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144 Cards in this Set

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What are female sex hormones used for?
to replace hormones that are missing or to act on the control mechanisms of the endocrine system to decrease the release of endogenous hormones.
What are the female sex hormones?
estrogens and progestins
Give an example of a type of HRT (hormone replacement therapy) that is used when ovarian activity is blocked or absent?
Estrogens
What else can estrogens be used for?
estrogens can be used for discomfort of menopause when many of the beneficial effects of estrogen are lost.
What are some of estrogens effects on the female body?
It protects the heart from atherosclerosis.
It retains calcium in the bones by increasing HDL.
It maintains secondary female sex characteristics
Important for the development of the female reproductive system.
It prepares the female body for childbirth and pregnancy.
What are indications for estrogen?
HRT
Palliative and preventive therapy during menopause
Following a hysterectomy.
When we loose estrogens we also loose calcium, leading to what?
Osteoporosis
Contraindications for estrogens:
Allergies and pregnancy
Because estrogen increases clotting factors it is important that the patient does not already have Idiopathic (unknown causes) vaginal bleeding, breast cancer, and estrogen dependent cancer, thromoembolic disorders.
Caution:
breast feeding, metabolic bone disease, renal insufficiency, hepatic impairment.
What are the adverse effects of Estrogens?
GI tract (nausea, vomiting, edema)
Systemic effects of estrogens (fluid gain)
Drug-to-drug Interactions:
Drugs that enhance hepatic metabolism
Corticosteroids (when taken with estrogens,) If patient is taking coticosteroids for asthma along with estrogen, monitor closely.
Estrogen Receptor Modulators: (Raloxifene)
not hormones, so not as risky, but they effect specific estrogen receptor sites, stimulating some and blocking others.
Estrogen Receptor Modulators: (Raloxifene)
What do they do?
Modulating effects on estrogen receptors.
Used to stimulate specific estrogen receptors to increase bone density.
What are the Indications for Raloxifene (Estrogen Receptor Modules)?
Postmenopausal osteoporosis
(very similliar to Estrogen)
When would Raloxifene be contraindicated?
allergies and pregnancy, lactation
Patients w/ venous throbosis or smoking.
Adverse effects of Estrogen Receptor modulators:
Gi upset
Changes if fluid balance: headache, dizziness, and visual changes
Estrogen receptor stimulation: hot flashes, skin rash, edema, and vaginal bleeding.
What is an indication for estrogen receptor modulators?
Postmeopausal osteoporosis
Progestins:

Action:
Transform the proliferative endometrium into a secretory endometrium
Inhibit the secretion of FSH and LH
Prevent follicle maturation and ovulation
Inhibit uterine contractions
Indications:
Contraception
Treament of primary and secondary amenorrhea
Fertility protocols
Contraindications for Progestins:

(UID, transdermal, oral)
Allergies, pregnancy, idiopathic vaginal bleeding, breast or genital cancer, history of THROMBOEMBOLES DISORDERS, sexually transmitted disease, endometriosis, or pelvic surgery.
Adverse effects:
varies based on route of administration:
oral:could have systemmic effects
Transdermal: localized irritation
gels: redness, edema
Drug-to-Drug Interactions:
Barbiturates, Carbamazepine, Phenytoin, Rifampin.

Do not take Progestins while taking anti-seizure meds.
Fertility Drugs:
Actions:
Directly or by stimulating the hypothalamus to inccrease FSH and LH levels, leading to ovarian follicular development and maturation of ova.
Indications:
Infertility in men and women
Contraindications for Fertility Drugs:
Primaro ovarian failure
Thyroid or adrenal dysfunction
Ovarian cycts (increases cyst growth)
Pregnancy, idiopathic UTERINE bleeding, and known allergy.
Caution with Fertlitiy drugs:
Breast feeding, thromboembolic disease, or respiratory disease.
Adverse effects of Fertility Drugs:
Increase risk of multiple births and birth defects
Ovarian overstimulation (can result in early menopause)
Headache, fluid retention, nausea bloating
Uterine bleeding, ovarian enlargement
GYNECOMASTIA (secondary female characteristics are enlarged)
True/False:
Fertility drugs act by stimulating the pituitary to increase FSH,and LH levels, leading to ovarian follicular development and maturation of ova.
FALSE
Fertility drugs either act DIRECTLY or by stimulating the HYPOTHALMUS, (not the pituitary) to increase FSH and LH levels, leading to the ovarian follicular development and maturation of ova.
Nursing Considerations for Pateints receiving sex hormones or estrogen receptor modulators:
Assess for contraindications and cautions: current status of pregnancy or lactation, hepatic dysfunction,etabolic bone disease, breast or genital cancer, history of thromboembolism or smoking, idiopathic vaginal bleeding






