Pharm 2 Test 2

interactions of anticholinergics (oxybutyin chloride)

1. CYP3A4 inhibitors (grapefruit juice, ketoconazole, erythromycin, itraconazole [Sporanox], plus others) may increase toxicity. 2. CYP3A4 inducers (phenytoin [Dilantin], rifampin [Rifadin], carbamaze- pine [Tegretol], plus others) decrease effectiveness.

interactions for cholinergics (bethanechol)

1. Cholinesterase inhibitors worsen cholinergic effects and increase the risk of toxicity. 2. Mecamylamine (Inversine) worsens abdominal symptoms and hypotension. 3. Procainamide (Pronestyl), quinidine, atropine, and epinephrine interfere with therapeutic effects.

precautions of ergot alkaloids (methylergonovine)

1. Sepsis 2. Liver disease 3. Renal disease 4. Do not take if breastfeeding

adverse effects of progesterone (medroxyprogesterone acetate)

1. Thromboembolism 2. Breast cancer 3. Breakthrough bleeding and other menstrual irregularities 4. Nausea 5. Edema

2 HRT drugs for women

1. estrogen 2. estrogen and progesterone

used for Propecia male-patterned baldness SE: sexual dysfunction, gynecomastia, reduced libido, ejaculatory disorders

5- alpha reductase inhibitors (Finasteride)

The provider discharges the client to home with a prescription to warfarin. You should advise the client to do which of the following (Select all that apply) a. avoid taking NSAIDs b. use a disposable razor c. brush his teeth with a soft toothbrush d. increase intake of dark green, leafy vegetables e. ask the provider before taking the OTC drugs

A,C,E

Used for urinary retention related to BPH Relaxes the muscles of the prostate and bladder neck, enabling the patient to pass urine more easily. SE: postural hypotension, weakness, sleepiness, congestion, sore throat, blurred vision

Alpha 1 adrenergic blockers (Tamsulosin, Uroxatral, Doxazosin)

precautions for glucocorticoids (betamethasone)

Avoid using higher-than-recommended doses

interactions of ovulation stimulant (Human chorionic gonadotropin- hCG)

Concurrent use with tricyclic antidepressants, butyrophenones, phenothiazines, and methyldopa may impair fertility.

Works by inhibiting ovulation and helps make cervical mucus resistant to penetration by sperm. Almost 100% effective if taken properly (patient needs education regarding drug regimen); can cause high blood pressure or DVT's. Stop use if patient experiences a blood clot or high blood pressure. Don't use with patients that have pre-existing CAD or High blood pressure. DON'T SMOKE (age over 35 and obesity use cautiously) Can lead to MI (thickens blood) Can be harmful to a fetus if taken during pregnancy Can stimulate Breast cancer tumor growth Antibiotics & antiseizure medications can reduce effectiveness causing unwanted pregnancy Can cause an increase in blood glucose levels in the diabetic patient

Contraceptives: combination estrogen/ progesterone

medication for hemophilia A

Factor VIII

stimulates hormone prolactin after delivery. Don't use in patients with history of depression.

Lactation Induction: Reglan

what drug class does Viagra (sildenafil) belong to?

Phosphodieterase type 5 (PDE5) inhibitors

precautions of LH and FSH stimulant (clomiphene)

Polycystic ovarian enlargement

Can help with dysmenorrhea by providing physiological action on the neuroendocrine control of ovarian function. And in combination birth control. Also for breakthrough bleeding & endometriosis, emergency contraception (morning after pill)

Progestins

used for insufficient response to other ED medications; injection into the penis or as a pellet inserted into the urethral opening.

Prostaglandins (Alprostadil)

precautions of hyperprolactinemia inhibitor (carbergoline)

Severe hepatic insufficiency

newest PDE5 inhibitor that is fast-acting and highly selective; can be used with patient's who no longer respond as rapidly to other PDE5 inhibitors.

Stenda (Avanafil)

-Drugs used to terminate pregnancy

abortifacients

A client is about to start taking oprelvekin for thrombocytopenia. To assess for adverse effects of this drug, you should monitor which of the following carefully during drug therapy a. liver function b. hearing c. ECG d. LOC

c. ECG

ovarian stimulator and selective estrogen receptor. This drug increases the amount of follicle stimulating hormone (FSH) and luteinizing hormone (LH) secreted by the pituitary gland, thus inducing ovulation for women who have infrequent or absent menstrual periods

clomiphene citrate

You are reviewing the history of a client who is about to start therapy with factor VIII to treat hemophilia A. Which of the following drugs the client takes should alert you to take further action a. albuterol b. phentoin c. phenetzine d. aspirin

d. aspirin

what could penicillin be used for in the mother to treat the fetus

exposure to maternal syphilis

what does the drug clopidogrel do

inhibits platelet aggregation

what does the drug epotein alfa do

stimulates EBC production

When can PDE5 inhibitors (sildenafil) not be used

with patients who are being treated with nitroglycerin for angina

contraindications of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Acute pelvic inflammatory disease 2. Active cardiac disease 3. Active lung disease 4. Liver or kidney impairment 5. Fetal malpresentation 6. Nonreassuring fetal heart rate pattern 7. Uterine scarring from previous surgery

administration of oxytocin

1. Administer IV via infusion pump. 2. Gradually increase the flow rate by 1 to 2 milliunits/min every 30 to 60 min until contractions last 1 min or less every 2 to 3 min. 3. Monitor blood pressure and pulse rate. 4. Monitor for uterine hyperstimulation (contractions lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20 mm Hg). Stop the infusion and report hyperstimulation immediately. 5. Monitor fetal heart rate and rhythm, and report signs of fetal distress. 6. Stop the infusion for serious alterations in fetal heart rate or rhythm.

interactions of testosterone (androderm, delatestryl)

1. Androgens may reduce insulin or antidiabetic drug requirements. 2. Androgens may increase or decrease the effects of oral anticoagulants. 3. Androgens increase the risk of cyclosporine toxicity.

contraindications of anticholinergics (oxybutyin chloride)

1. Angle-closure glaucoma 2. Myasthenia gravis 3. Gastrointestinal obstruction 4. Genitourinary obstruction 5. Active cardiac dysfunction

interactions for GnRH agonists (leuprolide)

1. Antiandrogens such as megestrol and flutamide can increase antineoplastic effects. 2. Increased risk of seizures if administered concurrently with bupropion or SSRIs.

client instructions for glucocorticoids (betamethasone)

1. Instruct client to report shortness of breath, cough, and increased production of sputum. 2. Tell the client to report polyphagia, polydipsia, or polyuria. 3. Instruct client to report headache and dizziness.

contraindications for 5-Alpha Reductase Inhibitor (Finasteride)

1. Pregnancy (teratogenic) 2. Female, children

interventions of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Tell clients about the possibility of altered ejaculation. 2. Monitor for headache. 3. Treat with mild analgesic. 4. Monitor blood pressure. 5. Report changes in B/P and HR.

adverse effects of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Thromboembolism; even greater risk with addition of progesterone than with estrogen alone 2. Nausea 3. Hypertension 4. Breast cancer 5. Breakthrough bleeding and other menstrual irregularities 6. Edema

therapeutic use of glucocorticoids (betamethasone)

1. To increase the production of lung surfactant and to accelerate lung maturity in fetuses between 24 and 34 weeks' gestation 2. To reduce the risk of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and neonatal death

Therapeutic use of ergot alkaloids (methylergonovine)

