Pharm 4

Which FDA Pregnancy Risk Category are Estrogens classified as? A. B B. A C. X D. D

Estrogens are classified in category X as they have no legitimate use in pregnancy.

Glycerin suppository

Osmotic agent that softens and lubricates hardened, impacted feces May also stimulate rectal contraction Evacuation occurs about 30 minutes after suppository insertion Useful for reestablishing normal bowel function after termination of chronic laxative use

emergency contraception

(Ella, Plan B, Copper IUD) Prevents or delays a woman from releasing an egg (ovulation) after unprotected vaginal sex. Types of emergency contraceptives: pills or copper IUD: Plan B One-Step (and generic equivalent) contains progestin Ella:contains the hormone ulipristal acetate Efficacy: 89% effective with perfect use; 75% with typical use Plan B One-Step pills' efficacy decreases significantly if not used within the recommended 72 hours following unprotected sex. Ella can be used for up to 5 days after unprotected sex

constipation management

-Fiber softens feces and increases size, Can be digested by colonic bacteria, whose growth increases fecal mass -Hydration -laxatives: Used to ease or stimulate defecation (Decreases painful elimination, Patients with CV disease, Older patient population). Often misused

Ranitidine [Zantac] (gen characteristics, ADRs)

-Has properties similar to cimetidine BUT more potent -fewer adverse effects -fewer drug interactions than cimetidine -Not affected by antacids Adverse effects are uncommon Does not bind to androgen receptors (no gynecomastia) Less-likely to cross blood-brain barrier than cimetidine

serotonin receptor antagonists (uses/effectiveness)

-Most effective drug for suppression of chemotherapy-induced nausea and vomiting (CINV) -Also effective in N/V associated with: Radiation therapy Anesthesia Viral gastritis Pregnancy

three ways antiulcer drugs work

-eradicate H. pylori (antibiotics) -reduce gastric acidity (antisecretory agents, misoprostol) -enhance mucosal defenses (sucralfate, misoprostol)

Match the following drug to the appropriate drug class. A. Lactulose B. Docusate sodium C. Psyllium D. Senna 1. Bulk-forming laxative 2. Surfactant laxative 3. Stimulant laxative 4. Osmotic laxative

1:C, 2:B, 3:D, 4:A

NSAID induced ulcer treatment and prophylaxis

Treatment: Antisecretory agents Histamine blockers and PPIs (for example, omeprazole) are preferred *misoprostol Discontinue NSAIDs if possible Prophylaxis indicated for individuals with risk factors for ulcer development: Age over 60 years history of ulcers high-dose NSAID therapy

PUD courses of therapy (h. pylori)

Triple therapy: (usually 7-14 days) - for first time having ulcer Clarithromycin Metronidazole/amoxicillin Antisecretory agent (PPI) Quadruple Therapy: (if triple therapy is unsuccessful or second time with PUD) Tetracycline Metronidazole Bismuth subsalicylate Antisecretory agent (PPI)

mylanta

aluminum hydroxide mixed with magnesium hydroxide

Which planned activity would be warned against in a patient prescribed an antihistamine for motion sickness? A. going on a fishing trip B. taking a train cross country 3. driving a car 4. flying a plane

C. driving because the patient's SE includes sedation.

Ondansetron (Zofran) (MOA, ADR, contraindications)

serotonin receptor antagonists MOA: blocks type 3 serotonin receptors (5-HT3 receptors) located in the chemoreceptor trigger zone (CMZ) and on the afferent vagal neurons in the upper GI tract Adverse effects: Common: Headache, diarrhea, dizziness, Concerning: prolongs QT interval increasing the risk of torsades de pointes (Contraindicated in patients with long QT syndrome) Caution in pts with: electrolyte abn, HF, bradydysrhythmias, QT drugs

Constipation may be defined as:

Constipation may be defined as: Hard stools, infrequent stools, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation -Delayed transport through colon causes excessive fluid absorption and hard stool

Ondansetron (Zofran) (caution/contraindications, interactions

Contraindicated in patients with long QT syndrome Use with caution among patients with: Electrolyte abnormalities Heart failure Bradydysrhythmias Those taking other QT drugs (antibiotics - macrolides like azithromycin) Drug-Drug interaction: effect is enhanced with dexamethasone (glucocorticoid)

