PHARM EXAM 4

A client calls the women's health clinic and tells the nurse that she went to the dentist for an abscessed tooth. The dentist put her on an antibiotic, and the client wants to know if it will cause problems with her prescribed oral contraceptives. What is the nurse's best response?

"Use alternate means of birth control until you are finished with the antibiotic." Antibiotics lessen the effectiveness of oral contraceptives, so the client should use alternative methods of birth control until the antibiotics are completed and the client begins a new cycle of oral contraceptives.

A client experiences weight gain secondary to systemic steroid therapy for temporal arteritis and expresses a desire to discontinue the medication. Which response is most appropriate?

"Your prescription must be tapered gradually with the provider's order." Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include gradually tapering the dose of any systemic corticosteroid.

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays which of the following signs?

-dizziness or light-headedness, sweating, nervousness Symptoms of hypoglycemia include shakiness, dizziness or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger. The other signs are more consistent with hyperglycemia

The pediatric nurse understands that growth hormone (GH) deficiency can cause which of the following disorders?

-dwarfism GH deficiency can cause dwarfism in children and SDS in adults

Levothyroxine

-used for hypothyroidism -synthetic version of thyroxine -can be pushed into hyperthyroidism -DOESN'T GET ALONG WITH OTHER MEDS -TAKE IT ALONE IN THE MORNING ON AN EMPTY STOMACH (can affect stomach) -START AT LOWEST DOSE TO AVOID TOXIC LEVELS -CATEGORY A DRUG (given during pregnancy safetly)

A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications?

-"Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots." The FDA has issued a black box warning that estrogens increase the risk for developing cancer of the uterus. The warning instructs people who take estrogens with or without progestins of the increased risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot.

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?

-"I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections." Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs

A female client with a six-month-old infant has been prescribed propylthiouracil (PTU). What is the most important question the nurse should ask this client?

-"Are you breastfeeding your baby?" Mothers taking PTU should not breastfeed their children (pregnancy category D). For the safety of the infant, the nurse should ask the client if she's breastfeeding. Taking thyroid medications in the past does not have an immediate impact on safety for the client or infant. Using PTU during pregnancy can cause hypothyroidism in the fetus. The time frame in which the client has had thyroid-related symptoms does not have an immediate effect on safety of the client or infant.

A client is taking phenazopyridine and ciprofloxacin for a urinary tract infection. What is the most important instr

-"If you notice yellowing of your eyes or skin contact your health care provider immediately." Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatotoxicity. Phenazopyridine should not be used more than 2 days, especially if taken, as here, with an antibacterial agent (ciprofloxacin). The other suggested options are important and should be included in the instructions given the client. However, the possibility of toxicity is the most important.

A pregnant client asks about the safety of taking thyroid hormone replacement drugs during her pregnancy. What is the nurse's best response?

-"Thyroid hormones are pregnancy category A drugs and may be taken safely during pregnancy." Thyroid hormones are classified as pregnancy category A and should be continued by hypothyroid women during pregnancy. Thyroid hormones are not used as treatment for obesity or infertility. Thyroid hormones are used cautiously for clients with heart disease but are safe during pregnancy.

The nurse is aware that oral contraceptives are effective but associated with potential health risks that must be carefully considered. Which of the following clients has the highest risk of experiencing the adverse effects of oral contraceptive use?

-A 38-year-old diabetic woman who smokes one-and-a-half packs of cigarettes daily. The risk of cardiovascular and cerebrovascular effects of oral contraceptives is substantially increased in women age 35 years or older with other risk factors (e.g., smoking, uncontrolled hypertension, hypercholesterolemia, elevated low-density lipoprotein [LDL] cholesterol, obesity, and diabetes). Consequently, the combination of being 38 years old, diabetic, and a cigarette smoker would create a significant risk. Previous pregnancies and abortions are not noted to increase the risk of adverse effects associated with oral contraceptives.

CAUSES of adrenal insufficiency

-A patient does not produce enough adrenocorticotrophic hormone (ACTH); Adrenal glands are not able to respond to ACTH -Adrenal gland is damaged -Secondary to surgical removal of the gland -Prolonged use of corticosteroid hormones -Primary adrenal insufficiency results from destruction of the adrenal cortex ----The patient will need hormonal replacement for life ----Prednisone, hydrocortisone, and prednisolone are examples of steroids used for prolonged therapy mainly to treat diseases such as adrenocortical insufficiency

Nursing Considerations /Client Education for those receiving Glucocorticoids

-Administer drug daily at 8 to 9 am to mimic normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. -Space multiple doses evenly throughout the day to try to achieve homeostasis. -Use the minimal dose for the minimal amount of time to minimize adverse effects. -Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids. -Arrange for increased dose when the patient is under stress to supply the increased demand for corticosteroids associated with the stress reaction. -Use alternate-day maintenance therapy with short-acting drugs whenever possible to decrease the risk of adrenal suppression. -Do not give live virus vaccines when the patient is immunosuppressed because there is an increased risk of infection. -Protect the patient from unnecessary exposure to infection and invasive procedures because the steroids suppress the immune system and the patient is at increased risk for infection. -Assess the patient carefully for any potential drug-drug interactions to avoid adverse effects. -Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of problems, and the need for regular evaluation, including blood tests, to enhance patient knowledge of drug therapy and promote compliance. Explain the need to protect the patient from exposure to infections to prevent serious adverse effects -Assess for acute infections, peptic ulcer disease, pregnancy, lactation, endocrine disturbances, and renal dysfunction weight; temperature -Asses VS, peripheral perfusion; glucose tolerance, renal function, serum electrolytes, and endocrine function tests as appropriate -Dosing: Alternate-day administration (medication given every other day instead of daily) of long-term, systemic glucocorticoids has been used to lessen the suppression of the hypothalamus, the anterior pituitary, and the rate of bone loss. ----Abrupt changes in dosing can cause adrenal insufficiency and cardiovascular collapse; therefore, if a client plans to discontinue the medication, he/she needs to taper the dose gradually -An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite -The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis -Glucocorticoids increase glucose production (clients have risk for hyperglycemia) and stimulate fat deposition -Skin changes related to the use of glucocorticoids include oily skin often with acne.

A nurse is caring for a male client who has been seen for numerous broken ribs over the past year. He is diagnosed with osteoporosis. Which of the following bisphosphonate meds is appropriate for treating osteoporosis in men?

-Alendronate (Fosamax) Alendronate is the only bisphosphonate that has been approved for the treatment of osteoporosis in men.

Androgens and Their Indications

-Androgens are male sex hormones and include testosterone produced in the testes, and the androgens which are produced in the posterior pituitary gland -Testosterone (Duratest, Testoderm, others) ----Hypogonadism; breast cancer -Danazol (generic) ----Block the release of FSH and LH in women -Fluoxymesterone (Androxy) ----Hypogonadism; breast cancer -Methyltestosterone (Testred) ----Breast cancers

A client is diagnosed with diabetes insipidus. The health care provider orders desmopressin, which the nurse knows is the synthetic equivalent of which of the following hormones?

-Anti-diuretic hormone (ADH) Desmopressin (DDAVP, Stimate) and vasopressin (Pitressin) are synthetic equivalents of ADH. A major clinical use is the treatment of neurogenic diabetes insipidus, a disorder characterized by a deficiency of ADH and the excretion of large amounts of dilute urine.

A client presents with excessive and frequent urination and excessive thirst? Which of the following hormone deficiencies would lead to these symptoms?

-Anti-diuretic hormone (ADH) deficiency Antidiuretic hormone (ADH), also called vasopressin, functions to regulate water balance. When ADH is secreted, it makes renal tubules more permeable to water. This allows water in renal tubules to be reabsorbed into the plasma and so conserves body water. In the absence of ADH, little water is reabsorbed, and large amounts are lost in the urine.

Treatment for UTIs

-Antibiotics -Drugs that: ---Block spasms of the urinary tract muscles ---Decrease urinary tract pain ---Protect the cells of the bladder from irritation ---Treat enlargement of the prostate gland in men -Non-pharmacological treatment ---Cranberry juice helps to acidify the urine and create a hostile environment for bacteria.

Mineralocorticoids

-Mineralocorticoids affect electrolyte levels and homeostasis. These steroid hormones directly affect the levels of electrolytes in the system -Classic mineralocorticoid is aldosterone; Aldosterone holds sodium—and with it water—in the body and causes the excretion of potassium by acting on the renal tubule. Aldosterone is no longer available for pharmacological use. -Mineralocorticoids that are available include cortisone, fludrocortisone (generic), and hydrocortisone (Cortef).Cortisone; Fludrocortisone (generic); Hydrocortisone (Cortef)

A nurse is assigned to administer glargine to a patient at a health care facility. Which of the following considerations is most appropriate when administering glargine?

-Avoid mixing glargine with other insulin When administering glargine to the patient, the nurse should avoid mixing it with other insulin or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via SC once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end-to-end immediately before withdrawing the insulin. Glargine is a long-acting insulin, and therefore is administered about one time per day and not with meals.

Urinary tract Infection

-BACTERIAL INFECTION -FAIRLY TREATABLE BUT CAN ASLO GET KIDNEY DAMAMGE -ANTIBIOTIC

Benign Prostatic Hypertrophy

-BPH -OLDER MEN HAVE THIS -PROSTATE GLAND CAN GROW WHICH CAN CAUSE HARD URINATING -FLOW OF URINE OF ADRENERGIC BLOCKER -BLOCKS TESTOSTERONE PRODUCTION (EFFECTS SEX DRIVE) -CAN TAKE BOTH TOGETHER IF WANTED OR NEEDED

Glucocorticoids

-Beclomethasone (Beconase AQ) -Betamethasone (Celestone Soluspan and others) -Budesonide (Rhinocort, Entocort EC) -Cortisone (generic) -Dexamethasone (generic) -Flunisolide (generic) -Hydrocortisone (Cortef and others) -Methylprednisolone (Medrol) -Prednisolone (Omnipred, Pred Forte, and others) -Prednisone (Rayos)- for oral use only! -Triamcinolone (Kenalog and others)

Urinary Tract Antispasmodics

-Block the spasms of urinary tract muscles caused by various conditions -Flavoxate (generic) -Oxybutynin (Ditropan XL) -Tolterodine (Detrol) -Fesoterodine (Toviaz) -Darifenacin (Enablex) -Solifenacin (VESIcare) -Trospium (Sanctura) -Mirabegron (Myrbetriq)

GROWTH HORMONE ANTAGONISTS

-Bromocriptine (Parlodel): dopamine agonist -Octreotide acetate (Sandostatin): somatostatin analogue -Lanreotide (Somatuline Depot): somatostatin analogue -Pegvisomant (Somavert): GH analogue

Nursing Considerations/Client Education for URINARY TRACT INFECTIONS (UTIs)

-Caffeine in coffee can irritate the bladder and increase the urge to urinate -Orange juice in large amounts may irritate the bladder, and if it is a sweetened drink, may feed the bacteria -Alcohol in wine is a bladder irritant and should be avoided during a urinary tract infection -Nurse should instruct the patient to increase the fluid intake to at least 2000 ml/d to help remove bacteria from the genitourinary tract when caring for a patient with a genitourinary tract bacterial infection. -Cystitis is very difficult to treat in young girls and can become a chronic problem. To decrease the number of bacteria introduced into the bladder, PATIENT EDUCATION should cover the following hygiene measures: -Always wipe from front to back and never from back to front to avoid the introduction of intestinal bacteria into the urethra -Avoid baths, particularly bubble baths, which facilitate the entry of bacteria into the urethra on the bubbles -Wear dry cotton underwear to discourage bacterial growth -PATIENT EDUCATION also should stress the importance of avoiding alkaline ash foods and antacids and encouraging foods that acidify the urine.

