CH 34: WOMEN'S HEALTH DRUGS

Which medication is used for treating infertility? 1. Oxytocin 2. Clomiphene 3. Indomethacin 4. Dinoprostone

2. Clomiphene Infertility is an absence of ovulation caused by an imbalance in reproductive hormones. Clomiphene stimulates the production of gonadotropin hormones, which in turn leads to ovulation. Oxytocin is used to induce labor when uterine contractions are weak. Indomethacin is used during preterm labor. Dinoprostone is used to evacuate the uterine contents during miscarriage and for cervical ripening.

Which condition in a patient's history is a contraindication for the administration of estrogens? 1. Weight gain 2. Hypertension 3. Dysmenorrhea 4. Thrombophlebitis

4. Thrombophlebitis Contraindications for estrogen administration include known drug allergy, any estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or a history of such a disorder. It is not contraindicated in patients with weight gain, hypertension, or dysmenorrhea.

Contraceptives

Available oral contraceptives- biphasic, triphasic, monophasic, or extended cycle.

Contraceptives- ADVERSE EFFECTS

CV- HTN, edema, thromboembolism, PE, MI CNS- Dizziness, HA, migraines, depression, stroke GI- N/V/D, anorexia, cramps, constipation, increased weight GU- Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, breast changes

Estrogens- ADVERSE EFFECTS

CV- HTN, thromboembolism, edema GI- N/V/D, constipation GU- Amenorrhea, breakthrough uterine bleeding Derm- Chloasma (facial skin discoloration; AKA melasma), hirsutism, alopecia O/- Tender breasts, fluid retention, HA

Uterine Stimulants- ADVERSE EFFECTS

CV- Hypotension or HTN, chest pain CNS- HA, dizziness, fainting GI- N/V/D GU- Vaginitis, vaginal pain, cramping O/- Leg cramps, joint swelling, chills, fever, weakness, blurred vision

Soy

Estrasorb (Glycine max) Chemically similar to the female hormone estradiol. Soy-based emulsion applied like a lotion. Reduces both LDL & total cholesterol levels.

Progestins- ADVERSE EFFECTS

GI- N/V GU- Amenorrhea, spotting O/- Edema, weight gain or loss, rash, pyrexia, somnolence or insomnia, depression

Bisphosphonates- ADVERSE EFFECTS

HA, GI upset, joint pain. Risk for esophageal burns with these medications if they become lodged in the esophagus before reaching the stomach. Several case reports of osteonecrosis of the jaw.

Progestins- MOA

Induction of secretory changes in the endometrium: diminished endometrial tissue proliferation; an increase in the basal body temp; thickening of the vaginal mucosa; relaxation of uterine smooth muscle; stimulation of mammary alveolar tissue growth; feedback inhibition (negative feedback) of the release of pituitary gonadotropins (FSH and LH); and alterations in menstrual blood flow, especially in the presence of estrogen.

Bisphosphonates- MOA

Inhibits osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density. Can reverse lost bone mass and reduce Fx risk.

Fertility Drugs- INDICATIONS

Ovulation in anovulatory women, spermatogenesis in infertile men

Soy- COMMON USES

Reduction of cholesterol level, relief of menopause Sx (alternative to hormonal therapy), osteoporosis prevention

Menotropins- MOA

Standardized mixture of FSH and LH that is derived from the urine of postmenopausal women. The FSH component stimulates the development of ovarian follicles, which leads to ovulation.

Tocolytics

magnesium sulfate indomethacin (NSAID) + nifedipine (CCB)

Ergot alkaloids- INDICATIONS

used after delivery of the infant and placenta to prevent postpartum uterine atony (lack of muscle tone) and hemorrhage

Mifepristone

used to induce abortion and is often given with the synthetic prostaglandin drug misoprostol

SERMs- CONTRAINDICATIONS

women who are or may become pregnant, and in women with a venous thromboembolic disorder (DVT, PE and retinal vein thrombosis) or with a Hx of such a disorder

