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19 Cards in this Set
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- Back
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Oral contraceptives |
•Treat: prevents pregnancy, reduces fluid retention associated with premenstrual syndrome; also decreases the risk for hormone induced migraine headaches, uterine and ovarian cancers, pelvic inflammatory disease and ovarian cysts Examples: -Ethinyl estradiol and drospirenone (Yasmin) -Ethinyl estradiol and norethindrone (Ortho-novum 10/11+ Necon 1/35) -Norethindrone (Micronor) •Mimic properties of natural hormones, suppresses secretion of FSH and LH, thickens cervical mucus to prevent adequate sperm movement, reduces ovum implantation, prevents premenstrual syndrome and decreases risk for hypertension •Side effects: -Thromboembolism (monitor for DVT, PE, MI and CVA) -Uterine bleeding -Increased growth of breast malignancies (recommend mammograms and breast exams) -Hypertension (monitor blood pressure) -Hyperkalemia (caused by drospirenone; monitor EKG) •Encourage patient to stop smoking •Make sure patients are NOT pregnant (category X) •Instruct patient to report pain, leg edema, sudden change in vision, severe headache or shortness of breath •Stop taking 4 weeks before any surgery that increases the risk for thromboembolic events •Stop smoking •Report regular blood pressure checks •Perform regular self breast exams + regular mammograms/breast exams •Do not give to patients with these conditions: -pregnancy category X -History or other risk for thromboembolic events -Suspected or confirmed breast cancer -Altered liver function -Altered renal function or adrenal function -Smoker older than 35 years |
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Drugs for Menopause |
•Estrogen therapy •Estrogen and progesterone [combination therapy] |
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Estrogen HRT |
•Treat: relieve menopausal symptoms (vasomotor), prevents valvular and vaginal atrophy and prevents postmenopausal osteoporosis •Examples: -Conjugated equine estrogen (Premarin) -transdermal estradiol (Estraderm, Climara, FemPatch) -estradiol intravaginal tablets (Vagifem) or estradiol cream (Estrace vaginal cream) •Estrogen binds to estrogen receptors in target tissues, hormone replacement therapy (HRT) substitute a smaller, stable amount of estrogen for previous fluctuating amounts •Side effects -Nausea -Hypertension -Endometrial hyperplasia (increases risk for endometrial + ovarian cancer) -Thromboembolism •Monitor and report signs of DVT, PE, MI, & CVA •Encourage patients to quit smoking •Monitor blood pressure •Monitor for vaginal bleeding [instruct patients to report to provider] •Advice use of HRT for no more than 3 to 4 years •Instruct patient to report pain, leg edema, sudden change in vision, severe headache or shortness of breath •Stop taking 4 weeks before any surgery that increases the risk for thromboembolic events •Exercise regularly and follow a healthy, low fat diet •Do not give to patients with these conditions: -History of or other risks for thromboembolic events -Suspected or confirmed cancer -liver disease -Undiagnosed vaginal bleeding |
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Estrogen and Progesterone HRT |
•Treat: relieves severe menopausal symptoms (vasomotor) and vulvar and vaginal atrophy and prevents post menopausal osteoporosis •Examples: -Conjugated estrogen and medroxyprogesterone acetate -estradiol and norethindrone acetate transdermal system •Estrogen binds to estrogen receptors in target tissues, hormone replacement therapy substitutes a smaller, stable amount of estrogen, progesterone antagonizes estrogen-influenced tissue growth in the uterine endometrium •Side effects -Nausea -Hypertension -Thromboembolism -Acute cardiac events -vaginal bleeding and spotting -Edema + weight gain -Breast cancer •Monitor and report signs of DVT, PE, MI, & CVA •Encourage patients to quit smoking •Monitor blood pressure •Monitor for vaginal bleeding [instruct patients to report to provider] •Advice use of HRT for no more than 3 to 4 years •Instruct patient to report pain, leg edema, sudden change in vision, severe headache or shortness of breath •Stop taking 4 weeks before any surgery that increases the risk for thromboembolic events •Perform regular self breast exams + regular mammograms/breast exams Do not give to patients with these conditions: -History of or other risks for thromboembolic events -Suspected or confirmed cancer -liver disease -Undiagnosed vaginal bleeding |
