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Ati flash cards 12, medications affecting the reproductive system

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Ati flash cards 12, medications affecting the reproductive system

  1. 1. Meds Affecting Reproduction (General Key Points) N203 ATI (Unit 12) Reproductive System -
  2. 2. · Testosterone produced by testes, ovaries, and adrenal cortex. Primary androgen in both genders. · ♀: Primary estrogen and progestional are estradiol and progesterone. Both made in ovaries  maturation of ♀ reproductive organs & 2º sex characteristics. · Menstruation results from  progesterone toward end of cycle · Menopausal symptoms result from  estrogen levels. · Clinical uses of hormone preparations: Hormone deficiencies and oppositional treatment of hormone-dependent cancers. · Postmenopausal HRT: Benefits include vasomotor symptom relief and prevention of osteoporosis. Risks include embolic events and cancers. · Oral contraceptives suppress ovulation using ethinyl, estradiol, and norethindrone · OC risks are minimal except in smokers and those with Hx of embolic events. · Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics are used to delay preterm labor.
  3. 3. Oxytocics N203 ATI (Unit 12) Reproductive System -
  4. 4. Expected Action: Proto: oxytocin (Pitocin) Others: methylergonovine (Methergine) ·  strength, frequency, and duration of uterine contractions Therapeutic Uses: · · Methergine: Emergency intervention for serious postpartum hemorrhage · Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of postpartum bleeding // Fetal stress testing // Milk letdown (intranasal) Adverse Effects: · · Methergine: Hypertensive crisis (IV): Headache, nausea, BP · Oxytocin: Uterine rupture {Relax myometrium ĉ Mg(SO4)} Contraindications/Precautions: ♀ (?) · Methergine: Hypertension · Methergine: Cardiovascular, renal, or hepatic failure. · Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs, cephalopelvic disproportion, prolapsed umbilical cord, fetal distress. Interactions: · Vasopressors  hypertension Education: · Use infusion pump and gradually  rate ·  contractions longer than 60 sec, freq > q 2-3 min  infusion
  5. 5. Tocolytic Medications N203 ATI (Unit 12) Reproductive System -
  6. 6. Expected Action: Proto: Terbutaline sulfate (Brethine) Others: magnesium sulfate, ritodrine · Selectively activates β2-adrenergic receptors  uterine smooth muscle relaxation Therapeutic Uses: · Delay of preterm labor Adverse Effects: · Tremors, anxiety, headache (β2 skeletal muscle side effects) · Tachycardia, palpitations, chest pain (β1 side effects) Contraindications/Precautions: ♀ (?) · Pregnancy // lactation Interactions: · Concurrent use of β-blockers  blunt effects · Concurrent use of adrenergic agonists  additive effects · Concurrent use of MAOIs  Hypertension
  7. 7. Androgens N203 ATI (Unit 12) Reproductive System -
  8. 8. Expected Action: Proto: testosterone (Delatestryl) — Others: fluoxymesterone (Halotestin), methyl testosterone (Oreton), danazol (Danocrine) · Growth and maturation of ♂ sex organs and 2º sex characteristics. Promotes skeletal muscle growth. Therapeutic Uses: · Hypogonadism in androgen-deficient men · Delayed puberty · Palliative treatment of androgen-responsive breast cancer Adverse Effects: · Hypercalcemia (ĉ breast cancer treatment) · CV risks:  LDL,  HDL, edema · Hepatotoxicity · ♂: Acne, facial hair, gynecomastia, impotence, priapism · ♀: Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities Contraindications/Precautions: ♀ (X) · Pregnancy · Prostate cancer · Liver, heart, or renal failure · Interactions: · Hepatotoxic drugs:  risk of liver damage · Warfarin, oral hypoglycemics, and glucocorticoids  androgen effects on metabolism can  levels of these. Education: · Report weight gain > 2 lb/week.
  9. 9. Estrogens N203 ATI (Unit 12) Reproductive System -
  10. 10. Expected Action: Proto: conjugated equine estrogens (Premarin) Others: estradiol (Estrace), estradiol hemihydrate (Vagifem) · Growth and maturation of ♀ reproductive tract and 2º sex characteristics. They  bone resorption and  LDL. At high levels they suppress release of FSH. Therapeutic Uses: · Dysfunctional uterine bleeding & endometriosis · Postmenopausal symptoms & osteoporosis · Prostate cancer · Contraception Adverse Effects: · Risk for estrogen-dependent breast cancer · Prolonged estrogen  endometrial / ovarian cancers (Give progestins, too) · Emboli ( risk from smoking) · Feminization, impotence,  libido in ♂ Contraindications/Precautions: ♀ (X) · Pregnancy · Breast cancer · Risk of thromboembolic disease · Pt. or family Hx of heart disease Interactions: · Estrogens  η of warfarin · Phenytoin   toxicity Education: · IM deep into large muscle mass · Apply patches to trunk
