Reproductive pharm MISSING ch 95
•Dinoprostone for cervical ripening is contraindicated in patients with a history of what condition(s)? (Select all that apply) A.Diabetes mellitus type II B.Genital herpes simplex C.1st daughter delivered via c-section D.Thyroidectomy E.Herpes zoster F.Uterine surgery
B,C, F,
In the absence of estrogen, bone resorption accelerates, leading to a
12% loss of bone density shortly after menopause.
2 hours
How long should patients wait to shower or bathe after applying Testim, Fortesta,Vogelxo (gels), and Axiron (topical)
Drugs Used to Prevent Preterm Labor
Hydroxyprogesterone Caproate (Makena): • Only approved drug for prevention of preterm labor •Singleton birth, hx of at least one preterm birth •Contraindicated: uncontrolled HTN, liver cancer, liver disease, hx thrombosis, cholestatic jaundice of pregnancy, undiagnosed uterine bleeding, breast cancer or other hormone -sensitive cancer ABX :Treat bacterial vaginosis = decreased risk preterm labor
preterm labor
before 37 weeks gestation
In menopausal women, HT can reduce
bone resorption and slow the development of osteoporosis. More importantly, HT can decrease the risk of osteoporotic fractures.
Menopausal therapy with estrogen alone might increase
breast cancer risk. If so, the risk for most women appears to be small, especially with short-term use.
Nitrofurantoin [Furadantin, Macrodantin, Macrobid]
broad-spectrum antibacterial drug, producing bacteriostatic effects at low concentrations and bactericidal effects at high concentrations
dopamine agonists
cabergoline and bromocriptine class name
yes!
can androgens also influence sexuality in females?
reinfection
caused by colonization with a new organism
Relapse infection
caused by recolonization with the same organism responsible for the initial infection
Alprostadil (Prostaglandin E1)
causes Relaxation of smooth muscle resulting in a rapid inflow of arterial blood (vasodilating properties)
cervical ripening
cervix pull back up and shortening and softening and dilates so babys head can get through
Osteoporosis
characterized by bone demineralization, altered bone architecture, and reduced bone strength.
-foreign body sensations -coital problems -ring expulsion -vaginal symptoms -headache -emotional lability
common reasons for discontinuing the ring
PDE5 inhibitors
considered first line treatment for ED
The purpose of estrogen in both regimens is to
control menopausal symptoms by replacing estrogen that has been lost owing to menopause. The progestin is present for one reason only: to counterbalance estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer.
In the human male, small amounts of testosterone are
converted into estradiol and estrone by the testes.
•hands with soap and warm water after every application. •cover the application site with clothing after the gel has dried. •wash the application site before skin-to-skin contact with another person. • Women and children should avoid skin-to-skin contact with application sites on gel users. • Women and children who make accidental contact with a gel application site should wash contaminated skin immediately.
what are the guidelines of using gel and topical testosterone?
-trigger ovulation in women who are infertile due to anovulation -promote late follicular maturation and early luteinization in women undergoing assisted reproductive technology
what are the indications of use of Choriogonadotropin alfa [Ovidrel]
Misoprostol
has been used to induce labor
Drugs for Induction of Labor- what do u have to do before giving these drugs?
have to ripen cervix before doing this
EPT increases
he risk of dementia, primarily Alzheimer's disease.
-taking with meals (all doses) -initiating treatment at low doses
how can adverse effects of bromocriptine be minimized?
serial ultrasound examinations -progressive follicular enlargement -conversion of the follicle to a corpus luteum
how can the effects of Clomiphene be monitored?
by giving progesterone
how can the luteal-phase defect caused by Clomiphene be corrected?
(1) releasing spermicide (2) absorbing seminal fluid (3) blocking penetration of sperm
how does contraceptive sponge [Today Sponge] protect against pregnancy?
resolves spontaneously after discontinuing drug use supportive treatment: bed rest, electrolytes, analgesics)
how is ovarian hyperstimulation syndrome treated?
3 years
how long does nexplanon provide blood levels sufficient for contraception?
5 to 6 hours
how long should patients wait to shower or bathe after applying AndroGel?
10 to 14 days
how long should treatment mild to moderate Acute uncomplicated pyelonephritis last?
24 hours
how much time should elapse between doses of Sildenafil [Viagra] and Nitrates
once a week for 3 weeks, followed by 1 week off
how often are transdermal contraceptive patches applied?
left in place for 3 weeks, and then removed; a new ring is inserted 1 week later
how often are vaginal rings inserted?
should be held in place (with a finger over the lip) for 30 seconds
how to ensure good adhesion of buccal tablets?
-administer with milk or meals -reduce dosage -use macrocrystalline formulations
how to reduce GI disturbances caused by Nitrofurantoin?
-pituitary is capable of producing LH and FSH -only if the ovaries are capable of responding
what are the requirements (only way) for Clomiphene to induce ovulation?
many women are discontinuing treatment. There are two basic methods:
immediate cessation and tapering slowly. However, there are no controlled studies to indicate which option might result in fewer symptoms.
Testosterone pellets [Testopel]
implanted subdermally in the hip area or abdominal wall lateral to the umbilicus.
Strong data show that HT using EPT increases both
incidence of breast cancer and breast cancer mortality.
HT increases the risk of
incontinence in women who are not incontinent and makes incontinence worse in women who already are.
Conventional therapy (males, children, pregnant women, and women with suspected upper tract involvement)
indicated for all patients who do not meet the criteria for short-course therapy
Carboprost
indicated for control of postpartum hemorrhage
In girls with estrogen insufficiency, puberty can be
induced by giving exogenous estrogens.