1. prevention and treatment of postpartum and post abortion hemorrhage

A nurse is providing safety education to a client who is scheduled to begin treatment with Tamsulosin for BPH. Which of the following instructions should the nurse include in the teaching a. change positions slowly b. crush the medication c. take the medication on an empty stomach d. report increase urinary output immediately

a. change positions slowly

A nurse should question the use of ethinyl estradiol and drospirenone by a client who has renal disease due to the increased risk of which of the following a. hyperkalemia b. hyponatremia c. hypoglycemia d. respiratory alkalosis

a. hyperkalemia

A nurse is teaching a client who has a new prescription for transdermal testosterone gel to treat delayed puberty. Which of the following instructions should the nurse include? Select all that apply a. apply the gel to the scrotum b. cover the area of application with clothing c. wash your hands after applying the gel d. do not shower for several hours after applying the gel e. apply the gel to the gums above an upper incisor

b,c,d

A nurse is assessing a client who has a new prescription for the combination oral contraceptive ethinyl estradiol and drospirenone. Which of the following findings should the nurse identify as a contraindication to use of this medication a. drinks a glass of wine each night b. smokes a half a pack of cigarettes' a day c. runs marathon regularly d. drives a school bus

b. smokes a half a pack of cigarettes' a day

A nurse is caring for a client who received human menopausal gonadotropin (hMG). Which of the following findings should the nurse expect a. prolactin secretion b. estrogen release c. follicular maturation d. oxytocin secretion

c. follicular maturation

A nurse is teaching a client about conjugated estrogen and medroxyprogesterone. Which of the following instructions should the nurse include a. monitor for rectal bleeding b. avoid drinking alcoholic beverages c. have blood pressure checked regularly d. sit up for 30 minutes after taking the drug

c. have blood pressure checked regularly

A nurse is preparing to administer finasteride to a client who has BPH. Which of the following precautions should the nurse plan to take when administering this drug a. administer medication while client is sitting or reclining b. withhold the medication if the client doesnt eat c. wear gloves when handling the tablet d. monitor heart rate prior to administration

c. wear gloves when handling the tablet

A nurse is teaching a client who has a new prescription for a testosterone transdermal patch. Which of the following statements made by the client indicates an understanding of the teaching a. i should have pancreatic function tests obtained while taking this drug b. i should have my white blood cell count checked annually c. i should take off the patch to shower d. i should apply the medication to a different site each time

d. i should apply the medication to a different site each time

A nurse is caring for a client who is about to begin taking cabergoline to treat infertilities. The nurse should explain to the client the need to monitor for which of the following laboratory values a. potassium b. glucose c. BUN and creatine d. prolactin level

d. prolactin level

why are infertility drugs prescribed

drugs are prescribed for a woman experiencing infertility increase follicular maturation and promote ovulation.

Used for birth control (cardiovascular risk in women over 35), menopause symptoms, replacement therapy, osteoporosis, hormonal imbalances Use in the lowest effective amount for the shortest time possible SE: increased risk of thromboembolic conditions & endometrial hyperplasia, dementia, & breast cancer

endogesnous estrogens 1. Estrogens: Conjugated estrogens Premarin, Cenestin, & Enjuvia Esterified Estrogens: & Estradiol (IM, PO, topical)

true or false only the strong medications should be avoided during pregnancy and lactation

false rationale: Drug use before and during pregnancy and during lactation requires special consideration and, in general, should be avoided or minimized when possible

what could digoxin be used for in the mother to treat the fetus

fetal tachycardia or heart failure

medication for chronic neutropenia

filgrastim

medication for megaloblastic anemia

folic acid

used to induce ovulation and thus promote fertility. administration is subcutaneous, in calibrated syringes provided by the manufacture. It is important that the drugs not be shaken before administration. After receiving ___________, as with menotropins. women should also receive hCG one day after the last dose of this drug

follitropins

Can help prevent osteoporosis Available in pills, patches, sprays, creams, injection Can increase the risk of stroke, MI, and breast cancer especially in elderly women.

hormone replacement therapy

what could levothyroxine be used for in the mother to treat the fetus

hypothyroidism

commonly used form of injectable birth control used every 3 months: can lead to loss of bone mass long term. Provera: indicated in the treatment of Dysfunctional uterine bleeding.

medroxyprogesterone acetate

Purpose of folic acid in women of child bearing age

prevent neural tube defects

Used to promote cervical ripening, labor induction, & prevent PP hemorrhage. Also used to abort a fetus or end a pregnancy up to 20 weeks:

prostagladins

can be used from many factors including chronic diseases that decrease blood flow including diabetes and from medications used to treat high blood pressure.

sexual dysfunction

What does the drug filgrastim do

stimulates leukocyte production

Androgen deficiency can be treated with _________________ but caution with BPH and can increase the risk of prostate cancer

testosterone

when is maternal-placental-fetal circulation complete?

third week after conception

therapeutic use for cholinergics (bethanechol)

treatment of urinary retention

Mainly used to prevent or control postpartum hemorrhage, but Pitocin also used for labor induction

uterotonics

therapeutic use of LH and FSH stimulant (clomiphene)

1. Promotion of ovulation 2. Treatment of infertility

adverse effects of glucocorticoids (betamethasone)

1. Pulmonary edema (if given with beta-adrenergic medications) 2. Hyperglycemia (if client has pregestational or gestational diabetes) 3. Hypertension

adverse effects of ergot alkaloids (methylergonovine)

1. Rare with PO or IM administration - more common when administered IV 2. Hypertension 3. Nausea, vomiting (rare with oral administration) 4. Cramps 5. Arrhythmias 6. Seizures

interventions of LH and FSH stimulant (clomiphene)

1. Recommend comfort measures such as cold compresses and over-the- counter analgesics. 2. Monitor for worsening symptoms and vomiting. 3. Monitor for and report vision alterations. 4. Recommend an ophthalmology examination if symptoms occur. 5. Discontinue therapy if symptoms occur/persist. 5. Monitor for indications of ovarian enlargement. 6. Make sure clients understand that multiple gestation, usually twins, is not uncommon with clomiphene use.

adverse reactions for 5-Alpha Reductase Inhibitor (Finasteride)

1. Reduced libido and ejaculate volume 2. Reduced prostate-specific antigen (PSA) levels 3. Gynecomastia (males)

3 progesterone only contraceptives

1. norethindrone 2. medroxyprogesterone 3. megestrol acetate

hormonal/ combo contraceptives (estrogen and progesterone)

1. oral medications - ethinyl estradiol and drospirenone -ethinyl estradiol and norethindrone 2. patch/IM - ethinyl estradiol and noreglestromin - medroxyprogesterone acetate 3. ring/ IUD/ implant - ethinyl estradiol and etonogestrel - etonogestrel implants - hormonal IUD

therapeutic use for anticonvulsants (magnesium sulfate)

1. present and treat seizure activity in client with severe preeclampsia or eclampsia

therapeutic use for Beta 2 adrenergic agonists (Terbutaline)

1. preterm labor inhibition (off label use)

therapeutic use of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. promotion of cervical ripening before labor induction

therapeutic use of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. promotion of ovulation 2. treatment of infertility in conjugation with drug therapy for follicular maturation

drugs used to induce labor

1. prostaglandins 2. oxytocics

adverse effects of oxytocin

1. Uterine hyperstimulation 2. Hypertensive crisis 3. Water intoxication (rare at therapeutic doses)

therapeutic use of oxytocin

1. Uterine stimulation 2. Induction or enhancement of labor near or post term 3. Treatment of postpartum hemorrhage

adverse effects of testosterone

1. acne 2. change in sex drive 3. hair loss 4. HA 5. bitter taste 6. hypercalcemia (lead to cardiac problems) 7. jaundice 8. edema

action of progesterone only contraceptives (norethindrone, medroxyprogesterone, megestrol acetate)

1. bind with progesterone receptors in cell nucleus 2. contraception, alone or with estrogen 3. endometriosis 4. prevention of preterm birth 5. amenorrhea due to hormonal imbalance

4 drugs for post partum hemorrhage

1. carboprost 2. methergine 3. misoprostol 4. oxytocin

drugs for infertility

1. clomiphene citrate 2. follitropins alfa 3. human chorionic gonadotropin 4. menotropin 5. leuprolide

therapeutic use of hyperprolactinemia inhibitor (carbergoline)

1. correction of amenorrhea from excessive secretion of prolactin 2. treatment of infertility

interactions for anticonvulsants (magnesium sulfate)

1. decreased absorption of tetracyclines 2. Ca channel blockers-- increases antihypertensives effects

adverse reactions of leuprolide

1. hot flashes 2. HA 3. mood swings 4. insomnia 5. vaginal dryness 6. decreased breast size 7. painful intercourse 8. bone loss

5 drugs for pre term labor

1. hydroxyprogesterone 2. mag sulfate 3. indomethcim 4. terbutaline 5. nifedipine

precautions for anticonvulsants (magnesium sulfate)

