussed topics, ensuring comprehensive coverage for educational purposes.
Chapter Overview
This document discusses drugs for osteoporosis and hormonal problems in women's and men's health, focusing on treatments available as of 2022.
Page 1: Female Reproductive Functions
Female Sex Steroid Hormones:
Estrogens
Progesterone
Pituitary Gonadotropin Hormones:
Follicle-Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Page 2: Estrogenic Drugs
Common Estrogen Drugs:
Conjugated Estrogens: Premarin
Transdermal Estradiol: Estraderm
Ethinyl Estradiol: Estinyl
Vaginal Dosage Forms: Vagifem
Page 3: Estrogens - Indications
Treatment/prevention of estrogen deficiency conditions:
Atrophic vaginitis, hypogonadism
Oral contraception (with progestin)
Vasomotor spasms of menopause ("hot flashes")
Osteoporosis (treatment and prophylaxis)
Palliative treatment for breast/prostate cancer
Page 4: Estrogens - Contraindications
Previous drug allergy
Estrogen-dependent cancer
Undiagnosed abnormal vaginal bleeding
Pregnancy
Active thromboembolic disorders or history thereof
Page 5: Estrogens - Adverse Effects
Most Serious Event: Thromboembolic events
Common Side Effects: Nausea, hypertension, edema, fluid retention, headaches
Page 6: Estrogens - Drug Interactions
Oral anticoagulants: Decreased activity
Rifampin, St. John’s Wort: Decreased effect
Smoking: Increases effects
Page 7: Estrogens - Use Recommendations
Always initiate at the smallest effective dosage.
Page 8: Progestins - Mechanisms of Action
Induce secretory changes in endometrium
Increase basal body temperature
Thicken vaginal mucosa
Relax uterine smooth muscle
Stimulate mammary tissue growth
Feedback inhibition of pituitary gonadotropins release
Page 9: Common Progestins
Hydroxyprogesterone (Hylutin)
Levonorgestrel (Plan B)
Medroxyprogesterone (Provera, Depo-Provera)
Progesterone (Prometrium)
Page 10: Progestins - Indications
Treat functional uterine bleeding (hormonal imbalances, fibroids, cancers)
Treat primary and secondary amenorrhea
Adjunctive and palliative treatments for cancers and endometriosis
Page 11: Progestins - Additional Indications
Combined with estrogens for:
Contraception
Prevention of miscarriage
Relief of premenstrual syndrome symptoms
Page 12: Progestins - Contraindications
Similar to estrogens: liver dysfunction, thromboembolic disorders, pregnancy
Page 13: Progestins - Adverse Effects
Most Common Effects: Nausea, vomiting, amenorrhea, spotting, edema, weight changes
Page 14: Medroxyprogesterone (Provera, Depo-Provera)
Inhibits pituitary gonadotropins to prevent ovulation.
Stimulates mammary tissue growth.
Has antineoplastic actions against endometrial cancer.
Used for uterine bleeding, secondary amenorrhea, and as a contraceptive.
Page 15: Contraceptive Drugs - Overview
Medications to prevent pregnancy. Most oral contraceptives are estrogen-progestin combinations.
Page 16: Alternative Contraceptive Forms
Long-acting injectable medroxyprogesterone
Transdermal patch
Intravaginal ring
Implantable rods
Page 17: Contraceptive Drugs - Mechanism of Action
Prevent ovulation (gonadotropin inhibition, increased uterine mucus viscosity).
Reduce sperm movement and fertilization.
May prevent implantation.
Page 18: Contraceptive Drugs - Other Effects
Improve cycle regularity
Reduce blood loss and occurrences of ovarian cysts/ectopic pregnancies.Page 19: Contraceptive Drugs - Drug Interactions
Decreased Oral Contraceptive Effectiveness: Antibiotics (penicillins, cephalosporins), barbiturates, isoniazid, rifampin.
Potential Interactions: Beta blockers, warfarin, tricyclic antidepressants, antidiabetics.
Page 20: Uterine Stimulants - Overview
Medications to alter uterine contractions for: labor promotion, prevention of premature labor, reduction of postpartum hemorrhage.