Estrogens- PT TEACHING

• Hormonal drugs are better tolerated if taken with food or milk to minimize GI upset. • Openly discuss concerns about the meds. Although risks may be associated with HRT, the prescriber will weigh each case individually and make a recommendation based on the benefits versus risks, but with the ultimate decision resting with the patient. • Report the following conditions to the prescriber immediately: HTN, edema, thromboembolism, migraines, depression, and breakthrough bleeding. • Report a weight gain of 2+ pounds in 24 hours or 5+ pounds in 1 week, as well as any breakthrough bleeding or a change in menstrual flow. • Hormones make Pt sensitive to sunlight and tanning beds. Must use appropriate sun protection at all times. • Estrasorb is generally applied once daily to the thighs and calves, as ordered, with one dose provided in two separate pouches. Do not apply sunscreen and other lotions at the same time because they interfere with the drug. To reduce the chance of transfer of this medication to other individuals, allow the application areas to dry completely before covering them with clothing. The drug contained in this dosage form, estradiol, has been found to be present on the skin for up to 8 hours after application. • Conjugated estrogens are used for menopausal Sx and are given orally every day; however, other uses of these estrogens may require different doses and a different dosage schedule/regimen. Emphasize the expected adverse effects such as edema, nausea, diarrhea/constipation, breakthrough uterine bleeding, chloasma (facial skin discoloration), hirsutism, tender breasts, and headache. Encourage Pt to report the following conditions: elevated blood pressure, severe headache with changes in vision and vomiting, abdominal pain, and edema. • Make lifestyle changes as recommended, such as engaging in weight-bearing exercise (e.g., walking), stopping smoking, and limiting or eliminating alcohol intake. These measures will help encourage fewer adverse effects.

Progestins- PT TEACHING

• Hormonal drugs are better tolerated if taken with food or milk to minimize GI upset. • Openly discuss concerns about the meds. Although risks may be associated with HRT, the prescriber will weigh each case individually and make a recommendation based on the benefits versus risks, but with the ultimate decision resting with the patient. • Report the following conditions to the prescriber immediately: HTN, edema, thromboembolism, migraines, depression, and breakthrough bleeding. • Report a weight gain of 2+ pounds in 24 hours or 5+ pounds in 1 week, as well as any breakthrough bleeding or a change in menstrual flow. • Hormones make Pt sensitive to sunlight and tanning beds. Must use appropriate sun protection at all times. • Make lifestyle changes as recommended, such as engaging in weight-bearing exercise (e.g., walking), stopping smoking, and limiting or eliminating alcohol intake. These measures will help encourage fewer adverse effects.

A female patient with strep throat is taking amoxicillin with clavulanate to treat the infection. Because the patient also takes an oral contraceptive (OC), how long should the nurse instruct the patient to use a different method of birth control? 1. For at least a month after starting the antibiotic 2. During the entire period the patient is taking the antibiotic 3. Until three throat cultures have been negative for the pathogen 4. For at least 6 weeks, starting at the end of the antibiotic regimen

1. For at least a month after starting the antibiotic Because antibiotics, especially penicillin and cephalosporins, can impair the action of OCs, the nurse should instruct the patient to use another method of birth control for at least 1 month after starting the antibiotic. The effect of OCs is reduced when antibiotic therapy is started. Hence, using birth control only at the end of the antibiotic regimen is not effective. If three throat cultures are negative for the pathogen, it indicates a need to stop the antibiotic therapy, not to resume the use of birth control.

The labor and delivery nurse is caring for a patient in preterm labor who is receiving indomethacin. The patient develops hypotension. What should be the nurse's initial action? 1. Place the patient on her left side. 2. Immediately discontinue IV fluids. 3. Administer phentolamine mesylate. 4. Instruct the patient to bear down and push.

1. Place the patient on her left side. Placement of the patient in the left lateral recumbent position minimizes hypotension, increases renal blood flow, and increases blood flow to the fetus. Phentolamine mesylate is an alpha-adrenergic blocker and antihypertensive and is not indicated in the treatment of hypotension. Bearing down and pushing when the patient is not ready to deliver could result in fetal compromise.

The clinical reports of a patient taking a bisphosphonate and calcium supplement indicate poor therapeutic levels of the bisphosphonate. Which changes in the medication administration will the nurse need to encourage the patient to implement? 1. "Discontinue the calcium supplement." 2. "Space the medications 1 to 2 hours apart." 3. "Replace the bisphosphonate with calcitonin." 4. "Obtain a prescription for increasing the bisphosphonate dose."

2. "Space the medications 1 to 2 hours apart." Calcium supplements interfere with the absorption of bisphosphonates. Spacing the medications 1 to 2 hours apart helps prevent this interaction. The nurse does not replace the drug without consulting the primary health care provider. The nurse does not discontinue the calcium supplement, because it may affect the patient's health. Increasing the dose of bisphosphonate will not aid in absorption if it interacts with calcium supplements.