Acute uncomplicated pyelonephritis (young children, older adults, and women of childbearing age)
infection of the kidneys
Acute bacterial prostatitis
inflammation of the prostate caused by local bacterial infection
Depot medroxyprogesterone acetate (DMPA)
injected IM or subQ, protects against pregnancy for 3 months or longer by inhibiting secretion of gonadotropins
short-course therapy
is single-dose therapy or short-course therapy more effective?
However, the use of short-term HT to manage menopausal symptoms
is still deemed appropriate, provided women use the smallest effective dosage for the shortest time needed.
no!
is testoserone replacement therapy approved for women in the US?
Estradiol
is the principal endogenous estrogen.
Progesterone
is the principal endogenous progestational hormone.
The benefits of long-term HT to prevent chronic disorders do not
justify the risks.
Progestin-only OCs
less effective and are more likely to cause irregular bleeding
Acute cystitis
lower UTI that occurs most often in women of childbearing age
The principal noncontraceptive application of estrogens and progestins
menopausal hormone therapy (HT): Estrogens are given to manage hot flushes and other menopausal symptoms; progestins are given to oppose estrogen-mediated stimulation of the endometrium.
5-alpha-reductase inhibitors
most appropriate for men with very large prostates
Fluoxymesterone Methyltestosterone Oxandrolone
names of 17-Alpha-Alkylated Androgens
finasteride dutasteride
names of 5-alpha-reductase inhibitors
Leuprolide nafarelin goserelin
names of GnRH agonists
-sildenafil -tadalafil -vardenafil -avanafil.
names of PDE5 inhibitors
-Misoprostol -Carboprost -Dinoprostone
names of Prostaglandins
nandrolone stanozolol methenolone
names of androgens that are commonly used by athletes that are abused
papaverine plus phentolamine alprostadil
nonoral agents
Androgens
noted most for their ability to promote expression of male sex characteristics
Complicated UTIs
occur in males and females who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection
By activating estrogen receptors, tamoxifen protects against what?
osteoporosis and has a favorable effect on serum lipids. However, receptor activation also increases the risk of endometrial cancer and thromboembolism.
For most women, the benefits of long-term HT for disease prevention do not
outweigh the risks, and hence long-term HT should generally be avoided.
Periodic liver function tests
patients should have what type of tests done while taking androgens?
Two anterior pituitary hormones—follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—
play central roles in regulating the menstrual cycle.
Human chorionic gonadotropin (hCG)
polypeptide hormone produced by the placenta
Estrogen increases the risk of breast cancer primarily in
postmenopausal women who are using estrogen combined with a progestin. Estrogen does not cause breast cancer--it only promotes the growth of a cancer that already exists, and then only if the cancer is estrogen receptor-positive.
alpha blockers
preferred for men with relatively small prostates
Progesterone levels increase during
pregnancy. These high levels suppress contraction of uterine smooth muscle and thereby help sustain pregnancy.
abruptio placentae
premature separation of the placenta from the uterine wall can be from trauma
GnRH antagonists
prevent premature LH release and thereby eliminate the chance of premature ovulation (with menotropins or follitropin [FSH])
•Magnesium Sulfate
previously heavily used. Research says no clinically significant tocolytic effect, but recommended b/c can decrease risk for cerebral palsy with preterm delivery AE: hypotension, flushing, HA, dizziness, lethargy, dry mouth, pulmonary edema, hypocalcemia, altered LOC MONITOR: big thing to assess is DTR before and during if they weaken is a sign of toxicity
Causes of estrogen deficiency include
primary ovarian failure, hypopituitarism, bilateral oophorectomy (removal of both ovaries), and Turner's syndrome (a genetic disorder that impairs gonadal function).
Methenamine [Hiprex, Urex, Mandelamine ]
prodrug that, under acidic conditions, breaks down into ammonia and formaldehyde
Papaverine Plus Phentolamine (not fda approved)
produce erection by increasing arterial inflow to the penis and decreasing venous outflow
Lutropin alfa
recombinant form of LH
controlled ovarian stimulation
refers to the use of drugs to facilitate follicular maturation and ovulation
nifedepine CCB
reflex tachy very common w this drug as good as terbutaline, but fewer AE. MAX 48HR use AE: hypotension, tachycardia, facial flushing, HA, dizziness, nausea
Recurrent UTIs
result from relapse or from reinfection
injected directly into the corpus cavernosum
route of administration for Papaverine Plus Phentolamine
For women younger than 60 years who have undergone hysterectomy, HT may be
safer than for any other group.
UTIs
second most common infection encountered today
yes!
should Choriogonadotropin alfa [Ovidrel] be first induced with a follicle-stimulating agent?
yes!
should the vaginal ring still be inserted on schedule even if bleeding is still ongoing?
hypotension
side effect of combining Sildenafil [Viagra] with Nitrates or Alpha-adrenergic antagonists
-hot flashes -nausea -abdominal discomfort -bloating -breast engorgement -visual disturbances -ovarian hyperstimulation -multiple births
side effects of Clomiphene [Clomid, Serophene]
-Increased appetite -Weight gain -Depression -Tiredness -Fatigue -Hypomenorrhea -Breast regression -Monilial vaginitis -Acne, oily scalpa -Hair lossa -Hirsutism
side effects of Progestin excess
-Early or midcycle breakthrough bleeding -Increased spotting -Hypomenorrhea
side effects of estrogen deficiency
-Nausea -Breast tenderness -Edema -Bloating -Hypertension -Migraine -Cervical mucorrhea -Polyposis
side effects of estrogen excess
-Late breakthrough bleeding -Amenorrhea -Hypermenorrhea
side effects of progestin Deficiency
-urinary hesitancy -urinary urgency -increased frequency of urination -dysuria -nocturia -straining to void -postvoid dribbling -decreased force and caliber of the urinary stream -sensation of incomplete bladder emptying
signs and symptoms of BPH
high-fat meal
slows down Sildenafil [Viagra] absorption
nexplanon
subdermal Etonogestrel Implants
Unfortunately, progesterone also
suppresses contraction of GI smooth muscle, which leads to prolonged transit time and constipation. In the breast, progesterone promotes growth and proliferation of alveolar tubules (acini), the structures that produce milk.