Nursing Considerations/Client Education for diuretic agents

-Client Education: Daily weights (at the same time and with the same clothes) and blood pressures should be monitored at home in a client taking diuretics -The nurse should administer the drug early in the day to prevent any night-time sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy -When a patient who is taking a diuretic decreases fluid intake, fluid rebound occurs, which leads to water retention and subsequent edema and weight gain,.

Oral Contraceptives

-ESTROGEN AND PROGESTIN -ESTROGEN IS GIVEN IN SYNTHETIC VERSION, SIDE EFFECTS OR RISK FACTORS INCLUDE- BLOOD CLOT (THROMBOLEMBIC DISORDERS- HEART ATTACK, STROKE), -SOMEONE AT RISK COULD INCLUDE- SMOKING, HYPERTENSION, HYPERCHOLESTEROLEMIA, ELEVATED LDL, OBESTITY, DIABETES, DOESN'T EXERCISE -IF YOURE ON AN ANTIBIOTIC WITH ORAL CONTRACEPTIVES, IT CAN AFFECT THE ORAL CONTRACEPTIVE AND BE LESS INEFFECTIVE

Loop Diuretics

-Ethacrynic acid (Edecrin); Bumetanide (Bumex); Torsemide (Demadex) *******FUROSEMIDE (LASIX) ACTIONS: -Block the chloride pump in the ascending loop of Henle -This causes reabsorption of sodium and chloride INDICATIONS: -Acute CHF -Acute pulmonary edema -Edema associated with CHF -Edema associated with renal or liver disease -Hypertension CONTRAINDICATIONS: -Allergy- Or allergy to sulfonamides -Electrolyte depletion -Anuria -Severe renal failure -Hepatic coma -Pregnancy and lactation DRUG-DRUG INTERACTIONS: -Aminoglycosides or cisplatine -Anticoagulation -Indomethacin, ibuprofen, salicylates, or NSAIDs CAUTION: -SLE, gout, and diabetes mellitus -----Nurse should monitor for increased blood glucose levels in the diabetic client receiving a loop diuretic. ADVERSE EFFECTS: -Related to the imbalance in electrolytes and fluid -Hypokalemia ----Serum potassium levels should be monitored in patients taking the drug to help avoid the condition and its effects -Alkalosis -Hypocalcemia CLIENT EDUCATION: -patient needs to eat potassium rich foods -NURSE needs to watch out for increased blood glucose levels

Abortifacients MIFEPRISTONE

-Evacuate uterine contents via intense uterine contractions ----Carboprost (Hemabate) ----Dinoprostone (Cervidil, Prepidil Gel, Prostin E2) ----Mifepristone (RU-486, Mifeprex) ACTIONS: -Stimulate uterine activity -Dislodge any implanted trophoblast and preventing implantation of fertilized egg INDICATIONS: -Termination of pregnancy at 12-20 weeks CAUTION: -Asthma, hypertension, or adrenal disease -Acute vaginitis or scarred uterus -Abortifacients should not be used with active Pelvic Inflammatory Disease (PID or acute) cardiovascular, hepatic, renal, or pulmonary disease. ADVERSE EFFECTS: -Abdominal cramping -Heavy uterine bleeding/Vaginal Bleeding -Perforated uterus or uterine rupture -Headache, nausea, vomiting, diarrhea, diaphoresis, backache, and rash

The nurse is providing education to the parents of a child newly diagnosed with type 1 diabetes. What distinguishing characteristic of the disorder does the nurse include in the teaching?

-Exogenous insulin is required for life. Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. Therefore, the client will require insulin supplementation (exogneous insulin) for life. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed in ages 4 through 20 years, not only in childhood.

anatomy of the adrenal glands

-Flattened bodies which sit on top of each kidney -Adrenal medulla: An inner core; part of the SNS ----Part of the sympathetic nervous system (SNS). ----It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated ----This is thought to be a backup system for the sympathetic system, adding an extra stimulus to the fight-or-flight response. -Adrenal cortex: An outer shell; produces hormones called corticosteroids ----Surrounds the medulla and consists of three layers of cells, each of which synthesizes chemically different types of steroid hormones that exert physiological effects throughout the body ----Produces hormones called corticosteroids. ----1. Androgens- form of the male sex hormone testosterone; both men and women produce these hormones. ----2. Glucocorticoids-Stimulate an increase in glucose levels for energy ----3. Mineralocorticoids - increase sodium reabsorption in renal tubules, leading to sodium and water retention, and increase potassium excretion.

Antidiuretic hormone (ADH)

-Functions to regulate water balance -Secreted by the posterior pituitary gland, is secreted when body fluids must be conserved, exhibits its greatest activity on the renal tubular epithelium, regulates the reabsorption of water from the kidney, and is USED TO TREAT DIABETES INSIPIDUS -ADH is secreted when body fluids become concentrated (high amounts of electrolytes in proportion to the amount of water) and when blood volume is low. -When ADH is secreted, it makes renal tubules more permeable to water. This allows water in renal tubules to be reabsorbed into the plasma and so conserves body water ----Dilution of extracellular fluids, and restoration of normal osmotic pressure. ----Raises blood volume and arterial blood pressure toward homeostatic levels.

drugs affecting hypothalamic hormones FACTORS STIMULATING RELEASE OF HORMONES

-Growth hormone-releasing hormone (GHRH) -Thyrotropin-releasing hormone (TRH) -Gonadotropin-releasing hormone (GnRH) -Corticotropin-releasing hormone (CRH) -Prolactin-releasing hormone (PRH)

Which adverse effects should be addressed in a teaching plan for a client prescribed finasteride? Select all that apply.

-Hypotension -Impotence -Ejaculatory disorders Finasteride inhibits the mechanism of testosterone, causing decreased proliferation of prostatic cells of benign prostatic hypertrophy (BPH) and thereby reducing the enlargement of the prostate gland and mechanical obstruction to the urethra. The 5-alpha reductase inhibitors can cause a drop in blood pressure, so hypotension should be included in the plan of care. Adverse effects include impotence, gynecomastia, reduced libido, and ejaculatory disorders. Urinary frequency is caused by BPH. Dysuria is painful urination and is not associated with BPH.

Phenazopyridine

-IS NOT AN ANTIBIOTIC -TREATS PAIN AND SYMPTOMS FROM UTI -CAN CAUSE URINE TO BE REDISH ORANGE

Deficiency in ADH- Diabetes Insipidus

-In the absence of ADH, little water is reabsorbed, and large amounts are lost in the urine. ----Characterized by the production of a large amount of dilute urine -Blood becomes concentrated and blood glucose levels are higher than normal, and the patient presents with polyuria (lots of urine), polydipsia (lots of thirst), and dehydration.

Actions of Adrenocortical Hormones

-Increase blood volume (aldosterone effect) -Cause the release of glucose for energy -Slow rate of protein production (reserves energy) -Block activities of the inflammatory and immune systems (reserves a great deal of energy)

The nurse is discussing the use of estrogen with a woman who smokes cigarettes. The nurse informs the client that clients who take estrogen and continue to smoke are at a greater risk for thromboembolic disorder because of what reasons? (Select all that apply.)

-Increased platelet aggregation -Increase in liver production of blood clotting factors Women who smoke cigarettes have a greater risk of thromboembolic disorders if they take estrogen supplements, possibly because of increased platelet aggregation with estrogen ingestion and cigarette smoking. In addition, estrogen increases hepatic production of blood clotting factors.

Mifepristone (RU-486)-Abortifacient

-LEGAL IN MOST STATES -MEDICATION THAT WILL INDUCE AN ABORTION -CAN CAUSE UTERINE CONTRACTIONS -EXPEL CONTENTS OF UTERUS -ADVERSE EFFECTS INCLUDE- HEAVY VAGINAL BLEEDING, CRAMPING, PAIN

A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate?

-Low bone density and a family history of osteoporosis Bisphosphonate drugs are recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. Low bone density and a family history of osteoporosis would consequently indicate a potential benefit. Impaired growth, cold intolerance, and cognitive deficits are not indications for the use of bisphosphonates.

Testosterone Anabolic Steroids

-MOSTLY ASSOCIATED WITH MALES -RESPONSIBLE FOR PRODUCTION OF PUBERTY IN YOUNG MEN -MUSCULARITY -WHEN WOMEN TAKE TESTOSTERONE, THE WOMEN WOULD GROW MORE HAIR, DEEPENING OF VOICE, ETC (MASCULARIZATION) -CAN CAUSE MASCULARIZATION IN PEOPLE WHO TAKE THEM

Mannitol (Osmitrol)

-MOSTLY USED WITH INCREASED CRANIAL PRESSURE

Drugs Affecting the Male Reproductive System

-Male Steroid Hormones or Androgens ----Act like testosterone ----Development of male sexual characteristics -Male Sex Hormone or Anabolic Steroids ----Synthetic testosterone preparations that have more anabolic effects than androgenic effects ----Tissue building -Drugs to Improve Penile Dysfunction

The nurse is caring for a client with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?

-Mannitol Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.

A female athlete is using high doses of anabolic steroids to enhance her performance. When a female use anabolic steroids at high doses, what result may she have?

-Masculinization Adverse effects in women include masculinization effects, hirsutism. and deepening of voice. The female using anabolic steroids would not expect the result to be joint immobility, obesity, or hypotension

drugs affecting hypothalamic hormones FACTORS INHIBITING RELEASE OF HORMONES

-Somatostatin (growth hormone-inhibiting factor) -Prolactin-inhibiting factor (PIF)

Potassium-Sparing Diuretics SPIRONOLACTONE (ALDACTONE)

-Not as powerful as the loop diuretics, but they retain potassium instead of wasting it. -Amiloride (Midamor) -*****Spironolactone (Aldactone)**** -Triamterene (Dyrenium) ACTIONS: -Cause a loss of sodium while retaining potassium -Block the actions of aldosterone in the distal tubule INDICATIONS: -Adjuncts with thiazide or loop diuretics -Patients who are at risk for hypokalemia CONTRAINDICATIONS: -Allergy -Hyperkalemia- through the inhibition of aldosterone and the subsequent retention of potassium. -Renal disease (because of high risk of hyperkalemia), or anuria Patients taking amiloride or triamterene ADVERSE EFFECTS: -Hyperkalemia *******TEACH CLIENT TO AVOID FOOD WITH HIGH POTASSIUM, SUCH AS BANANAS DRUG-DRUG INTERACTIONS: -Salicylates

Propylthiouracil

-PTU; prevents formation of thyroid hormones; reduces amount of hormones being released by thyroid gland -can push patient from hypERthyroidism to hypOthyroidism -WILL BE TIRED, COLD, GAINING WEIGHT, (if this happens, change dose)

Urinary Tract Analgesia PHENAZOPYRIDINE

-Pain involving the urinary tract can be very uncomfortable and lead to urinary retention and increased risk of infection *******Phenazopyridine (Azo-Standard, Baridium, and others) is a dye that is used to relieve urinary tract pain ---Rapid onset ---Used to reduce pain from UTI, but has no anti-infective properties ---Causes the urine and tears to become reddish orange ---------"normal" finding with this med; no cause for worry!