Which assessment finding indicates that a patient is a suitable candidate for oxytocin therapy? 1. Vaginal bleeding at 38 weeks' gestation 2. Ineffective contractions in a full term pregnancy 3. Absence of cervical ripening at 42 weeks' gestation 4. Radiographic confirmation of cephalopelvic disproportion

2. Ineffective contractions in a full term pregnancy A patient whose pregnancy is full term but who has ineffective contractions is a suitable candidate for oxytocin therapy to augment the strength and increase the frequency of contractions. Vaginal bleeding in a patient near term is an obstetric emergency, and oxytocin is contraindicated, because it is likely to increase the bleeding, increase and strengthen the contractions, and cause fetal distress. Oxytocin is indicated for the induction of labor in a postterm patient, but the patient must have a soft cervix. In a patient with cephalopelvic disproportion, the fetus's head may be too large for the patient's pelvis; harm to both patient and fetus could occur if oxytocin were administered.

What is the reason for prescribing dinoprostone to a patient who is at 38 weeks' gestation? 1. To terminate pregnancy 2. To induce cervical ripening 3. To treat gestational hypertension 4. To treat pelvic inflammatory disease

2. To induce cervical ripening Dinoprostone is a cervical ripening agent that is used to induce labor near term. Although certain forms of this medication can be used to terminate a pregnancy, this is not its use near term. This medication is not used to treat gestational hypertension or pelvic inflammatory disease.

Ovulation commonly occurs at which day during the menstrual cycle? 1. Day 3 2. Day 7 3. Day 14 4. Day 21

3. Day 14 Ovulation typically occurs at day 14 in the menstrual cycle, when the mature follicle ruptures and releases its ovum. It does not occur on day 3, 7, or 21.

What condition is usually treated by administering menotropins? 1. Menopause 2. Endometriosis 3. Ovulatory dysfunction 4. Central precocious puberty

3. Ovulatory dysfunction Menotropins is the drug name for a standardized mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that is derived from the urine of postmenopausal women. The FSH component stimulates the development of ovarian follicles, which leads to ovulation. The LH component stimulates the development of the corpus luteum, which supplies female sex hormones (estrogens and progesterone) during the first trimester of pregnancy. Hormone replacement therapy is used to treat symptoms associated with menopause-related estrogen deficiency. Progestins are used in treating endometriosis. Menotropins are not used to treat central precocious puberty.

Which instruction should a nurse provide to a patient who is taking alendronate? 1. "Take the medication with aspirin." 2. "Take the medication with antacids." 3. "Take the medication with calcium supplements." 4. "Take the medication on an empty stomach with an 8-oz glass of water."

4. "Take the medication on an empty stomach with an 8-oz glass of water." Alendronate is a bisphosphonate medication used to treat osteoporosis. This medication causes esophageal burns and can lead to gastrointestinal upset. To prevent the esophageal burns, the nurse should instruct the patient to take the medication with an 8-oz of glass of water on an empty stomach. The nurse should not instruct the patient to take the medication along with antacids, because antacids can decrease the absorption of alendronate. Aspirin can cause gastric irritation if it is ingested along with alendronate. Calcium supplements can decrease the absorption of bisphosphonates; therefore, the nurse should suggest that the patient take calcium supplements 1 hour after receiving alendronate.

Which medication is contraindicated in patients who have osteoporosis and a history of renal dysfunction? 1. Calcitonin 2. Tamoxifen 3. Ibandronate 4. Denosumab

4. Denosumab Denosumab prevents bone resorption in patients who have osteoporosis; however, it is contraindicated for patients who have a history of renal dysfunction, because it increases the risk for renal failure. Calcitonin is used to treat osteoporosis and is contraindicated in patients who are allergic to salmon, because it is derived from salmon. Tamoxifen is a selective estrogen receptor modulator (SERM) used to treat osteoporosis and is contraindicated in patients who have deep vein thrombosis or pulmonary embolism, because it increases the risk for thrombosis. Ibandronate is used in the treatment of osteoporosis and is contraindicated if the patient has hypocalcemia and esophageal dysfunction.

Which type of oral contraceptive (OC) delivers hormones for more than 30 days? 1. Biphasic 2. Triphasic 3. Monophasic 4. Extended-cycle

4. Extended-cycle Extended-cycle oral contraceptives deliver hormones for 84 to 365 consecutive days, shortening or eliminating the hormone-free period. Biphasic OCs, which deliver estrogen in a fixed amount for 21 or 28 days, contain a low dose of progestin for the first 10 days and a higher dose of progestin for the remainder of the cycle. Triphasic OCs deliver three different estrogen-progestin combinations over the course of the cycle. Monophasic OCs deliver an unchanging combination of estrogen and progestin.

Which medication helps reduce postpartum uterine hemorrhage? 1. Megestrol 2. Raloxifene 3. Clomiphene 4. Methylergonovine

4. Methylergonovine Methylergonovine is a uterine stimulant used to treat postpartum hemorrhage. Megestrol is a progestational medication used to treat uterine bleeding. Raloxifene is a selective estrogen receptor modulator (SERM) used to prevent the occurrence of postmenopausal osteoporosis. Clomiphene is used to treat infertility.