Page 21: Uterine Stimulants - Types
Also known as oxytocics:
Oxytocin (Pitocin)
Prostaglandins
Ergot derivatives
Mifepristone (RU-486)
Page 22: Oxytocin (Pitocin) - Uses
Induce/enhance labor.
Prevent/control postpartum bleeding, complete incomplete abortions, promote lactation.
Page 23: Ergot Alkaloids - Uses
Increase uterine contraction strength and frequency.
Used post-delivery to prevent atony and hemorrhage (e.g., Methylergonovine - Methergine).
Page 24: Uterine Relaxants - Overview
Medications to stop/prevent premature labor (between 20 and 37 weeks gestation).
Page 25: Nonpharmacologic Measures
Recommended measures: bed rest, sedation, hydration.
Page 26: Uterine Relaxants - Examples of Drugs
Indomethacin (inhibits prostaglandin activity)
Nifedipine (blocks calcium influx)
Page 27: Corticosteroids in Preterm Labor
Betamethasone or dexamethasone (24-34 weeks) promote fetal lung maturity when uterine relaxants fail.
Page 28: Osteoporosis - Overview
Low bone mass and increased fracture risk.
Affects women (40% over 50 developing fractures) and 20% of men.
Page 29: Osteoporosis - Risk Factors
European/Asian descent, slender body build, early estrogen deficiency, smoking, alcohol, low-calcium diet, sedentary lifestyle, family history.
Page 30: Drug Therapy for Prevention of Osteoporosis
Calcium and vitamin D are protective, especially for those over 60.
Page 31: Major Classes of Osteoporosis Drugs
Bisphosphonates: Alendronate (Fosamax), Zoledronic acid (Reclast) (inhibit osteoclast-mediated resorption)
Selective Estrogen Receptor Modifiers (SERMs): Raloxifene (Evista) (stimulate estrogen receptors on bone)
Hormones:
Calcitonin (Calcimar) (inhibits osteoclast activity)
Teriparatide (Forteo) (stimulates bone formation)
Denosumab (Prolia) (blocks osteoclast activation)
Page 32: Bisphosphonates - Mechanism of Action
Inhibit osteoclast-mediated bone resorption, increasing bone mineral density.
Page 33: Selective Estrogen Receptor Modulators (SERMs) - Function
Stimulate estrogen receptors on bone to increase bone density.
Page 34: Calcitonin - Mechanism of Action
Directly inhibits osteoclastic bone resorption.
Page 35: Teriparatide - Mechanism of Action
Unique action: Stimulates bone formation, similar to natural parathyroid hormone (PTH).
Page 36: Denosumab (Prolia) - Mechanism of Action
Monoclonal antibody blocking osteoclast activation, preventing bone resorption. Administered subcutaneously every six months with daily calcium and vitamin D.
Page 37: Drug Therapy for Osteoporosis - Indications
Raloxifene for postmenopausal osteoporosis.
Bisphosphonates for prevention and treatment.
Teriparatide for high fracture risk, especially with prior fractures.
Page 38: Drug Therapy for Osteoporosis - Contraindications
Bisphosphonates: Allergies, hypocalcemia, esophageal dysfunction, inability to remain upright for 30 min post-dosing.
SERMs: Allergies, pregnancy, current/history of venous thromboembolic disorders.
Calcitonin: Drug or salmon allergy.
Teriparatide: Drug allergy.
Denosumab: Hypocalcemia, renal impairment/failure, infection risk.
Page 39: Drug Therapy for Osteoporosis - Adverse Effects
SERMs: Hot flashes, leg cramps, increased risk of venous thromboembolism, teratogenic effects.
Bisphosphonates: Headaches, GI upset, joint pain, esophageal burns, osteonecrosis of the jaw, incapacitating bone/joint/muscle pain.
Page 40: Calcitonin - Adverse Effects
Flushing of face, nausea, diarrhea, reduced appetite.
Teriparatide: Chest pain, dizziness, hypercalcemia risk, nausea.
Denosumab: Potential for infections.
Page 41: Alendronate (Fosamax) - Overview
Oral bisphosphonate. First non-estrogen, non-hormonal option for preventing bone loss.
Indications: Prevention/treatment of osteoporosis in men and postmenopausal women, glucocorticoid-induced osteoporosis, Paget disease.
Page 42: Raloxifene (Evista) - Overview
Class: SERM. Use: Prevention of postmenopausal osteoporosis. Adverse Effect: Hot flashes.