1. kidney disease 2. cardiac disease

contraindications for Beta 2 adrenergic agonists (Terbutaline)

1. known sensitivity

adverse effects for cholinergics (bethanechol)

1. Hypotension, bradycardia 2. Excessive gastric acid and salivation, diarrhea, fecal incontinence 3. Bronchoconstriction 4. Dizziness, fainting

contraindications of testosterone (androderm, delatestryl)

1. Pregnancy - teratogenic 2. Breast cancer in males 3. Prostate cancer or obstruction benign prostatic hypertrophy 4. Hypertension 5. Serious cardiac, renal, or hepatic disease 6. Note: Using androgens to improve athletic performance is illegal.

interactions of oral contraceptives (ethinyl estradiol and drospirenone)

1. ACE inhibitors and other drugs that can elevate serum potassium can cause hyperkalemia (due to drospirenone). 2. Rifampin (Rifadin), ritonavir (Norvir), phenobarbital (Luminal), carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John's wort can reduce the effectiveness of oral contraceptives. 3. Oral contraceptives can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs. 4. Oral contraceptives can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants.

adverse effects of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Amniotic fluid embolism, uterine rupture, headache, chills or hypotension. 2. Nausea, vomiting, diarrhea

contraindications for anticonvulsants (magnesium sulfate)

1. Anuria 2. Hypermagnesemia 3. Heart block 4. Hypocalcemia

precautions of progesterone (medroxyprogesterone acetate)

1. Asthma 2. Seizures 3. Cerebrovascular accident 4. Migraines 5. Cardiac or kidney dysfunction

precautions for cholinergics (bethanechol)

1. Bacteremia 2. History of syncope

interventions of hyperprolactinemia inhibitor (carbergoline)

1. Begin treatment at lowest therapeutic dose. 2. Monitor serum prolactin levels. 3. Monitor for worsening GI symptoms and vomiting. 4. Begin treatment at lowest therapeutic dose. 5. Monitor serum prolactin levels. 6. Monitor for headache and other CNS effects. 7. Begin treatment at lowest therapeutic dose. 8. Monitor serum prolactin levels. 9. Monitor blood pressure

precautions for GnRH agonists (leuprolide)

1. Osteoporosis 2. Advanced age

3 drugs for labor induction

1. misoprostol (vaginal pill) 2. oxytocin (IV) 3. dinoprostone (gel and insert)

Medications that are administered to the mother to treat the fetus

1. digoxin (fetal tachycardia or HF) 2. levothyroxine (hypothyroidism) 3. penicillin (exposure to maternal syphilis) 4. corticosteroids (decrease respiratory distress syndrome in preterm infants)

2 drugs used in clients with BPH

1. finasteride 2. tamsulosin

contraindications for glucocorticoids (betamethasone)

1. Hypersensitivity to betamethasone or any component 2. Systemic fungal infections

precautions of oral contraceptives (ethinyl estradiol and drospirenone)

1. Hypertension 2. Diabetes mellitus 3. Heart disease 4. Migraines

precautions of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Hypertension 2. Gallbladder disease 3. Diabetes mellitus 4. Heart disease 5. Migraines 6. Kidney dysfunction

contraindications of ergot alkaloids (methylergonovine)

1. Induction of labor 2. Threatened spontaneous abortion 3. Hypertension

a gonadotropin-releasing hormone that has an unlabeled use in the treatment of infertility. Administered subcutaneously or IM, it prevents ovulation and enhances the production of a larger quantity of quality eggs.

Leuprolide

A nurse is caring for a client who has a new prescription for transdermal conjugated estrogen and medroxyprogesterone to treat postmenopausal symptoms. The nurse should explain to the client that this drug combination includes which of the following therapeutic effects. Select all that apply a. reduces the risk of ovarian cancer b. relieves hot flashes c. prevents osteoporosis d. reduces the risk of breast cancer e. reduces the risk of thromboembolism

a,b,c

client instructions of ergot alkaloids (methylergonovine)

1. Report any nausea. 2. Report headache. 3. Report any weakness or palpitations.

client instructions for cholinergics (bethanechol)

1. Report dizziness. 2. Increase fluid intake to maintain hydration. 3. Report any difficulty breathing. 4. Report dizziness or fainting. 5. Do not engage in dangerous activities if dizziness occurs or tends to recur. 6. Sit or lie down if feeling dizzy.

client instructions for oxytocin

1. Report increasing duration or strength of contractions. 2. Report headache, palpitations, nausea, or chest pain. 3. Report drowsiness or headache

client instructions of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Report increasing duration or strength of contractions. 2. Report nausea, vomiting, and diarrhea 3. Increase clear fluid intake as needed. 4. Report fever.

A client is about to start taking liquid ferrous sulfate to treat iron deficiency anemia. Which of the following instructions should you include when talking with the client about taking this drug. Select all that apply a. swish it in your mouth before swallowing it b. drink it through a straw c. do not rinse your mouth after it d. dilute it first with water e. take it with food if needed

b,d,e

A client is about to start taking warfarin to prevent venous thrombosis. You should explain to the client that taking this drug initially requires daily blood samples to monitor the results of which of the following laboratory tests a. fibrinogen b. PT/INR c. platelets d. aPTT

b. PT/INR

-Drugs given to inhibit labor, maintain pregnancy -Postpone birth long enough to reduce problems associated with prematurity

tocolytics

Drugs given to inhibit labor and maintain pregnancy: Magnesium Sulfate, Nifedipine, Terbutaline, Hydroxprogesterone caproate & Indomethacin

tocolytics

what is delayed puberty treated with in children and adolescent males

treated with testosterone in children and adolescent males: watch for signs of early puberty

true or false •Maternally ingested medications, at any time during the pregnancy, can result in adverse effects to the brain of the neonate or infant.

true rationale: Drugs taken at any time during pregnancy can affect the baby's brain because brain development continues throughout pregnancy and after birth.

contraindications for oxytocin

1. Unripe cervix 2 Placental abnormalities 3. Active genital herpes 4. Uterine surgery 5. Fetal distress 6. Lung immaturity 7. Cephalopelvic disproportion 8. Malpresentation 9. Prolapsed umbilical cord

precautions of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. renal impairment 2. history of syncope 3. hypotension

5- alpha reducatase inhibitors can cause _______________ ______________ because it reduces testosterone levels in order to shrink the prostate

1. sexual dysfunction

3 HRT drugs for men

1. testosterone 2. sildenafil 3. finasteride

therapeutic use for Alpha-adrenergic receptor antagonists (Tamsulosin)

1. treatment of benign prostatic hypertrophy

therapeutic use of PDE5 inhibitors (sildenafil)

1. treatment of erectile dysfunction

therapeutic use of testosterone (androderm, delatestryl)

1. treatment of male hypogonadism, delayed puberty, and testicular failure (males) 2. treatment of breast cancer (females)

therapeutic use of anticholinergics (oxybutyin chloride)

1. treatment of urinary urge incontinence caused by overactive bladder 2. treatment of neurogenic bladder

drug effects on the fetus

1. type, amount of drugs 2. duration of exposure 3. level of fetal growth and development when exposed to medications 4. teratogenicity (birth defects-- typically occur in first trimester. 2nd/3rd trimester drugs manifest adverse effects= growth retardation, respirtaory issues, infection, bleeding) 5. brain effects

interactions for oxytocin

1. vasopressors can cause hypertension

adverse effects of LH and FSH stimulant (clomiphene)

1. Vasomotor instability (hot flashes) 2. Breast engorgement 3. Nausea, abdominal discomfort 4. Blurred vision, flashes of light, dizziness 5. Ovarian hyperstimulation 6. Multiple gestation

adverse effects of testosterone (androderm, delatestryl)

1. Virilization (females, children) 2. Increased growth of existing (undiagnosed) prostate cancer 3. Edema/weight gain 4. Liver toxicity (17-alpha-alkylated androgens only) 5. Premature epiphyseal closure in young clients who have not reached full height 6. Gynecomastia (males)

medications that alter uterine motility

1. abortifaceients (drugs used to terminate the pregnancy) 2. tocolytics (inhibit labor, maintain pregnancy, postpone birth)

action of labetalol

1. alpha/beta adrenergic blocker, 2. decreases HR 3. negative chronotropic action 4. decrease myocardial contraction

client instructions for 5-Alpha Reductase Inhibitor (Finasteride)