Review:
Estrogens are:
hormones associated with the devlopment of the female reroductive system and secobdary sexual characteristics; estrogens are used to prevent conception, to stimulate ovulation in women with hypogonadism, and to replace hormones after menopause
Progestins:
maintain pregnancy, by inhibiting uterine contractions and follicle maturation and ovulation, are are also involved with development of secondary sex characteristics.
Indications
Life Span:
Women should receive an annual exam of breasts and pap smear. Women taking estrogen should be advised to not smoke because of the increased risk of thrombotic events.
When a combination of hormones are used in fertility programs, women need psychological support and comfort to cope w/ adverse effects such as multiple births.
HRT is no longer commonly used by postmenopausal women. Reports of benefits and risks are frequent and conflicting.
Prototype Estrogen
Estradiol
menopause comfort, prevention of postmenopausal osteoporosis, treatment of female hypogonadism, female castration, female ovarian failure, palliation of inoperable and progressing breast cancer and inoperable prostate cancer.
action:
the most potent endogenous female sex hormone, responsible for estrogen effects on the body
Adverse effects:
corneal changes, edema, nausea, vomiting chnages in menstraul flow, dysmenorrhea, pre-menstrual like syndrome
Prototype Estrogen Receptor Modulators:
Raloxifene
Indications:
Prevention and treatment of osteoporosis in postmenopausal women.
Action:
Increases bone density w/ out stimulating the endometrium; modulates effects of endogenous estrogen at specific receptor sites.
Adverse effects:
Venous thromboembolism, hot flashes, skin rash, nausea, vomiting, vaginal bleeding, depression, light headedness.
Prototype Progestins:
Norethindrone acetate:
Indications:
Treatment of amenorrhea (absence of menstruation) abnormal uterine bleeding due to hormonal imbalance, treatment of endometriosis; component of some hormonal contraceptives
Actions:
Progesterone derivative that transforms the proliferative endometrium into a secretory endometrium; inhibits the secretion of pituitary FSH and LH, which prevents ovulation; and inhibits uterine contractions.
Prototype Fertility Drugs:
Clomiphene
Indications:
Treatment of ovarian failure in patients w/ normal liver function, off label use of male sterility
Adverse effects:
Vasomotor flushing, visual changes, OVARIAN enlargement, multiple pregnancies
In women with functioning ovaries, fertility drugs increase follicle development by stimulating what?
FSH and LH to increase the chances of pregnancy
What should women receiving fertility drugs be monitored for?
ovarian overstimulation, they need to be aware of the possibilty of multiple births, and support and encouragement to deal w/ self-esteem issue related to infertility
Drugs used to affect the male reproductive system:

Male steroid Hormone or Androgens:
Act like testosterone
Development of male sexual characteristics

