Pharm Test 5
Estrogen
Estradiol
decreases osteoporosis risk
• Long term use (> 5 years) of HRT
Increased risk of CV disease and stroke
Small increased risk of breast cancer
• Contraindications
breast cancer, and estrogen dependent cancer
• S/S
Vaginal bleeding
Estrogen Receptor Modulators
raloxifene: PO daily
• Adverse effects-
Headache, dizziness, visual changes, and mental changes
Hot flashes, and vaginal bleeding
Venous thromboembolism
Menopause
• Contraception should be used until 1 year after cessation of spontaneous menstruation
• Managing symptoms
Increase calcium in diet due to calcium loss from menopause
Weight-bearing exercises such as walking
Avoid caffeine and ETOH
Progestins
Inhibit the secretion of FSH and LH
• Side effects
Due to excess progestin
Increased appetite, weight gain, decreased breast size
Oily skin and scalp, acne, excess hair growth, depression
Vaginitis from yeast, amenorrhea after cessation of use
Due to progestin deficiency
Dysmenorrhea, bleeding late in cycle, heavy flow with clots, amenorrhea
The effectiveness of the Oral Contraceptive is reduced by the following drugs
Rifampin
Phenytoin (Dilantin)
Phenobarbital
Tegretol
Ampicillin
Doxycycline
Tetracycline
Use backup method for duration of treatment plus 7 days
OC also decreases effectiveness of
oral anticoagulants (warfarin)
Monitor PT/INR (it will DECREASE PT/INR)
oral hypoglycemics
Monitor blood glucose (it will INCREASE blood glucose)\
Oral Contraceptive teaching
ACHES: for dangerous side effects that must be reported to a health care provider:
A: Abdominal pain (severe)
, C:Chest pain or shortness of breath
H: Headaches that are severe; dizziness, weakness, numbness, speech difficulties
E: Eye disorders including blurring or loss of vision
S: Severe leg pain or swelling in the calf or thigh
Take at same time each day
Managing missed doses
take tablet as soon as realize and back up contraception for 48 hrs
smoking inc risk of CV complications (DVT)
Emergency Contraception
• IDEALLY, EC should be taken within 72 hours after unprotected sex for MAXIMUM effectiveness
• Yuzpe regimen: involves taking BC pills the pt may already have
By combining pills in a specific order, the estrogen and progestin in those pills work to prevent an unplanned
pregnancy before it starts. Most effective when used within 72 hours after having unprotected sex.
• Plan B (levonorgestrel): available OTC
• EDUCATION is Key
Should NOT be used as a form of birth control
Follow-up care is advised
Women should still get annual screenings
Fertility Drugs
Clomiphene
increase FSH and LH levels
• Side/Adverse Effects
Increase risk of multiple births and birth defects
fluid retention
nausea, vomiting, bloating
Depression
• Assess-
Uterine bleeding, pelvic examinations and appropriate lab values
Symptoms of depression: may need to add psychological counselling to the treatment regimen
Oxytocics
Oxytocin
• Indications:
used to induce labor
strengthen labor contractions during childbirth
control bleeding after childbirth
Prevention and treatment of uterine atony (uterus fails to contract) after delivery (which is the most
common cause of post-partum hemorrhage)
• Actions
Affect neuroreceptors sites to stimulate contractions of the uterus
• Side/Adverse Effects
GI upset (nausea, vomiting)
Headache
Hypertension
Androgens
testosterone
Hypogonadism; breast cancer
danazol
Block the release of FSH and LH in women
Used to treat endometriosis
• Side Effects
Acne, hirsutism (male-pattern hair growth in women)
, Deepening of the voice, weight gain, Priapism
Edema: due to water and salt retention (monitor daily weights and swelling of extremities)
• Adverse Effects
Elevated LDL/Decreased HDL, polycythemia,
Anabolic Steroids
Oxandrolone
• Side/Adverse Effects
Cardiomyopathy
Hepatic carcinoma
Personality changes
Sexual dysfunction
Erectile Dysfunction
Sildenafil
Tadalafil
vardenafil
• Contraindications
Condition that might predispose to priapism (erection lasting more than 4 hours)
Penile implants
• Caution
Bleeding disorders, coronary artery disease, active peptic ulcer, hypotension, or severe hepatic or renal
disorders
• Adverse Effects
headache, dizziness, angina, dyspnea, hypotension
• Drug-to-Drug Interactions
PDE5 inhibitors combined with organic nitrates or alpha blockers
BPH
5-alpha reductase inhibitors: blocks testosterone production & shrinks the prostate gland
Finasteride
Dutasteride
SE: dec. libido, erectile dysfxn
Alpha-adrenergic blocking agents (blocks alpha receptors in prostatic smooth muscle causing prostate gland to constrict,
therefore reducing urethral and bladder pressure and inc urine flow
Tamsulosin
Doxazosin
Terazosin
Alfuzosin
SE: ortho hypo, dizziness, fatigue
Drug effectiveness (therapeutic effects): decreased hesitancy and nocturia, ability to fully empty bladder
Gonadotropin-Releasing Hormone (GnRH) Agonists
Leuprolide
GnRH agonist that occupies pituitary Gonadotropin-Releasing Hormone (GnRH) receptor sites so that they no
longer respond to GnRH.