The principal benefits of postmenopausal estrogen/progestin therapy (EPT) and estrogen therapy (ET) are
suppression of menopausal symptoms and prevention of osteoporosis.
biggest concern of preme babies
surfactant don't have for lungs
-low abdominal pain -pressure -weight gain -swelling
symptoms of ovarian hyperstimulation syndrome
Three SERMs are available
tamoxifen, toremifene, and raloxifene.
-promote follicular maturation and ovulation in anovulatory patients -induce the development of multiple follicles in ovulatory women participating in an in vitro fertilization program. -promote spermatogenesis (primary or secondary hypogonadotropic hypogonadism)
what are the therapeutic uses of Menotropins [Repronex , Menopur]?
can correct: -amenorrhea -galactorrhea -infertility -hyperprolactinemia
what are the therapeutic uses of bromocriptine?
X
what category are androgens listed as for pregnancy risk?
reversible bone loss (increase in fractures is unclear)
what does DMPA pose a risk of?
causative organism and infection severity
what does drug selection and route for drug therapy of Acute bacterial prostatitis depend on?
erythropoietin
what does testosterone promote the synthesis of?
two visits to a qualified physician
what does the induction of mifepristone/misoprostol require?
-rifampin (tuberculosis) -ritonavir (HIV) -antiseizure agents (carbamazepine, phenobarbital, phenytoin, and primidone) -St. John's wort (depression)
what drugs and herbs can reduce effects of OCs?
-warfarin -hypoglycemic agents (reduce sugar)
what drugs does OCs reduce the effects of?
pituitary increases secretion of gonadotropins (LH and FSH), and these hormones then stimulate the ovary, promoting follicular maturation and ovulation
what happens in response to Clomiphene [Clomid, Serophene] blocking receptors for estrogen?
-heavy smoking -hx of thromboembolism -thrombophilias -diabetes -hypertension -cerebrovascular disease -coronary artery disease -surgery in which immobilization increases
what increases risk of thromboembolism?
bleeding that has been refractory to more conventional agents (oxytocin, ergot alkaloids)
what is Carboprost reserved for?
chronic infection of the lower urinary tract (trimethoprim/sulfamethoxazole is preferred)
what is Methenamine used for?
upper UTIs
what is Nitrofurantoin and Methenamine not recommended for?
Cachexia
what is Oxandrolone [Oxandrin] approved for the use of?
IV antibiotics -ciprofloxacin -ceftriaxone -ceftazidime -ampicillin plus gentamicin -ampicillin/sulbactam
what is Severe pyelonephritis treated with?
uncomplicated community-associated infections in women who are not pregnant and whose symptoms began less than 7 days before starting treatment
what is Single-dose therapy and short-course therapy are recommended only for
can be transferred to others by skin-to-skin contact
what is a disadvantage of gel testosterone?
-correct amenorrhea -infertility associated with excessive prolactin secretion -parkinsons
what is cabergoline used for?
promoting spermatogenesis
what is follitropins approved for in men?
to stimulate ovulation
what is hCG given for?
hCG
what is menotropoins and follitropins used sequentially with?
oral antibiotics -trimethoprim/sulfamethoxazole -trimethoprim alone -ciprofloxacin, and levofloxacin
what is mild to moderate infections of Acute uncomplicated pyelonephritis treated with?
misoprostol
what is required to be used with Mifepristone (RU 486) [Mifeprex]?
blocks receptors for estrogen
what is the MOA of Clomiphene [Clomid, Serophene]?
should be replaced with a new one, and the next scheduled dose should be skipped
what is the dosing schedule if a buccal tablet falls out after 8 hours?
replaced with a new one for the remainder of the dosing interval
what is the dosing schedule if a buccal tablet falls out before 8 hours?
termination of early intrauterine pregnancy
what is the indication of use for the drug Mifepristone (RU 486) [Mifeprex]
testosterone
what is the major endogenous androgen?
1 tablet every 12 hours, alternating sides of the mouth
what is the recommended dosage of buccal tablets?
-promote follicular maturation -ovulation in women who are infertile because of ovulatory failure -in men to reach adequate testosterone levels
what is the therapeutic uses of hCG?
-IV agent (a fluoroquinolone [e.g., ciprofloxacin]) -followed by 6 weeks with an oral agent (either trimethoprim-sulfamethoxazole or a fluoroquinolone)
what is the treatment of severe Acute bacterial prostatitis
women with active disease of the heart, lungs, kidneys, or liver.
what is use of Prostaglandins contraindicated in?
follitropin alfa [Gonal-f]
what must Lutropin alfa be combined with for use?
hCG
what must be administered after use of lutropin alfa/follitropin alfa?