1. Expect decreases in libido and ejaculate volume. 2. Undergo regular prostate cancer screenings. 3. Report breast enlargement

Maternal therapeutics to manage common pregnancy complaints. What are some of the typical complaints

1. anemia 2. constipation 3. GERD 4. gestational diabetes 5. n/v 6. preeclampsia

administration of hyperprolactinemia inhibitor (carbergoline)

1. Take orally twice per week on the same days of the week. 2. Take with or without food. 3. Discontinue when prolactin levels are within the expected reference range

A nurse should question the use of conjugated equine estrogen by a client who has a history of which of the following a. osteoporosis b. peptic ulcer disease c. rheumatoid arthritis d. blood clots

d. blood clots

After administering terbutaline to a client to inhibit preterm labor the nurse should assess which of the following a. peripheral pulses b. temperature c. vision d. heart rate

d. heart rate

Which of the following drugs should you have in case of heparin overdose a. aminocaproic acid b. deferoxamine c. vitamin K d. protamine

d. protamine

Before administering IV folic acid, you should explain to the client that this drug can cause which of the following adverse effects a. headache b. nausea c. dizziness d. rash

d. rash

medication for heparin

deep vein thrombosis

precautions for PDE5 inhibitors (sildenafil)

1. Myocardial infarction, cerebrovascular accident, or potentially fatal dysrhythmias within the past 6 months 2. Unstable angina 3. Heart failure 4. Hepatic or renal disease

contraindications of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Concurrent use of erectile dysfunction drugs such as sildenafil (Viagra) 2. Females, children

contraindications of PDE5 inhibitors (sildenafil)

1. Concurrent use of nitroglycerin or other nitrates 2. Children

What does the drug altepase do?

dissolve blood clots

administration for glucocorticoids (betamethasone)

1. Betamethasone (Betaject) 12 mg IM for 2-3 doses 24 hr apart 2. Dexamethasone 6 mg IM for four doses 12 hr apart 3. Give deep IM in ventral gluteal or vastus lateralis muscle

adverse effects of GnRH agonists (leuprolide)

1. Bone loss 2. Vasomotor instability (hot flashes) 3. Vaginal dryness 4. Headache

administration of ergot alkaloids (methylergonovine)

1. Check blood pressure before administration. Do not give if B/P exceeds parameters set by provider 2. Give orally for 2 to 7 days or IM every 2 hr as needed. 3. Give the drug IV only for emergency control of severe hemorrhage. 4. Administer IV doses slowly (over 1 min to minimize adverse effects). 5. Administer after the delivery of the placenta. 6. Monitor vital signs and uterine response. 7. Tell clients to expect some cramping

precautions of testosterone (androderm, delatestryl)

1. Diabetes mellitus 2. Benign prostatic hypertrophy 3. Older adults

patient teaching for PDE5 inhibitors (sildenafil)

1. Side effects - HA -facial flushing - dyspepsia -nasal congestion - dizziness - rarely NAION - priaprism

contraindications of hyperprolactinemia inhibitor (carbergoline)

1. Uncontrolled hypertension 2. Pregnancy-induced hypertension

Therapeutic use of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Relief of severe menopausal symptoms (vasomotor) and vulvar and vaginal atrophy 2. Prevention of postmenopausal osteoporosis

administration of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Take orally once a day. 2. Take at the same time each day, 30 min after the same meal (such as breakfast). 3. Swallow the capsules whole; do not crush or chew them

testosterone belongs to what drug class

androgens

administration for cholinergics (bethanechol)

1. Take orally three to four times a day. 2. Take 1 hr before or 2 hr after meals.

adverse effects of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Reduced ejaculate volume, ejaculation failure, retrograde ejaculation (tamsulosin and silodosin) 2. Headache and dizziness 3. Hypotension, fainting, (nonselective alpha blockers, not tamsulosin)

_______________ use in the pediatric population may increase the risk of suicidality.

antidepressant

what could corticosteroids be used for in the mother to treat the fetus

decrease respiratory distress syndrome in preterm infants

interventions of ergot alkaloids (methylergonovine)

1. Monitor blood pressure. 2. Monitor for nausea and vomiting. 3. Monitor for headache and note any worsening of headache. 4. Monitor heart rate. 5. Monitor for signs of seizure activity. 6. Institute seizure precautions if indicated

administration for anticonvulsants (magnesium sulfate)

1. Loading dose of 4 to 6 g magnesium sulfate intermittent IV bolus as a secondary infusion over 15 to 30 min. Use a volumetric pump to ensure accuracy of dose. 2. Administer maintenance dose by continuous infusion at 2 g/hr. 3. Monitor blood levels to maintain therapeutic level at 4 to 7 mEq/L

administration of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. Confirm follicular maturation with clomiphene (Clomid), menotropins, or follitropins before administration. 2. Give via IM injection after reconstituting powder with the supplied diluent. 3. When used with clomiphene, give 7 to 9 days after the previous dose of clomiphene. 4. When used with menotropins or follitropins, give 1 day after the previous dose

administration of oral contraceptives (ethinyl estradiol and drospirenone)

1. Confirm negative pregnancy status before starting therapy. 2. Use an additional method of contraception during the first cycle. 3. Take pills at the same time each day. 4. Take according to the precise dosing schedule, typically 21 days of a drug-containing pill and 7 days of an inactive pill. 5. Follow the manufacturer's instructions for missed pills, typically taking one missed pill with the next pill, two pills for 2 consecutive days after 2 missed days, and after 3 missed days starting a new cycle 7 days later with alternative contraception in the interim.

interventions for cholinergics (bethanechol)

1. Monitor blood pressure and heart rate. 2. Monitor bowel elimination patterns. 3. Monitor respiratory status. 4. Monitor for dizziness. 5. For in-patient use, have a bedpan or urinal readily available and assist with ambulation

precautions for Beta 2 adrenergic agonists (Terbutaline)

1. Diabetes mellitus 2. Cardiac disease, hypertension 3. Hyperthyroidism 4. Glaucoma

contraindications for cholinergics (bethanechol)

1. Hypotension 2. Hyperthyroidism 3. Low cardiac output 4. Asthma, chronic obstructive pulmonary disease 5. Gastric ulcers 6. Urinary tract obstruction or bladder wall weakness 7. Intestinal obstruction 8. Recent intestinal surgery

administration for Beta 2 adrenergic agonists (Terbutaline)

1. Confirm preterm labor and gestation between 20 and 36 weeks. 2. Usually administered subcutaneously (lateral deltoid area) 3. every 20 min 4. up to 3 hr 5. no longer than 48 hr 6. Less often administered by IV infusion 7. Monitor fetal heart rate and rhythm, and report signs of maternal or fetal distress. 8. Stop the infusion for serious alterations in fetal heart rate (above 180 beats/min) or rhythm (nonreassuring).

interactions of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Drugs that lower blood pressure can increase hypotensive effects of nonselective alpha blockers. 2. Erythromycin, itraconazole (Sporanox), nefazodone (Serzone), and HIV protease inhibitors increase levels of nonselective alpha blockers. 3. Cimetidine (Tagamet) may worsen orthostatic hypotension.

interactions of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Oxytocic agents increase the risk of uterine hyperstimulation.

adverse effects of anticholinergics (oxybutyin chloride)

1. Dry mouth 2. Constipation 3. Urinary retention 4. Mydriasis (pupil dilation), dry eyes, blurred vision 5. Headache 6. Dizziness, drowsiness 7. Fever, heat exhaustion

client instructions of Alpha-adrenergic receptor antagonists (Tamsulosin)

1. Expect decreases in ejaculate volume and ejaculation failure. 2. Report headache not relieved with an over-the-counter analgesic. 3. Have blood pressure checked regularly. 4. Rise slowly from a reclining or sitting position. 5. Report dizziness or fainting. 6. Do not engage in dangerous activities if dizziness occurs or tends to recur. 7. Advise client this drug will need to be taken lifelong.