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Drug therapy for endometrial hyperplasia and endometriosis |
•GnRH agonist •Progesterone |
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GnRH agonist |
•Treat: endometriosis, uterine fibroids and advanced prostate cancer in males •Examples: -Leuprolide (Lupron) -Nafarelin •Increases secretion of estrogen + progesterone which decreases LH + FSH, chemically induces menopause, endometrial hyperplasia SHRINKS [In women]. In men with prostate cancer levels of LH + FSH decrease which leads to less testosterone production and less prostate cancer symptoms •Side effects: -Vasomotor -Vaginal dryness -Headache -Bone loss [perform weight bearing exercises + adequate consumption of calcium & vitamin D] •Limit drug therapy for up to 6 months to minimize bone loss •For therapy that lasts longer than 6 months, monitor for bone loss via bone density scan •Suggest vitamin B6 + vitamin E supplements •Recommend water soluble lubricants •Monitor for headache + other CNS effects •Give IM injections or IM depot form every 3 to 4 months, rotate injection site, EXPECT amenorrhea [no menses] + other menstrual irregularities •Report headache, dizziness or paresthesia •Do not use in patients with these conditions: -pregnancy [category X] -Allergy to benzyl alcohol -Abnormal vaginal bleeding -Metastatic cerebral lesions |
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Progesterone |
•Treats: endometriosis, dysfunctional uterine bleeding and endometrial carcinoma •Examples: -Medroxyprogesterone acetate (Provera) -Norethindrone (Micronor) -Megestrol •Antagonizes estrogen influenced tissue growth in the uterine endometrium, prevents hyperplasia, suppresses growth of endometrial ovum implant, may reduce inflammation in the pelvic cavity |
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Drug Therapy for Infertility |
•LH and FSH stimulants •Ovulation stimulants •Hyperprolactinemia inhibitors |
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LH + FSH stimulant |
•Treat: infertility + promotes ovulation •Example: -Clomiphene •Blocks the effects of estrogen receptors on pituitary gland, increases secretion of gonadotropin releasing hormone, stimulates secretion of LH + FSH, stimulates ovary to produce mature follicle and ovulation occurs when follicle ruptures •Side effects: -vasomotor instability [hot flashes] -Breast engorgement [wear supportive bra] -Nausea + abdominal discomfort [take drug with food] -Blurred vision, flashes of light, dizziness [monitor & report vision alterations + recommend eye exams if this occurs, discontinue therapy if visual symptoms persist) -Ovarian hyper-stimulation -Multiple gestation •Give PO, beginning 5 days after onset of menses + continue therapy for 5 days [repeat 5 day course at 30 day intervals as prescribed] •Stop taking drug if any suspicion of pregnancy •Report pelvic pain •Do not give to patients with these conditions: -pregnancy category X -primary ovarian failure -Undiagnosed uterine bleeding -Liver disease -Uncontrolled thyroid disease -Thrombophlebitis |
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Ovarian Stimulant |