The nurse is about to administer dinoprostone to a patient. What condition is this medication used for? 1. Premature labor 2. Accelerated labor 3. Postpartum hemorrhage 4. Termination of pregnancy

4. Termination of pregnancy The use of dinoprostone or other prostaglandin E2 drugs is indicated in specific situations requiring termination of pregnancy. It is not required during premature labor, accelerated labor, or postpartum hemorrhage.

A patient tests positive for pregnancy even though she has been taking oral contraceptives. What is a possible cause of this unintended pregnancy? 1. The patient has diabetes. 2. The patient has hypertension. 3. The patient takes anticonvulsants. 4. The patient is on antibiotic therapy.

4. The patient is on antibiotic therapy. Antibiotics reduce the effectiveness of oral contraceptives; hence, the nurse needs to instruct patients to use alternative birth control methods during antibiotic therapy. Diabetes does not reduce the effect of oral contraceptives. Hypertension may be an adverse effect of oral contraceptives. The effectiveness of anticonvulsants is reduced when taken with oral contraceptives.

Fertility Drugs- ADVERSE EFFECTS

CV- Tachycardia, DVT CNS- Dizziness, HA flushing, depression, restlessness, anxiety, nervousness, fatigue GI- Nausea, bloating, constipation, vomiting O/- Urticaria, ovarian hyperstimulation, multiple pregnancy (twins or more), blurred vision, diplopia, photophobia, breast pain

Contraceptives- BIPHASIC

Contain a fixed estrogen dose combined with a low progestin dose for the first 10 days and a higher dose for the rest of the cycle and are available in 21- or 28-day dosage packages

Contraceptives- TRIPHASIC

Contain three different estrogen-progestin dose ratios that are administered sequentially during the cycle and are provided in 21- or 28-day dosage packages. *most closely duplicate the normal hormonal levels of the female cycle*

Estrogens- INTERACTIONS

Decrease the activity of the oral anticoagulants Rifampin, St. John's wort, smoking- decrease estrogenic effect. Tricyclic antidepressants- promote toxicity of the antidepressant. Smoking- add to the risk for thrombosis.

Contraceptives- EXTENDED CYCLE

Differ from the traditional 21 days on, 7 days off pills by decreasing or eliminating the hormone-free dosing interval. Consecutive days of hormonal therapy may extend to 84 to 365 days. *Improved efficacy in women who forget to restart the pill and patient preference to decrease the frequency of menstrual bleeding*

SERMs- MOA

Helps prevent osteoporosis by stimulating estrogen receptors on bone and increasing bone density in a manner similar to that of the estrogens themselves.

SERMs- ADVERSE EFFECTS

Hot flashes and leg cramps Increase the risk for venous thromboembolism and are teratogenic Leukopenia- can predispose the patient to various infections

Progestins- INTERACTIONS

Increase the effects of benzodiazepines and voriconazole. Barbiturates, carbamazepine, phenytoin, rifampin, and St. John's wort- decrease the effectiveness of progestin.

Clomiphene- MOA

Nonsteroidal ovulation stimulant that works by blocking estrogen receptors in the uterus and brain. This results in a false signal of low estrogen levels to the brain. The hypothalamus and pituitary gland then increase their production of Gn-RH (from the hypothalamus) and FSH and LH (from the pituitary gland), which stimulates the maturation of ovarian follicles. Ideally this leads to ovulation and increases the likelihood of conception.

Soy- INTERACTIONS

Orally administered soy may interfere with thyroid hormone absorption (avoid concurrent use).

Contraceptives- MOA

Prevent ovulation by inhibiting the release of gonadotropins and by increasing uterine mucous viscosity, which results in: (1) decreased sperm movement and fertilization of the ovum (2) possible inhibition of implantation (nidation) of a fertilized egg (zygote) into the endometrial lining.

Contraceptives- INDICATIONS

Prevent pregnancy Tx- endometriosis and hypermenorrhea Produce cyclic withdrawal bleeding in patients with amenorrhea Postcoital emergency contraception

Fertility Drugs- CONTRAINDICATIONS

Primary ovarian failure, uncontrolled thyroid or adrenal dysfunction, liver disease, pituitary tumor, abnormal uterine bleeding, ovarian enlargement of uncertain cause, sex hormone-dependent tumors, and pregnancy

Progestins

Produced by the corpus luteum after each ovulation and during pregnancy by the placenta. • Hydroxyprogesterone (Hylutin) • Levonorgestrel (Plan B) • Medroxyprogesterone (Provera, Depo-Provera) • Megestrol (Megace) • Norethindrone acetate (Aygestin) • Norgestrel (Ovrette, Ovral) • Progesterone (Prometrium) • Etonogestrel implant (Implanon)

The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis? 1. The patient smokes cigarettes. 2. The patient's fluid intake is low. 3. The patient takes herbal supplements. 4. The patient takes tricyclic antidepressants.