  11. 11. Progesterones N203 ATI (Unit 12) Reproductive System -
  12. 12. Expected Action: Proto: medroxyprogesterone (Provera) Others: norethindrone (Micronor), megestrol acetate (Megace) · Induce favorable conditions for fetal development and maintain pregnancy.  in progesterone levels  menstruation. Therapeutic Uses: · · Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine bleeding, amenorrhea, endometriosis, and endometrial cancer. Adverse Effects: · Breast cancer · Edema · Thromboembolic events · Breakthrough bleeding, amenorrhea, breast tenderness Contraindications/Precautions: ♀ (X) · Breast cancer · · Hx of thromboembolic, cardiovascular, cerebrovascular disease. · Undiagnosed vaginal bleeding Interactions: · · Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all η of oral contraceptives. Education: · Anticipate withdrawal bleeding for 3-7 days
  13. 13. Oral Contraceptives N203 ATI (Unit 12) Reproductive System -
  14. 14. Expected Action: Proto: Ovcon 35 — Others: Necon, ortho-novum ·  fertility by inhibiting ovulation, thickening cervical mucous, and making lining of endometrium less favorable to implantation. Therapeutic Uses: · Prevent pregnancy Adverse Effects: · Hypertension · Thromboembolic events · Breakthrough or abnormal uterine bleeding · Cervical cancer Contraindications/Precautions: ♀ (X) · Pregnancy · Hx of thrombophlebitis and cardiovascular events · Smoker > 35 · Family history or risk factors for breast cancer Interactions: · OC η of warfarin and oral hypoglycemics · Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all η of oral contraceptives. Education: · Take for 21 days followed by 7 days with no drug · 1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days
  15. 15. Antineoplastic Agent (1 of 2) N203 ATI (Unit 12) Reproductive System -
  16. 16. Expected Action: Proto: leuprolide (Lupron) · Synthetic luteinizing hormone  testosterone levels and  uterine fibroid growth Therapeutic Uses: · Palliative treatment of advanced prostate cancer · Uterine fibroids and endometriosis Adverse Effects: · Hot flashes · Bone pain · Thromboembolic events ( risk with smoking) Contraindications/Precautions: ♀ (X) · Pregnancy and lactation Education: · Administer leuprolide immediately upon reconstitution · Administer leuprolide depot preparations deep IM
  17. 17. Antineoplastic Agents (2 of 2) N203 ATI (Unit 12) Reproductive System -
  18. 18. Expected Action: Proto: tamoxifen (Nolvadex), Selective Estrogen Receptor Modulators (SERMs) · Tamoxifen competes ĉ estrogen   estrogen effects Therapeutic Uses: · Breast cancer · Breast cancer prevention Adverse Effects: · Hot flashes · Bone pain · Hyperlipidemia · Hypercalcemia: Patients with bone metastases  risk for hypercalcemia Contraindications/Precautions: ♀ (X) · Pregnancy and lactation · History of DVT Interactions: · Warfarin:  anticoagulant effect · Antineoplastic agents:  antineoplastic effects (nausea, vomiting, neutropenia) Education: · Give with food or fluid if gastric upset occurs · Omit missed doses · Monitor for weight gain and peripheral edema
  19. 19. Erectile Dysfunction N203 ATI (Unit 12) Reproductive System -
  20. 20. Expected Action: Proto: sildenafil (Viagra) — Others: tadalafil (Cialis), vardenafil (Levitra) · Augments effects of nitric oxide released during stimulation  blood to corpus cavernosum  penile erection. Therapeutic Uses: · Erectile dysfunction Adverse Effects: · Priapism:  if longer than 4 hours · MI, sudden death: Evaluate and monitor cardiovascular history and health Contraindications/Precautions: ♀ (?) · Cardiovascular disease · Taking medications in nitrate family including nitroglycerin Interactions: · Organic nitrates (nitroglycerin)  fatal hypotension · Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil metabolism   plasma level of sildenafil. Education: · Take 1 hour before sex; limit to 1x/day.

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