– Antineoplastic for prostate cancer
Reduces amount of testosterone which feeds the cancer
Estrogen
Estradiol
decreases osteoporosis risk
• Long term use (> 5 years) of HRT
Increased risk of CV disease and stroke
Small increased risk of breast cancer
• Contraindications
breast cancer, and estrogen dependent cancer
• S/S
Vaginal bleeding
Estrogen Receptor Modulators
raloxifene: PO daily
• Adverse effects-
Headache, dizziness, visual changes, and mental changes
Hot flashes, and vaginal bleeding
Venous thromboembolism
Menopause
• Contraception should be used until 1 year after cessation of spontaneous menstruation
• Managing symptoms
Increase calcium in diet due to calcium loss from menopause
Weight-bearing exercises such as walking
Avoid caffeine and ETOH
Progestins
Inhibit the secretion of FSH and LH
• Side effects
Due to excess progestin
Increased appetite, weight gain, decreased breast size
Oily skin and scalp, acne, excess hair growth, depression
Vaginitis from yeast, amenorrhea after cessation of use
Due to progestin deficiency
Dysmenorrhea, bleeding late in cycle, heavy flow with clots, amenorrhea
The effectiveness of the Oral Contraceptive is reduced by the following drugs
Rifampin
Phenytoin (Dilantin)
Phenobarbital
Tegretol
Ampicillin
Doxycycline
Tetracycline
Use backup method for duration of treatment plus 7 days
OC also decreases effectiveness of
oral anticoagulants (warfarin)
Monitor PT/INR (it will DECREASE PT/INR)
oral hypoglycemics
Monitor blood glucose (it will INCREASE blood glucose)\
Oral Contraceptive teaching
ACHES: for dangerous side effects that must be reported to a health care provider:
A: Abdominal pain (severe)
, C:Chest pain or shortness of breath
H: Headaches that are severe; dizziness, weakness, numbness, speech difficulties
E: Eye disorders including blurring or loss of vision
S: Severe leg pain or swelling in the calf or thigh
Take at same time each day
Managing missed doses
take tablet as soon as realize and back up contraception for 48 hrs
smoking inc risk of CV complications (DVT)
Emergency Contraception
• IDEALLY, EC should be taken within 72 hours after unprotected sex for MAXIMUM effectiveness
• Yuzpe regimen: involves taking BC pills the pt may already have
By combining pills in a specific order, the estrogen and progestin in those pills work to prevent an unplanned
pregnancy before it starts. Most effective when used within 72 hours after having unprotected sex.
• Plan B (levonorgestrel): available OTC
• EDUCATION is Key
Should NOT be used as a form of birth control
Follow-up care is advised
Women should still get annual screenings
Fertility Drugs
Clomiphene
increase FSH and LH levels
• Side/Adverse Effects
Increase risk of multiple births and birth defects
fluid retention
nausea, vomiting, bloating
Depression
• Assess-
Uterine bleeding, pelvic examinations and appropriate lab values
Symptoms of depression: may need to add psychological counselling to the treatment regimen
Oxytocics
Oxytocin
• Indications:
used to induce labor
strengthen labor contractions during childbirth
control bleeding after childbirth
Prevention and treatment of uterine atony (uterus fails to contract) after delivery (which is the most
common cause of post-partum hemorrhage)
• Actions
Affect neuroreceptors sites to stimulate contractions of the uterus
• Side/Adverse Effects
GI upset (nausea, vomiting)
Headache
Hypertension
Androgens
testosterone
Hypogonadism; breast cancer
danazol
Block the release of FSH and LH in women
Used to treat endometriosis
• Side Effects
Acne, hirsutism (male-pattern hair growth in women)
, Deepening of the voice, weight gain, Priapism
Edema: due to water and salt retention (monitor daily weights and swelling of extremities)
• Adverse Effects
Elevated LDL/Decreased HDL, polycythemia,
Anabolic Steroids
Oxandrolone
• Side/Adverse Effects
Cardiomyopathy
Hepatic carcinoma
Personality changes
Sexual dysfunction
Erectile Dysfunction
Sildenafil
Tadalafil
vardenafil
• Contraindications
Condition that might predispose to priapism (erection lasting more than 4 hours)
Penile implants
• Caution
Bleeding disorders, coronary artery disease, active peptic ulcer, hypotension, or severe hepatic or renal
disorders
• Adverse Effects
headache, dizziness, angina, dyspnea, hypotension
• Drug-to-Drug Interactions
PDE5 inhibitors combined with organic nitrates or alpha blockers
BPH
5-alpha reductase inhibitors: blocks testosterone production & shrinks the prostate gland
Finasteride
Dutasteride
SE: dec. libido, erectile dysfxn
Alpha-adrenergic blocking agents (blocks alpha receptors in prostatic smooth muscle causing prostate gland to constrict,
therefore reducing urethral and bladder pressure and inc urine flow
Tamsulosin
Doxazosin
Terazosin
Alfuzosin
SE: ortho hypo, dizziness, fatigue
Drug effectiveness (therapeutic effects): decreased hesitancy and nocturia, ability to fully empty bladder
Gonadotropin-Releasing Hormone (GnRH) Agonists
Leuprolide
GnRH agonist that occupies pituitary Gonadotropin-Releasing Hormone (GnRH) receptor sites so that they no
longer respond to GnRH.
– Antineoplastic for prostate cancer
Reduces amount of testosterone which feeds the cancer