Smoking causes thrombosis in patients who undergo estrogen therapy. Thrombosis is not caused by a decrease in fluids. Herbal medicines such as St. John's wort decrease the estrogenic effect of drugs. The use of estrogen therapy with tricyclic antidepressants causes toxicity of the antidepressant.

Denosumab

Tx of osteoporosis and bone metastases SubQ injection once every 6 months along with daily calcium and vitamin D.

Estrogens- INDICATIONS

Tx or prevention of a variety of disorders that result primarily from estrogen deficiency: • Atrophic vaginitis (shrinkage of the vagina and/or urethra) • Hypogonadism • Oral contraception (in combination with a progestin) • Ovarian failure or castration (or removal of ovaries) • Uterine bleeding • Breast or prostate cancer (palliative treatment of advanced inoperable cases) • Osteoporosis (treatment and prophylaxis) • Vasomotor symptoms of menopause (e.g., hot flashes)

Progestins- INDICATIONS

Tx- functional uterine bleeding caused by a hormonal imbalance, fibroids, or uterine cancer, primary and secondary amenorrhea Adjunctive/ palliative- Tx of some cancers and endometriosis Alone or in combo w/ estrogens- prevention of conception. Prevention- threatened miscarriage and alleviating the Sx of premenstrual syndrome.

Estrogens

• Conjugated estrogens (Premarin) • Esterified estrogens (Estratab) • Estradiol transdermal (Estraderm, Climara, Vivelle) • Estradiol cypionate (Depo-Estradiol, DepoGen) • Estradiol valerate (Delestrogen) • Ethinyl estradiol (Estinyl) • Estradiol vaginal dosage forms (Vagifem, Estrace Vaginal Cream) • Estrone (Estrone Aqueous) • Estropipate (Ogen, Ortho-Est)

Contraceptives- PT TEACHING

• Openly discuss concerns about the meds. Although risks may be associated with HRT, the prescriber will weigh each case individually and make a recommendation based on the benefits versus risks, but with the ultimate decision resting with the patient. • Take oral contraceptives exactly as ordered and keep all appointments for follow-up examinations (e.g., pelvic examination, Pap smear, and practitioner-performed breast examination). • Stress importance of and technique for monthly breast self-examinations during the ideal time—that is, 7 to 10 days after the start of menstruation or 2 to 5 days after menses ends. • If using progesterone-only intravaginal gel with other gels, be sure to insert the other gels at least 6 hours before or after the progesterone-based product. • Slow-release progesterone IUDs are placed in the uterine cavity by a health care provider. Insets are left in place for 5 years (after insertion) and then must be replaced. Report abnormal uterine bleeding, cramping, abd pain, or amenorrhea immediately. • Using an estrogen/progestin vaginal ring for contraception- insertion and removal techniques and a return demo before the patient leaves the prescriber's office. Menstruation will follow in 2-3 days after the ring is removed and replace the used ring in its foil pouch and discard it in the trash rather than flushing it down the commode. • Oral contraceptive hormones must be taken at the same time every day and exactly as prescribed. If one dose is missed, advise the patient to take the dose as soon as it is remembered; however, if it is close to the next dose time, advise the patient not to double up and to use a backup form of contraception in these situations. • Missed 1 "active" tablet in weeks 1, 2, or 3- tablet needs to be taken as soon as she remembers. • Missed 2 "active" tablets in week 1 or week 2- needs to take 2 tablets the day she remembers and two tablets the next day, and then continue taking one tablet a day until the pack is finished. Use a backup method of birth control such as condoms if she has sex in the 7 days after missing pills. • Missed 2 "active" tablets in the third week, or 3+ "active" tablets in a row- throw out the rest of the pack and start a new pack that same day. Use a backup method of birth control if she has sex in the seven 7 days after missing pills. • Stress the importance of using condoms with oral contraception to prevent sexually transmitted diseases. • Emphasize backup contraception (e.g., condom use) is needed when antibiotics, barbiturates, griseofulvin, isoniazid, rifampin, or St. John's wort is taken with oral contraceptives. These drugs and herbs diminish the effectiveness of oral contraception. • Make lifestyle changes as recommended, such as engaging in weight-bearing exercise (e.g., walking), stopping smoking, and limiting or eliminating alcohol intake. These measures will help encourage fewer adverse effects.