•Treat: promotes ovulation, treats infertility + used in conjunction with a drug that stimulates follicular maturation •Example: -hCG (Pregnyl) •Stimulates the secretion of LH in patients who do not ovulate, causes ovulation after another fertility drug has stimulated maturation of the ovarian follicle [drugs used in conjunction with hCG: Menotropins + Follitropins] •Side effects: -Ovarian hyper-stimulation -Ovarian cyst rupture -CNS effects: irritability, headache, fatigue and restlessness •Monitor for indications of ovarian hyper-stimulation [EMERGENCY] •Monitor for indications of bleeding into the peritoneum [Cullen signs or grey tunner sign] •Ovulation stimulant + clomiphene [give ovulation stimulant 7 to 9 days after last dose of clomiphene] •Menotropins or Follitropins + ovulation stimulant [give ovulation stimulant 1 day after the last dose of menotropins or follitropins] •Monitor and report for pelvic or abdominal pain, pelvic pressure, unusual weight gain or swelling [EMERGENCY call 911] •Do not give to patients with these conditions: -pregnancy category X -pituitary tumor -Dysfunctional uterine bleeding -Uncontrolled thyroid disease -Adrenal insufficiency |
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Hyperprolactinemia inhibitor |
•Treat: infertility and corrects amenorrhea from excessive secretion of prolactin •Examples: -Cabergoline -Bromocriptine •decreases level of gonadotropin releasing hormone, decreases levels of LH + FSH, decreases levels of estrogen + progesterone, disrupts menstrual cycle + pregnancy cannot occur, increases amount of dopamine, dopamine causes prolactin levels to decrease, menstrual cycle normalizes •Side effects: -Nausea -Headache + dizziness -Orthostatic hypotension [monitor blood pressure] •Begin treatment starts lowest level therapeutic dose [monitor prolactin serum levels/stop drug when prolactin levels are within expected range] •Do not give to patients with these conditions: -Uncontrolled hypertension -pregnancy induced hypertension |
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Drugs Therapy that induces Uterine Contractions |
•Oxytocin [Pitocin] •Dinoprostone •Methylergonovine |
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Oxytocin |
•Treat: uterine stimulant, induces labor and treats postpartum hemorrhage •Stimulates smooth muscle to contract at the end of pregnancy, responsible for milk ejection from milk channels, causes water retention by the kidneys •Side effects -Uterine hyper-stimulation [turn patient on her left side, stop oxytocin infusion, administer oxygen by mask 8 to 10 liter and give tocolytic] -Hypertensive crisis [monitor for nausea, vomiting, increasing blood pressure] -Water intoxication •Monitor length, strength and duration of contractions •Monitor for risk factors like multiple deliveries •Monitor FHR and report signs of distress •Report headache, palpitations, nausea, chest pain •Do not give to patients with these conditions: -Unripe cervix, placental abnormalities -Active genital herpes -Uterine surgery -Fetal distress -Lung immaturity -Cephalopelvic disproportionation -Malpresentation -Prolapsed umbilical cord |
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Ergot Alkaloids |
•Treat: prevent and treat postpartum and post abortion hemorrhage •Examples: -Methylergonovine -Ergonovine •Cause strong uterine contraction by stimulating muscles in the uterus; help stop bleeding in the postpartum period, or following a surgical or spontaneous abortion •Side effects -Hypertension [monitor blood pressure] -Nausea, vomiting -Headache -Bradycardia [monitor heart rate] -Seizures [seizure precautions] •Monitor blood pressure before administration and withhold drug if blood pressure is greater or equal to 140/90 •Uterine cramping is expected •Give the drug IV ONLY for emergency control of severe hemorrhage •Monitor + report headache, nausea and palpitations •Do not give to patients with these conditions -Induction of labor -Threatened spontaneous abortion -Hypertension -Uterine sepsis -Cardiac cardiac |
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Synthetic prostaglandins |