client instructions of LH and FSH stimulant (clomiphene)

1. Expect hot flashes as a side effect of this therapy. 2. Apply cold compresses as needed and if helpful. 3. Take over-the-counter anti-inflammatory drugs as needed. 4. Wear a supportive bra. 5. Take the drug with food. 6. Report any visual disturbances. Do not engage in dangerous activities if symptoms occur. 7. Report pelvic pain. 8. Be aware of the possibility of twins.

client instructions of testosterone (androderm, delatestryl)

1. Expect virilization if being treated for breast cancer (women). 2. Report body hair growth, acne, and changes in voice and menstruation. 3. Report changes in urination, pain with ejaculation, or blood in the urine. 4. Undergo regular prostate cancer screenings. 5. Check weight twice a week. 6. Report weight gain and swelling in the legs. 7. Undergo liver function tests at recommended intervals. 8. Report jaundice, fatigue, nausea, or loss of appetite. 9. Obtain hand and wrist x-rays at recommended intervals. 10. Report breast enlargement.

adverse effects for anticonvulsants (magnesium sulfate)

1. Flushing, diaphoresis 2. Drowsiness, muscle weakness 3. Maternal hypotension, bradycardia, bradypnea 4. Depressed/absent deep tendon reflexes (DTRs) 5. Altered level of consciousness 6. Decreased urine output 7. Magnesium toxicity 8. Reduced variability of fetal heart rate

A nurse is caring for a client who is about to begin taking finasteride to treat benign prostatic hypertrophy. The nurse should explain to the client the need to monitor which of the following laboratory values a. prostate-specific antigen (PSA) b. BUN c. creatine phosphokinase (CPK) d. ALT

a. prostate-specific antigen (PSA)

A nurse is teaching a client about receiving leuprolide to treat endometriosis. The nurse should instruct the client to expect which of the following side effects a. vaginal dryness b. hypertension c. blurred vision d. orthostatic hypotension

a. vaginal dryness

- drug class used for treatment for androgen deficiency - Testosterone: In many forms: excreted in response to luteinizing hormone; many potential side effects.

androgens

administration of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Gel: - Administer intracervically using a syringe prefilled with the drug in gel form and an endocervical catheter. - Have clients lie supine during instillation and remain supine for 30 min. - Repeat dosing every 6 hr, twice, if the desired therapeutic effect has not occurred. - Monitor uterine activity and fetal heart rate. - Monitor uterine hyperstimulation (contractions lasting longer than 60 seconds, occurring more frequently than every 2 to 3 min, resting uterine pressure greater than 15 to 20 mm Hg). Report hyperstimulation immediately. - Begin oxytocin 6 to 12 hr after the last dose. 2. Vaginal insert: - Insert the pouch containing the drug into the posterior fornix of the vagina. - Have clients lie supine for 2 hr while the pouch gradually releases the drug. - Remove the pouch using the attached tape when active labor begins or 12 hr later. - Follow the monitoring precautions listed above.

administration of progesterone (medroxyprogesterone acetate)

1. Give orally daily or cyclically or via IM injection. 2. Expect amenorrhea and other menstrual irregularities.

administration of GnRH agonists (leuprolide)

1. Give via IM injection monthly or give depot form IM every 4 months. 2. Rotate injection sites. 3. Refrigerate unopened vials. 4. Expect amenorrhea and other menstrual irregularities.

interactions for glucocorticoids (betamethasone)

1. Glucocorticoids can decrease antibody responses to vaccines and can increase the risk of infection from live vaccines. 2. Immunizations should be avoided while glucocorticoids are in use

contraindications of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. History of or other risk for thromboembolic events 2. Suspected or confirmed breast, vaginal, cervical, or endometrial cancer 3. Liver disease 4. Undiagnosed vaginal bleeding

contraindications of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. History of or other risk for thromboembolic events 2. Suspected or confirmed breast, vaginal, cervical, or endometrial cancer 3. Liver disease 4. Undiagnosed vaginal bleeding

precautions of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Hypertension 2. Gallbladder disease 3. Diabetes mellitus 4. Heart disease 5. Migraines 6. Kidney dysfunction

precautions of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Hypo- or hypertension 2. Asthma 3. Diabetes mellitus 4. Uterine scarring from previous cesarean section 5. Seizure 6. Glaucoma

interactions for Beta 2 adrenergic agonists (Terbutaline)

1. Hypoglycemic (antidiabetes) drugs require increased dosing due to hy- perglycemic effects. 2. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risks of hypertension, tachycardia, and angina.

interventions of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Inform clients that this effect diminishes with time. 2. Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident. 3. Encourage clients who smoke to quit smoking. 4. Use HRT for no more than 3 to 4 years to treat vasomotor or genital symptoms of menopause. 5. Monitor blood pressure. 6. Monitor for vaginal bleeding. 7. Advise a yearly pelvic examination. 8. Check that clients who have an intact uterus are prescribed progesterone with their estrogen.

client instructions for Beta 2 adrenergic agonists (Terbutaline)

1. Report shortness of breath, difficulty breathing, or cough. 2. Report palpitations or chest pain. 3. Report weakness, nausea, palpitations, or paresthesia. 4. Report polyphagia, polydipsia, and polyuria.

interventions of GnRH agonists (leuprolide)

1. Limit drug therapy to 6 months. 2. For longer-term therapy, monitor for bone loss via bone density scanning at recommended intervals. 3. Discuss complementary/alternative therapies. 4. Suggest vitamin B6 and vitamin E supplements. 5. Recommend water-soluble vaginal lubricants as appropriate. 5. Monitor for headache and other central nervous system effects

precautions for 5-Alpha Reductase Inhibitor (Finasteride)

1. Liver impairment 2. Obstructive uropathy

interventions of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident. 2. Encourage clients who smoke to quit smoking. 3. Plan for temporary use of HRT (3 to 4 years) for vasomotor symptoms. 4. Inform clients that this effect diminishes with time. 5. Monitor blood pressure. 6. Recommend mammograms and breast examinations at appropriate intervals. 7. Discontinue the drug for any indications of breast cancer. 8. Monitor the pattern and amount of any reported bleeding. 9. Monitor for edema and weight gain

interventions of oral contraceptives (ethinyl estradiol and drospirenone)

1. Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident. 2. Encourage clients who smoke to quit. 3. Monitor potassium levels and electrocardiogram periodically. 4. Monitor blood pressure. 5. Monitor the pattern and amount of any reported bleeding. 6. Recommend mammograms and breast examinations at appropriate intervals. 7. Discontinue the drug for any indications of breast cancer

interventions of progesterone (medroxyprogesterone acetate)

1. Monitor for and report any indications of deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident. 2. Encourage clients who smoke to quit. 3. Recommend mammograms and breast examinations at appropriate intervals. 4. Discontinue the drug for any indications of breast cancer. 5. Monitor the pattern and amount of any reported bleeding. 6. Inform clients that this effect diminishes with time. 7. Monitor weight.

interventions of anticholinergics (oxybutyin chloride)

1. Monitor for anticholinergic effects. 2. Monitor bowel elimination patterns. 3. Monitor urinary elimination patterns, especially in older adults. 4. Recommend periodic eye examinations. 5. Monitor for headache. 6. Monitor for dizziness and somnolence. 7. Advise clients to use caution in hot weather, as the drug suppresses sweating

interventions of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. Monitor for indications of ovarian hyperstimulation syndrome. If sus- pected, this syndrome warrants hospitalization and immediate discon- tinuation of drug therapy. 2. Monitor for indications of bleeding into the peritoneum. 3. Monitor for CNS effects

interventions for anticonvulsants (magnesium sulfate)

1. Monitor infusion site. 2. Check client for adverse effects. 3. Check client before and throughout therapy for headache, dizziness, blurred vision, and muscle weakness. 4. Monitor blood pressure, pulse, and respiratory rate every 15 to 30 min. 5. Report respiratory rate of 12/min or less. 6. Monitor DTRs every 1 to 4 hr. 7. Discontinue infusion and notify provider of diminished or absent reflex. 8. Monitor level of consciousness before initiation of medication and throughout therapy. 9. Monitor strict input and output, with urinary output hourly. - Report urine output of less than 25 to 30 mL/hr. - Output less than 25 mL/hr can warrant discontinuation of treatment. 10. Monitor serum magnesium levels (target range 4 to 7 mEq/L). 11. Ensure antidote for toxicity, calcium gluconate or calcium chloride, is readily available. 12. Monitor breath sounds. 13. Report presence of crackles. 14. Discontinue infusion and notify provider of findings. 15. Monitor fetal heart rate for decreased variability

interventions for glucocorticoids (betamethasone)