Diphenoxylate [Lomotil] and Loperamide [Imodium]

Diphenoxylate [Lomotil] Formulated with atropine to discourage abuse High doses can elicit typical morphine-like subjective responses Loperamide [Imodium] Structural analog of meperidine Used to treat diarrhea and to reduce the volume of discharge from ileostomies -metabolized by cyp3a4 so if taken with grapefruit juice/cemenidine levels of drug increases to point of euphoric effect of high *Bismuth subsalicylate - black tongue (peptobismol)

Promethazine [Phenergan] (MOA, SE)

Dopamine antagonists (Phenothiazines) MOA: Non-selective blockade of dopamine2 receptors; may block acetylcholine, histamine and norepinephrine receptors in CNS Side effects: not used as often as zofran Extrapyramidal reactions - movement disorders that may be irreversible Anticholinergic effects Hypotension Sedation/respiratory depression **contraindicated in children under age 2

primary cause of stomach ulcerations

Helicobacter pylori: colonizes GI tract by converting urea into amonia to protect the bacteria from stomach acid so it isn't destroyed while reproducing -treatment includes antibiotics, bismuth, and acid blockers

Defensive Factors that protect against ulcers

Mucus--protects stomach lining Bicarbonate--neutralizes acid Blood flow--reduces injury Prostaglandins:Stimulates release of mucous and bicarbonate, Promotes blood flow, Suppresses acid secretion

Emergency Contraception Facts

No long term effect on a woman's reproductive health or ability to get pregnant in the future if taken often. Doesn't work as well as taking a regular, ongoing birth control method.

Paragard (what, moa, SE)

Nonhormonal IUD: Small, T-shaped device wrapped in copper. Last 10-12 years MOA: Prevents conception by producing a local inflammatory response (spermicidal) Inhibits implantation, should fertilization occur (EC) Potential Side Effects: Mild to moderate cramping when the IUD is inserted Cramping or backache (usually relieved with Ibuprofen) Spotting between periods in the first 3-6 months Heavier periods and worse menstrual cramps (usually improves after 3-6 months)

Nonspecific Antidiarrheal Agents (MOA, examples)

OPIOIDS: Most effective antidiarrheal agents MOA - Activate opioid receptors in GI tract to: reduce intestinal motility and slow intestinal transit decreases secretion of fluid into small intestine increases absorption of fluid and salt Most commonly used: Diphenoxylate [Lomotil] loperamide [Imodium]

A nurse administers which medication to inhibit an enzyme that makes gastric acid in a patient who has a duodenal ulcer? A. Omeprazole [Prilosec] B. Misoprostol [Cytotec] C. Famotidine [Pepcid] D. Ranitidine [Zantac]

Omeprazole causes irreversible inhibition of the proton pump, the enzyme that generates gastric acid. It is a powerful suppressant of acid secretion. Famotidine and ranitidine block histamine2 receptors on parietal cells. Misoprostol protects against ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) by stimulating the secretion of mucus and bicarbonate to maintain submucosal blood flow.

Omeprazole [Prilosec] (drug interactionsuses)

Proton Pump Inhibitor (More effective than the H2RAs) Drug interactions: -Reduces absorption of some anti-retrovirals and antifungals by elevating gastric pH levels -Clopidogrels effectiveness may be reduced Short term treatment of: Gastric/duodenal ulcers GERD Ulcer prophylaxis is indicated only for patients in intensive care units

The Shot (Depo-Provera) (prototype, hormone, moa)

Prototype: depot medroxyprogesterone acetate [DPMA] What is it: An injection in the arm once every 3 months (IM or sub Q) Hormone: Progestin-only MOA: maintains level of circulating progestins to suppress LH surge and ovulation

Laxative Effect vs. Catharsis

Laxative effect Production of soft, formed stool over 1 or more days Relatively mild Catharsis Prompt, fluid evacuation of the bowel Fast and intense

receptors involved in emetic response

Serotonin Glucocorticoids Substance P Neurokinin Dopamine Acetylcholine Histamine

Contraindications to Laxative Use

-Abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis -Acute surgical abdomen -Fecal impaction or bowel obstruction -History of habitual use or eating disorders -Use with caution in pregnancy and lactation (its possible to induce labor)