"Adrenal Crisis"

-Patients who have an adrenal insufficiency may do quite well until they experience a period of extreme stress, such as a motor vehicle accident, a surgical procedure, or a massive infection. -Because they are not able to supplement the energy-consuming effects of the sympathetic reaction, they enter an adrenal crisis, -MEDICAL EMERGENCY -SIGNS: -Physiological exhaustion; Hypotension; Fluid shift; Shock and even death TREATMENT: -Massive infusion of replacement steroids -Constant monitoring and life support procedures

Drugs for treating penile erectile dysfunction

-Penile Erectile dysfunction: condition in which the corpus cavernosum does not fill with blood to allow for penile erection. It can be related to aging or to neurological or vascular conditions -The 5-alpha reductase inhibitors can cause a drop in blood pressure, so hypotension should be included in the plan of care. Adverse effects include impotence, gynecomastia, reduced libido, and ejaculatory disorders. -Alprostadil (Caverject, Muse) -Avanafil (Stendra) -Sildenafil (Viagra, Revatio) ---Action of Viagra (sildenafil) persists for 4 hours. -Should be taken approximately 1 hour before sexual activity -Tadalafil (Cialis, Adcirca) -Vardenafil (Levitra, Staxyn)

Nursing Considerations for Antiinfectives used to treat UTI

-Prior to beginning a urinary anti-infective agent, it is important to get a urine culture and sensitivity test to ensure that the appropriate agent is being used. -Liver or renal dysfunction -Pregnancy and lactation -Skin, CNS function, urinary elimination patterns, including amount and episode frequency, complaints of frequency, urgency, pain, or difficulty voiding and appropriate lab values -Nurse should monitor vital signs of the patient every four hours after administration of anti-infective therapy or as ordered by the primary health care provider ---Any significant rise in body temperature is reported to the primary health care provider because the methods of reducing the fever or culture and sensitivity tests may need to be repeated ---Nurse should document the symptoms experienced by the patient and assess the patient for bladder distension as part of the pre-administration assessment before administering the drug to the patient.

ACTIONS of the thyroid gland

-Produces two thyroid hormones using iodine found in the diet: ----Tetraiodothyronine or levothyroxine (T4) ----Triiodothyronine or liothyronine (T3) ----Iodine is the essential element for the manufacturing of thyroxine and triiodothyronine. --Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH) --Secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor --Client who has adequate levels of TRH will still have deficient TSH if the anterior pituitary is dysfunctioning.

Antithyroid Agents

-Propylthiouracil (PTU) and methimazole are used to treat hyperthyroidism and are given in 8-hour intervals.

Osmotic Diuretics: MANNITOL (OSMITROL)

-Pull water into the renal tubule without sodium loss. ---*******Mannitol (Osmitrol) is an osmotic diuretic that is used to treat oliguria and anuria in an effort to prevent renal failure. It is also used to reduce intracranial pressure, reduce intraocular pressure, and assist in the urinary excretion of toxic substances ACTIONS: -Pull water into the renal tubule without sodium loss INDICATIONS: -Increased cranial pressure or acute renal failure due to shock, drug overdose, or trauma CONTRAINDICATIONS: -Renal disease and anuria -Pulmonary congestion -Intracranial bleeding, dehydration -CHF ADVERSE EFFECTS: -Related to sudden drop in fluid levels -Nausea, vomiting, hypotension, light-headedness, confusion, and headache

excessive adrenal cortical excretion

-Results in a disorder called Cushing disease or Cushing syndrome. -Could be the result of an adrenal hyperplasia or tumor, an ACTH-secreting tumor, or an early sign of excessive administration of exogenous steroids. -The person with this disorder often presents with a moon-like face, central obesity, hypertension, protein breakdown, and osteoporosis, and females develop hirsutism (Table 36.1). -A medication to treat Cushing disease in patients for whom pituitary surgery is not an option is described in

Spironolactone

-SHOULD NOT EAT A LOT OF POTASSIUM

Urinary Tract Infections (UTIs)

-Second most common infection in the U.S. -More common in females -Patients with indwelling catheters or intermittent catherization are at risk SIGNS AND SYMPTOMS: -Urinary frequency -Urgency -Burning on urination (associated with cystitis) -Chills, fever, flank pain, and tenderness (associated with acute pyelonephritis)

A 25-year-old female client is diagnosed with hypothyroidism. The client is prescribed levothyroxine. Which instruction about the administration of this medication would be important?

-She should take the medication in the morning before breakfast. Levothyroxine interacts with many drugs. Many drugs interfere with its absorption, resulting in decreased serum concentration. Coadministration with levothyroxine should be separated by several hours. Levothyroxine is best taken as a single daily dose before breakfast. Assist the patient to establish a routine for taking the medication. Assess the patient's intake of grapefruit juice; excessive

Deficiency of Adrenocortical Hormones

-Some patients experience a shortage of adrenocortical hormones and develop signs of adrenal insufficiency -Can occur when a patient does not produce enough ACTH, when the adrenal glands are not able to respond to ACTH, when an adrenal gland is damaged and cannot produce enough hormones (as in Addison disease), or secondary to surgical removal of the glands. -A more common cause of adrenal insufficiency is prolonged use of corticosteroid hormones. When exogenous corticosteroids are used, they act to negate the regular feedback systems (Fig. 36.1). The adrenal glands begin to atrophy because ACTH release is suppressed by the exogenous hormones, so the glands are no longer stimulated to produce or secrete hormones. It takes several weeks to recover from the atrophy caused by this lack of stimulation. To prevent this from happening, patients should receive only short-term steroid therapy and should be weaned slowly from the hormones so that the adrenals have time to recover and start producing hormones again

Estrogen Receptor Modulators

-Stimulate specific estrogen receptor sites, which results in an increase in bone mineral density without stimulating the endometrium in women and used as an antineoplastic agent ----Raloxifene (Evista) ----Toremifene (Fareston) ACTIONS: -Modulating effects on estrogen receptors -Used to stimulate specific estrogen receptors to increase bone mineral density INDICATIONS: -Postmenopausal osteoporosis CONTRAINDICATIONS: -Patients with history of venous thrombosis or smoking ADVERSE EFFECTS: -GI upset -Changes in fluid balance: headache, dizziness, and visual changes -Estrogen receptor stimulation: hot flashes, skin rash, edema, and vaginal bleeding DRUG-DRUG INTERACTIONS: Cholestyramine; Diazepam (Valium); Ibuprofen (Motrin);Indomethacin (Indocin); Naproxen (Naprosyn); Warfarin

Oxytocics

-Stimulate uterine contractions to assist labor (oxytocics) or induce abortion (ab -Methylergonovine (Methergine) -Oxytocin (Pitocin) ----Hormone that is produced in the hypothalamus, stored in the posterior pituitary, and released into the circulatory system. Once the pituitary releases oxytocin, oxytocin binds to cell membrane receptors on target tissues, primarily the uterine myometrium (muscle cells) and the mammary epithelium ----Used antepartum to induce uterine contractions

Sildenafil (Viagra)

-TREATED FOR ERECTILE DYSFUNCTION IN MEN -SIDE EFFECTS INCLUDE- TAKEN 1 HOUR BEFORE SEXUAL ACTIVITY -ERECTION SHOULD NOT LAST LONGER THAN 4 HOURS -CAN CAUSE NECROSIS OF PENIS IF IT LASTS MORE THAN 4 HOURS -CAN CAUSE RAPID HEART BEAT, HYPOTENSION (DROP IN BLOOD PRESSURE) -WHEN TAKING THIS AND HYPERTENSION MEDS, GREATER AT RISK FOR HYPOTENSION -CANT TAKE NITROGLYCERIN WITH VIAGARA BECAUSE IT CAN CAUSE A FATAL HYPOTENSION -DON'T TAKE VIAGARA WITH ANY DRUGS THAT LOWER BLOOD PRESSURE

Insulin

-TYPE 1 DIABETES- they do not produce insulin at all -TYPE 2 DIABETES- they don't produce enough insulin/ or have poor synthesis -LONG-ACTING INSULIN WILL NEVER BE MIXED WITH ANOTHER INSULIN (CAUSE PRECIPITATION OF INSULIN WHICH WILL MAKE THEN INEFFECTIVE) -RAPID-ACTING WILL BE GIVEN ABOUT 3 TIMES A DAY -OPTIMAL LEVEL FOR BLOOD GLUCOSE LEVELS IS 70-110 MG/DECILETER -RAPID ACTING INSULIN SHOULD BE GIVEN 10-30 MINUTES BEFORE EATING -RAPID ACTING INSULIN CAN BOTTOM OUT IF IT IS GIVEN AND PATIENT HAS NOT EATEN (if this happens, give the patient a sugary snack) -ANYTHING UNDER 70 IS CONSIDERED HYPOGLYCEMIA -IF GLUCOSE IS 55, mental confusion, dizziness, difficulty speaking, shaky, anxious, jittery, heart palpitations CAN OCCUR

Estrogen-General Client Education

-The FDA has issued a black box warning that estrogens increase the risk for developing cancer of the uterus ---Warning instructs people who take estrogens with or without progestins of the increased risk of dementia, myocardial infarctions, strokes, breast cancer, and blood clot ADVERSE EFFECTS OF ESTROGEN -Systemic effects of estrogens ----increased rates of CHD, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer -headache, breast pain, depression, abdominal cramps, and breakthrough bleeding or changes in menstrual flow -With aging, estrogen secretion diminishes, the vaginal wall shortens and thins, scar tissue replaces prostate cells, and testicular tissue diminishes.

Drugs for Treating Benign Prostatic Hyperplasia

-The enlargement of the gland surrounding the urethra leads to discomfort, difficulty in initiating a stream of urine, feelings of bloating, and an increased incidence of cystitis. The two class of drugs assist in decreasing these symptoms -Alpha-adrenergic blockers- doxazosin (Cardura),tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and terazosin (generic) -----Affects α1 specific receptor blockade in urethra; Causes relaxation of smooth muscle of urinary bladder neck AND bladder neck outlet -Drugs that block testosterone production- finasteride (Proscar) and dutasteride (Avodart) ----Androgen hormone inhibitor INDICATIONS: -Treats benign prostatic hypertrophy

Hormones that influence Female Fertility Cycle

-The female fertility cycle is under the influence of estrogen and progesterone. -Estrogen is a hormone that thickens the lining of the uterus in preparation for egg, assist the body to process calcium to maintain bone structure, helps keep cholesterol levels in balance, and maintains vaginal health. -Progesterone regulates the menstrual cycle and maintains pregnancy.