Testosterone is nother word for androgens
Male sex hormone or Anabolic steroids:
Synthetic testosterone preparations that have more anabolic effects than androgenic effects
-Tissue building
Signs and symptoms of Adverse Effects of Androgens/Anabolic Steroids:
Swelling in fingers or legs
Continual erection
Uncontrollable sex drive
Yellowing skin (Hepatic toxicity)
Chest pain, or difficulty breathing
Hoarseness
Loss of hair or growth of facial hair in women
Contraindications of Androgens:
Allergy
Pregnancy and Lactation
Prostate or breast cancer in men
Caution using Androgens:
people w/ liver dysfunction or cardiovascular disease
Indications for Androgens:
Replacement therapy in hypogonadism and delayed puberty in males
Inoperable breast cancer
Prevention of ovulation to treat endometriosis
Adverse effects:
acne, edema, hirsutism (hair growth)
Deepening of the voice, oily skin and hair, weight gain, decreased breast size, testicular atrophy.
Adverse effects (Androgens a.k.a. Testosterone
flushing, sweating, vaginitis, nervousness, and emotion labiality (unstable)
Headaces, dizziness, sleep disorders, and altered electrolytes
Drug Laboratory Tests: Thyroid function
Creatnine
Anabolic steroids and their indications:
Oxandrolone (Oxandrin)
Promote weight gain in debilitated patients (end stage HIV-cancer)
Increase protein anabolism
Treat certain inoperable breast cancers in women.)
Anabolic steroids and their indications:
Oxymetholone (Anadrol-50)
Treat various enemias.
Anabolic Steroids:
Actions:
Promote body tissue-building processes
Reverse catabolic or tissue destroying processes
Increase hemoglobin and red blood cell mass
Anabolic steroids used by athletes:
Promotes body tissue buliding processes
Reverse catabolic or tissue destroying processes
Increase hemoglobin and red blood cell mass
Anabolic steroids used by athletes Indications:
vary w/ each drug
Treatment of anemias, certain cancers, and angiodema
Promote weight gain and tissue repair
Protein anabolism
Why are steroids used in treatment of breast cancer?
To decrease inflammation
Contraindications for Anabolic Steroids:
Allergy and liver dysfunction
Pregnancy and lactation
Coronary disease (because of Na+, H20, and K+ retention)
Prostate or breast cancer in males.
Adverse effects of Anabolic Steroids:
Cardiomyopathy
Hepatic carcinoma
Personality chnages
Sexual dysfunction
Virilization (increase in virility)
Inhibition of testicular function, gynecomastia, testicular atrophy, baldness and change in libido
Anabolic steroids
Drug-to-Drug Interactions:
Oral Anitcoagulants
Antidiabetic medications
Drugs Approved for Penile Erectile Dysfunction
Sildenafil (Viagra) Levitra
Selectively inhibits phosphodiesterase type 5 receptors (PDE5) and increases nitrous oxide levels, allowing blood flow into the corpus cavernosum
Indications:
Treatment of erectile dysfunction in the presence of sexual stimulation
Contraindications:
Condition that might predispose to priapism (erection that won't go away)
Penile implants
Use in women
Caution:
Coronary Artery disease, peptic ulcer, bleeding disorder
Use of Drugs Affecting the Male Repoductive System Across the life Span
These drugs are used in kids as replacement therapy and to increase red blood cell production in renal failure. Children should be closely monitored w/ hand and wrist radiographs pretreatment and every 6 months. If precocious puberty occurs, the drug should be stopped.
Increased Acne in Adolescents should be told.
Women may experience masculinizing effects. In older adults hypertension, heart failure, and coronary artery disease may be aggrevated by the fluid retention associated w/ these drugs. BPH (Benign prostatic hypertrophy may be aggrevated by enlarging the prostate further.

BE ware of use w/ older adults that have heart disease.
Prototype Androgen
Testosterone
Indications:
Replacement therapy in hypogonadism, inoperable breast cancer
Actions:
Primary natural androgen, responsible for growth and development of male sex organs and maintenance of secondary sex characteristics, increases the retention of nitrogen, sodium, and potassium, and phosphorus, decreases urinary excretion of calcium; increases protein anabolism, stimulates red blood cell production
Adverse effects:
Dizziness, headache, sleep disorders, fatigue, rash, adrogenic effects (acne, deepening voice, oily skin) hypoestrogenic effects (flushing, sweating, vaginitis)
Prototype Anabolic Steroids:
Oxandrolone
Indications:
Adjunctive therapy to promote weight gain after weight loss associated w/ tramatic disease, surgery, etc. To offset protein catabolism associated w/ prolonged coticosteroid use. HIV
Actions:
Testosterone analogue w/ androgenic and anabolic activity, promotes tissue building, reverses catabolic processes, increases red blood cell mass.
Adverse effects:
Excitation, virilization, acne, retention of sodium water and chloride, baldness, loss of libido.