Classification of Laxatives by Mechanism of Action

-Bulk-forming laxatives (Psyllium [Metamucil]) -Surfactant laxatives (Docusate sodium [Colace]) -Stimulant laxatives (Bisacodyl [Dulcolax]) - commonly abused -Osmotic laxatives (Polyethylene glycol [Miralax])

Scopolamine (MOA, SE)

-Muscarinic Antagonists: drug for motion sickness MOA: block receptors for acetylcholine and/or histamine on path from inner ear to vomiting center Side effects: Sedation (H1 receptor blocking) Anticholinergic effects: Dry mouth, blurred vision, urinary retention, constipation

Nonpharm therapy for peptic ulcer disease

-Traditional "ulcer diet" does not accelerate healing -No convincing evidence indicates that caffeinated beverages promote ulcers or delay healing -Change in eating pattern to five or six small meals a day reduces pH fluctuations -Avoid smoking, aspirin, other NSAIDs, and alcohol Stress reduction

Emesis indirect stimulation

1. Signal from stomach/small intestine via vagal afferents OR Direct action of emetogenic drugs via blood 2. Chemoreceptor Trigger Zone (CMZ) 3. Activation of vomiting center 4. Activation of stomach, diaphragm, abdominal muscles = vomit

Match the following drug with the appropriate mechanism of action. 1. Bulk forming laxatives 2. Surfactant laxatives 3. Osmotic laxatives 4. Mineral oil 5. Lubiprostone A. Retains water through osmotic action and thereby softens the feces. B. Lubricates and reduces water absorption. C. Absorb water, thereby softening and enlarging the fecal mass; fecal swelling promotes peristalsis. D. Softens stool by facilitating penetration of water; also cause secretion of water and electrolytes into the intestine. E. Opens chloride channels in the intestinal epithelium and thereby increases intentional motility and secretion of fluid into the lumen.

1:C, 2:D, 3:A, 4:B, 5:E

Match the following drug with the appropriate drug class. A. Aluminum hydroxide B. Sucralfate [Carafate] C. omeprazole [Prilosec] D. Famotidine [Pepcid] E. Bismuth [Pepto-Bismol] F. Misoprostol [Cytotec] Matching Items 1. Antibacterial drug 2. H2 receptor antagonist 3. Proton pump inhibitors 4. Mucosal protectant 5. Anti-secretory agent to enhance mucosal defenses 6. Antacids

1:E, 2:D, 3:C, 4:B, 5:F, 6:A

Match the following drug with its corresponding drug class. A. Aprepitant [Emend] B. Lorazepam [Ativan] C. Haloperidol [Haldol] D. Dexamethasone E. Chlorpromazine F. Meclizine [Antivert] G. Dronabinol [Marinol] H. Ondansetron [Zofran] 1.Serotonin antagonists 2. Glucocorticoids 3. Substance P/Neurokinin1 Antagonists 4. Benzodiazepine 5. Phenothiazines 6. Butyrophenones 7. Cannabinoids 8. Anticholinergic

1:H, 2:D, 3:A, 4:B, 5:E, 6:C, 7:G, 8:F

Which of the following are considered defensive factors that serve to protect the stomach and duodenum from self-digestion? [SELECT ALL THAT APPLY] A. Blood flow B. H. pylori C. Prostaglandins D. NSAIDs E. Bicarbonate F. Mucus

A, C, E, F

List the following ovarian events during the menstrual cycle in order from first to occur last to occur. A. Ovarian follicle ripens B. corpus luteum atrophies C. corpus luteum develops D. Follicle ruptures, causing ovulation

ADCB

Cimetidine [Tagamet] (ADR, interactions)

Adverse effects 1. Minor effects-headache, n/v, diarrhea 2. Anti-androgenic effects: Reversible gynecomastia, decreased libido, impotence 3. CNS effects-primarily in older population 4. Pneumonia Drug interactions -Inhibitor of P450 metabolism of: warfarin, phenytoin, theophylline, lidocaine -Antacids can reduce absorption of cimetidine (Dose 1 at least one hour apart)

risk factors for gastric ulcers

Aggressive risk factors -H. Pylori -NSAIDs daily: Inhibit the biosynthesis of prostaglandins, Reduce blood flow, mucus, and bicarbonate -Gastric acid (overproduction): Zollinger-Ellison syndrome -Pepsin: Proteolytic enzyme can cause cell injury -Smoking: Delays ulcer healing and increases risk for recurrence