Oral Contraceptives- Client Education

-The risk of cardiovascular and cerebrovascular effects of oral contraceptives is substantially increased in women age 35 years or older with other risk factors (e.g., smoking, uncontrolled hypertension, hypercholesterolemia, elevated low-density lipoprotein [LDL] cholesterol, obesity, and diabetes) -Antibiotics lessen the effectiveness of oral contraceptives, so the client should use alternative methods of birth control until the antibiotics are completed and the client begins a new cycle of oral contraceptives -Specifically oral contraceptive with estrogen and progestin CONTRAINDICATIONS: -Thromboembolism, including deep vein thrombosis or a pulmonary embolism are contraindications because oral contraceptives increase risks for the formation of blood clots -Estrogen-dependent neoplasms- breast cancer, uterine; ovarian -Liver disease-reduction of the liver function is a contraindication for progestin because the hormone will not be properly metabolized -Migraine

The nurse is aware that somatropin is not appropriate for the person who exhibits growth impairment and which of the other following conditions?

-closure of the epiphyseal plate Somatropin is not used in clients with growth impairment who have closure of the epiphyseal plates

Carbonic Anhydrase Inhibitors

-These drugs are used as adjuncts to other diuretics when a more intense diuresis is needed **ACETAZOLAMIDE (DIAMOX) -Dichlorphenamide (Keveyis) -Methazolamide (generic) ACTIONS: -Block the effects of carbonic anhydrase; slow down the movement of hydrogen ions -More sodium and bicarbonate are lost in the urine INDICATIONS: -Adjuncts to other diuretics -Glaucoma CAUTION: -Fluid or electrolyte imbalances -Renal or hepatic disease -Adrenocortical insufficiency -Respiratory acidosis -COPD ADVERSE EFFECTS: -Related to disturbances in acid and base balance and electrolyte balances -Metabolic acidosis -Hypokalemia -Paresthesias of extremities, confusion, drowsiness

Classes of Diuretics

-Thiazide and Thiazide-like Diuretics -Loop Diuretics -Carbonic Anhydrase Inhibitors -Potassium-Sparing Diuretics -Osmotic Diuretics

Oxytocin

-USED IN LABOR -PRODUCED IN HYPOTHALAMUS -STIMULATES UTERINE CONTRACTION

Antiinfectives Used to Treat UTI

-Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. -Fosfomycin (Monurol) -Nitrofurantoin (Furadantin) -Trimethoprim (Primsol) -Ciprofloxacin (Cipro) -Ofloxacin (Floxin) -Levofloxacin (Levaquin)- indicated for more complicated UTIs -Cefixine (Suprax) -Trimethoprim-sulfamethoxazole (Bactrim) -Methenamine (Hiprex) -Methylene blue (Urolene Blue)

Nursing Considerations/ Client Education for those receiving Mineralocorticoids

-Use only in conjunction with appropriate glucocorticoids to maintain control of electrolyte balance. -Increase dose in times of stress to prevent adrenal insufficiency and to meet increased demands for corticosteroids under stress. -Monitor for hypokalemia (weakness, serum electrolytes) to detect the loss early and treat appropriately. -Discontinue if signs of overdose (excessive weight gain, edema, hypertension, cardiomegaly) occur to prevent the development of more severe toxicity. -Provide thorough patient teaching, including drug name, dosage, and administration; measures to avoid adverse effects; warning signs of problems; and the need for regular evaluation, including blood tests, to enhance patient knowledge about drug therapy and promote compliance.

Progestins

-Used as contraceptives, most effectively in combination with estrogens. Additionally, used to treat primary and secondary amenorrhea and functional uterine bleeding and as part of fertility programs ACTIONS: -Transform the proliferative endometrium into a secretory endometrium, Inhibit the secretion of FSH and LH -Prevent follicle maturation and ovulation -Inhibit uterine contractions INDICATIONS: -Contraception -Treatment of primary and secondary amenorrhea -Fertility protocols CONTRAINDICATIONS: -Allergies, pregnancy, idiopathic vaginal bleeding, breast or genital cancer, history of thromboembolic disorders, PID, sexually transmitted disease, endometriosis, ADVERSE EFFECTS: -Varies based on route of administration DRUG-DRUG INTERACTIONS: -Barbiturates, Carbamazepine, Phenytoin, or Rifampin

Bladder Protectant

-Used to coat or adhere to the bladder mucosal wall and protect it from irritation related to solutes in urine. -*****Pentosan polysulfate sodium (Elmiron) ACTIONS: -Heparin-like compound that has anticoagulant and fibrinolytic effects -Adheres to the bladder wall mucosal membranes and acts as a buffer to control cell permeability, preventing irritating solutes in the urine from reaching the bladder wall cells INDICATIONS: -Interstitial cystitis CONTRAINDICATIONS: -Condition that involve a risk of bleeding -Heparin induced thrombocytopenia CAUTION: -Hepatic or splenic dysfunction DRUG-DRUG INTERACTIONS: -Anticoagulants, aspirin, or NSAIDs

Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?

-Vitamin D and calcium Fosamax is a bisphosphonate medication. An intake of 1500 mg calcium and 400 to 800 units of vitamin D are recommended daily while taking bisphosphonates.

INDICATIONS for use of adrenal agents

-Widely used to suppress the immune system -Short-term use to relieve inflammation during acute stages of illness ----Do not cure any inflammatory disorders

An older adult client has been prescribed metformin for the treatment of type 2 diabetes for several years. Which change in the client's laboratory values may demonstrate a need to discontinue the medication?

-an increase in serum lactate It is essential to discontinue metformin if renal impairment occurs or if serum lactate increases. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.

When providing medication teaching to a client who has been prescribed spironolactone, what foods should the nurse instruct the client to avoid?

-bananas Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the client to eat fish, apples, and crackers because of their low sodium content.

The nurse is caring for a client who has been receiving long-term growth hormone treatment to stimulate growth. What diagnostic testing would the nurse expect to see ordered as a standard part of the treatment plan? (Select all that apply)

-blood sugar level -serum electrolytes -x-ray of the long-bones Periodic radiography of the long bones, as well as monitoring of blood sugar levels and electrolytes, should be a standard part of the treatment plan for children who receive any of the hypothalamic or pituitary agents. Growth hormone would not be expected to impact liver function. There would be no obvious indication for a CT head, which is usually used to visualize the brain.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) and has been prescribed a medication to affect the posterior pituitary gland's production of antidiuretic hormone (ADH). Which of the following nursing assessments is most critical to this client's safety?

-clients fluid balance Fluid balance needs to be monitored when patients are taking drugs that affect antidiuretic hormone (ADH). SIADH presents with fluid retention, dilution of the blood and all of the blood elements, serious issues with water balance and fluid volume. This disorder is now treated with drugs that block the ADH or vasopressin receptors, so water is no longer retained and urine is produced, helping to restore water balance. Keeping the fluid balance in check can be very tricky and patients receiving these drugs need to be closely monitored in the hospital. While the other options are appropriate, they do not have the priority when monitoring a client prescribed medications affecting ADH

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which of the following?

-eat potassium-rich foods. The client is most likely experiencing muscle cramps due to potassium loss. Therefore, the nurse should advise the client to include potassium supplements in the diet. Drinking plenty of fluids or using calcium supplements will not reduce the occurrence of cramps. It is important to caution the client to avoid foods high in sodium because they could counteract the effects of drug therapy.

A 49-year-old female client is asking the nurse about how her changing hormones relate to menopause. The nurse explains that atrophic vaginitis is a common problem during menopause. The treatment for atrophic vaginitis requires replacing:

-estrogen Estrogen is used for palliation of moderate to severe vasomotor symptoms, atrophic vaginitis, and kraurosis vulvae. The human chorionic gonadotropin hormone is used to help maintain the follicle once ovulation has occurred. Progesterone is used with estrogen as contraception, to treat amenorrhea, functional uterine bleeding, and as part of fertility programs. Testosterone is used to treat sexual and metabolic disorders in males.

A nurse encourages a patient who is receiving a diuretic to maintain his fluid intake to prevent the risk for developing which of the following conditions?

-fluid rebound When a patient who is taking a diuretic decreases fluid intake, fluid rebound occurs, which leads to water retention and subsequent edema and weight gain, not dehydration. Electrolyte imbalances may or may not occur depending on the type of diuretic being used.

A male client is prescribed GH. He also takes a medication to control his type 2 diabetes. The nurse understands that GH can cause what condition?

-hyperinsulinemia GH is often considered an insulin antagonist because it suppresses the abilities of insulin to stimulate uptake of glucose in peripheral tissues and enhance glucose synthesis in the liver. Paradoxically, administration of GH produces hyperinsulinemia by stimulating insulin secretion.

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated?

-hyperkalemia The nurse should know that potassium-sparing diuretics are contraindicated in clients with hyperkalemia and are not recommended for children. Potassium-sparing diuretics should be used cautiously in clients with liver disease, diabetes, or gout, but presence of these conditions does not contraindicate the use of potassium diuretics.

Which of the following times of the day should a nurse instruct a client to take an oral glucocorticoid?

-in the morning Typically, a glucocorticoid is taken in the morning around 8 or 9 AM to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis.

endocrine system

-main function is to maintain homeostasis -too much or too little glandular activity -----disrupts homeostasis -----leads to various disorders -----interferes with the normal functioning of other endocrine glands -hypothalamus of the brain and the pituitary gland interact to control most metabolic functions of the body and to maintain homeostasis -hypothalamus controls secretions of the pituitary gland -pituitary gland, in turn, regulates secretions or functions of other body tissues, called target tissues

Furosemide

-most famous loop diuretic -works in the loop of henle -POTASSIUM LEVELS SHOULD BE FROM 3.5-5

The nurse should advise clients taking phenazopyridine (Pyridium) that they may notice a change in urine color. Which color would the nurse identify?

-orange The nurse should advise clients taking phenazopyridine that their urine may become discolored and may appear a dark orange to brown color. Phenazopyridine does not cause the urine to become blue, purple, or green.

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

-osmotic diuretic An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing which of the following conditions?

-osteoporosis The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis. Glucocorticoids are used to reduce swelling in the brain and spinal column and to promote bronchodilation.

A 32 year old pregnant patient is experiencing a prolonged labor and her contractions are ineffective. Which of the following agents would the nurse expect to be ordered?

-oxytocin Oxytocin is a posterior pituitary hormone that is used to promote uterine contractions. Abarelix is used to treat advanced prostate cancer. Desmopressin is used to treat diabetes insipidus. Chorionic gonadotropin alfa is a fertility agents.

An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?

-potassium levels Furosemide, a loop diuretic, causes potassium loss, which can lead to hypokalemia. Serum potassium levels should be monitored in patients taking the drug to help avoid the condition and its effects.

A client diagnosed with diabetic ketoacidosis (DKA) has been admitted to the intensive care unit. The client is prescribed an intravenous insulin

-regular Regular insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures. All the other options are administered subcutaneously.

Somatropin

-synthetic growth hormone -given to people (children) at a decreased height or dwarfism -has to be given to children with fused growth plates to work -measuring height growth

Metformin (Glucophage)

-treatment of type 2 diabetes -one of the first treatments -if youre at risk for type 2 diabetes you take this -headache, agitation, nausea, vomiting, LACTIC ACIDOSIS -LACTIC ACIDOSIS CAN CAUSE fatigue, chills, excessive sleepiness and drowsiness, muscle pain (mayalsia) -can be dangerous in 80 or older patients because it can be toxic

Which laboratory values should the nurse review prior to the administration of hydrocortisone? Select all that apply.