APPETITE STIMULATION AND ANTI_INFLAMMATORY
Prototype Drugs for Treatment of Ercetile Dysfunction
Sildenafil
Indications:
Treatment of erectile dysfunction in the presence of sexual stimulation; treatemtn of pulmonary arterial hypertension.
Actions:
Inhibits PDE5 receptors leading to a release of nitrous oxide, which activates cGMP to cause a prolonged smooth muscle relaxation, allowing the flow of blood into the corpus cavernosum causing erection
Drug-to Drug Interactions
Viagra :Alphablockers
Adverse Effects:
Headache, abnormal vision, flushing, dyspepsia, UTI, rash
Drugs Affecting The Urinary Tract and the Bladder:
Drugs for Treatment of BPH (Benign Prostatic Hyperplasia)
Actions:
varies w/ drug
Indications:
Treats benign prostatic hypertrophy (non-cancerous enlarged prostate)
Drugs manage BPH, they do not cure it.
Cautions:
Hepatic or renal dysfunction
Adverse effects:
Varies w/ drug:
Headache, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset
Decreased libido , impotence, sexual dysfunction
Drug-to-Drug Interactions
Thephylline
Prototype Drugs for Treatment of Benign Prostatic Hyperplasia:
Doxazosin:
Indications:
Treatment of Benign prostatic hypertrophy
Actions:
Doxazosin
Blocks postsynaptic alpha adrenergic receptors, which results in dilation of arterioles and veins and a relaxation of sympathetic effects on the bladder and urinary tract.
Adverse effects
Doxazosin
Headache, fatigue, dizziness, postural drainage, lethargy, vertigo, tachycardia, palpations, nausea, dyspepsia, diarrhea, sexual dysfunction, rash.
Alpha-adrenergic blocker is an anti-hypertensive; not only does it dilate smooth muscle in the heart, it dilates smooth muscle in the urethra to increase urinary flow.
Caution:Monito BP to make sure it doesn't go to low, watch for dizziness w/ standing
Antidiarrheals and Laxatives

Acute diarrhea:
sudden onset
lasts from 2 days-2 weeks
Self-limiting
The Gi system begins at the mouth and ends at the....
anus

(Includes espohagus, stomach, small intestine, large intestine)
What controls vomiting?
Chemoreceptor trigger zone (CTZ) in the medulla or in the emetic zone in immature or injured brains.
Emetic can be projectile
Bacteria starts in what type of environment in the stomach?
An acidic environment has a pH of 1-4
GI disorders are the most common complain seen in clinical practice. What are the underlying causes of these disorders?
Dietary excess
stress
hernia
GERD (Esophageal reflux)
Peptic Ulcer Disease
H. Pyloria Disease
It is believed that chronic ulcers can be the reult of
Helicobacter pylori bacteria.
Acute or stress ulcers can be caused by
stree, trauma, burns , or prolonged illness
H.Pylori can be treated with a triple treatment of antibiotics.
An endoscopy will be done to biopsy.
Over use of NSAID's can also lead to ulcers.
(05 of ulcers take place in the duodenum, and 70% or so in gastric area (stomach)
Diarrhea
Acute Diarrhea
Chronic Diarrhea
abnormal, frequent passage of watery stool
Accute:2 days to 2 weeks
Chronic:3-4 weeks
Causes of Diarrhea
loss of normal intestinal flora, so C. Diff takes over, say someone is on too many antibiotics
Antidiarrheals:

