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38 Cards in this Set
- Front
- Back
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Therapeutic Uses of Estrogen and Progesterone
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- Conception
- Dysfunctional Uterine Bleeding - Hypogonadism - Adjunctive and palliative tx for some cancers - Premenstrual Dysphoria (syndrome) - Menopausal Symptoms (vasomotor, perineal atophy, prevention of osteoporosis) **Chemically they work in opposition to each other |
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Effects of Estrogen
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Positive:
- Bone Mass - Cholesterol levels Negative: - Endometrial hyperplasia and carcinoma (when used alone w/o progesterone and an intact uterus) - Breast cancer - Ovarian cancer - Can decrease milk production |
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Effects of Progesterone
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Adverse effects:
- Teratogenic - Gynecologic - Breast cancer - Depression - Breast tenderness |
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Birth Control Pills
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Dosed in 3 ways: Monophasic, Biphasic, and Triphasic - all dependent on level/amount of progesterone dosing
Stimulates pregnancy by: - Inhibiting ovulation - Decreases risk of ectopic pregnancy - Decreases blood loss during menstruation |
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Contraindications for BCP Use
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> 35 yrs
> Smoker High risk for Breast cancer **Antibiotics can decrease effectiveness of BCP - need alternative form of BC |
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Menopausal Hormone Therapy Benefits
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- Relief of vasomotor symptoms (hot flashes, HR, etc)
- Mgmt of urogenital atophy - Prevention of osteoporosis - Prevention of colorectal cancer - Positive effect on wound healing - Tooth retention - Glycemic control |
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Side Effects and Adverse Reactions of Menopausal Hormone Therapy
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CV: hypotension, edema
CNS: dizziness, H/A, migraines, depression GI: N/V, diarrhea, anorexia, pancreatits, cramps, constipation, incr. appetite, incr. weight, cholestatic jaundice GU: amenorrhea, cervical errosion, breakthrough bleeding, dysmenorrhea, breast changes Thromboembolic: stroke, MI, PE, DVT |
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MEDROXYPROGESTERONE (Depoprovera)
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Long-Acting Progesterone BC
- Inhibits/blocks estrogen by: suppressing ovulation, causes cervical mucus thickening, and endometrium alteration IM q 3 months - not recommended for longer than 2 yrs - difficulty getting pregnant after discontinuation Adverse effects: Weight gain, irreg. menses, depression, osteopenia |
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Treatment for Premenstrual Dysphoria
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Aerobic exercise
Low Na+ diet (reduce H20 retention) Vit B6 (decr. depression) Mg (decr. fluid and decr. H/A) Ca+ (decr. aches/pain and decr H20) SSRI's (anti-depressants) NSAIDS BCP (manipulates hormone levels) GnRH inhibitor (Lupron) (decr FSH and LH at pituitary-female castration) 8 hours of sleep No caffeine |
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ALENDRONATE (Fosamax)
IBANDRONATE Na (Boniva) RISEDRONATE (Actonel) (-dronate) |
Inhibits osteoclast medicated bone resorption
Side Effects: H/A, GI upset, esophageal burns **cannot lie down for 30 min after taking, due to digestion process |
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Benign Prostatic Hyperplasia (BPH)
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- Overgrowth of epitelial cells causing mechanical obstruction of urethra
- Overgrowth of smooth muscle causing dynamic obstruction |
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Treatment for BPH
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1. Waiting
2. Medication - 5-alpha reductase inhibitors (lg prostrate) - alpha 1-adrenergic antagonist (sm prostrate_ 3. Surgery |
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FINASTERIDE (Proscar)
DUTASTERIDE (Avodart) |
Treatment for BPH
5-alpha reductase inhibitor (-asteride) Promotes regression of epithelial cell tissue growth causing mechanical obstruction Side effects: decreased libido, gynecomastia |
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Precautions with Phosphodiesterase (PDE) inhibitors
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Interact with cardiac meds, ex. nitroglycerin products, antidysrhythmic or rate control meds
Caution with meds that inhibit CYP3A4 (increases circulating levels of PDE5) |
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SILENADFIL (Viagra)
VARDENAFIL (Levita) TADALAFIL (Cialis) (-fil) |
Phosphodiesterase (PDE) inhibitors
Work on enhancing the effects of nitric oxide (NO), chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow Usu. 1 hour before activity One dose only |
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What is GENERAL ANESTHESIA
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State of CNS depression, M/S relaxation, and alteration in reflexes
100% unconscious |
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What is BALANCED ANESTHESIA
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Using a combination of drugs