-white blood cell count -glucose level Hydrocortisone is an adrenocorticoid and mineralocorticoid used in the treatment of Addison disease. The anti-inflammatory medication can reduce the white blood cell count and cause an increase in the glucose level. The nurse does not need to review the platelet, protein, or magnesium level since these levels are not directly affected by this class of medications.

Sulfonylureas

ACTIONS: •Stimulate insulin release from the beta cells in the pancreas •They improve binding to insulin receptors INDICATIONS: •Adjunct to diet and exercise to lower blood glucose levels in type 2 diabetes CONTRAINDICATIONS: •Diabetic complications •Type 1 diabetes mellitus ADVERSE EFFECTS: •Hypoglycemia •GI distress •Allergic skin reactions DRUG-DRUG INTERACTIONS: •Drugs that acidifies the urine •Beta blockers •Alcohol

Antiinfectives Used to Treat UTI

ACTIONS: -Act specifically within the urinary tract to destroy bacteria -They act either through direct antibiotic effect or through acidification -Urinary antiseptics are not used in systemic infections because they do not attain therapeutic plasma levels INDICATIONS: -Chronic UTI -Adjunctive therapy in acute cystitis and pyelonephritis -Prophylaxis with urinary tract anatomical abnormalities and residual urine disorders CAUTION: -Renal dysfunction -Pregnancy and lactation ADVERSE EFFECTS: -Nausea, vomiting, anorexia, bladder irritation, and dysuria -Pruitus, urticaria, headache, dizziness, nervousness, and confusion

Thiazide and Thiazide-Like Diuretics

ACTIONS: -Action is to block the chloride pump -Keeps chloride and the sodium in the tubule to be excreted in the urine, thus preventing the reabsorption of both in the vascular system INDICATIONS: -Treatment of edema associated with CHF, liver, or renal disease -Monotherapy or adjuncts for the treatment of hypertension CONTRAINDICATIONS: -Allergy to thiazides or sulfonamides -Fluid and electrolyte imbalances -Renal and liver disease CAUTION: -Gout -SLE -Liver disease -Hyperparathyroidism -Bipolar disorder -Pregnancy and lactation -Diabetes or glucose tolerance abnormalities ADVERSE EFFECTS: -GI upset, fluid and electrolyte imbalances, Hypokalemia, hypotension, increased blood glucose levels, alkalinized urine, hyperuricemia (increased uric acid levels), hypercalcemia, and hyperglycemia (with long-term use) DRUG-DRUG INTERACTIONS: -Cholestyramine or colestipol -Digoxin -Antidiabetic agents -Lithium

Oxytocics OXYTOCIN (PITOCIN)

ACTIONS: -Affect neuroreceptors sites to stimulate contractions of the uterus INDICATIONS: -Prevention and treatment of uterine atony after delivery -A nurse may be asked to administer oxytocin (Pitocin) intravenously to a client with: -----gestational diabetes and a large fetus -----Rh problems -----premature rupture of membranes -----Uterine inertia -----Pregnancy-induced hypertension CONTRAINDICATIONS: -Allergy and early pregnancy -Cephalopelvic disproportion CAUTION: -Coronary artery disease, hypertension, lactation, and previous Cesarean section ADVERSE EFFECTS: -Excessive effects: uterine hypertonicity; spasm; uterine rupture -GI upset (nausea) -Headache -Blood pressure changes -Fetal bradycardia -Water intoxication ----serious complication that can occur with the continuous use of oxytocin, especially if the drug is administered by continuous infusion and the client is receiving fluids by mouth. ASSESS: -History and physical -Known allergy -Current status of pregnancy or lactation uterine atony, undesirable fetal position, and cephalopelvic disproportion -Neurological status, fetal status and labor pattern

Urinary Tract Antispasmodics

ACTIONS: -Block the spasms of urinary tract muscles -Blocking parasympathetic activity -Relaxing the detrusor and other urinary tract muscles INDICATIONS: -Bladder spasm and dysuria CONTRAINDICATIONS: -Pyloric or duodenal obstruction -Recent surgery -Obstructive urinary tract problems -Glaucoma, myasthenia gravis, or acute hemorrhage CAUTION: -Renal or hepatic dysfunction -Pregnancy and lactation ADVERSE EFFECTS: -Related to blocking of the parasympathetic system -May cause dry mouth, constipation, and drowsiness. DRUG-DRUG INTERACTIONS: -Phenothiazines (such as promethazine- the effect of the antispasmodic is stronger) -Haloperidol (Antispasmodics make antipsychotics and antivirals less effective)

Fertility Drugs

ACTIONS: -Directly or by stimulating the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova INDICATIONS: -Infertility in men and women CONTRAINDICATIONS: -Primary ovarian failure -Thyroid or adrenal dysfunction -Ovarian cysts -Idiopathic uterine bleeding CAUTION: -Breast feeding, thromboembolic disease; respiratory disease ADVERSE EFFECTS: -Increase risk of multiple births and birth defects -Ovarian overstimulation -Headache, fluid retention, nausea, bloating -Uterine bleeding, ovarian enlargement -Gynecomastia ASSESS: -History and physical -Known allergy -Primary ovarian failure or thyroid or adrenal dysfunction -Uterine bleeding, pelvic and breast examinations and appropriate lab values

Glucocorticoids

ACTIONS: -Enter target cells and bind to cytoplasmic receptors -Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects -Hydrocortisone, cortisone, and prednisone have some mineralocorticoid activity INDICATIONS: -Short-term treatment of many inflammatory disorders -To relieve discomfort -To give the body a chance to heal from the effects of inflammation CONTRAINDICATIONS: -acute infection CAUTION: -Diabetes; Acute peptic ulcer; heart failure; decreased muscle mass; osteoporosis ADVERSE EFFECTS: -Systemic use is associated with endocrine disorders -Adverse effects of systemic corticosteroids may include infections, hypertension, glucose intolerance- may cause the development of diabetes, obesity, cosmetic changes, bone loss, growth retardation in children, cataracts, pancreatitis, peptic ulcerations ( due to gastric erosion), and psychiatric disturbances. DRUG-DRUG INTERACTIONS: -Increase in drug when given with erythromycin, ketoconazole, or troleandomycin -Decrease in drug when given with salicylates, barbiturates, phenytoin, or rifampin

Mineralocorticoids

ACTIONS: -Holds sodium, and with it, water in the body -Causes the excretion of potassium by acting on the renal tubule INDICATIONS: -replacement therapy in primary and secondary adrenal insufficiency CONTRAINDICATIONS: -hypertension; CHF; cardiac disease CAUTION: -Pregnancy -Presence of any infection -High sodium intake ADVERSE EFFECTS: -Increase fluid volumes -Allergic reactions DRUG-DRUG INTERACTIONS: -Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, and anticholinesterases ASSESS: -Heart failure, hypertension, or infections; high sodium intake; lactation; and pregnancy

Androgens TESTOSTERONE

ACTIONS: -Increase the retention of nitrogen, sodium, potassium -Decrease the urinary excretion of calcium -Increase protein anabolism -Decrease protein catabolism -Increase the production of red blood cells CONTRAINDICATIONS: -Pregnancy and lactation -Prostate or breast cancer in men CAUTION: -Liver dysfunction or cardiovascular disease INDICATIONS: -Replacement therapy in hypogonadism and delayed puberty in males ----In pre-pubertal boys, administration of male sex hormone-like drugs will stimulate development of masculine characteristics -Cryptorchidism -Inoperable breast cancer -Prevention of ovulation to treat endometriosis ADVERSE EFFECTS: -Acne, edema, hirsutism -Deepening of the voice, oily skin and hair, weight gain, decreased breast size, testicular atrophy -Flushing sweating, vaginitis, nervousness, and emotional labiality -Headache, dizziness, sleep disorders, and altered electrolytes DRUG-LABORATORY TEST INTERFERENCES: -thyroid function -creatinine

Estrogen

ACTIONS: -Protecting the heart from atherosclerosis -Retaining calcium in the bones -Maintaining the secondary female sex characteristics INDICATIONS: -Hormone replacement therapy (HRT) -Palliative and preventive therapy during menopause ----Such as atrophic vaginitis Replacement therapy (HRT) when ovarian activity is blocked or absent and menopause: -Estradiol (Estrace, Climara) -Conjugated estrogens (Premarin) -Esterified estrogen (Menest) -Estropipate (Ogen) CONTRAINDICATIONS: -Idiopathic vaginal bleeding, breast cancer, and estrogen dependent cancer, thromboembolic disorders CAUTION: -Breast feeding, metabolic bone disease, renal insufficiency, hepatic impairment DRUG-DRUG INTERACTIONS: -Drugs that enhance hepatic metabolism -Corticosteroids

drugs affecting anterior pituitary hormones

ACTIONS: -Somatropin is a hormone of recombinant DNA origin that is equivalent to human growth hormone -GH deficiency can cause dwarfism in children INDICATIONS: -used in patients experiencing growth failure CONTRAINDICATIONS: -known allergy; allergy to ingredients in the drug -presence of closed epiphyses -underlying cranial lesions ADVERSE EFFECTS: -inflammation -swelling and joint pain -hypothyroidism -GH is often considered an insulin antagonist because it suppresses the abilities of insulin to stimulate uptake of glucose in peripheral tissues and enhance glucose synthesis in the liver. -----Paradoxically, administration of GH produces hyperinsulinemia by stimulating insulin secretion.

Urinary Tract Analgesia PHENAZOPYRIDINE

ACTIONS: -When phenazopyridine is excreted in urine, it exerts a direct topical analgesic effect on the urinary mucosa INDICATIONS: -Relieve symptoms related to urinary tract irritation from infection, trauma, or surgery -Relieves dysuria, burning, and frequency and urgency of urination CONTRAINDICATIONS: -Allergy and renal dysfunction -Pregnancy and lactation ADVERSE EFFECTS: -GI upset, headache, rash, reddish-orange coloring of the urineand staining of contact lenses -Renal and hepatic toxicity -----Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatic toxicity. DRUG-DRUG INTERACTIONS: -Antibacterial agents

GROWTH HORMONE ANTAGONISTS

ACTIONS: -is an inhibitory factor released from the hypothalamus -not used to decrease GH -has multiple effects on many of the secretory systems INDICATIONS: -treatment of acromegaly (pituitary gland produces too much growth hormone) CAUTION: -pregnancy or lactation -presence of any other endocrine disorder ADVERSE EFFECTS: -varies with each medication DRUG-DRUG INTERACTIONS: -Erythromycin, phenothiazines, opioids ASSESS: -history of allergy to any GH antagonist or binder; other endocrine disturbances -pregnancy and lactation -orientation, affect, and reflexes; blood pressure, pulse, and orthostatic blood pressure

Antihypercalcemic Agents

ACTIONS: •Bisphosphonates- Slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization •Calcitonin's- Inhibits bone resorption, lowers serum calcium levels in children and in patients with Paget's disease, and increases the excretion of phosphate, calcium, and sodium from the kidney CONTRAINDICATIONS: -Bisphosphonates- Hypocalcemia, pregnancy and lactation, renal dysfunction, GI disease -Calcitonins- Pregnancy, renal dysfunction or pernicious anemia ADVERSE EFFECTS: -Bisphosphates- Most common, headache, nausea, and diarrhea, bone pain with Paget's disease -Calcitonins- Flushing of the face and hands, ASSESS: •Hypocalcemia; and renal dysfunction •skin lesions; orientation and affect; abdominal examination; serum electrolytes; and renal function tests