bismuth subsalicylate
(Pepto-Bismol)
Treatment of traveler's diarrhea; prevention of cramping and distention associated with w/ dietary excess and some viral infections.
Coats the walls of the GI tract/Absorbant. Binds to causitive bacteria or toxin, which is then eliminated through the stool.
Darkening of the stool is normal...not to be used in kids uner 16 because it is a salicylate. (Could experience ringing in the ears.)
proton pump inhibitor
drug that lowers the acid levels in the stimach used to treat ulcers, gerd, etc. (like Prilosec)
Anticholinergics: (Donnatal)
What do they do?
decrease intestinal muscle tone and peristalsis of GI tract
Slows fecal the movement of fecal material through GI tract.
Intestinal Flora Modifiers:
Lactobacillus acidophilus
Bacterial cultures of Lactobacillus organisms.
Supply missing bacteria to GI tract
Supress growing of bacteria causing bacteria.
Replaces natural flora in intestinal system; mainly used in patients with C.Diff.
Opiates
Opium, paregoric
Short-term use only, decrease bowel motility and relieve rectal spasms.
What labs would you monitor in a patient with dairrhea?
Chem Panel, Fluid and Electrolytes
Anticholenergics
Side effects of Antidiarrheals:
Donnatel
Urinary retention (Don't give to a patient with BPH as that already causes urinary retention)
Headache, dizziness, confusion, anxiety, drowsiness
dry skin, rash flushing
Blurred vision...(Don't give to a patient w/ glaucoma)
Antidiarrhals: Side effects
Opiates:
drowsiness, sedation, dizziness
N.V.D.
Respiratory depression
Bradycardia, palpitation, hypotension
Interactions:
Absorbants:Peptobismol
INCREASES BLEEDING TIME W/ ANTICOAGULANTS
Antacids decrease the effects of Anticholinergic agents
Decrease the absorption of many agents
Nursing Implications:
How many bowel movements per day?
No pepto to kids under 16 due to potential Rye Syndrome
Use absorbants carefully in the elderly or with clotting disorders.
Anticholinergics:
Do NOT give w/ history of glaucoma, BPH, urinary retention, cardiac, recent bladder surgery
Monitor I & O's for therapeutic effect.
When should laxatives be given?
Following a MI, or delivery. We do not want these patients straining.
Bulk forming:
High fiber
Absorbs H20 to increase bulk
Distends bowel to initiate reflex bowel activity (Metamucil)
Mild laxative-short term treatment of constipation
Hyperosmotic because it pulls H20 into the feces.
Emollient:
Stool softeners and lubricants
Promotes more H20and fat in the stools
Lunbricates the fecal mateiral and intestinal walls.
Colace
Lubricant
softens stool, not necessarily going to promote defecation
Nursing Implications for use of laxatives:
All laxatives can cause electrolyte imbalances!
Obtain history of presenting symptoms, allergies, and bowel patterns.
Assess fluid and electrolytes before initiating therapy
Patients should not take a laxative if they are experiencing nausea, vomiting, or abdominal pain.
A healthy high fiber diet and increased fluid intake should be encouraged as an alternative to laxative use
Long term use can result in decreased bowel tone and may lead to dependency
Swallow whole, not crushed, or chewed
Take w/ 6-8oz. of H20
Bulf forming laxatives take as directed by manufacture or at least 8 oz. of H20.
When should patients contact their physician?
increased abdominal pain
muscle weakness, cramps, or dizziness; which may indicate electrolyte loss.
Monitor for therapeutic effects.
Nausea and vomiting:
Emetics:
cause vomiting.
No longer recommended for at home poison control.
Antiemetics:
decrease or prevent nausea and vomiting
Centrally acting or locally acting
Varying degrees of effectiveness
If a person has a CNS depression should they take antiemetics?
NO
How many groups are there to treat vomiting?
6

All groups block CNS, so they are contraindicated in patients w/ CNS depression
Compazine:
Antiemetic drug
(rapid onset limited adverse effects)
Treatment of severe nausea and vomiting and intactable hiccough's, which occur with repetitive stimulation of the diaphragm and lead to persistent spasms.
Do not use in patients w/ CNS depression!
Adverse effects are linked to their interference w/ normal CNS stimulation.
More adverse effects of Compazine an anitemetic drug:
Drowsiness
dystonia (muscle twitching)
photophobia
blurred vision
urine discolored pink to red-brown
Nonphenothiazines:

