ATI Pharmacology: The Reproductive and Genitourinary System

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1) Water retention
2) Headache
3) Backache
4) Diarrhea
5) Irritability
6) Depression
7) Mood swings
List some PMS symptoms.

During the luteal phase of the menstrual cycle, it spontaneously resolves after menstruation begins
When does PMS occur?

1) Exercise
2) Decreasing sodium in the diet
What lifestyle changes can treat PMS?

1) Oral contraceptives
2) Selective serotonin re-uptake inhibitors
3) Calcium supplements
4) Mild analgesics
5) Diuretics
What are some drug therapies for PMS?

1) Combination therapy: Estrogen and progestin
-Estrogen: Ethinyl estradiol, mestranol
-Progestin: Norethindrone, levonorgestrel, drospirenone
2) Single hormone therapy: Progestin
-Norgestrel
-Norethindrone
What are the two different types of oral contraceptives?

1) Prevents pregnancy
2) Reduced fluid retention associated with premenstrual syndrome
Other benefits of oral contraceptives include decreased risk for:
1) Hormone-induced migraine headaches
2) Uterine and ovarian cancers
3) PID
4) Benign breast disease
5) Ovarian cysts
What are oral contraceptives used for?

Ethinyl estradiol and drospirenone (Yasmin)
What is the prototype drug for oral contraceptives?

1) Ethinyl estradiol nad noerthindrone (Ortho-Novum 10/11)
2) Ethinyl estradiol and norethindrone (Necon 1/35)
3) Norethindrone (Micronor)
What are some other oral contraceptive drugs?

1) Mimic properties of natural hormones
2) Suppress secretion of FSH and LH
3) Thicken cervical mucus to prevent adequate sperk movement
4) Inadequately prepare uterine endometrium to reduce ovum implantation
5) Prevent symptoms of PMS and decrease risk for hypertension
What do oral contraceptives do?

1) Thromboembolism
2) Uterine bleeding
3) Increased growth of breast malignancies
4) Hypertension (less likely with ethinyl estradiol and drospirenone than with other combination oral contraceptives)
5) Hyperkalemia (caused by the drospirenone)
What do combination oral contraceptives increase risk for?

Indications of:
1) DVT
2) PE
3) MI
4) CVA
Which conditions should be monitored for when taking oral contraceptives?

1) Encourage patient to quit smoking
2) Monitor potassium levels and ECG periodically (ethinyl estradiol and drospirenone)
3) Monitor BP
4) Monitor the patter and amount of uterine bleeding
5) Recommend mammograms and breast examinations
6) Discontinue the drug for any indications of breast cancer
What else should monitored when women are taking oral contraceptives?

Class X, so be sure patients are NOT pregnant before starting therapy
What class of pregnancy drug is oral contraceptive?

Additional method of contraception
What else does a woman need during the first cycle of her oral contraceptive use?

1) 21 days of a drug-containing pill
2) 7 days of inactive pill
What is the precise dosing schedule of oral contraceptives?

1) 1 missed pill: take one missed pill with the next pill
2) 2 missed pills: two pills for two consecutive days
3) 3 or more missed pills: start new cycle 7 days later with additional contraceptive
What are the manufacturer’s instruction for missed pills?

1) Pain
2) Leg edema
3) Sudden change in vision
4) Severe headache
5) Shortness of breath
6) Palpitations
7) Parasthesias
8) Weakness
9) Abdominal cramps
10) Any menstrual issues
You should instruct patients taking an accommodation oral contraceptive to report what?

At least 4 weeks before nay surgery that increases risk of thromboembolic events
When should someone stop taking oral contraceptive?

1) Do not smoke
2) Perform self-breast examination every month
3) Obtain a mammogram and breast examination
What should you instruct the patient to remember to do if taking oral contraceptives?

1) Pregnancy category x
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 above age 35
List the contraindications of oral contraceptives.

1) Hypertension
2) DM
3) Heart disease
4) Migraines
Take caution in patients who are taking oral contraceptives and have what?

1) ACE inhibitors can cause hyperkalemia
2) Rifambin, ritonavir, phenobarbitol, carbamazepine, primidone, oneytoin, St, John’s wort can reduce effectiveness of oral contraceptives
3) Can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs
4) Can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants
What are some drug interactions associated with oral contraceptives?

1) Hot flashes
2) Insomnia
3) Atrophy of vagina and vulva
3) Bone loss that can osteoporosis
4) Altered metabolism of lipids, which can cause high cholesterol levels
What are some symptoms that can indicate a decrease in estrogen?

1) Estrogen therapy
2) Estrogen and progesterone therapy
What are the two different types of hormone replacement therapies (HRT) that treat menopause?

Decrease endometrial cancer of the uterus
Why is estrogen and progesterone therapy used for women who still have their uterus?