INSULIN

ACTIONS: •Hormone that promotes the storage of the body's fuels •Facilitates the transport of various metabolites and ions across cell membranes • Simulatesthe synthesis of glycogen from glucose Reacts with specific receptor sites on the cells INDICATIONS: •Treatment of type 1 diabetes mellitus •Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents DRUG-DRUG INTERACTIONS: •When given with any drug that decreases glucose levels •Beta blockers ADVERSE EFFECTS: -Lipodystrophy ----atrophy or thickening of subcutaneous tissue -Somogyi effect ----hypoglycemia during sleep -Hypoglycemia (Insulin shock) -Hyperglycemia (diabetic ketoacidosis)

INSULIN

ACTIONS: •Hormone that promotes the storage of the body's fuels •Facilitates the transport of various metabolites and ions across cell membranes •Simulates the synthesis of glycogen from glucose •Reacts with specific receptor sites on the cells INDICATIONS: •Treatment of type 1 diabetes mellitus •Treatment of type 2 diabetes mellitus in patients whose diabetes cannot be controlled by diet or other agents DRUG-DRUG INTERACTIONS: •When given with any drug that decreases glucose levels •Beta blockers ADVERSE EFFECTS: -Lipodystrophy ---atrophy or thickening of subcutaneous tissue -Somogyi effect ---hypoglycemia during sleep -Hypoglycemia (Insulin shock) -Hyperglycemia (diabetic ketoacidosis)

thyroid hormones

ACTIONS: •Increases the metabolic rate of body tissues, increasing oxygen consumption, respiration, and heart rate; the rate of fat, protein, and carbohydrate metabolism; and growth and maturation INDICATIONS: •Replacement therapy in hypothyroidism; pituitary TSH suppression in the treatment of euthyroid goiters, management of thyroid cancer; thyrotoxicosis in conjunction with other therapy; myxedema coma CONTRAINDICATIONS: •Thyrotoxicosis •Acute MI ADVERSE EFFECTS: •Skin reactions •Symptoms of hyperthyroidism •CNS effects •Cardiac stimulation ; used cautiously for clients with heart disease DRUG-DRUG INTERACTIONS: •Cholestyramine •Oral anticoagulants •Digitalis •Theophylline •Levothyroxine interacts with many drugs; Many drugs interfere with its absorption, resulting in decreased serum concentration •Co-administration with levothyroxine should be separated by several hours.

Antihypocalcemic Agents

ACTIONS: •Stimulation of osteoclasts or bone cells to release calcium from the bone •Increased intestinal absorption of calcium •Increased calcium resorption from the kidneys •Stimulation of cells in the kidney to produce calcitriol INDICATIONS: •Management of hypocalcemia in patients undergoing chronic renal dialysis •Treatment of hypoparathyroidism CONTRAINDICATIONS: •Allergy to vitamin D, hypercalcemia, vitamin D toxicity, and pregnancy CAUTION: •History of renal stones ADVERSE EFFECTS: •GI effects; CNS effects DRUG-DRUG INTERACTIONS: •Magnesium containing antacids •Cholestyramine or mineral oil ASSESS: •Hypercalcemia, vitamin toxicity, renal stone, and pregnancy or lactation •Skin lesions; orientation and affect; liver evaluation; serum calcium, magnesium, and alkaline phosphate levels; and radiographs of bones as appropriate

Antithyroid Agents

ACTIONS: •Thioamides: prevent formation of thyroid hormone within the thyroid cells, lowering the serum level, partially inhibit conversion of T4 to T3 •Iodine Solutions: high doses block thyroid function INDICATIONS: •Hyperthyroidism CONTRAINDICATIONS: -pregnancy CAUTION: •Lactation •Mothers taking PTU should not breastfeed their children (pregnancy category D) ADVERSE EFFECTS: • Thioamides: Thyroid suppression • Iodine Solutions: Hypothyroidism DRUG-DRUG INTERACTIONS: •Thioamides: Oral anticoagulants, theophylline, metoptolol, propranolol, digitalis •Iodine Solutions: Anticoagulants, theophylline, digoxin, metoprolol, propranolol ASSESS: •Known allergy, pregnancy and lactation status, liver dysfunction; and pulmonary edema or pulmonary tuberculosis •Skin lesions; orientation and affect; baseline, pulse, blood pressure, and electrocardiogram; respiration, and adventitious sounds; and thyroid function tests

Drugs for Treating Penile Erectile Dysfunction SILDENAFIL (VIAGRA)

ACTIONS: -Alprostadil: Injected and acts locally to relax vascular smooth muscle and promote blood flow into the corpus cavernosum causing penile erection. -Inhibits PDE5 receptors, leading to a release of nitrous oxide, which activates cGMP to cause a prolonged smooth muscle relaxation, allowing the flow of blood into the corpus cavernosum and facilitating erection. INDICATIONS: -Treatment of erectile dysfunction in the presence of sexual stimulation CONTRAINDICATIONS: -Condition that might predispose to priapism -Penile implants -Use in women CAUTION: -Bleeding disorders, coronary artery disease, active peptic ulcer, retinitis pigmentosa, hypotension or severe hypertension, congenital prolonged Q T interval, or severe hepatic or renal disorders ADVERSE EFFECTS: -Edema, headache, dizziness, syncope, angina, dyspnea -Medical attention should be sought for erections sustained for more than 4 hours (priapism) DRUG-DRUG INTERACTIONS: -PDE5 inhibitors combined with organic nitrates ( such as nitroglycerin) or alpha blockers ----Can cause dangerous cardiovascular effects, severe hypotension, including death ----Careful patient teaching is essential

-Goserelin (Zoladex): synthetic GnRH -Histrelin (Vantas): GnRH used as antineoplastic -Leuprolide (Lupron): GnRH agonist -Nafarelin (Synarel): GnRH agonist -Tesamorelin (Egrifta): GRH analogue used to simulate GH release from pituitary

ADVERSE EFFECTS: -Agonists can lead to increased release of sex hormones, leading to ovarian overstimulation, flushing, increased temperature and appetite, and fluid retention -Antagonists can lead to a decrease in testosterone levels, leading to loss of energy, decreased sperm count and activity, and potential alterations in secondary sex characteristics

nursing considerations for bladder protectants

ADVERSE EFFECTS: -Bleeding that may progress to hemorrhage (related to the drug's heparin effects) ----Necessary to notify the health care provider if the client showed any signs of bleeding -Headache, alopecia, GI disturbances ASSESS: -History and Physical Exam and known allergy -History of bleeding abnormalities, splenic disorders, or hepatic dysfunction -Pregnancy and lactation -Skin, VS, urinary elimination patterns -Appropriate lab values

Nursing Considerations for Anabolic Steroids

ASSESS: -History and Physical Exam -Known allergy -Pregnancy or lactation, skin and hair distribution -Affect, orientation, and peripheral sensation -Abdominal examination and serum electrolytes, serum cholesterol, and liver function tests -Adverse effects in women include masculinization effects, hirsuitism, and deepening of voice

Nursing Considerations for Urinary Tract Antispasmodics

ASSESS: -History and Physical Exam and known allergy -Pyloric or duodenal obstruction or obstructions of the other GI lesions lower urinary tract -Glaucoma, pregnancy or lactation -Skin, CNS, urinary elimination pattern, including amount and frequency of episodes, and for any complaints of frequency, urgency, pain, or difficulty voiding and appropriate lab values

Nursing Considerations for Urinary Tract Analgesia PHENAZOPYRIDINE

ASSESS: -History and Physical Exam and known allergy -Renal insufficiency, pregnancy and lactation -Skin, sclera, GI and hepatic function urinary elimination patterns, including color, amount, and complaints of frequency, dysuria, or difficulty voiding -Appropriate lab values

Nursing Considerations for Patients Receiving Sex Hormones or Estrogen Receptor Modulators

ASSESS: -History and physical -Known allergy -Pregnancy and lactation -History of CV disease, breast or genital cancer, renal disease, or metabolic bone disease, thromboembolism or smoking, vaginal bleeding or pelvic disease -Pelvic and breast examinations and appropriate lab tests

NURSING CONSIDERATIONS for drugs affecting anterior pituitary hormones

ASSESS: -Presence of closed epiphyses -----Must be administered before epiphyses (growth plates) close in children -----Underlying cranial lesions -----Serious infection following open heart surgery, abdominal surgery, and pregnancy or lactation status -Height, weight, thyroid function tests, glucose tolerance tests, and GH levels Periodic radiography of the long bones, as well as monitoring of blood sugar levels and electrolytes, should be a standard part of the treatment plan for children who receive any of the hypothalamic or pituitary agents.

NURSING CONSIDERATIONS WITH drugs affecting hypothalamic hormones

ASSESS: -history and physical -known allergy -The specific nursing care of the patient who is receiving a hypothalamic-releasing factor is related to the hormone (or hormones) that the drug is affecting

Nursing Considerations for Insulin

ASSESS: •Exercise amount, skin, Glucose levels, and appropriate lab values •Insulin is administered subcutaneously ---Studies indicate that insulin is absorbed fastest from the abdomen ---Regular insulin, a short-acting insulin, is the only type of insulin that may be administered IV ---When administering glargine (long-acting) to the patient, the nurse should avoid mixing it with other insulin or solutions -------It will precipitate in the syringe if mixed

Nursing Considerations for Thyroid Hormones

ASSESS: •Lab work to determine thyroid hormone dosages includes TSH (thyroid-stimulating hormone), T3 and T4 levels, and possibly thyroid antibodies. •Assess for Addison disease, acute myocardial infarction not complicated by hypothyroidism, and thyrotoxicosis, skin lesions •Orientation and affect; baseline pulse, blood pressure, and electrocardiogram; respiration and adventitious sounds; and thyroid function tests •Levothyroxine is best taken as a single daily dose before breakfast • Assess the patient's intake of grapefruit juice; excessive grapefruit juice may delay the absorption of levothyroxine •Nurse should advise the client to take levothyroxine in the morning on an empty stomach with a full glass of water. •Thyroid hormones are classified as pregnancy category A and should be continued by hypothyroid women during pregnancy. •Thyroid hormones are not used as treatment for obesity •Thyroid hormones are but are safe during pregnancy.

types of corticosteroids

Androgens -Male and female sex hormones Glucocorticoids Mineralocorticoids -Affect electrolyte levels and homeostasis -Mineralocorticoids For this reason, the nurse must closely monitor the client's sodium and potassium levels -Not all adrenocortical agents are classified as only glucocorticoids or mineralocorticoids. Hydrocortisone, cortisone, and prednisone have glucocorticoid and some mineralocorticoid activity and affect potassium, sodium, and water levels in the body when present in high levels (Table 36.2). Box 36.3 discusses their use in different age groups. Figure 36.2 displays the sites of action of the glucocorticoids and the mineralocorticoids

Antihypercalcemic Agents

BISPHOSPHONATES •These drugs act on the serum levels of calcium and not directly on the parathyroid gland or PTH •Slow normal and abnormal bone resorption •Recommended for long-term management of hypercalcemia to increase bone resorption of calcium, in treating and preventing osteoporosis in postmenopausal women, and in managing Paget disease. •Side effects: headache, nausea, and diarrhea CALCITONINS •Hormones secreted by the thyroid gland to balance the effects of PTH •Inhibit bone resorption Side effects: flushing of face and hands