Spotting and bleeding
what occurs most often during the first 3 months when low-estrogen OCs are used?
sulfonamides
what should Methenamine not be taken with because formaldehyde forms an insoluble complex when combined (risk for UTI injury from crystalluria)
possibility of pregnancy
what should be assessed if a period is missed while taking monthly-cycle OCs?
examine every other day while taking and for 2 weeks after stopping
what should be done to ensure early detection of ovarian hyperstimulation syndrome while taking menotropins
microbiologic testing
what should be obtained before giving antibiotics for Complicated UTIs
ectopic pregnancy (drugs can mask bleeding)
what should be ruled out before mifepristone/misoprostol is used?
x-ray of hand and wrist every 6-months
what should children while taking androgens?
switch to oral antibiotics (usually within 24 to 48 hours)
what should happen once Severe pyelonephritis is controlled with IV antibiotics
sniffing or blowing for at least 1 hour
what should patients avoid after applying Testosterone nasal gel [Natesto]
produces a harmless brown color to urine
what should patients be aware of when taking Nitrofurantoin?
5.5 or less
what should the ph of urine be for formaldehyde to be released?
women with a history of asthma or hypertension
what should use of Carboprost be avoided in?
broad-spectrum antibiotic
what the treatment if immediate therapy is needed because of severe symptoms with a Complicated UTI
can be washed off in warm water (not hot water) and reinserted -(effects may be diminished if more than 3 hours pass: use backup 7 days)
what to do if ring is expelled before 3 weeks have passed?
beginning in the early follicular phase and continuing until the day of hCG administration
when are GnRH antagonists administered?
after days 14 and 35 and periodically thereafter.
when are testosterone levels of Fortesta and Vogelxo checked?
second trimester only
when can Carboprost and dinoprostone be used to induce abortion?
early pregancy and 2nd trimester
when can Misoprostol be used to induce abortion?
(1) during the first 5 days of a normal menstrual period (2) within the first 5 days postpartum (not breast-feeding) (3) at the sixth week postpartum (exclusively breast-feeding)
when is DMPA administered to ensure that the recipient is not pregnant?
21st postpartum day
when is nexplanon safe for breastfeeding?
once a day 30 min-4 hours before sexual activity
when should Sildenafil [Viagra] be taken
before applying topical solution
when should deoderant be applied when using topical solution?
14 days after initiating therapy and periodically thereafter
when should levels of testosterone for AndroGel and Testim be checked?
If an erection persists more than 4 hours
when should patients seek help when experiencing priapism?
immediately
when should patients taking Nitrofurantoin report peripheral neuropathy?
before intercourse, but no more than 1 hour in advance (when used alone)
when should spermicide be inserted?
during the first 24 hours of the menstrual period
when should the first transdermal contraceptive patches for women not currently using OCs
on the first day of withdrawal bleeding
when should the first transdermal contraceptive patches for women switching from OCs
at least 10 to 15 minutes before intercourse to allow time for dissolution
when should the supporsitory form of spermicide be inserted?
upper arm, thigh, back, or abdomen
where are Testosterone patches [Androderm] applied?
only in urine
where are therapeutic levels of Nitrofurantoin achieved?
once daily to clean, dry skin of the shoulders, upper arms, or abdomen
where is AndroGel (gel) applied?
groove between the biceps and triceps in the nondominant arm
where is nexplanon inserted?
to the axilla (armpit, underarm)
where is the topical solution testonerone (Axiron) applied?
front or inner thigh
where should Fortesta (gel) be applied?
once daily shoulders or upper arms
where should Testim (gel) be applied?
-lower abdomen -buttocks -upper outer arm, or upper torso (front or back)
where should the transdermal contraceptive patches be appplied?
progestin-only OCs
which OCs method is taken continuously?
testosterone enanthate testosterone cypionate
which androgens are used for Hypogonadism and Replacement Therapy (testicular failure)?
fluoxymesterone [Androxy] methyltestosterone [Android, Methitest, Testred] both oral
which androgens are used for delayed puberty?
Beta-lactam antibiotics (e.g., amoxicillin; cephalexin and other cephalosporins) -less effective and less well tolerated)
which antibiotics should be avoided in uncomplicated cystitis
-theophylline -tricyclic antidepressants -diazepam -chlordiazepoxide
which drugs can OCs increase the effects of?
Urinary Alkalizers (acetazolamide, sodium bicarbonate) -do not give patients these
which drugs reduce the effects of Methenamine
men who do not have ED (likely placebo)
which group of people does Sildenafil [Viagra] have little or no effect in?
BRCA1 gene mutation (not brca2)
which group of women does OCs increase risk for cancer?
severe pyelonephritis
which infection requires IV therapy in the hospital?
-acute cystitis -Acute uncomplicated pyelonephritis -recurrent uti
which infections can be treated at home with oral therapy?
progestin-only method
which oral contraceptive should women with a history of thrombosis use?
Suppositories
which route of Dinoprostone is used for abortions?
gel [Prepidil] vaginal inserts [Cervidil]
which route of Dinoprostone is used for cervical ripening?
topical solution
which route should patients not swim or bathe for 2 hours after application?
Axiron (topical), Fortesta (gel), Vogelxo (gel)
which testosterone formulations are flammable?
patients with liver dysfunction (decomposition of methenamine generates ammonia)
who is contradicted for taking Methenamine
-pregnant women near term -infants under the age of 1 month
who is contradicted when taking Nitrofurantoin?
-older than 65 years -hepatic impairment -severe renal insufficiency
who is delayed clearance of Sildenafil [Viagra] present in?