1) Relieves menopausal symptoms (vasomotor)
2) Prevents vulvar and vaginal hypertrophy
3) Prevents postmenopausal osteoporosis
What are does estrogen HRT relieve and prevent?

1) Oral: conjugated equine estrogen (Premarin)
2) Transdermal estradiol (Estraderm, Climara, FemPatch)
3) Estradiol intravaginal tablets (Vagifem) or estradiol cream (Estrace Vaginal Cream)
What are some prototype drugs that are estrogen HRT?

1) Nausea
2) Hypertension
3) Endometrial hyperplasia, endometrial and ovarian cancer
4) Thromboembolitic disorder- estrogen increases the amount of clotting factors in the blood, making it more likely for clots to form
What are some side and adverse effects of estrogen HRT?

1) Nausea diminishes with time
2) Monitor for and report any indications of DVT, PE, MI, CVA
3) Encourage patients who smoke to quite smoking
4) Advise use of HRT for no more than 3 to 4 years
5) monitor BP
6) Monitor for vaginal bleeding
7) Check that patients with an intact uterus are prescribe progesterone
What are some interventions associated with estrogen HRT?

1) Apply to clean, dry, intact skin on abdomen or trunk
2) Do not use the same site more than once per week
What are some important points to know when placing transdermal estradiol patches?

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

1) History of other risks for theomboembolic events
2) Suspected or confirmed cancer
3) Liver disease
4) Undiagnosed vaginal bleeding
What are the contraindications for estrogen HRT?

1) Hypertension
2) Gall bladder disease
3) DM
4) Heart disease
5) Migraines
6) Kidney dysfunction
What ares some precautions with estrogen HRT?

1) Rifampin, ritonavir, phenobarbital, carbamazapine, primidone, phenytoin, and St, John’s wort can reduce 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
What are some drug interactions associated with estrogen HRT?

1) Relieves severe menopausal symptoms (vasomotor) and vulvar and vaginal atrophy
2) Prevents postmenopausal osteoporosis
What does estrogen and progesterone HRT do?

1) Oral: conjugated estrogen and medroxyprogesterone acetate (Prempro)
2) Transdermal: estradiol and norethindrone acetate transdermal system (CombiPatch)
What are the prototype drugs for estrogen and progesterone HRT?

1) Estrogen binds to estrogen receptors in target tissues
2) Hormone replacement therapy substitutes a smaller, stable amount of estrogen
3) Progesterone antagonizes estrogen-influenced tissue growth in the uterine endometrium
What is the expected pharmacologic action of estrogen and progesterone HRT?

1) Nausea
2) Hypertension
3) Thromboembolism
4) Acute cardiac events
5) Vaginal bleeding and spotting
6) Edema and weight gain
7) Breast cancer
What are some side and adverse effects of estrogen and progesterone HRT?

1) Monitor and report DVT, PE, MI, CVA
2) Encourage patients who smoke to quit
3) Encourage temporary use of HRT for vasomotor symptoms (night sweats, hot flashes, etc.)
4) Inform patients that nausea diminishes with time
5) Monitor BP
6) Recommended mammograms and breast exams
7) Discontinue drug for any indications of breast cancer
8) Monitor the pattern and amount of any vaginal bleeding
9) Monitor for edema and weight gain
What are some interventions for estrogen and progesterone HRT?

1) Apply patches to clean, dry, intact skin on the abdomen or trunk
2) Press firmly for 10 seconds
3) Do not use the same site more than once per week
What are some important points for administration of transdermal
estrogen and progesterone HRT patches?

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 thromboembolic event risk
4) Obtain regular blood pressure checks
5) Exercise regularly and follow a health, low-fat diet
6) Take oral forms with food, take pill or apply transdermal patch at a bedtime
7) Report vaginal bleeding or spotting to the provider
What are some patient instructions for estrogen and progesterone HRT?

1) History of or risk for thromboembolic events
2) Suspected or confirmed cancer
3) Liver disease
4) Undiagnosed vaginal bleeding
What are contraindications for estrogen and progesterone HRT?

1) Hypertension
2) Gall bladder disease
3) DM
4) Heart disease
5) Migraines
6) Kidney dysfunction
What are some precautions for estrogen and progesterone HRT?

1) Rifampin, ritonavir, phenobarbiral, carbamazapine, primidone, phenytoin, and St. John’s wort can reduce the effectiveness of estrogens
2) Hormone replacement therapy can reduce the effects of warfarin (Coumadin) and hypoglycemic drugs
3) Hormone replacement therapy can increase levels of theophylline (Theo-24), diazepam (Valium), chlordiazepoxide (Librium), and tricyclic antidepressants
4) Ketoconazole may increase the adverse effects of progesterone
What are some drug interactions with estrogen and progesterone HRT?

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