1. Monitor lung sounds and other indications. 2. Report crackles in the lungs, productive cough, dyspnea, cyanosis, and other clinical manifestations of pulmonary edema to the provider. 3. Monitor and treat episodes of hyperglycemia. 4. Monitor blood pressure.

interventions for Beta 2 adrenergic agonists (Terbutaline)

1. Monitor respiratory status, including oxygen saturation. 2. Initiate fluid restrictions if indicated. 3. Stop tocolytic therapy for indications of pulmonary edema (dyspnea, drop in oxygen saturation, crackles). 4. Obtain baseline vital signs and an ECG before tocolytic therapy. 5. Monitor fetal and maternal heart rate and blood pressure. 6. Monitor patterns and intensity of chest pain. 7. Stop tocolytic therapy for indications of maternal tachycardia, dysrhythmias, chest pain, or blood pressure below set parameters 8. Prepare to administer propranolol (Inderal) to counteract cardiac adverse effects. 9. Monitor cardiovascular status for 12 hr after discontinuation of tocolytic therapy. 10. Initiate fluid and electrolyte remediation or replacement. 11. Monitor blood glucose levels, especially for clients who have diabetes mellitus. 12. Adjust dosages of insulin/hypoglycemic drugs accordingly. 13. Monitor fetal heart rate and rhythm and report signs of fetal distress. 14. Stop the infusion for serious alterations in fetal heart rate or rhythm

interventions of synthetic prostaglandins (dinoprostone vaginal insert or gel)

1. Monitor risk factors such as multiple deliveries. 2. Monitor length, strength, and duration of contractions. 3. For indications of hyperstimulation, turn client on her side, remove the pouch (if it is used), and administer oxygen. 4. Be prepared to administer a uterine relaxant. 5. Monitor for nausea, vomiting, and diarrhea. For clients who develop these symptoms, pretreat subsequent doses of gel with antidiarrheal and antiemetic agents. 6. Maintain hydration. 7. Monitor temperature.

interventions of oxytocin

1. Monitor risk factors such as multiple deliveries. 2. Monitor length, strength, and duration of contractions. 3. For indications of hyperstimulation, turn clients on their side, stop the infusion, and administer oxygen. 4. Be prepared to administer a uterine relaxant 5. Monitor for headache, nausea, vomiting, and increasing blood pressure. 6. Monitor intake and output and level of consciousness.

adverse effects of hyperprolactinemia inhibitor (carbergoline)

1. Nausea 2. Headache, dizziness 3. Pulmonary fibrosis, pericardial fibrosis, valvular disorders and retroperitoneal fibrosis.

adverse effects of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Nausea 2. Thromboembolism: thrombophlebitis, pulmonary embolism, stroke, myocardial infarction 3. Hypertension 4. Endometrial hyperplasia, endometrial and ovarian cancer

interactions for PDE5 inhibitors (sildenafil)

1. Nitrates (nitroglycerin) increase the risk of life-threatening hypotension. 2. CYP3A4 inhibitors (grapefruit juice, ketoconazole, erythromycin, itraconazole [Sporanox], cimetidine [Tagamet], and others) increase plasma levels and the risk of adverse effects. 3. Alpha-adrenergic antagonists such as doxazosin (Cardura) and drugs used to treat benign prostatic hypertrophy can cause orthostatic hypotension. 4. Rifampin (Rifadin) can decrease drug levels.

administration of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Oral: - Take according to the precise dosing schedule, typically continuously to avoid monthly bleeding. - Take pills at the same time each day. 2. Transdermal - Apply patches at the recommended interval, typically every 3 to 4 days. - Apply to clean, dry, intact skin on the abdomen or trunk (not breasts or waistline) and press firmly for 10 seconds. - Do not use the same site more than once per week

administration of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Oral: - Take according to the precise dosing schedule, typically continuously to avoid monthly bleeding. - Take pills at the same time each day. 2. Transdermal estradiol patches: - Apply patches at the recommended interval, typically once or twice per week. - Apply to clean, dry, intact skin on the abdomen or trunk (not breasts or waistline) and press firmly for 10 seconds. - Do not use the same site more than once per week. 3. ntravaginal estradiol hemihydrate tablets (Vagifem) or vaginal cream (Estrace vaginal cream): - Use according to the precise dosing schedule, typically tablets are inserted once daily for 2 weeks, then twice per week. - Insert tablet using provided applicator at bedtime. - Vaginal cream is applied using a reusable applicator to measure the precise dose; insert into vagina at bedtime.

interactions of ergot alkaloids (methylergonovine)

1. Other ergot alkaloids, vasopressors, and triptans increase the risk of hypertension. 2. Protease inhibitors and itraconazole (Sporanox) increase the risk of toxicity. 3. Smoking increases vasoconstrictive effects. 4. Grapefruit juice increases blood levels of drug.

adverse effects of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. Ovarian hyperstimulation 2. Ovarian cyst rupture 3. CNS effects: irritability, headache, fatigue, restlessness

client instructions for GnRH agonists (leuprolide)

1. Perform weight-bearing exercise daily. 2. Consume adequate calcium and vitamin D. 3. Identify and avoid conditions that trigger hot flashes, such as fluctuations in glucose levels. 4. Consider alternative therapies with the provider's prescription. 5. Use vaginal lubricants if indicated. 6. Report headache, dizziness, or paresthesia. 7. Take over-the-counter analgesics to relieve headache.

contraindications of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. Pituitary tumor 2. Dysfunctional uterine bleeding 3. Uncontrolled thyroid disease 4. Adrenal insufficiency

precautions for oxytocin

1. Pre-eclampsia/hypertension 2. Multiparity (multiple fetuses) 3. Seizures 4. Polyhydramnios 5. Cardiac disease

contraindications of LH and FSH stimulant (clomiphene)

1. Pregnancy - teratogenic 2. Primary ovarian failure 3. Undiagnosed uterine bleeding 4. Liver disease 5. Uncontrolled thyroid disease 6. Thrombophlebitis

contraindications for GnRH agonists (leuprolide)

1. Pregnancy - teratogenic effects 2. Allergy to benzyl alcohol 3. Abnormal vaginal bleeding 4. Metastatic cerebral lesions

contraindications of progesterone (medroxyprogesterone acetate)

1. Pregnancy - teratogenic effects 2. History of or high risk for thromboembolic events 3. Undiagnosed vaginal bleeding 4. Liver disease 5. Cervical, uterine, vaginal, or breast cancer

contraindications of oral contraceptives (ethinyl estradiol and drospirenone)

1. Pregnancy-has teratogenic effects 2. History or other risk for thromboembolic events 3. Suspected or confirmed breast cancer 4. Altered liver function 5. Altered renal or adrenal function (estradiol and drospirenone) 6. Smokers older than 35 years

therapeutic use of oral contraceptives (ethinyl estradiol and drospirenone)

1. Prevention of pregnancy 2. Reduction in fluid retention associated with premenstrual syndrome 3. Other benefits of oral contraceptives include decreased risk for: - Uterine and ovarian cancers - Pelvic inflammatory disease - Benign breast disease - Ovarian cysts

adverse effects of PDE5 inhibitors (sildenafil)

1. Priapism (persistent erection) 2. Headache 3. Hypotension, fainting, dizziness 4. Sudden loss of hearing (rare) 5. Irreversible loss of vision (rare)

client instructions of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath. 2. Do not smoke. 3. Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events. 4. Exercise regularly and follow a healthy, low-fat diet. 5. Take oral forms with food. 6. Take pill or apply transdermal patch at bedtime. 7. Obtain regular blood pressure checks. 8. Perform breast self-examination every month. 9. Obtain a mammogram and breast examination at the recommended intervals. 10. Report vaginal bleeding or spotting to the provider. 11. Advise client to report edema to provider

client instructions of progesterone (medroxyprogesterone acetate)

1. Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath. 2. Do not smoke. 3. Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events. 4. Perform breast self-examination every month. 5. Obtain a mammogram and breast examination at the recommended intervals. 6. Report any unusual breakthrough bleeding or spotting or changes in menstrual patterns. 7. Take oral forms with food. 8. Take at bedtime.

client instructions of oral contraceptives (ethinyl estradiol and drospirenone)

1. Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath. 2. Do not smoke. 3. Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events. 4. Report palpitations, paresthesia, weakness, or abdominal cramps. 5. Obtain regular blood pressure checks. 6. Report any unusual breakthrough bleeding or spotting or changes in menstrual patterns. 7. Perform breast self-examination every month

adverse effects for Beta 2 adrenergic agonists (Terbutaline)

1. Respiratory effects: pulmonary edema, dyspnea, cough, tachypnea 2. Cardiac effects: tachycardia, myocardial ischemia, chest pain, palpitations, hypotension 3. Hypokalemia 4. Hyperglycemia 5. Fetal effects: hypotension, tachycardia, hyperinsulinemia/hypoglycemia, hyperbilirubinemia, hypocalcemia

interactions of progesterone (medroxyprogesterone acetate)

1. Rifampin (Rifadin), ritonavir (Norvir), phenobarbital (Luminal), carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John's wort can reduce the effectiveness of progesterones. 2. Progesterones may require adjustments in the dosage of hypoglycemic drugs.

interactions of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. Rifampin (Rifadin), ritonavir (Norvir), phenobarbital, carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John's wort can reduce the effectiveness of hormone replacement therapy. 2. HRT can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs. 3. HRT can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants. 4. Ketoconazole may increase the adverse effects of progesterone.

interactions of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Rifampin, ritonavir (Norvir), phenobarbital, carbamazepine (Tegretol), primidone (Mysoline), phenytoin (Dilantin), and St. John's wort can reduce the effectiveness of estrogens. 2. Estrogens can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs. 3. Estrogens can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants.

client instructions for PDE5 inhibitors (sildenafil)

1. Seek medical care immediately for an erection lasting more than 4 hr. 2. Report headache. 3. Take over-the-counter analgesics to relieve headache. 4. Report dizziness or fainting. 5. Have blood pressure checked regularly. 6. Stop taking the drug if hearing loss is suspected; further evaluation should be done by provider. 7. Seek medical care immediately for changes in vision.

client instructions of ovulation stimulant (Human chorionic gonadotropin- hCG)

1. Seek medical care immediately for pelvic or low abdominal pain or pressure, unusual weight gain, or swelling. 2. Report pelvic or abdominal pain. 3. Take over-the-counter analgesics as needed for headache.

client instructions of anticholinergics (oxybutyin chloride)

1. Suck on hard candy. 2. Sip water. 3. Increase fluid and fiber intake. 4. Increase activity levels. 5. Report any undesirable changes in urinary elimination (retention, infection). 6. Use over-the-counter lubricating eye drops. 7. Obtain regular eye examinations (potential for glaucoma). 8. Report headache not relieved by over-the-counter analgesics. 9. Report dizziness or fainting. 10. Do not engage in dangerous activities if dizziness occurs or tends to recur. 11. Avoid becoming overheated. 12. Seek medical attention for fever and signs of heat exhaustion (muscle cramps, dizziness, nausea, vomiting).

client instructions of Estrogen HRT: Conjugated Equine Estrogen, Transdermal Estradiol, Intravaginal Estradiol

1. Take oral forms with food. 2. Report leg or chest pain, leg edema, sudden change in vision, severe headache, or shortness of breath. 3. Do not smoke. 4. Stop taking at least 4 weeks before any surgery that increases the risk of thromboembolic events. 5. Exercise regularly and follow a healthy, low-fat diet. 6. Take, apply, or instill at bedtime. 7. Obtain regular blood pressure checks. 8. Report persistent or recurrent vaginal bleeding

administration of anticholinergics (oxybutyin chloride)

1. Take orally (either short-acting syrup or tablets) two to four times a day. • Take the extended-release (ER) tablets once a day. 2. Swallow ER tablets whole; do not crush or chew them. 3. Expect excretion of the insoluble shell of the ER tablets in stool. 4. Apply the transdermal patch twice a week to dry and intact skin on the abdomen, hip, or buttocks. 5. Rotate patch adhesion sites

administration of PDE5 inhibitors (sildenafil)

1. Take orally 1 hr before sexual activity - limit to once daily. 2. Take with or without food (but high-fat foods delay effects and reduce peak effects: sildenafil and vardenafil [Levitra], not tadalafil [Cialis]). 3. Expect effects to last up to 4 hr. 4. Do not take within 24 hr of using nitrates. 5. Do not take more than one dose in a 24-hr period.

administration of LH and FSH stimulant (clomiphene)

1. Take orally, beginning 5 days after menstruation onset and continuing therapy for 5 days. (With amenorrhea, begin any time.) 2. Repeat the 5-day course at 30-day intervals as prescribed, depending on the occurrence of ovulation and conception. 3. Take the drug at the same time each day. 4. For a missed dose, take it as soon as possible. Double the next dose if not remembered until then. For two missed doses, consult the provider. 5. Stop taking the drug for any suspicion of pregnancy

administration for 5-Alpha Reductase Inhibitor (Finasteride)

1. Take orally, with or without food. 2. Crush the tablets if needed. 3. Expect drug therapy to be lifelong. 4. Ensure that women do not handle the drug, especially if crushed, due to the possibility of transdermal absorption. 5. Expect therapeutic effects to take 6 to 12 months.

client instructions of hyperprolactinemia inhibitor (carbergoline)

1. Take the drug with food if GI symptoms persist. 2. Report headache or dizziness. 3. Do not engage in dangerous activities if dizziness occurs or tends to recur. 4. Take over-the-counter analgesics to relieve headache.

interactions of hyperprolactinemia inhibitor (carbergoline)

1. Taken with phenothiazines, butyrophenones, thioxanthenes, or meto- clopramide (Reglan), cabergoline and the other drug lose effectiveness. 2. Concurrent use with antihypertensives can increase risk of hypotension 3. Increased effects of SSRIs and serotonin agonists

interventions for 5-Alpha Reductase Inhibitor (Finasteride)

1. Tell clients about the possibility of reductions in libido and ejaculate volume. 2. Obtain a baseline PSA level and monitor periodically. 3. Expect PSA levels to decline with therapy. 4. Evaluate any increases in PSA level, as they may indicate prostate cancer or nonadherence to therapy. 5. Monitor for breast enlargement. 6. Evaluate if there is concern for body image.

interventions of PDE5 inhibitors (sildenafil)

1. Tell clients about the risk of impotence following priapism. 2. Explain that treatment involves aspirating blood from the corpus cav- ernosum and irrigating with a vasoconstrictor. 3. Monitor for headache. 4. Monitor blood pressure. 5. Monitor for hearing loss. 6. Monitor for vision changes.

interventions of testosterone (androderm, delatestryl)

1. Tell female clients and children about the possibility of changes in distribution of hair growth, deepening of the voice, menstrual changes, and acne. 2. Monitor for these indications, which are reversible with early discontinuation of androgen therapy. 3. Check if client is being screened periodically for prostate cancer. 4. Monitor intake and output, weight, and sodium levels periodically. 5. Sodium and water retention may warrant a lower dose and possibly diuretic therapy. 6. Monitor liver function test in clients taking 17-alpha-alkylated androgens. 7. Monitor the risk for adult height impairment. 8. Recommend x-rays of the hands and wrists twice per year. 9. Monitor for breast enlargement

client instructions for anticonvulsants (magnesium sulfate)

1. Tell the client to report adverse effects. 2. Provide comfort measures 3. Instruct the client to change positions slowly from supine to upright and to sit until dizziness resolves. 4. Assist the client as needed to promote safety. 5. Explain the purpose of strict measurement of oral intake and urinary output. 6. Explain that magnesium sulfate is used to prevent seizures. 7. Explain to the client the importance of frequent monitoring of respiratory status. 8. Explain to the client the importance of frequent monitoring of fetal heart rate.