-renal impairment -taking it chronically
who is most likely to develop peripheral neuropathy when taking Nitrofurantoin?
individuals with renal impairment
who should not receive Nitrofurantoin and Methenamine salts (mandelate, hippurate [Hiprex, Urex])
women with adrenal insufficiency or on long-term glucocorticoid therapy
who should not take mifepristone?
have no role in pregnancy (not because they are harmful)
why are OCs classified as category X?
risk for liver damage
why should oral androgen therapy not be used long-term?
Prolonged use of estrogens alone by postmenopausal women is associated
with an increased risk of endometrial carcinoma. However, when estrogens are used in combination with a progestin, there is little or no risk of uterine cancer.
Drugs for Cervical Ripening & Induction of Labor
•>22% deliveries are induced in US •Post-term pregnancy- most common reason •Indications for early induction: •Abruptio placenta (placenta separates from uterus) •Premature rupture of membranes •Gestational hypertension •Preeclampsia/Eclampsia •Maternal medical conditions •Fetal compromise •Fetal demise
Estrogens support
the development and maintenance of the female reproductive tract and secondary sex characteristics.
The first half of the menstrual cycle (days 1 through 14) is called
the follicular phase, and the second half is called the luteal phase. One full cycle typically takes 28 days.
Menopausal hormone therapy (HT) consists of low doses of estrogen (with or without a progestin) taken to compensate for
the loss of estrogen that occurs during menopause.
Hormone therapy in postmenopausal women is
the most common noncontraceptive use of estrogens.
Alprostadil pellets [Muse]
the only ED drug that is approved for twice-daily use, is inserted into the urethra
Progesterone is produced by
the ovaries and the placenta. Ovarian production occurs during the second half of the menstrual cycle.
The principal concerns with estrogen therapy are
the potential for endometrial hyperplasia, endometrial cancer, and cardiovascular events.
In premenopausal women, the ovary is
the principal source of estrogen
Postmenopausal ET and EPT increase
the risk of cholecystitis.
In addition, estrogen alone increases
the risk of coronary heart disease and myocardial infarction, but only in women older than 60 years.
In postmenopausal women, therapy with estrogen alone or estrogen combined with a progestin may increase?
the risk of ovarian cancer.
Progesterone secreted during
the second half of the menstrual cycle converts the endometrium from a proliferative state into a secretory state. If implantation does not occur, progesterone production by the corpus luteum declines. The resultant fall in progesterone levels is the principal stimulus for the onset of menstruation.
-suppresses endometriosis (not a cure) -uterine fibroids -central precocious puberty -advanced prostate cancer
therapeutic uses of Leuprolide [Lupron Depot, Eligard]
Beyaz, Rajani, and Safyral
these combination OCs contain levomefolate, a metabolite of folic acid (reduce the risk of fetal neural tube defects)
The primary noncontraceptive use of progestins is
to counteract the adverse effects of estrogen on the endometrium in women undergoing HRT.
Ortho Evra and Xulane
transdermal contraceptive patches
eclampsia
true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma - when actually having seizure and only cure is having the baby
(1) estrogen plus a progestin (combination OCs) (2) just a progestin ("minipills")
two main categories of oral contraceptives
5-alpha-reductase inhibitors alpha1-adrenergic antagonist
two major classes of drugs for BPH
oral agents and nonoral agents
two major groups of drugs for erectile dysfunction
Nausea is the most frequent
undesired response to the estrogens.
Alprostadil [Caverject, Caverject Impulse, Edex]
used for direct injection into the corpus cavernosum
Dinoprostone and misoprostol
used to initiate ripening of the cervix before induction of labor.
Clomiphene [Clomid, Serophene]
used to promote follicular maturation and ovulation in selected infertile women
uterine tachysystole
uterus contracts more then its supposed to •>5 contractions in 10 min (normal rate ≤5 contractions in 10 min) which can lead to fetal distress •fetal HR monitoring should be done continuously
In postmenopausal women, estrogen, used either alone or combined with a progestin, increases the risk of
venous thromboembolism (VTE) and stroke
Raloxifene
very similar to tamoxifen. The principal difference is that raloxifene does not activate estrogen receptors in the endometrium, and hence does not pose a risk of uterine cancer.
Tamoxifen
was the first SERM to be widely used. By blocking estrogen receptors, tamoxifen (and its active metabolite, endoxifen) can inhibit cell growth in the breast. As a result, the drug is used extensively to prevent and treat breast cancer.
premature rupture of membranes
water breaking early
progestin-only contraceptives
what are adverse effects of DMPA similar to?
to induce abortion
what are all three prostaglandins used for?
ergot, an alkaloid found in plants
what are cabergoline and bromocriptine derivatives of?
-rheumatoid arthritis decrease risk of: -ovarian cancer -endometrial cancer -ovarian cysts -pelvic inflammatory disease (PID) -benign breast disease -iron deficiency anemia -acne decreases symptoms of: -menstual -premenstrual dysphoric disorder -menstrual-associated migraine
what are some Noncontraceptive Benefits of OCs
-ethinyl estradiol -mestranol -estradiol valerate
what are some names of estrogens?
first generation -Ethynodiol diacetate -Norethindrone second generation -Levonorgestrel -Norgestrel third generation -Desogestrel -Norgestimate fourth generation Dienogest Drospirenone
what are some names of progestins?
-Replacement Therapy in Menopausal Women fatigue, reduced libido, and reduced genital sensitivity -Treatment of Transsexualism -Cachexia -anemias
what are some other therapeutic uses of androgens?
(1) single-dose therapy (2) short-course therapy (3 days) (3) conventional therapy
what are the 3 types of oral therapy employed for community-associated infections?