Clomiphene

(Clomid) is primarily used to stimulate the production of pituitary gonadotropins, which in turn induces the maturation of the ovarian follicle and eventually ovulation. It is currently available only for oral use.

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? 1. Male condom 2. Spermicidal agent 3. Intrauterine device 4. Cervical diaphragm

1. Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease, because they provide the most barrier protection. A spermicidal agent kills sperm. An intrauterine device is placed in the uterus. A cervical diaphragm is not as effective as condoms.

What is an adverse effect associated with estrogen therapy? 1. Nausea 2. Dry skin 3. Weight loss 4. Higher-pitched voice

1. Nausea The most common undesirable effect of estrogen use is nausea. Photosensitivity may also occur with estrogen therapy. One common dermatologic effect of note is chloasma, not dry skin. Weight loss and a higher-pitched voice are not caused by estrogen therapy.

Soy- CONTRAINDICATIONS

Allergy to soy products; Estrasorb shares the same contraindications as other estrogen products.

magnesium sulfate- ADVERSE EFFECTS

Calcium gluconate must be readily available to reverse *magnesium toxicity* if it occurs

Bisphosphonates- INTERACTIONS

Calcium supplements and antacids can interfere with the absorption of the bisphosphonates. *Need to be spaced 1-2 hours apart to avoid this interaction.* Aspirin & o/ NSAIDs- additive GI irritation if taken with bisphosphonates.

Calcitonin- INTERACTIONS

Calcium supplements, although often needed by patients with osteoporosis, are also more likely to cause hypercalcemia in patients receiving calcitonin.

SERMs- INTERACTIONS

Cholestyramine decreases the absorption of raloxifene. Raloxifene can decrease the effects of warfarin.

Fertility Drugs

Clomiphene Menotropins

Tocolytics- MOA

Indomethacin- inhibits prostaglandin activity Nifedipine- inhibits myometrial activity by blocking calcium influx

Denosumab- ADVERSE EFFECTS

Infections occur more frequently

Calcitonin- MOA

Like the natural thyroid hormone, calcitonin directly inhibits osteoclastic bone resorption

Soy- ADVERSE EFFECTS

Nausea, bloating, diarrhea, abd pain (ingested forms), & hypersensitivity. When Estrasorb- still present on the skin up to 8 hours after application and can transfer to men, which results in increased estradiol levels.

Tocolytics- INDICATIONS

Preterm labor- substantial uterine contractions that could progress to delivery and occur prior to the 37th week of pregnancy.

6. A patient calls the clinic because she realized she missed one dose of an oral contraceptive. Which statement from the nurse is appropriate? (Select all that apply.) a. "Go ahead and take the missed dose now, along with today's dose." b. "Don't worry, you are still protected from pregnancy." c. "Please come to the clinic for a reevaluation of your therapy." d. "Wait 7 days, and then start a new pack of pills." e. "You will need to use a backup form of contraception concurrently for 7 days."

a. "Go ahead and take the missed dose now, along with today's dose."

Bisphosphonates

alendronate prevention and treatment of osteoporosis

2. When teaching a patient who is taking oral contraceptive therapy for the first time, the nurse relates that adverse effects may include which of the following? a. Dizziness b. Nausea c. Tingling in the extremities d. Polyuria

b. Nausea

Drugs for Osteoporosis

bisphosphonates selective estrogen receptor modulators (SERMs), the hormones: calcitonin and teripartide, denosumab

8. A woman comes into the emergency department. She says that she is pregnant and that she is having contractions every 3 minutes but she is "not due yet." She is very upset. While assessing her vital signs and fetal heart tones, what is the most important question the nurse must ask the patient? a. "What were you doing when the contractions started?" b. "Are you preregistered at this hospital to give birth?" c. "How many weeks have you been pregnant?" d. "Have you felt the baby move today?"

c. "How many weeks have you been pregnant?"

1. The nurse is assessing a patient who is to receive dinoprostone (Prostin E2). Which condition would be a contraindication to the use of this drug? a. Pregnancy at 15 weeks' gestation b. GI upset or ulcer disease c. Ectopic pregnancy d. Incomplete abortion

c. Ectopic pregnancy

5. The nurse is discussing therapy with clomiphene (Clomid) with a husband and wife who are considering trying this drug as part of treatment for infertility. It is important that they be informed of which possible effect of this drug? a. Increased menstrual flow b. Increased menstrual cramping c. Multiple pregnancy (twins or more) d. Sedation

c. Multiple pregnancy (twins or more)