adverse effects of oral contraceptives (ethinyl estradiol and drospirenone)

1. Thromboembolism 2. Hyperkalemia (due to the drospirenone in this drug) 3. Hypertension (less likely with ethinyl estradiol and drospirenone than with other combination oral contraceptives) 4. Uterine bleeding 5. Increased growth of breast malignancies

administration of testosterone (androderm, delatestryl)

1. Transdermal (Androderm) - Apply the patch to the upper arm, back, abdomen, or thigh. - Apply once per day. - Rotate sites; do not use the same site more often than once per week. - A gel is also available (AndroGel, Testim). If used, wash hands after applying and cover the site of application, then do not shower or swim for several hours. - Underarm liquid: Use the metered-dose pump to apply liquid into applicator and then apply to axilla. 2. Buccal (Striant) - Apply to gums above an upper incisor. - Apply external pressure with a finger for 30 seconds to promote adhesion. - Alternate sides of the mouth. - Tell clients to expect a bitter taste and changes in taste. - Tell clients the tablets are not affected by eating, drinking, brushing the teeth, or chewing gum. 3. Subcutaneous (implantable pellets) (Testopel) - Using local anesthesia, the provider implants pellets under the skin of the abdomen. - Two to six pellets are implanted every 3 to 4 months. IM (Delatestryl) - Long-acting formulations are injected every 2 to 4 weeks. - Serum testosterone levels will vary; tell clients to expect changes in mood, energy, and libido.

Therapeutic use for 5-Alpha Reductase Inhibitor (Finasteride)

1. Treatment of benign prostatic hypertrophy (also reduces the risk of prostate cancer) 2. Treatment of male pattern hair loss (Propecia)

interactions of LH and FSH stimulant (clomiphene)

1. Tricyclic antidepressants, phenothiazines, and methyldopa (Aldomet) increase prolactin concentrations, thus interfering with fertility

precautions of anticholinergics (oxybutyin chloride)

1. Urinary tract infection 2. Hiatal hernia with reflux 3. Hyperthyroidism 4. Hypertension 5. Benign prostatic hypertrophy 6. Autonomic hypertrophy 7. Liver or renal disease

What medications fall under progestins

1. medroxyprogesterone acetate 2. levonorgestrel 3. megestrol acetate 4. norethindrones acetate 5. progesterone

3 drugs for pre eclampsia

1. methyldopa 2. magnesium sulfate 3. labetalol

Therapeutic use of Estrogen plus Progesterone HRT: Conjugated Estrogen and Medroxyprogesterone Acetate, Transdermal Estradiol and Norethindrone

1. relief of postmenopausal symptoms (vasomotor) and vulvar and vaginal atrophy 2. prevention of postmenopausal osteoporosis

therapeutic use of progesterone (medroxyprogesterone acetate)

1. treatment of endometriosis 2. treatment of dysfunctional uterine bleeding 3. treatment of endometrial carcinoma

therapeutic use of GnRH agonists (leuprolide)

1. treatment of endometriosis 2. treatment of uterine fibroids 3. treatment of advances prostate cancer in males

A provider has prescribed a dinoprostone vaginal insert to promote cervical ripening in a client who is at 40 weeks of gestation. When administering dinoprostone, which of the following actions should the nurse take? Select all that apply a. encourage the client to urinate prior to insertion b. remove the pouch when active labor begins c. monitor for uterine hyperstimulation d. encourage the client to walk after insertion e. monitor the clients temperature

a,b,c,e

A nurse is providing teaching to a client who is taking bethanechol for urinary retention. Which of the following instructions should the nurse include? (Select all that apply) a. avoid driving and activities that require alertness b. increase fluid intake c. take the drug with food d. stay close to a bathroom after taking the drug e. increase weight bearing activities

a,b,d

You should monitor a client throughout continuous heparin therapy for which of the following adverse reactions? Select all that apply a. thrombocytopenia b. hypotension c. hypokalemia d. deep vein thrombosis e. fever

a,b,d,e

You are caring for a client who is receiving alteplase to dissolve a thrombus. Which of the following should you include in your care plan for this client. Select all that apply a. monitor temperature b. reposition frequently c. limit venipunctures d. assess neurologic status e. apply pressure to oozing sites

a,c,d,e

A client is about to start taking clopidogrel to prevent TIA. You should instruct the client to watch for and report which of the following adverse effects of this drug. Select all that apply a. petechiae b. tinnitus c. diaphoresis d. weakness e. vision changes

a,d,e

A nurse is providing teaching to a client about using leuprolide to treat endometriosis. Which of the following instructions should the nurse include a. perform weight bearing activities b. wear sunscreen or protective clothing c. take the drug with food to increase absorption d. avoid drinking grapefruit juice

a. perform weight bearing activities

A client is about to start taking cyanocobalamin, a vitamin B12 preparation. You understand that this drug treats which of the following types of anemia a. pernicious b. sickle cell c. aplastic d. iron deficiency

a. pernicious

While the client is still receiving continuous IV heparin (enoxaparin), the provider prescribes oral warfarin. This is because.. a. warfarin takes 3-5 days to achieve therapeutic effects b. IV heparin alone becomes ineffective after the first 1-2 days c. abrupt cessation of heparin therapy increases the risk for thrombocytopenia d. warfarin increases the risk for hemorrhage

a. warfarin takes 3-5 days to achieve therapeutic effects

A nurse is assessing a client who has a new prescription of oxybutynin to treat neurogenic bladder. Which of the following assessment findings should the nurse identify as an adverse effect of the drug? Select all that apply a. diaphoresis b. dilated pupils c. dizziness d. distended bladder e. fever

b,c,d,e

A provider prescribes IV heparin for this client. Which of the following parameters should you monitor for in regard to determining if a therapueitc dose is being administered? a. INR, 2-3 times the clients baseline b. aPTT, 1.5-2 times the clients baseline c. platelet count of 125,000/mm3 d. PT 11 to 12.5

b. aPTT, 1.5-2 times the clients baseline

A nurse is caring for a male client who has hyperthyroidism and is not responding to treatment. The nurse should identify that hyperthyroidism is a contraindication for which of the following drugs a. sildenafil b. bethanechol c. Tamsulosin d. finasteride

b. bethanechol

A nurse is providing teaching to a client about sildenafil to treat erectile dysfunction. Which of the following instructions should the nurse include a. take the drug with a glass of grapefruit juice b. do not take the drug with high fat foods c. increase intake of foods rich in vitamin K d. avoid ages cheeses and red wine

b. do not take the drug with high fat foods

A nurse is caring for a client who has BPH and is taking tamsulosin. The nurse should question the use of the drug if the client also has which of the following a. a seizure disorder for which he takes carbamazepine b. erectile dysfunction for which he takes sildenafil c. diabetes mellitus for which he takes glyburide d. angle closure glaucoma for which he takes pilocarpine

b. erectile dysfunction for which he takes sildenafil

A nurse is caring for a client who is about to being clomiphene therapy to treat infertility. Th nurse should monitor the client for which of the following adverse effects a. breast cancer b. DVT c. ovarian hyperstimulation syndrome d. restless leg syndrome

c. ovarian hyperstimulation syndrome

A nurse is caring for a client who missed a dose of her oral contraceptive. Which of the following instructions should the nurse give the client? a. take a pregnancy test b. double up on pills for remainder of the pack c. take the missed dose as soon as possible d. stop the oral contraceptive and use a different contraceptive

c. take the missed dose as soon as possible

A nurse is caring for a client who has a new prescription for conjugated equine estrogen. The nurse should instruct the client to report which of the following indications of a serious adverse reaction a. hot flashes b. UTI c. vaginal bleeding d. bone pain

c. vaginal bleeding

A nurse is caring for a client who is taking combination oral contraceptive ethinyl estradiol and drospirenone and is about to begin taking rifampin to treat tuberculosis. Which of the following instructions should the nurse give the client due to a possible drug interactions? a. increase the rifampin dose b. increase the oral contraceptive dose c. wait 2 hours between taking each drug d. use additional birth control methods

d. use additional birth control methods