Pharm therapy goal for PUD (Goals of drug therapy)

Alleviate symptoms Promote healing Prevent complications Prevent recurrence Drugs create conditions conducive to healing

antacid families

Aluminum compounds - common Magnesium compounds - common Calcium compounds Sodium compounds

A nurse is planning care for a patient who has peptic ulcer disease and is taking amoxicillin [Amoxil]. The nurse is aware that the action of this medication is which of the following? A. Coating of the ulcer crater as a barrier to acid B. Selective blockade of parietal cell histamine2 receptors C. Inhibition of an enzyme to block acid secretion D. Disruption of the bacterial cell wall, causing lysis and death

Amoxicillin disrupts the cell wall of H. pylori, which causes lysis and death. Inhibition of an enzyme to block acid secretion is a function of the proton pump inhibitors (PPIs). Coating of the ulcer crater as a barrier to acid is an action of sucralfate [Carafate]. Selective blockade of parietal cell histamine2 receptors is an action of the histamine2 receptor antagonists cimetidine, ranitidine, famotidine, and nizatidine.

A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect? A. Reduced duodenal pH B. Neutralized gastric acid C. Reduced stomach motility D. Increased barrier to pepsin

Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief. Increased barrier to pepsin is an effect of sucralfate [Carafate]. Reduced stomach motility is not an effect of milk of magnesia.

antiulcer drug classes

Antibiotics (eliminates H. pylori) Antisecretory agents Mucosal protectants Antisecretory agents that enhance mucosal defenses Antacids

H. pylori associated ulcers treatments

Antibiotics: Should be given to all patients with gastric/duodenal ulcers with documented H. pylori infection Guidelines: give at least 2-3 antibiotics to reduce risk of resistance Antibiotics commonly given: clarithromycin, amoxicillin, tetracycline, metronidazole, bismuth Antisecretory agents MAT, CAT, BAT

Proton Pump Inhibitor (gen, examples)

Antisecretory Agent Gen: Most effective drugs for suppressing secretion of gastric acid -Selection of PPI is based on cost and prescriber's preference due to similarities between PPIs -Well tolerated BUT can increase the risk of serious adverse events Examples: Omeprazole [Prilosec] Esomeprazole [Nexium] Lansoprazole [Prevacid] Dexlansoprazole [Dexilant] Rabeprazole (Aciphex) Pantoprazole [Protonix]

Histamine2-Receptor Antagonists (H2RA) - gen characteristics, MOA, types

Antisecretory agents Gen characteristics: First-choice drug, All promote healing by suppressing secretion of gastric acid, All four are equally effective, Serious ADRs are uncommon MOA: Selective blockade of histamine 2 (H2)receptors of the parietal cells in the stomach to suppress the secretion of gastric acid 4 types: Cimetidine [Tagamet] Ranitidine [Zantac] Famotidine [Pepcid] Nizatidine [Axid]

which contraceptive method would you rec for a lactating mother A. combined OCs B. progestin only OC C. nuvaring D. withdrawal method

B. shouldn't give mom a drug with estrogen

Depo-Provera Potential Side Effects:

Break through bleeding Amenorrhea Prolonged used can lead to bone-density loss Black-box warning Return to fertility can be delayed Weight gain Mood changes/aggressiveness Headache *shouldn't be on it for more than 2 years at a time, take calcium to replenish bone loss

common SE of hormone contraceptions

Break-through bleeding Amenorrhea (esp progestin only) Hormone effects: n/v, breast tenderness, bloating, fatigue, headache Withdrawal bleed For some women: increased risk of VTE, pulmonary embolism, gallstones, stroke, MI (combination pills)

Which laxatives have which MOA?

Bulk forming (Metamucil): Swell with water to form a gel that softens and increases fecal mass to stimulate peristalsis Surfactant (Colace): lower surface tension which facilitates penetration of water into feces Stimulant (Dulcolax): stimulates intestinal motility and increases water/electrolytes in intestines and prevents resorption of water Osmotic (MIralax): non-absorbable compound that draws and retains water in the intestinal lumen

Methylcellulose [Metamucil] (MOA, ADR)

Bulk forming laxative: plant based materials that are nondigestable MOA: Swell with water to form a gel that softens and increases fecal mass to stimulate peristalsis Often used daily to prophylactically to reduce occurrence of constipation

An 80-year-old patient with a history of renal insufficiency recently was started on cimetidine. Which assessment finding indicates that the patient may be experiencing an adverse effect of the medication? A. 3+ pitting edema to bilateral lower extremities B. Painful urination C. New onset altered mental status D. Tachypnea

C Effects on the central nervous system are most likely to occur in elderly patients who have renal or hepatic impairment. Patients may experience confusion, hallucinations, lethargy, restlessness, and seizures.