Page 43: Nursing Implications - General
Assess baseline vital signs, weight, blood glucose, renal/liver function, smoking history, drug interactions/contraindications (e.g., pregnancy).
Page 44: Uterine Stimulants - Nursing Implications
Assess mother's vital signs and fetal heart rate before administration.
Uterine relaxants used for preterm labor between weeks 20-37.
Page 45: Bisphosphonates - Nursing Implications
Ensure no esophageal abnormalities; patient can remain upright for 30 minutes post-dosing.
Page 46: Bisphosphonates - Administration Instructions
Take each morning with full glass of water, 30 min before eating, remain upright for at least 30 min.
Page 47: SERMs - Nursing Implications
Discontinue 72 hours prior to and throughout prolonged immobility (surgery, long trips).
Page 48: Men's Health Overview
Androgens: Male sex hormones (testosterone). Functions: development/maintenance of male characteristics, bone/muscle development, metabolic inhibition, blood cell production stimulation.
Page 49: Anabolic Steroids - Overview
Enhance tissue synthesis, increase formation. Classified as Schedule III (misuse potential).
Examples: Oxymetholone (Anadrol-50), Oxandrolone (Oxandrin), Nandrolone (Deca-Durabolin).
Page 50: Anabolic Steroids - Approved Uses
Promote weight gain post-surgery/trauma/chronic diseases, anemia, hereditary angioedema, metastatic breast cancer.
Page 51: Anabolic Steroids - Misuse Risks
Common among athletes/bodybuilders. Serious side effects: sterility, cardiovascular diseases, liver cancer, psychological dependency.
Page 52: Androgen Inhibitors - Overview
5-alpha reductase inhibitors: Finasteride, Dutasteride. Used for benign prostatic hyperplasia (BPH).
Page 53: Prostate Shrinkage - Timeline
Clinical effects of 5-alpha reductase inhibitors may take up to 6 months.
Page 54: Finasteride - Further Details
Prevents DHT-induced hair thinning, treats male pattern baldness. Teratogenic effects possible in pregnant women; gloves necessary when handling.
Page 55: Doxazosin and Other Alpha1-Adrenergic Blockers
Alleviate obstruction from BPH. Examples: Tamsulosin (Flomax), Terazosin (Hytrin).
Page 56: Erectile Dysfunction Drugs
Phosphodiesterase (PDE) Inhibitors: Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis).
Relax smooth muscle in corpora cavernosa, promoting blood inflow to treat ED. Also used for pulmonary hypertension.
Page 57: Contraindications for Erectile Dysfunction Drugs
Known androgen-responsive tumors.
Major cardiovascular disorders, especially with nitrate medications.
Page 58: Adverse Effects of Androgen Drugs
Fluid retention, risk of thromboembolic disorders.
Anabolic steroids: liver issues, severe effects like heart attack.
Page 59: Common Androgen-side Effects
Both ED drugs and anabolic steroids may cause priapism (requiring urgent medical attention).
Page 60: PDE Inhibitors - Specific Risks
Unexplained visual loss, gynecomastia, libido loss, myopathy (with finasteride).
Page 61: Drug Interactions in Men's Health
Androgens can alter anticoagulation effects.
Risks of hypotension with PDE inhibitors and nitrates.
Page 62: Alpha Blockers - Interactions
Additive Effects: Increased hypotension with antihypertensives; risk potentiation with azole antifungals, erythromycins, cardiac drugs.
Page 63: Administration Techniques for Androgens
Specific instructions for sublingual, buccal, oral forms. Transdermal patches applied to scrotal or body skin.
Page 64: Patient Education on Hormonal Drugs
Pregnant women should avoid crushed/broken hormone medications. Education on administration and monitoring for adverse effects is crucial.
Page 65: Endocrine Drugs Overview
Function: Maintain physiological stability via hormones (body's chemical messengers).
Page 66: Neuroendocrine System Overview
Hypothalamus (CNS) and Pituitary Gland (anterior, posterior) control body functions via hormone release and negative feedback.
Page 67: Negative Feedback Loop in Endocrine System
Regulates hormone activity based on bodily needs, sustaining homeostasis.