•Stimulate uterine contraction Examples: -dinoprostone vaginal insert [Cervidil] or vaginal gel [prepidil] -Misoprostol [Cytotec] •Prostaglandins activate the enzyme collagenase, collagenase breaks down the rigid collagen complex and softens the cervix and stimulates uterine contractions •Side effects: -Uterine hyper-stimulation -Nausea, vomiting diarrhea [maintain hydration] -Fever [Monitor temp] •Monitor patient vitals + FHR (if these are abnormal): turn her on her left side, stop administration med, give oxygen by face mask 8 to 10 liters, give tocolytic •Have patient void before insertion of gel form, have the patient lie supine and remain in that position for 30 minutes after instillation of gel [dose given every 6 hours] •Begin oxytocin 6 to 12 hours after last dose of gel •Vaginal insert [cervidil]: insert pouch into posterior fornix of the vagina, have patient lie supine for 2 hours, remove pouch when active labor begins or 12 hours later, continue to monitor mom vitals and FHR •Do not give to patients with these conditions: -Acute pelvic inflammatory disease [PID] -Active cardiac disease -Active lung disease -Liver or kidney impairment -Fetal malpresentation -Non-reassuring fetal heart rate [FHR] pattern -Previous uterine surgery [C-section is contraindicated because it leads to uterine rupture while on this drug] |
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Beta 2 adrenergic Agonist [tocolytics] |
•Preterm labor inhibitor [tocolytic or uterine contraction relaxant] •Example: -Terbutaline •Phosphorylated myosin light chain kinase [enzyme] interacts with actin to begin uterine contractions~Beta adrenergic agonist stop labor by decreasing the availability of myosin light chain kinase •Side effects: -Respiratory effects (pulmonary edema, dyspnea, cough, tachycardia) -Cardiac effects (tachycardia, MI, chest pain, palpitations, HYPOtension) -HYPOkalemia [potassium containing foods] -HYPERglycemia [instruct patient to report polydipsia, polyphagia, polyuria] •Monitor EKG before tocolytic therapy •Stop tocolytic therapy for maternal tachycardia, dysrhythmias, and chest pain •Prepare to give propranolol [to counteract the adverse effects of terbutaline] •Report abnormal fetal distress [monitor FHR] •Confirm preterm labor + gestation between 20 to 35 weeks; administer terbutaline Sub q on lateral deltoid area, every 20 minutes for up to 3 hours, yet no long than 48 hours[while on therapy monitor maternal and fetal vital signs] -Stop infusion of terbutaline for fetal heart rate greater than 180 beats per min [normal is 110 to 160 beats per min] or non-reassuring fetal rhythm •Do not use in patients with these conditions: -Cardiac disease -Hypertension or preeclampsia -Hyperthyroidism -Uncontrolled diabetes -Recent (within 14 days) use of MAOIs -Angle closure glaucoma |
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Drugs for lung maturity |
•Examples: -Betamethasone -Dexamethasone •Administer deep IM [use gluteal or vastus lateralis muscles/ give betamethasone 12 mg IM 2 doses 24 hours apart/give dexamethasone 6 mg IM 4 doses 12 hours apart] •Side effects -Pulmonary edema [productive cough, crackles, shortness of breath] -Hyperglycemia -Hypertension •Check for allergy •Do not give to patient with active infection |
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Drug Therapy to prevent and treat seizures activity |
•Hypertension in pregnancy [magnesium sulfate] -Gestational hypertension -Preeclampsia -Severe preeclampsia -Eclampsia [seizure during pregnancy; life threatening EMERGENCY] -HELLP (Hemolysis, Elevated Liver enzyme, Low Platelet) syndrome |
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Magnesium sulfate [tocolytic + anti-seizure] |
•Treat: prevents preterm labor and eclampsia •Loading dose 4 to 6 grams magnesium sulfate [IV bolus/over 15 to 30 minutes] •A maintenance dose by continuous IV infusion at 2 grams per hour •Place patient on her left side [this increases oxygen + perfusion to uterus/fetus] •Side effects: -Burning at IV site -Warmth, flushing, diaphoresis -Nausea + vomiting -Drowsiness, headache, blurred vision, muscle weakness -Maternal HYPOtension, bradycardia, bradypnea -Decreased or absent deep tendon reflexes [DTR] -Altered level of consciousness -Decreased urine output -Magnesium toxicity [decreased DTR, maternal hypotension, bradycardia, bradypnea, decreased urine output less than 30 mL per hours; make sure to have calcium gluconate 10% which is mag antidote] -Pulmonary edema -Reduced variability of FHR •Do not give to patients with these conditions: -Myasthenia gravis -Kidney failure -HYPOcalcemia |