- Sedative, antianxiolytic, antiemetic, and anticholinergic |
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What is Conscious Sedation
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Reflexes remain intact, patient is aware but doesn't care
- Analgesic, sedative, benzodiazepine |
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ISOFLURANE
ENFLURANE HALOTHANE (-flurane) |
Inhaled Anesthesia
- Depression of cerebral and spinal cord function - Start as liquids and are aerosolized into a vapor and inhaled - Not metabolized by liver, and are inhaled in active form - Excreted through exhalation phase of expiration (not recom. for pulmonary disorders) Used to keep patient in general anesthesia |
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TUBOCURARINE (Tubarine)
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Long-Acting, non-depolarizing neurpmuscular blockers
Competes for receptor sites - nicotinic m Produces flaccid paralysis |
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SUCCINYLCHOLINE (Anectine)
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Ultra Short Acting, depolarizing neuromuscular blockers
Competes for receptor sites - nicotinic m Produces flaccid paralysis (only after a brief inital period of contraction) |
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Areas for Local Anesthesia
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Epidural
Infiltration Nerve Block Spinal Topical |
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Local Anethesia
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Mech of Action: blocks generation and conduction of impulse through nerve fibers (blocks K+, Na+, Ca+ ions)
Used for minor surgical, dental, and diagnostic procedures |
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Cholinesterase Inhibitors
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Reversible: prevents degradation of ACh by stimulating nicotinic and muscarinic receptors
Irreversible: produces ACh accumulation causing depolarizing blockade leading to paralysis of resp musc and death |
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ATOPINE
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Antagonizes the effects of excess acetylcholine due to organophosphorus poisoning
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What is Parkinson's Disease?
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Associated with the extrapyramidal system regulating movement
Imbalance between chemicals Dopamine and Acetylcholine in the brain |
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LEVODOPA
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Converts to Dopamine in the brain by passin BBB and activate receptors
Decreases ACh stimulation Decreases abnormal movements from excess ACh |
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CARBIDOPA
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Used in conjunction with Levodopa
- blocks the destruction of Levodopa in the intestine and peripheral tissues |
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What is Alzheimer's Disease?
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Decrease of ACh decreasing cholinergic function
- caused by neurotic plaques, neurofibrillary tangles, and injury |
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Treatment for Alzheimer's
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Cholinesterase Inhibitors
- Increases the availability of ACh at cholinergic synapses - ARICEPT - EXELON - REMINYL |
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PHENYTOIN (Dilantin)
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Action: Action potential suppressed - reduces voltage, frequency, and spread of electrical discharges in the motor cortex that causes seizures
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VALPROIC ACID (Depakote)
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Action: Blocks Na+ channels, suppresses Ca+ influx, and supports GABA's inhibitory effects
Uses: seizures, bipolar disorders, and migraine headaches |
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GABAPENTIN (Neurontin)
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Exerts analgesic action
Uses: Management of postherapeutic neuralgia and adjunctive therapy in treament for partial seizures |
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Muscle Relaxants
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- Effects come from sedative effect not direct muscle relaxation
- Enhance GABA's central inhibitory effects in the spinal cord - Decreases the muscle response to stimulus by depressing activity in the brainstem |
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DANTRIUM (Dantrolene)
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Only muscle relaxant that acts directly on spastic muscle and inhibits muscle contractio by preventing release of Ca+ in skeletal muscle
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DIAZEPAM (Valium)
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Central acting, works on spasms and muscle relaxation
**Special consideration in Asian population: metabolism uses different pathway making it toxic to them |
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METAXALONE (Skelaxin)
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Central acting, muscle relaxant and antispasmotic
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CYCLOBENZAPRINE (Flexaril)
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Non-neurogenic muscle spasms
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