Page 68: Anterior Pituitary Drugs
Hydrocortisone (Cortef): Drug form of cortisol, aids in anti-inflammatory responses.
Cosyntropin (Cortrosyn): Stimulates cortisol release, diagnoses adrenocortical insufficiency, aids renal sodium retention.
Page 69: Anterior Pituitary (Cont'd)
Somatropin/Somatrem: Recombinant growth hormone, stimulates skeletal growth in deficiencies.
Octreotide (Sandostatin): Reduces severe diarrhea from carcinoid tumors (secreting VIP).
Page 70: Posterior Pituitary - Vasopressin
Vasopressin and Desmopressin mimic antidiuretic hormone effects. Used for diabetes insipidus and managing severe bleeding.
Page 71: Special Uses of Desmopressin
Increases plasma levels of antihemophilic factor, beneficial for nocturnal enuresis.
Page 72: Nursing Implications for Posterior Pituitary Drugs
Monitor blood glucose, instruct on administration techniques, avoid abrupt discontinuation.
Page 73: Thyroid Hormones Overview
Thyroid Gland secretes T3, T4, and Calcitonin. Crucial for metabolic regulation.
Page 74: Hypothyroidism Basics
Thyroid gland defects or pituitary/hypothalamus dysfunctions leading to hormone deficiency. Classifications: congenital, myxedema, goiter.
Page 75: Hashimoto's Disease
Chronic autoimmune condition leading to reduced thyroid hormone, influenced by genetic factors.
Page 76: Common Symptoms of Hypothyroidism
Thickened skin, hair loss, constipation, lethargy, anorexia, weight gain, cold intolerance, bradycardia.
Page 77: Hyperthyroidism Overview
Excess thyroid hormones (e.g., Grave's disease). Symptoms: weight loss, increased appetite, nervousness, heat intolerance, tachycardia, diarrhea, anxiety.
Page 78: Treatments of Hyperthyroidism
Radioactive iodine and antithyroid drugs to suppress hormone production or remove affected tissues.
Page 79: Thyroid Replacement Drugs
Levothyroxine (Synthroid): Synthetic T4 for hypothyroidism.
Liothyronine (Cytomel): Synthetic T3.
Liotrix (Thyrolar): Combined T3 and T4.
Page 80: Thyroid Replacement Drugs - Mechanism and Indications
Replace hormone deficiency to achieve euthyroid status. Indicated for hypothyroidism, preventing goiters, post-gland removal.
Page 81: Thyroid Replacement Drugs - Adverse Effects
Cardiac dysrhythmia (most significant). Also hypertension, insomnia, tremors, weight loss.
Page 82: Levothyroxine - Special Instructions
Best taken at 0600 on an empty stomach; dosing in micrograms.
Page 83: Antithyroid Drugs Overview
Manage hyperthyroidism and prevent surges during treatments.
Page 84: Antithyroid Drugs - Mechanism of Action
Methimazole and propylthiouracil inhibit iodine incorporation (essential for T3, T4 synthesis). PTU also prevents T4 to T3 conversion.
Page 85: Antithyroid Drugs - Indications and Adverse Effects
Indications: Hyperthyroidism. Adverse effects: liver and bone marrow toxicity.
Page 86: Propylthiouracil (PTU)
Antithyroid agent with delayed symptom improvement (approx. 2 weeks).
Page 87: Nursing Implications for Antithyroid Drugs
Assess allergies, vital signs, caution in cardiac conditions or pregnancy.
Page 88: Special Considerations During Pregnancy
Hypothyroidism treatment should continue to prevent fetal growth retardation; monitor and adjust dosages regularly.
Page 89: Monitoring and Educating Patients
Ensure compliance with medication times and brands.
Page 90: Hyperthyroid Crisis Management
Assess for exacerbation causes (stress, infection), caution with drug interactions.
Page 91: Patient Education on Emergency Signs
Report unusual symptoms; caution against over-the-counter medications without consultation.
Page 92: General Monitoring Guidelines
Monitor therapeutic responses (improved energy, reduced hyperthyroid symptoms) and adverse effects.
Page 93: Comparison of Hypothyroid and Hyperthyroid Symptoms
Hyperthyroidism: Weight loss, increased appetite, heat intolerance, tachycardia, diarrhea, anxiety.
**Hyp