Laxative Abuse causes and consequences

Causes: Misconception that bowel movements must occur daily Can perpetuate their own use Bowel replenishment after evacuation can take 2 to 5 days; often mistaken for constipation Consequences: Diminished defecatory reflexes, leading to further reliance on laxatives Electrolyte imbalance, dehydration, colitis

Diarrhea characterization, causes, complications

Characterized by stools of excessive volume and fluidity and increased frequency of defecation. unformed watery stool more than 3 times a day. Adults: > 2 days, contact provider Children: > 24 hours, contact provider Causes: Infection, maldigestion, inflammation, functional disorders of the bowel Complications: Dehydration and electrolyte depletion

Types of Contraception

Combined Hormonal Methods: Oral contraception Ring Transdermal Patch Progestin-only methods: Mini-pill Injectable Implant LARCs IUD Non-hormonal Barriers Spermicide IUD Sterilization

Combination OCs: Adverse Effects and caution

Common: nausea, breast tenderness, edema Thromboembolic disorders (smoking, hx of) Hypertension Breast cancer- promotes growth; does not cause Break through bleeding Use in lactation-suppression of milk production Caution: Cardiovascular disorders Not recommended for women >35 years old and smokers (use other methods) MI risk Educate patients about signs of potential DVT or pulmonary embolism

estrogen physiologic effects

Ductal growth in the breast Thickening of vaginal epithelium Proliferation of the uterine epithelium secretion of mucus from endocervical glands Positive effect on bone mass Favorable effects on cholesterol levels Blood coagulation

progesterone physiologic effects

During the menstrual cycle: Maintains uterine lining for implantation Thickens cervical mucus Affects mood, body temperature, respiration Increases during pregnancy resulting in: Suppression of uterine contractions Suppression of GI motility

Management of Infectious Diarrhea

General considerations Variety of bacteria and protozoa can be responsible Infections are usually self-limited Many cases require no treatment Antibiotics should be used only when clearly indicated: Salmonella, Shigella, Campylobacter, or Clostridium infections Traveler's diarrhea

Classification of Laxatives by Therapeutic Effect

Group I: Act rapidly (within 2 to 6 hours) and give stool a watery consistency; useful for preparing bowel for diagnostic procedures or surgery Group II: Intermediate latency (6 to 12 hours); produce a semifluid stool Group III: act slowly (1 to 3 days) to produce a soft, formed stool; uses include treating chronic constipation and preventing straining at stool

emergency contraception (how to use and SE)

How to Use (Education): Take EC orally within 3-5 days after unprotected sex. Depending on the brand, a woman takes one or two pills 1-pill dose: should be taken as soon as possible 2-pill dose: 1st pill should be taken as soon as possible & second one 12 hours later *NOT an abortive. can't affect existing pregnancy Potential Side Effects: An earlier or later, heavier, or lighter period than usual. Breast tenderness Dizziness or headaches Nausea or vomiting.

Mirena (Others: Skyla, Liletta) (what, hormone, MOA, use, SE)

IUD: Small, T-shaped device that is placed in the uterus Hormones: Only progestin. MOA: Acts as a barrier for implantation, thickens cervical mucus Use: Long-term reversible birth control Potential Side Effects: Mild to moderate cramping when the IUD is inserted Cramping or backache (usually relieved with Ibuprofen) Irregular periods and spotting between periods in the first 3-6 months Amenorrhea Return to fertility may be delayed Increased risk for STIs

Combination OCs: Drug Interactions

Inducers of P450 reduce effectiveness of OCs: Rifampin Ritonavir Antiepileptic drugs St. John's wort Indications of reduced OC plasma levels: Spotting/break through bleeding Drugs decreased by OCs Warfarin Insulin Oral hypoglycemic Drug effects are increased in: theophylline, tricyclic antidepressants, diazepam

Antacids (MOA, ADR)