-surgical sterilization (tubal ligation, vasectomy) -mechanical devices (condom, diaphragm, cervical cap) -avoiding intercourse during periods of fertility (calendar method, temperature method, cervical mucus method)
what are the Nonpharmacologic methods of contraception?
-oral contraceptives -etonogestrel implants -injectable medroxyprogesterone acetate -intrauterine devices -vaginal rings -transdermal patches
what are the Pharmacologic methods of contraception?
-lower cost -greater adherence -fewer side effects -less potential for promoting the emergence of bacterial resistance
what are the advantages of short-term therapy over conventional therapy
-ovarian hyperstimulation syndrome -rupture of ovarian cysts -multiple birth
what are the adverse effects of Choriogonadotropin alfa [Ovidrel]?
-ovarian hyperstimulation syndrome -multiple births
what are the adverse effects of Menotropins [Repronex , Menopur]?
-occasional GI distress -bladder irritation: dysuria, frequent voiding, urinary urgency, proteinuria, and hematuria
what are the adverse effects of Methenamine
-severe bleeding -sepsis -bleeding -cramping -nausea -vomiting -diarrhea -headache
what are the adverse effects of Mifepristone (RU 486) [Mifeprex]?
-GI disturbances: anorexia, nausea, vomiting, diarrhea -Pulmonary: acute and subacute -Hematologic: agranulocytosis, leukopenia, thrombocytopenia, and megaloblastic anemia -Peripheral Neuropathy -Hepatoxicity: hepatitis, cholestatic jaundice, and hepatic necrosis -central nervous system effects: headache, vertigo, drowsiness, nystagmus
what are the adverse effects of Nitrofurantoin [Furadantin, Macrodantin, Macrobid]
-Virilization in Women, Girls, and Boys -Premature Epiphyseal Closure -hepatotoxicity -effected cholesterol levels -induce masculinization of the female fetus -promotion of growth of prostate cancer -edema
what are the adverse effects of androgen therapy?
-Nausea -Headache -dizziness -fatigue -abdominal cramps -risk for valvular heart injury
what are the adverse effects of bromocriptine?
-Thromboembolic Disorders (PE, MI, thrombotic stroke) -hypertension -uterine bleeding -stroke in women with migraine -Benign Hepatic Adenoma (mestranol only/nonmalignant) -hyperkalemia (Drospirenone) -excess or deficiency of estrogen or progestin
what are the adverse effects of combination oral contraceptives?
-ovarian hyperstimulation syndrome -rupture of ovarian cysts -edema -injection-site pain -central nervous system disturbances (h/a, irritability, restlessness, fatigue)
what are the adverse effects of hCG?
-headache -abdominal pain -nausea -breast pain -ovarian enlargement -ovarian hyperstimulation syndrome.
what are the adverse effects of lutropin alfa/follitropin alfa combination?
promote follicular maturation in: -infertile -hypogonadotropic -hypogonadal women with profound LH deficiency.
what are the approved drug uses of Lutropin alfa?
irregular and unpredictable
what are the bleeding patterns of nexplanon?
include high fever, chills, malaise, myalgia, localized pain, and various urinary tract symptoms
what are the clinical manifestations of Acute bacterial prostatitis
-dysuria -urinary urgency -urinary frequency -suprapubic discomfort -pyuria -bacteriuria
what are the clinical manifestations of Acute cystitis
-fever -chills -severe. flank pain -dysuria -urinary frequency -urinary urgency -pyuria -usually, bacteriuria
what are the clinical manifestations of Acute uncomplicated pyelonephritis?
-testes, penis, and scrotum enlargement -pubic and axillary hair -height and weight increase -accelerates epiphyseal closure -deepening of voice -sebaceous glands increase (acne and oily skin) -beard development -Spermatogenesis
what are the effects of testosterone in men?
-clitoral growth -maintenance of normal libido -virilization
what are the effects of testosterone in women?
FSH
what are the follitropins preparations of?
postpartum hemmorhage drugs
•Oxytocin (DOC) and Misoprostol •misoprostol - rectally •Oxytocin - IM/IV •Carboprost Tromethamine (Hemabate): - IM Uterine contractions and vasoconstriction AE - 60% V/D, N common. Fever vomiting is instant after shot
yes!
are nitrofurantoin and methenamine only used for UTIs?
The two basic regimens for HT are
(1) estrogen alone and (2) estrogen plus a progestin.
In the ovary, the following sequence occurs:
(1) several ovarian follicles ripen; (2) one of the ripe follicles ruptures, causing ovulation; (3) the ruptured follicle evolves into a corpus luteum; and (4) if fertilization does not occur, the corpus luteum atrophies.
HT has only three approved indications:
(1) treatment of moderate to severe vasomotor symptoms associated with menopause, (2) treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause, and (3) prevention of postmenopausal osteoporosis.
In the uterus, these events occur:
(1) while ovarian follicles ripen, the endometrium prepares for nidation by increasing in thickness and vascularity; (2) after ovulation, the uterus continues its preparation by increasing secretory activity; and (3) if nidation fails to occur, the thickened endometrium breaks down, causing menstruation, and the cycle begins anew.
Indomethacin
- Cyclooxygenase Inhibitor - don't want to use unless have to bc premature closure of ductus arteiosis and bleeding •reserved for extremely early labor b/c high risk of neonatal complications. (increased risk postpartum bleeding)
Menopause typically begins around age
50 years, but can begin as early as age 48 and as late as age 55.