Teriparatide- ADVERSE EFFECTS

chest pain, dizziness, hypercalcemia, nausea, and arthralgia

3. The nurse is reviewing the use of obstetric drugs. Which situation is an indication for an oxytocin (Pitocin) infusion? a. Termination of a pregnancy at 12 weeks b. Hypertonic uterus c. Cervical stenosis in a patient who is in labor d. Induction of labor at full term

d. Induction of labor at full term

Prostaglandins

dinoprostone misoprostol

Uterine Stimulants- CONTRAINDICATIONS

pelvic inflammatory disease, cervical stenosis, uterine fibrosis, high-risk intrauterine fetal positions before delivery, placenta previa, hypertonic uterus, uterine prolapse, or any condition in which vaginal delivery is contraindicated (e.g., increased bleeding risk). *Abortifacients-* presence of IUD, ectopic pregnancy, concurrent anticoagulant therapy or bleeding disorder, inadequate access to emergency health care, or the inability to understand or comply with follow-up instructions

Contraceptives- CONTRAINDICATIONS

pregnancy, known high risk for or Hx of thromboembolic events such as MI, venous thrombosis, PE, or stroke

Fertility Drugs- INTERACTIONS

tricyclic antidepressants, butyrophenones (e.g., haloperidol), phenothiazines (e.g., promethazine), antihypertensive drug (methyldopa)- prolactin concentrations increased, impairing fertility

alendronate

(Fosamax) *Pregnancy category C* Prevention and treatment of osteoporosis in men and in postmenopausal women. Treatment of glucocorticoid-induced osteoporosis in men and Paget disease in women.

Denosumab- MOA

(Prolia) is a monoclonal antibody that blocks osteoclast activation, thereby preventing bone resorption.

Teriparatide- MOA

*First and currently the only drug available that acts by stimulating bone formation.* Derivative of parathyroid hormone and works to treat osteoporosis by modulating the body's metabolism of calcium and phosphorus in a manner similar to that of the natural parathyroid hormone.

The nurse finds that concentrated solutions of magnesium sulfate administered to prevent premature labor have caused toxicity in a patient. What is the best nursing intervention in this case? 1. Obtain a prescription for terbutaline. 2. Decrease the drug dose immediately. 3. Obtain a prescription for indomethacin. 4. Request a prescription to give calcium gluconate.

4. Request a prescription to give calcium gluconate. The nurse administers calcium gluconate, as it reverses magnesium toxicity in the patient. Terbutaline is a beta-adrenergic drug used to prevent premature labor, but it has maternal and fetal safety risks. Decreasing the drug dose will not have the desired drug effect on the patient. Indomethacin is an effective drug for preterm labor, but the most important action here is to reverse magnesium toxicity.

Contraceptives- INTERACTIONS

Use alternative birth control methods for at least 1 month during and after taking any of the following drugs: antibiotics (especially penicillins and cephalosporins), barbiturates, isoniazid, and rifampin. Reduced effectiveness of: anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins.

Teriparatide

Used primarily for the subset of osteoporosis patients at highest risk for fracture (e.g., those with prior fracture)

Prostaglandins- INDICATIONS

Used therapeutically to induce labor by softening the cervix (cervical ripening) and enhancing uterine muscle tone. Also timulate the myometrium to induce abortion during the second trimester when the uterus is resistant to oxytocin.

4. The nurse has provided patient education regarding therapy with the SERM raloxifene (Evista). Which statement from the patient reflects a good understanding of the instruction? a. "When I take that long flight to Asia, I will need to stop taking this drug at least 3 days before I travel." b. "I can continue this drug even when traveling as long as I take it with a full glass of water each time." c. "After I take this drug, I must sit upright for at least 30 minutes." d. "One advantage of this drug is that it will reduce my hot flashes."

a. "When I take that long flight to Asia, I will need to stop taking this drug at least 3 days before I travel."

Uterine Stimulants

ergot derivatives prostaglandins progesterone antagonist mifepristone (RU-486) *the hormone oxytocin (Pitocin)*

Contraceptives- MONOPHASIC

estrogen and progestin doses are the same throughout the cycle

Estrogens- CONTRAINDICATIONS

estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or Hx of such a disorder

Progestins- CONTRAINDICATIONS

estrogen-dependent cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (e.g., stroke, thrombophlebitis) or Hx of such a disorder

Calcitonin- ADVERSE EFFECTS

flushing of the face, nausea, diarrhea, and reduced appetite

Bisphosphonates- CONTRAINDICATIONS

hypocalcemia, esophageal dysfunction, and the inability to sit or stand upright for at least 30 minutes after taking the medication

Denosumab- CONTRAINDICATIONS

hypocalcemia, renal impairment or failure, and infection

Oxytocin- INDICATIONS

induce labor at or near full-term gestation and to enhance labor when uterine contractions are weak and ineffective

magnesium sulfate- INDICATIONS

pregnancy-induced hypertension

SERMs

raloxifene (Evista) *Pregnancy category X* Primarily used for the prevention of postmenopausal osteoporosis.