MOA: React with gastric acid to produce neutral salts or salts of low acidity to reduce destruction of gut wall May also enhance mucosal protection by stimulating production of prostaglandins Antacids do not alter systemic pH (Exception: sodium bicarbonate) Adverse effects -Constipation: Aluminum hydroxide -Diarrhea: Magnesium hydroxide -Sodium loading (Use with caution in patients with renal impairment), High sodium content contraindicated in patients with HF and HTN

Cimetidine [Tagamet] (MOA, kinetics)

MOA: Selective blockade of H2 receptors in the parietal cells, decreasing secretion of gastric acid Pharmacokinetics -Absorption is slowed if taken with meals -Crosses the blood-brain barrier with difficulty, May cause some CNS side effects (Lethargy, confusion, restlessness, hallucinations) -Renal elimination

Misoprostol (Cytotec) (moa, uses, adrs)

MOA: a prostaglandin analogue that replenishes the decreasing levels of prostaglandins associated with taking NSAIDs. Therapeutic uses -FDA approval for prevention of gastric ulcers caused by long-term NSAID therapy Adverse effects Most common: diarrhea and abdominal pain Contraindicated during pregnancy (Category X) - labor induction

Omeprazole [Prilosec] (MOA, kinetics, ADR)

MOA: irreversible inhibition of H+,K+-ATP-ase pump that generates gastric acid Pharmacokinetics: Omeprazole is a prodrug-undergoes conversion in the parietal cells -Enteric coating ensures delivery to site of absorption -Short half-life (1 hour) but long lasting effect *Used for short-term therapy ADR: -Minor with short-term use: Headache, n/v, diarrhea -Rebound acid hypersecretion (if discontinued abruptly) -C. difficile infection -Fractures with long-term use -Pneumonia: Community or hospital acquired

Sucralfate [Carafate] (MOA, ADRs)

MOA: promotes ulcer healing by creating a protective barrier and reducing ulcer exposure to acid and pepsin **Occurs only if pH is below 4 No antacid properties or ability to decrease acid secretion -Adverse effects: Constipation (only 2% of patients) so increase fiber/water intake

diarrhea management

Management Diagnosis and treatment of underlying disease (shigella, etc) Replacement of lost water and salts Relief of cramping Reducing passage of unformed stools Major groups of antidiarrheals: Specific: treat underlying cause Nonspecificl: symptom relief

Progestin-Only Methods and gen characteristics

Mini-pill Injectable Implant IUD Reduced risk of thrombolytic disorders Safe option for women who are at risk with estrogen Break through bleeding is common

Polyethylene Glycol [Miralax] (MOA, how long until effects seen)

Osmotic lax MOA: non-absorbable compound that draws and retains water in the intestinal lumen Therapeutic effect: fecal mass softens and swells and peristalsis is stimulated Bowel movement in 2-4 days, Must be taken with at least 8 oz of fluid

Sucralfate [Carafate] (kinetic, ADR, interactions)

Pharmacokinetic properties: Oral admin only—minimal systemic absorption Adverse effects: Constipation (only 2% of patients) so increase fiber/water intake Drug interactions: Minimal - Antacids may interfere with effects of sucralfate because it'll raise the pH

Combined Oral Contraceptive Pills (OCPs) effects (progestin vs estrogen)

Progestin (nortestosterone, norgestrel, norethindrone, desogestrel, drospirenone) Suppresses release of LH & ovulation Thickens cervical mucus Creates atrophic uterine environment Estrogen (ethinyl estradiol) Suppresses secretion of FSH Supports endometrial lining to decrease break through bleeding (BTB)

Norethindrone [Micronor, Camila, Lyza] (MOA, use, edu)

Progestin-only Pill MOA: primarily thickens cervical mucus 40% of women still ovulate on this method Primary use: Breastfeeding women: Supports prolactin suppression of ovulation, Doesn't decrease milk production High-risk women who can't use estrogen EDUCATION: must be taken at the same time every day

Magnesium hydroxide (Milk of Magnesia) - gen, adr, avoid

Rapid acting, high acid-neutralizing capacity Long-lasting effects Adverse effect: diarrhea Usually taken in combination with aluminum hydroxide Avoid: patients with undiagnosed abdominal pain Use with caution in patients with renal failure

the emetic response

Reflex action that is activated by the vomiting center in the medulla oblongata Activated by two types of stimuli: -Direct-acting stimuli: Cerebral cortex (fear/anticipation), Sensory organs (upsetting sights, bad odors, pain), Vestibular apparatus (inner ear) -Indirect stimuli: infection, drugs

aluminum hydroxide (gen, ADR, interaction)