•A nurse is teaching a client about terbutaline. Which of the following statements by the client indicates understanding of the teaching? A."This medication will stop my contractions." B."This medication will prevent vaginal bleeding." C."This medication will promote blood flow to my baby." D."This medication will increase my prostaglandin production."
A
hydroxyprogesterone caproate
AE: injection-site rxn, hives, nausea, diarrhea, thromboembolism - rare Recognized as a hazardous drug - esp. for pregnant nurses
Finasteride [Proscar]
By decreasing DHT, promotes regression of prostate epithelial tissue and thereby decreases mechanical obstruction of the urethra
Known risks of EPT include
CHD, stroke, thromboembolic events, breast cancer, and dementia. ET appears to be safer than EPT but still can cause stroke, DVT, and other undesired effects.
For all postmenopausal women, regardless of age, ET increases the risk of
DVT and stroke. In addition, for women older than 60 years, ET increases the risk of MI and CHD.
Postpartum Hemorrhage more drugs
Ergot Alkaloids class Methylergonovine: •AE: Severe HTN - reserved for when unresponsive to other agents •Action: Constricts veins, arterioles •Fast - 60 sec IV Contraindicated: •Pregnancy •HTN
-relieve bothersome urinary symptoms -delay disease progression
goal of drug therapy for BPH
In the absence of estrogen, urogenital degeneration is inevitable. What can relieve these symptoms?
Hormone therapy, either oral or topical, can reduce symptoms.
women
group of people that Sildenafil [Viagra] is not approved for
Estrogens can affect various nonreproductive tissues.
Important among these are bone, blood vessels, and the heart, liver, and central nervous system (CNS).
primary (1) inhibiting ovulation secondary (1) thickening of the cervical mucus (2) alteration of the endometrium
MOA of Combination OCs
(1) inhibits follicular maturation and ovulation (2) thickens the cervical mucus (3) causes thinning of the endometrium
MOA of Depot medroxyprogesterone acetate (DMPA)
increases and preserves cGMP levels in the penis, thereby making the erection harder and longer lasting
MOA of Sildenafil [Viagra]
act directly on the ovary to stimulate follicle maturation
MOA of follitropins
contra for mag sulfate
MYASTHENIA GRAVIS, RENAL FAILURE AND HYPOCALCEMIA
Vardenafil
PDE5 inhibitor that prolongs QT interval
oral agents
PDE5 inhibitors
tadalafil
PDE5 inhibitors that has an effect of lasting 36 hours
Avanafil
PDE5 inhibitors that has fastest onset of action
loss of estrogen has multiple effects.
Prominent among these are vasomotor symptoms, sleep disturbances, urogenital atrophy, bone loss, and altered lipid metabolism.
Drugs for Cervical Ripening
Prostaglandins: DRUG: •Dinoprostone (Cervidil)- synthetic prostaglandin available in gel or vaginal insert •AE: uterine tachysystole, N/V/D, fever •Misoprostol (Cytotec) - more effective, cheaper, more convenient (off-label for this use) •AE: higher risk uterine tachysystole, delivery occurs faster than with dinoprostone
postpartum hommorhage is 2nd leading cause of maternal mortality behind preeclampsia
TRUE
Should any woman use HT?
The answer is "Yes"—provided the benefits for the individual outweigh the risks.
Estrogens and progestins are hormones with multiple actions.
They promote female maturation and help regulate the ongoing activity of the female reproductive organs. In addition, they affect bone mineralization and lipid metabolism.
nitrofurantoin and methenamine
Urinary Tract Antiseptics
Estrogens are classified by the U.S. Food and Drug Administration (FDA) as Pregnancy Risk Category
X, not because they are especially harmful, but because they have no legitimate use in pregnancy
yes!
are central nervous system effects of Nitrofurantoin reversible?
Spermicides
are chemical surfactants that kill sperm by destroying their cell membrane
Menopausal HT appears to pose
a small risk of ovarian cancer. However, data on this risk are conflicting.
preeclampsia
abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria, edema, and headache high risk of seizure
Vasomotor symptoms develop in
about 70% of postmenopausal women. Hormone therapy is the most effective way to suppress symptoms.
Estrogens, in the form of oral contraceptives, can help control
acne
(1) cause less local irritation (2) can't fall off (3) produce more consistent testosterone levels.
advantages of gel testosterone [AndroGel, Testim, Fortesta, and Vogelxo. AndroGel]
ovarian hyperstimulation syndrome
adverse effect of follitropins
-dull ache in penis -urethral burning -minor bleeding or spotting -testicular pain
adverse effects of Alprostadil (Prostaglandin E1)
-bone loss -hot flashes -vaginal dryness -decreased libido -mood changes -headache -teratogenic
adverse effects of Leuprolide [Lupron Depot, Eligard]
-erection lasting longer than 6 hours -painless fibrotic nodules in the corpus cavernosum -orthostatic hypotension -transient parethesias -ecchymosis -difficulty in achieving orgasm or ejaculation
adverse effects of Papaverine Plus Phentolamine
-hypotension -priapism -Nonarteritic Ischemic Optic Neuropathy -sudden hearing loss (dizziness, vertigo, tinnitus) -headache -flushing -dyspepsia -blue color tinge to vision -increased sensitivity to light -intensify symptoms of obstructive sleep apnea
adverse effects of Sildenafil [Viagra]
-nausea -headache -dizziness -orthostatic hypotension -risk for valvular heart damage
adverse effects of cabergoline?
-vomiting -diarrhea -nausea -fever -headache -shivering -chills
adverse effects of dinoprostone?