"Insulin Sensitizers"

Biguanides - Metformin (Glucophage) -Most effective first line treatment for Type II diabetes -Reduces glucose production by liver; Improves transport of glucose to cells ;Increases muscles' glucose uptake and use -May be used in prevention of type II diabetes in those who with prediabetes Thiazolidinediones - Pioglitazone (Actos) -Increases cellular response to insulin by decreasing insulin resistance NURSING IMPLICATIONS -Contraindicated for clients with renal impairment. -Withhold 48 hours before and after IV contrast dye administered

Drugs for Treating Benign Prostatic Hyperplasia

CAUTIONS: -Hepatic or renal dysfunction -A client who takes an androgen hormone inhibitor should not give blood for at least six months after stopping the medication, due to potential effects on pregnant women who may receive the blood product. ADVERSE EFFECTS: -Headache, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset -Decreased libido, impotence, and sexual dysfunction DRUG-DRUG INTERACTIONS: -Other antihypertensives, nitrates, erectile dysfunction drugs ASSESS: -History of heart failure or coronary heart disease cardiopulmonary status, including vital signs especially blood pressure and pulse rate, -α1 blockers relax smooth muscle in veins and arteries; Pt on hypertension meds: ensure prescriber is aware of this Rx -Auscultate heart sounds and assess tissue perfusion -Urinary elimination pattern, prostate

Diabetes Mellitus

CHARACTERISTICS: •Complex disturbances in metabolism •Affects carbohydrate, protein, and fat metabolism CLINICAL SIGNS: •Hyperglycemia (fasting blood sugar level greater than 126 mg/dL) •Glycosuria (the presence of sugar in the urine)

Anabolic Steroids

CONTRAINDICATIONS: -Allergy and liver dysfunction -Pregnancy ----Because of possible masculinizing effects on a female fetus. -Coronary disease -Prostate or breast cancer in males DRUG-DRUG INTERACTIONS: -Oral anticoagulants -Anti-diabetic medications ACTIONS: -Promote body tissue-building processes -Reverse catabolic or tissue-destroying processes -Increase hemoglobin and red blood cell mass INDICATIONS: -Indications vary with each drug -Treatment of anemias, certain cancers, and angioedema -Promote weight gain and tissue repair -Protein anabolism ADVERSE EFFECTS: -Cardiomyopathy -Hepatic carcinoma -Personality changes -Sexual dysfunction -Virilization (masculinization) -Inhibition or testicular function, gynecomastia, testicular atrophy, priapism, baldness, and change in libido -Adverse effects in women include masculinization effects, hirsuitism, and deepening of voice -Anabolic steroids are considered even more dangerous for teens because teens are still growing. Anabolic steroids can stop bone growth and damage the heart, kidneys, and liver of adolescents -A client abusing anabolic steroids might exhibit the following signs: uncontrolled rage, severe depression, suicidal tendencies, malignant or benign liver tumors, aggressive behavior, inability to concentrate, personality changes, acne, jaundice, anorexia, male pattern baldness, fluid and electrolyte imbalances, and muscle cramps.

short-acting corticosteroids

CORTISONE: equivalent dose (mg): 25 duration of effects (h): 8-12 HYDROCORTISONE: equivalent dose (mg): 20 duration of effects (h): 8-12

Which of the following is an example of a loop diuretic?

Furosemide (Lasix) Furosemide (Lasix) is an example of a loop diuretic

HYPERTHYROIDISM (overactivity)

DEFINITION: -Excessive amounts of thyroid hormones are produced and released into the circulation CAUSE: -Graves' disease SIGNS AND SYMPTOMS: -Increased body temperature, tachycardia, thin skin, palpitations, hypertension, flushing, intolerance to heat, amenorrhea, weight loss, and goiter

drugs affecting anterior pituitary hormones

Growth Hormone (GH) Agonist --Somatropin (Nutropin, Saizen, Humatrope, Zorbitive) GH Antagonists -Bromocriptine mesylate (Palodel) -Lanreotide (Somatuline Depot) -Octreotide (Sandostatin) -Pegvisomant (Somavert) Drugs affecting other anterior pituitary hormones -Chorionic Gonadotropin (Chorex et al.) -Chorionic gonadotropin alpha (Ovidrel)

Desmopressin; Anti-diuretic hormone (ADH)

Desmopressin- synthetic (works just like ADH); given to treat diabetes insipidus or for water regulation; when medication is given, WATCH FOR water intoxication, headaches, monitor intake and output, fluid retention (can cause edema and dilute blood) ADH; function- regulate water balance, retaining water balance

class 15: reproductive system

Drugs Affecting the Female Reproductive System

Function and Indications for use of Diuretic Agents

FUNCTION OF DIURETICS -Increase the amount of urine produced by the kidneys -Increase sodium excretion INDICATIONS FOR DIURETIC USE -Edema associated with congestive heart failure -Acute pulmonary edema -Liver disease (including cirrhosis) -Renal disease -Hypertension -Conditions that cause hyperkalemia

A 66-year-old man has made an appointment with his primary care provider to discuss his recent erectile dysfunction (ED) and has requested a prescription for tadalafil (Cialis) based on television commercials he has seen. What characteristic of this client would contraindicate the use of tadalafil for his ED?

He has unstable angina and uses a nitroglycerin patch Like the other drugs in this class, tadalafil should not be taken within 48 hours of taking nitrates, such as nitroglycerin, because substantially lower blood pressure and possibly death may result. Nitroglycerin use is a contraindication for taking tadalafil, as it is for all drugs in this class. Allopurinol, ginseng, and low bone density do not contraindicate the use of tadalafil.

Hypoglycemia

Hypoglycemia unawareness -No warning signs/symptoms until glucose level critically low -Related to autonomic neuropathy and lack of counter-regulatory hormones -Patients at risk should keep blood glucose levels somewhat higher Altered mental functioning -Difficulty speaking -Visual disturbances -Stupor -Confusion -Agitation -Coma ****Untreated hypoglycemia can progress to loss of consciousness, seizures, coma, and death

Drugs Affecting Posterior Pituitary Hormones Desmopressin (DDAVP, Stimate); Vasopressin(Pitrssin)

INDICATIONS: -Treatment of neurogenic diabetes insipidus -Desmopressin is also indicated for the treatment of hemophilia A and von Willebrand's disease -Nocturnal enuresis CONTRAINDICATIONS: -severe renal dysfunction CAUTION: -Known vascular disease -Epilepsy -Asthma -Pregnancy; Lactation ADVERSE EFFECTS: -Water intoxication, related to the shift in water retention ----Manifested by drowsiness, light-headedness, headache, coma, convulsions; Tremor, sweating, vertigo, related to the shift to water retention and resulting electrolyte imbalance; -Stimulation of GI tract ----flatulence, nausea, and vomiting; abdominal cramps -Local nasal irritation; Hypersensitivity DRUG-DRUG INTERACTIONS: -Carbamazepine, chlorpropamide, digoxin, ACE inhibitors, angiotensin receptor blockers, potassium-sparing diuretics, telithromycin

prototype abortifacients: DINOPROSTONE

INDICATIONS: -termination of pregnancy 12 to 20 weeks from the first day of the last menstrual period -evacuation of the uterus in the management of missed abortion or intrauterine fetal death -management of nonmetastatic gestational trophoblastic disease -initiation of cervical ripening ACTIONS: -stimulates the myometrium of the pregnant uterus to contract, evacuating the contents of the uterus PHARMACOKINETICS: route: intravaginal onset: 10 minutes peak: 15 minutes duration: 2-3 hours T 1/2: 5 to 10 hours -metabolized in the tissue and excreted in the urine ADVERSE EFFECTS: -headache -paresthesias -hypotension -vomiting -diarrhea -nausea -uterine rupture -uterine or vaginal pain -chills -diaphoresis -backache -fever

Classifications of Diabetes Mellitus

Type 1, Insulin-Dependent Diabetes Mellitus (IDDM) •Usually a rapid onset; seen in younger people •Connected in many cases to viral destruction of the beta cells of the pancreas Type 2, Non-Insulin-Dependent Diabetes Mellitus (NIDDM) •Usually occurs in mature adults •Has a slow and progressive onset

Prototype of Oxytocics: OXYTOCIN

INDICATIONS: To initiate or improve uterine contractions for early vaginal delivery; to stimulate or reinforce labor in selected cases of uterine inertia; to manage inevitable or incomplete abortion; for second trimester abortion; to control postpartum bleeding or hemorrhage; to treat lactation deficiency ACTIONS: synthetic form stimulates the uterus, especially the graded uterus; causes myoepithelium of the lateral glands to contract; resulting in milk ejection in lactating women PHARMACOKINETICS: route: IV onset: immediate peak: unknown duration: 60 min PHARMACOKINETICS: route: IM onset: 3-5 minutes peak: unknown duration: 2-3 hours T 1/2: 1-6 minutes -metabolized in the tissue and excreted in the urine ADVERSE EFFECTS: cardiac arrhythmias, hypertension, fetal bradycardia, nausea, vomiting, uterine rupture, pelvic hematoma, uterine hypertonicity, severe water intoxication, anaphylactic reaction

Prototype Estrogen Receptor Modulators: Raloxifene

INDICATIONS: -prevention and treatment of osteoporosis in post menopausal women ACTIONS: -increases bone mineral density without stimulating the endometrium -modulates effects of endogenous estrogen at specific receptor sites PHARMACOKINETICS: route: PO onset: varies peak: 4-7 hours duration: 24 hours T 1/2: -27.7 hours -metabolized in the liver and excreted in the urine ADVERSE EFFECTS: -venous thromboembolism -hot flashes -skin rash -nausea -vomiting -vaginal bleeding -depression -light-headedness

Glucose Regulation

INSULIN •Hormone produced by beta cells of the islets of Langerhans •Released into circulation when levels of glucose around these cells rise •Stimulates glycogen synthesis, conversion of lipids into fat stored as adipose tissue, and synthesis of proteins from amino acids •Released after meals, causing blood glucose levels to fall GLUCAGON •Released from alpha cells into islets of Langerhans in response to low blood glucose •Causes immediate mobilization of glycogen stored in the liver and raises blood glucose levels

Categories and subcategories of Hypoglycemic Meds

Insulin Secretagogues 1.Sulfonureas -Chlorpropamide -Glipizide -Glyburide 2.Meglitinides a-Glucosidase Inhibitors 1.Acarbose Insulin Sensitizers 1.Biguanides -Metformin (Glucophage) 2. Thiazolidinediones -Pioglitazone (Actos) Incretin Mimetics -Exentide (Byetta)

Tocolytics

USES: -Relax the uterine smooth muscle and prevent contractions leading to premature labor and delivery -Usually reserved for use after 20 weeks of gestation; neonate has a chance of survival outside the uterus PROTOTYPE: -Hydroxyprogesterone caproate (Makena) is the only drug approved for this purpose in the United States.