Relatively low ability to neutralize acid slow acting; effects have long duration Often used in combination with magnesium hydroxide Caution: contains large amounts of sodium Adverse effect: Constipation Drug interactions: Tetracyclines, warfarin, digoxin

A patient going on a vacation cruise is prescribed a scopolamine transdermal patch for motion sickness. The nurse teaches the patient to recognize which side effect? A. Urinary frequency B. Irritability C. Dry mouth D. Tachycardia

Scopolamine blocks the binding of acetylcholine with cholinergic receptors in the inner ear, an imbalance that is a common cause of motion sickness. The most common side effects are dry mouth, blurred vision, and drowsiness. Urinary retention occurs less frequently. An increased heart rate and irritability are not associated effects

Vaginal Ring (NuvaRing) (hormones, use, SE)

Small, flexible ring that is placed in the vagina. Contains: Estrogen and Progestin. Use: Place and leave inside the vagina for 3 weeks Taken out at the beginning of the 4th week New ring inserted monthly Hormones are released into the vagina and absorbed by the body Potential Side Effects: Bleeding or spotting between periods Breast tenderness Nausea and Vomiting Increase in vaginal discharge (some women)

Aprepitant [Emend] (MOA, uses, ADRs)

Substance P/Neurokinin1 Antagonists MOA: blockade of neurokinin1-type receptors in the CTZ 2 Important Uses:Prevention of acute/delayed chemo-induced n/v, Post-op n/v Common ADRs: fatigue, dizziness, asthenia (physical weakness) Drug is a inhibitor and inducer of CYP3A4; inducer of CYP2D6 *LOTS OF DRUG-DRUG INTERACTIONS

Docusate Sodium [Colace] (MOA, patient teaching)

Surfactant Laxatives MOA: lower surface tension which facilitates penetration of water into feces Produce a soft stool several days after onset of treatment Should be administered with an 8 oz glass of water

Transdermal Patch (what is it, hormones, use, SE)

What is it: A thin, beige square plastic patch. Contains: Estrogen and Progestin Use: Apply a new patch to: buttocks, upper outer arm, or back, rotating location each week for 3 weeks 4th week: no patch Potential Side Effects: Bleeding or spotting between periods Breast tenderness Nausea and Vomiting Itching or irritation at patch site Efficacy decreases with increasing weight Women > 198 pounds not recommended

etonogestrel [Nexplanon] (what, hormones, use, SE)

What is it: Implant, A thin flexible device containing progestins that is inserted in your arm Hormones: progestin Use: Long term reversible birth control, Lasts up to 4 years, but can be removed at any time. Potential Side Effects: Irregular bleeding is common, especially in the first (6-12 months) Amenorrhea For some women (longer heavier periods/ increased spotting and light bleeding between periods) Scarring or discoloration at implant site

Long-Acting Reversible Contraceptives (LARCs)

expensive and require invasive procedures: implant (implanon) and IUC options (mirena and paragard)

H2 receptor antagonists are most effective inhibitors of acid secretion. True False

false: PPI

bisacodyl [Dulcolax] / senna [Ex-Lax] (MOA, uses, effects)

stimulant laxative - Widely used and abused Effects on bowel: Stimulate intestinal motility Increases water/electrolytes in intestine and prevents reabsorption of water Group II agents: produce effect in 6-12 hours

All patients with gastric or duodenal ulcers and confirmed infection with H. pylori should be treated with antibiotics in combination with an anti secretory agent. True False

true

For management of CINV, antiemetics are more effective when given before chemotherapy than when given after chemotherapy. True False

true

For patients receiving highly emetogenic chemotherapy, the preferred antiemetic regimen consists of three drugs: aprepitant, a glucocorticoid, and a serotonin antagonist. True False

true

The goal of peptic ulcer disease therapy is to alleviate symptoms, promote healing, prevent complications, and prevent recurrence. True False

true

Misoprostol is contraindicated for use during pregnancy as it is classified in FDA Pregnancy Risk Category X. True False

true - could cause preterm contrations