-breast discomfort -headache -local irritation -nausea -menstrual cramps
adverse effects of transdermal contraceptive patches
-vaginitis -headaches -upper respiratory infection -leukorrhea -sinusitis -weight gain -nausea -thrombosis -embolism -hypertension
adverse effects of vaginal ring?
By contrast, for women age 50 to 59 years, ET appears to protect
against MI and CHD.
Menotropins [Repronex , Menopur]
also known as human menopausal gonadotropin (hMG) consists of equal amounts of LH and FSH activity
High-dose therapy during the first 4 months of pregnancy has been associated with
an increased incidence of birth defects.
Postmenopausal EPT is associated with
an increased risk of dying from non-small cell lung cancer (NSCLC), especially in current smokers.
fetal demise and fetal compromise
anything wrong w baby
Testosterone buccal tablets [Striant]
applied to the gum area just above the incisor tooth, and are designed to stay in place until removed.
no!
are buccal tablets affected by eating or drinking?
Because the risks of HT are greater than previously appreciated, many women are
discontinuing treatment.
no!
do any forms of Intrauterine Devices prevent ovulation?
Conversely, the benefits of short-term therapy (less than 4 to 6 years) to treat menopausal symptoms often
do justify the risks.
Progestin-only OCs
do not cause thromboembolic disorders, headaches, or nausea
yes! (drospirenone and desogestrel show greatest risk)
do progestins also contribute to thromboembolic disorders?
no!
does Methenamine prevent UTIs associated with catheter?
no!
does Sildenafil [Viagra] work in the absence of sexual stimuli?
yes!
does the bacteria that cause community-associated infections and hospital-associated (nosocomial) differ?
fluoroquinolones (ciprofloxacin, norfloxacin)
drug of choice for uncomplicated cystitis where resistance to these drugs exceeds 20%
SERMs
drugs that activate estrogen receptors in some tissues and block them in others. These drugs were developed in an effort to provide the benefits of estrogen while avoiding its drawbacks.
-ketoconazole -itraconazole -erythromycin -cimetidine -saquinavir -ritonavir -grapefruit juice
drugs that suppress metabolism of Sildenafil [Viagra]
GnRH agonists
drugs used to relieve pain of endometriosis
fetal monitoring will be needed w
drugs w cervical ripening to monitor how baby is doing during contractions
Progestin-only OCs
effects result largely from altering cervical secretions and can also modify the endometrium
Natazia
employs a four-phase dosing schedule, in which the amount of estradiol decreases over the monthly cycle and the amount of progestin (dienogest) increases -withdrawal bleeding is shorter -intensity of bleeding is lighter
Estrogens increase the risk of
endometrial hyperplasia and endometrial cancer, but only when used alone. When estrogens are combined with a progestin, the risk of endometrial cancer is reduced to the background level.
trimethoprim/sulfamethoxazole and nitrofurantoin
first drug of choice for uncomplicated cystitis
Sildenafil [Viagra]
first oral treatment for ED
Nitrofurantoin
first-choice drug for uncomplicated cystitis
urofollitropin [Bravelle] follitropin alfa [Gonal-f, Gonal-f RFF] follitropin beta [Follistim AQ, Puregon ]
follitropin names
Choriogonadotropin alfa [Ovidrel]
form of hCG produced by recombinant DNA technology
-foam -gel -jelly -suppository -vaginal film -contraceptive sponge.
forms of spermicide
GnRH antagonists
ganirelix (generic only) and cetrorelix [Cetrotide]
Drugs for Induction of Labor
•Oxytocin (Pitocin) - DOC •Also used in milk ejection reflex and to stop postpartum bleeding and uterine stimulation (contraction) •Contraindications* •Caution with ≥ 5 deliveries (high risk uterine rupture) •AE: water intoxication (acts like ADH) •Nursing care: •Monitor BP, pulse, uterine contractility •Fetal HR & rhythm •Stop if contractions too hard, too long, too quick, significant change in fetal heart rate/rhythm
Drugs to Suppress Preterm Labor (Tocolytics)
•Therapeutic Use: All promote uterine relaxation and delay delivery •Terbutaline - Beta2 Adrenergic Agonist •Nifedipine - Ca2+ channel blocker •Indomethacin (Indocin)- Cyclooxygenase Inhibitor •Magnesium Sulfate
Drugs for Menorrhagia
•Tranexamic acid (Lysteda): Dec bleeding by 50% Caution with h/o thrombosis Contraindicated - current use of OCPs •NSAIDS: - pain and bleeding reduction (20-46%) ibuprofen •Combo OCPs: •Levonorgestrel-Releasing Intrauterine System (Mirena IUD)
Contraindications to Induction
•Umbilical cord prolapse- cord is infront of baby can disrupt oxygen and nutrients and choking can happen •Transverse fetal position •Active genital herpes infection •Previous C-section/uterine sx- can rupture if have a vaginal birth •Hx myomectomy (sx removal of fibroids) •Placenta previa (placenta covers cervix)- placenta below where head is bleeing to death
Postpartum Hemorrhage causes
•Uterine Atony (failure to contract) •Lacerations •Maternal coagulopathies •Retention of placental tissue - can happen if it doesn't contract the right way nurse will try to push it down to stimulate contraction
menrrohagia
•heavy menstrual bleeding >7d or >80mL (Can cause iron deficiency anemia)
monitor for mag sulfate
•mag levels, renal fxn bc goes through kidneys , fluid balance, DTRs (loss of DTRs is early sign of toxicity)
Terbutaline
•some Beta 1 spillover (AE: pulmonary edema hypotension, hyperglycemia, tachycardia in mom and baby) Max 48h use (so bp will low hr high)