Calcitonin

salmon (Calcimar, Miacalcin, others) *Pregnancy category C* treatment of osteoporosis

Calcitonin- CONTRAINDICATIONS

salmon allergy

Uterine Stimulants- MOA

stimulate uterine contractions

Uterine Stimulants- INTERACTIONS

sympathomimetic drugs- severe HTN

Drugs for Osteoporosis- PT TEACHING

• Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6-8 oz of water. Remain upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions. • May require supplemental calcium and vitamin D, as ordered by the prescriber.

7. The order reads: "Give calcitonin (Miacalcin) 50 international units subcut daily." The medication is available in a vial that contains 200 international units/mL. How many milliliters will the nurse draw up in the syringe for this dose?

0.25 mL

Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol? 1. Rifampin 2. Furosemide 3. Calcium citrate 4. Acetaminophen

1. Rifampin Rifampin decreases the estrogenic effects of oral contraceptives. Furosemide is used for the treatment of edema. Calcium citrate is a calcium supplement used for preventing osteoporosis. Acetaminophen is used to relieve pain and fever.

A patient with which condition should not use oral contraceptives as a method of birth control? 1. Renal failure 2. Ovarian failure 3. Pulmonary embolism 4. Abnormal vaginal bleeding

3. Pulmonary embolism A history of pulmonary embolism increases the patient's risk for developing thromboembolism, so this patient should not use oral contraceptives. Renal failure, ovarian failure, and abnormal vaginal bleeding are not contraindications for the use of oral contraceptives. Denosumab is contraindicated in patients who have renal failure. Fertility medications, such as clomiphene, are contraindicated in patients who have ovarian failure. Estrogen therapy is contraindicated in patients who have abnormal vaginal bleeding.

Which of the following hormones initiates the cycle of events in the female ovary? 1. Antidiuretic hormone 2. Luteinizing hormone (LH) 3. Adrenocorticotropic hormone 4. Follicle-stimulating hormone (FSH)

4. Follicle-stimulating hormone (FSH) In women, follicle-stimulating hormone initiates the cycle of events in the ovary. Later in the cycle, the combined surges in the levels of estrogen, FSH, and LH stimulate ovulation. Antidiuretic hormone hinders the release of urine.

Estrogens- MOA

The binding of estrogen to intracellular estrogen receptors stimulates the synthesis of DNA, RNA, & proteins- building blocks for all living tissue. Feminization- estrogens produce their effects in estrogen-responsive tissues. Causes initiation of the menses, breast development, redistribution of body fat, softening of the skin, and other feminizing changes.

A pregnant patient has been prescribed oxytocin. What is the nurse's primary intervention for this patient? 1. Assess pulse oximetry continuously. 2. Administer acetaminophen as needed. 3. Monitor the patient's blood pressure frequently. 4. Suggest the patient take aluminum hydroxide with the medication.

3. Monitor the patient's blood pressure frequently. Hypertensive episodes can occur with oxytocin use, so the nurse should monitor the patient's blood pressure frequently. Pulse oximetry is not indicated. Acetaminophen is not given for pain. It is not necessary to give aluminum hydroxide.

What is the purpose of giving estrogen therapy in combination with progestins? 1. To treat ovarian cancer 2. To treat breast cancer 3. To prevent endometrial cancer 4. To reduce the chances of vaginal cancer

3. To prevent endometrial cancer To reduce the risk of endometrial hyperplasia or cancer, the concurrent use of a progestin for 10 to 14 days of the cycle is recommended for women with an intact uterus. Estrogens are administered to prevent complications from ovarian failure but not to treat ovarian cancer. Estrogen therapy raises recurrence risk if administered to patients with breast cancer. Vaginal cancer is treated with surgery or chemotherapy.

The nurse is teaching students about applying a transdermal estradiol patch. Which statement made by a student suggests effective learning? 1. "Rotate the patch every 2 weeks." 2. "Rotate the patch at the same time each day." 3. "Apply the patch to the breast area for better absorption." 4. "Apply the patch to the lower abdomen for better absorption."

4. "Apply the patch to the lower abdomen for better absorption." The estradiol transdermal patch should be applied as prescribed, which is usually one patch applied once or twice weekly to the lower abdomen and not to the breast or chest areas. The patch is not rotated unless prescribed by the primary health care provider and is changed once or twice each week, not daily or bi-weekly.