Drugs Affecting Posterior Pituitary Hormones Desmopressin (DDAVP, Stimate); Vasopressin(Pitrssin)

NURSING CONSIDERATIONS: -Water intoxication must be avoided with careful monitoring of the client's fluid intake. -Fluid balance needs to be monitored when patients are taking drugs that affect antidiuretic hormone (ADH) -Syndrome of inappropriate antidiuretic hormone (SIADH) ----Presents with fluid retention, dilution of the blood and all of the blood elements, serious issues with water balance and fluid volume ----Treated with drugs that block the ADH or vasopressin receptors, so water is no longer retained and urine is produced, helping to restore water balance ----Keeping the fluid balance in check can be challenging ----Patients receiving these drugs need to be closely monitored in the hospital.

Anabolic Steroids and Their Indications

Oxandrolone (Oxandrin) ---Promote weight gain in debilitated patients ---Increase protein anabolism ---Treat certain cancers Oxymetholone (Anadrol-50) ---Treat various anemias

A nurse is preparing to administer a drug in the antepartum period to induce a pregnant woman's labor contractions. Which medication would the nurse most likely administer?

Oxytocin The induction of labor is related to oxytocin, a hormone that is produced in the hypothalamus, stored in the posterior pituitary, and released into the circulatory system. Once the pituitary releases oxytocin, oxytocin binds to cell membrane receptors on target tissues, primarily the uterine myometrium (muscle cells) and the mammary epithelium.

Glucose Regulation

PANCREAS -Endocrine Gland ---Produces hormones in the islets of Langerhans -Exocrine Gland ---Releases sodium bicarbonate and pancreatic enzymes directly into the common bile duct to be released into the small intestine ---Neutralizes the acid chyme from the stomach and aids digestion

Metformin (Glucophage)

SIDE EFFECTS/ ADVERSE EVENTS •Headaches •Weakness; Dizziness; drowsiness •Agitation •Nausea; vomiting •Thrombocytopenia •Rash •Lactic Acidosis ---Acidosis occurs due to overproduction of lactate, which is a normal byproduct of glucose and amino acid metabolism NURSING IMPLICATIONS: •Take with meals to decrease GI upset •Be aware of symptoms of lactic acidosis: hyperventilation, fatigue, malaise, chills, myalgia, and somnolence (extreme drowsiness; excessive sleepiness) ---Rare but serious adverse event of metformin. If symptoms occur, discontinue medication and report to healthcare provider ---It is essential to discontinue metformin if renal impairment occurs or if serum lactate increases. • There is a black box warning against the use of metformin in persons older than 80 years.

fertility drugs

Stimulate the female reproductive system -Cetrorelix (Cetrotide) -Chorionic gonadotropin (Pregnyl) -Chorionic gonadotropin alpha (Ovidrel) -Clomiphene (Clomid and others) -Follitropin alfa (Gonal-F) -Follitropin beta (Follistim AQ) -Ganirelix (generic) -Menotropins (Pergonal) -Urofollitropin (Bravelle)

Drugs Affecting Posterior Pituitary Hormones Desmopressin (DDAVP, Stimate); Vasopressin(Pitrssin)

Synthetic equivalents of ADH A major clinical use is the treatment of neurogenic diabetes insipidus, a disorder characterized by a deficiency of ADH and the excretion of large amounts of dilute urine. Used cautiously in clients with a history of seizure disorder, migraine headaches, asthma, congestive heart failure, or vascular disease (angina and myocardial infarction)

Thiazide and Thiazide-Like Diuretics

THIAZIDE -Hydrochlorothiazide (generic) ---Only available as an oral preparation -Chlorothiazide (Diuril) ---Only given IV -Methyclothiazide (generic) THIAZIDE-LIKE -Chlorthalidone (generic) -Indapamide (generic) -Metolazone (Zaroxolyn)

posterior pituitary

The posterior pituitary stores two hormones produced in the hypothalamus: 1. Antidiuretic hormone (ADH), also known as vasopressin) 2. Oxytocin stimulates milk ejection or "let down" in lactating women. ---In pharmacological doses, it can be used to initiate or improve uterine contractions in labor.

A nurse is taking care of a woman receiving an abortifacient. Which of the following is the most serious side effect of which the nurse needs to be mindful?

vaginal bleeding All of the options are adverse effects of abortifacients. However, the most serious adverse effect would be vaginal bleeding, which could indicate a perforated uterus or uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken by the nurse.

long-acting corticosteroids

dexamethasone: equivalent dose (mg): 0.75 duration of effects (h): 36-54 betamethasone: equivalent dose (mg): 0.75 duration of effects (h): 35-54

A nurse is caring for a female client who states she has a 28-day cycle. Which two hormones are influential in the female fertility cycle?

estrogen and progesterone The female fertility cycle is under the influence of estrogen and progesterone. Estrogen is a hormone that thickens the lining of the uterus in preparation for egg, assist the body to process calcium to maintain bone structure, helps keep cholesterol levels in balance, and maintains vaginal health. Progesterone regulates the menstrual cycle and maintains pregnancy. Gonadotrophin, testosterone, and growth hormone are hormones secreted by the pituitary gland. Insulin is a hormone secreted by the pancreas.

Glucocorticoids/ Steroids

powerful drugs -short term or long term -ADMINISTER AT 8-9 AM -ADMINISTER SMALL DOSES EVENLY THROUGHOUT DAY TO CONTINUE HOMEOSTASIS -TAPER OFF DOSES WHEN DISCONTINUING DRUG (want a chance to recover because the ATCH or adrenal gland could be confused) -don't give live virus vaccines b/c PATIENT IS IMMUNOSUPPRESSED can cause infections -insulin resistance -decreased deficiency of glucose going to cells - WATCH FOR HYPERGLYCEMIA -S/S- weight gain, osteoporosis (weakening of bone), skin changes

intermediate-acting corticosteroids

prednisone: equivalent dose (mg): 5 duration of effects (h): 18-36 prednisolone: equivalent dose (mg): 5 duration of effects (h): 18-36 triamcinolone: equivalent dose (mg): 4 duration of effects (h): 18-36 methylprednisolone: equivalent dose (mg): 4 duration of effects (h): 18-36

A nurse teaching a 57-year-old client about the factors that must be considered around the use of hormone replacement therapy (HRT) should discuss what increased risk associated with the therapy?

venous thromboembolism Studies have demonstrated no evidence for HRT in secondary prevention of heart disease and showed increased rates of coronary heart disease, thromboembolic stroke, venous thromboembolism, dementia, and breast cancer. HRT does not increase the risk for bronchiectasis, malignant hyperthermia, or Crohn's disease.

CAUSES of hypothyroidism (Underactivity)

•Absence of the thyroid gland •Lack of sufficient iodine in the diet to produce the needed level of thyroid hormone •Lack of sufficient functioning thyroid tissue due to tumor or autoimmune disorders •Lack of TRH related to a tumor or disorder of the hypothalamus •Most common issue with thyroid function

glucose regulation

•Adipocytes secrete adiponectin, which increases insulin sensitivity, decreases release of glucose from liver, and protects blood vessels from inflammation •Endocannabinoid receptors keep the body in a state of energy gain to prepare for stressful situations •Sympathetic nervous system decreases insulin release, increases release of stored glucose, and increases fat breakdown •Corticosteroids decrease insulin sensitivity, increase glucose release, and decrease protein building

Sulfonylureas

•Bind to potassium channels on pancreatic beta cells, may improve insulin binding to insulin receptors and increase number of insulin receptors First Generation -Chlorpropamide(Diabinese) -Tolazamide (generic) -Tolbutamide (generic) Second generation -Glimepiride (Amaryl) -Glipizide (Glucotrol) -Glyburide (DiaBeta, Micronase, Glunase PresTab)

Hypoglycemia

•Blood glucose less than 70 mg/dL ---Normal fasting range: 70 - 110 mg/dL •Initial response is parasympathetic stimulation, followed by "fight-or-flight" reaction ---Breakdown of fat and glycogen to release glucose ---Pancreas releases glucagon to increase glucose and somatostatin ---Symptoms of hypoglycemia include shakiness, dizziness, or light-headedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger •Glucagon can be prescribed for the management of hypoglycemia

Clinical Signs and Symptoms of Hyperglycemia

•Fatigue •Lethargy •Irritation •Glycosuria •Polyphagia •Polydipsia •Itchy Skin DANGEROUS COMPLICATIONS: •Fruity breath as the ketones build up in the system and are excreted through the lungs •Dehydration as fluid and important electrolytes are lost through the kidneys •Slow, deep respirations (Kussmaul's respirations) as the body tries to rid itself of high acid levels •Loss of orientation and coma

Metabolic Changes Occurring When Insufficient Insulin is Released

•Hyperglycemia: Increased blood sugar •Glycosuria: Sugar is spilled into the urine •Polyphagia: Increased hunger •Polydipsia: Increased thirst •Lipolysis: Fat breakdown •Ketosis: Ketones cannot be removed effectively •Acidosis: Liver cannot remove all of the waste products

Replacement Hormone Products for Treating Hypothyroidism

•Levothyroxine (Synthroid, Levoxyl, Levothroid): Synthetic salt of T4 ----drug of choice for hypothyroidism because it is relatively inexpensive, requires once-a-day dosing, and has a more uniform potency than do other thyroid hormone replacement drugs. •Thyroid Desiccated (Armour Thyroid and others): Prepared from dried animal thyroid glands and contains both T3 and T4 •Liothyronine (Cytomel, Triostat): Synthetic salt of T3 •Liotrix (Thyrolar): Synthetic preparation of T4 and T3 in a standard 4:1 ratio

Glucose Elevating Agents

•Raise the blood level of glucose when severe hypoglycemia occurs (<40 mg/dL) ---Diazoxide (Proglycem, Hyperstat) ---Glucagon (GlucaGen) ACTIONS: -Increase the blood glucose levels by decreasing insulin release and accelerating the breakdown of glycogen in the liver to release glucose INDICATIONS: -Treatment of hypoglycem CAUTION: -Hepatic dysfunction or cardiovascular disease ADVERSE EFFECTS: •GI upset •Vascular effects DRUG-DRUG INTERACTIONS: •Thiazide diuretics •Anticoagulants ASSESS: •History of allergy to thiazides if using diazoxide •Severe renal or hepatic dysfunction and CV disease •Orientation and reflexes and baseline pulse, blood pressure, and adventitious sounds •Glucose levels and appropriate lab values

Functions of Thyroid Hormones

•Regulate the rate of metabolism •Affect heat production and body temperature •Affect oxygen consumption, cardiac output, and blood volume •Affect enzyme system activity •Affect metabolism of carbohydrates, fats, and proteins •Regulate growth and development

Antihypercalcemic Agents

•Slow or block bone resorption •Etidronate (Didronel); Ibandronate (Boniva); Pamidronate (Aredia); Risedronate (Actonel) ALENDRONATE (FOSAMAX) •An intake of 1500 mg calcium and 400 to 800 units of vitamin D are recommended daily while taking bisphosphonates ******•The only bisphosphonate that has been approved for the treatment of osteoporosis in men

Antihypocalcemic Agents

•Teriparatide (Forteo) •Parathyroid hormone (Natapara)

Parathyroid Dysfunction: HYPOPARATHYROIDISM

•The absence of parathormone •Most likely to occur with the accidental removal of the parathyroid glands during thyroid surgery

Parathyroid Dysfunction: HYPERPARATHYROIDSIM

•The excessive production of parathormone •Can occur as a result of parathyroid tumor or certain genetic disorders