Reglan:
Indications:
Prevention of nausea and vomiting associated with cancer therapy; prevention of postoperative nausea and vomiting
Reglan:
Adverse effects
Drowsiness
fatigue
restlessness
diarrhea
extrapyramidal symptoms
Serotonin (5-HT3) Recptor Blockers
Zofran
Treatment of severe nausea and vomiting associated w/ chemotherapy, postoperative situations
Zofran:
Caution and Adverse effects:
pregnancy and lactation
Headace, drowsiness, myalgia, urinary retention, constipation and pain at injection sites.
Use of Antiemetic agents across the lifspan:
call provider or local poison control if your child ingests toxic substances.
Use w/caution in children w/ CNS effects.
Antimetics are often used after surgery or chem, and precautions should be used to ensure that CNS effects do not interfere w/ mobility.
Older adults are likely to develop adverse effects with these drugs including sedation, dizziness, fluid imbalance, and cardiovascualr effects. Also, older adults are likely to have renal or hepatic dysfunction which could interfere w/ metabolism and excretion of these drugs.
GI = One long muscular tube
(30ft.)
food is propelled down the tube via peristalsis
Peristalsis and the enteric nervous system (AKA nerve plexus)
Fight or flight (Symathetic)
Decreased saliva production
Decrease gastric motility
Parasympathetic
Rest or digest
Increased saliva production
Increased digestion
Gastric juices secreted
Increased motility or peristalsis
Nerve plexus
Another way to think about it:
Increased anxiety=
stomach problems
(sympatheitc)
Decreased anxiety=
effective digestion
Rest and digest (parasympathetic)
Central reflexes:
Vomiting:
Emetic zone (projectile vomiting)
Chemoreceptor trigger zone (CTZ)
In response to a noxious stimulus
Chemicals
Choking
Stretch receptors
Drugs Affecting GI secretion:
Peptic Ulcers:
Most common in the stomach (Gastric) and duodenum
Can occur secondary to NSAID use
Stress ulcers can occur related to trauma
Primarily occurs secondary to Heliobacterpylori infection
**These bacteria can attach to the mucosal lining and are not affected by the high acidic environment.
What is the goal of peptic ulcer management?
To limit or neutralize HCL
H2 antagonists
Antacids
Proton Pump inhibitors
Antipeptic agents
Prostaglandins
Digestive Enzyme Dysfunction
Decrease saliva production
Pancreatic disease
Cystic fibrous
Do antacids produce an overproduction of acid?
No, they do not prevent acid but rather nuetralize the hyrogen ions coming from the parietal cells.
Histamine -2 Antagonists

Selectively block H2 receptors located on the parietal cells.
End result is decrease in acid production.

All end intidine
Cimetidine
Overuse of H2 Antagonists can lead to what?
Ulcers
Should not use for long periods of time
If Antacids are abused they can cause rebound acis production related to...
Gastric stimulation

Sodium Bicarbonate
Can mask the symptoms of stomach or esophageal cancer.
Essentially antacids are what?
Electrolytes:
Sodium bicarbonate
Calcium carbonate (TUMS)
Magnesium salts (MOM) be aware of someone w/ CHF.
Aluminum Salts
Maalox or Mylanta
Excessive amounts of Calcium Carbonate (TUMS) can lead to what?
Kidney Stones
Overuse of Antacids can lead to what?
A more alkaline environment
Seperate by 1-2 hours from other medications
Patient education: dosage, rebound acid production, chew tablets completely and follow with water.
Monitor electrolyes
Proton Pump Inhibitors:
(Similiar to H-2 antagonists)
Inhibit acid production

All end in Prazole
The proton pump is a term used to describe what?
The action that is occurring to increase HCL (gastric acid)
When activated the H+ ions are "pumped" acroos the cell membrane and made available for the production of "H" CL.
What is the choice of drug for H-pylori treatment?
PPI
Protein Pump Inhibitors
Similiar to H2 antagonists can cause diarrhe as a result of disruption of normal flora.
Maintenance of GERD
Short-term treatment of gastric disorders.
Adverse effects of PPI's.
Administer before meals
Do not open capsules
Safety
Follow up if symptoms not resolved
Antipeptic's
Sucralfate-Carafate Used for ulcers
"coats" injured site
Contraindicated in renal patinets
Constipation most frequent side effect
Encourage fluids
Prostaglandins
What do they do?
Cytosec
Inhibit acids secretions and promotes mucous production.

Used prophylacticly to prevent NSAID induced ulcers