Drugs Affecting the Reproductive System

Question 1

Enlarged prostate which leads to urinary stasis, obstruction, and infection - obstructs urinary flow
Clinical manifestations: difficult initiation of urine stream, incomplete bladder emptying, overflow incontinence, at risk for frequent UTI’s
Common condition of aging - see lot pats taking meds to treat BPH
Pharmacologic therapy goal: either shrink prostate or relax smooth muscle of urinary tract to increase ability to urinate; increase quality of life
Common prob

Answer 1

Review BPH

Question 2

Blocks testosterone; shrinks prostate

Answer 2

• 5-alpha reductase inhibitor: prototype: finasteride (Proscar)

Question 2

Blocks testosterone; shrinks prostate

Answer 2

MoA: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)

Question 3

Benign prostatic hypertrophy (BPH)

Answer 3

Indication: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)

Question 4

Reduced libido, hypotension - not lot AE that readily experience

Answer 4

AE: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)

Question 5

Teach: symptom improvement in 3-6 months - not overnight; takes time to shrink prostate; time to interfere processes that enlarges prostate and reverse them so takes awhile for symp improvement
Women wear gloves when handling medication (really harmful to women)
DO NOT HANDLE medication while pregnant (category X - never take it) - to developing fetus; no reason to take it and know causes harm
Men: DO NOT donate blood while on medication or father a child - get anybody pregnant because how med works and how excreted in fluids

Answer 5

Nursing: - 5-alpha reductase inhibitor: prototype: finasteride (Proscar)

Question 6

Blocks alpha-1 adrenergic receptor in smooth muscle of prostate, relaxes bladder neck and urethra allows urine flow; target alpha-1 receptors of SNS and blocking those receptors to cause relaxation of smooth muscle surrounding prostate gland in urinary sys; trying to relax everything/smooth muscle around prostate in UT so can urinate easier reducing symp of BPH

Answer 6

MoA: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 7

Benign prostatic hypertrophy

Answer 7

Indications: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 8

Oral; extended release

Answer 8

Route: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 9

heart failure or CAD

Answer 9

Contraindications/cautions: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 10

antihypertensive drugs - working to lower BP; if put on another med that also lowers BP so BP may get extremely low

Answer 10

Drug/drug: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 11

Tachycardia, hypotension- targets other blood vessels so get this, syncope, GI upset, sexual dysfunction

Answer 11

Adverse Effects: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 12

Monitor closely for hypotension; Do not crush or chew extended-release formulations; Monitor for symptom improvement of BPH

Answer 12

Nursing: - Alpha-1 adrenergic blockers: Prototype: Tamsulosin (Flomax)

Question 13

cause prolonged smooth muscle relaxation- allowing flow of blood into corpus cavernosum and facilitating erection; not that admin lot med because pats take before sex; not do in hospital lot times; in play make sure adequately understands what med for and affects can have so self-monitor effects when at home taking med

Answer 13

MoA: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 14

penile erectile dysfunction

Answer 14

Indications: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 15

Oral prior to sexual stimulation

Answer 15

Route: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 16

numerous – check drug resource prior to admin.

Answer 16

Contraindications: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 17

No organic nitrates (ex. nitro tablets) within previous 24 hours - causes vasodilation so high risk for hypotension; or alpha-adrenergic blockers

Answer 17

Drug/Drug: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 18

Headache, dizziness, hypotension (biggest AE because smooth muscle relaxation; monitor for s/s: dizzy, syncope, light-headed)

Answer 18

Adverse Effects: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 19

Teach: caution with nitrates to avoid hypotension; know how monitor for hypotension and report s/s of hypotension; is affected by grapefruit juice: alters hepatic enzyme sys - sys less effective so more med can stay in bloodstream - make sure not drink grapefruit juice 24-48 hrs before/after so best to avoid

Answer 19

Nursing: - Drugs for Penile Erectile Dysfunction: Prototype: Sildenafil (Viagra)

Question 20

Most meds contain estrogen
used for variety things/Indications:
sev diff Routes:

Answer 20

Female hormones: estrogens

Question 21

Atrophic vaginitis
Hypogonadism
Oral contraception
Ovarian failure
Uterine bleeding
Breast or prostate cancer
Osteoporosis
Vasomotor symptoms of menopause (hot flashes) - treat symptoms of menopause

Answer 21

used for variety things/Indications:

Question 22

Oral
Transdermal
Topical

Answer 22

sev diff Routes:

Question 23

Many symptoms of menopause attributed to decreased estrogen levels experienced - trying to minimize effects pat experiencing; sometimes can be sig and interfere with daily living and quality of life depending on what it is
Smallest effective dose - hard know amount and what do
May be combined with progestins (intact uterus)
Individualized plan based on benefit vs. risk - discuss with doc; amount and how long

Answer 23

Hormone replacement therapy: using the Estrogens

Question 24

Osteoporosis Hot flashes Atrophic vaginitis

Answer 24

Many symptoms of menopause attributed to decreased estrogen levels experienced - trying to minimize effects pat experiencing; sometimes can be sig and interfere with daily living and quality of life depending on what it is

Question 25

Many are combination of estrogen and progesterone - variety of routes; most contain estrogen; some progesterone only Some are progestin only Since Most drugs contain estrogen treat similarly Prevent pregnancy Do not prevent against sexually transmitted infections including HIV

Answer 25

Contraceptive drugs

Question 26

Oral: norethindrone/ethyl estradiol (Loestrin) Transdermal: norelgestromin/ethyl estradiol Intravaginal: etonogestrel-ethyl estradiol (NuvaRing)

Answer 26

Many are combination of estrogen and progesterone - variety of routes; most contain estrogen; some progesterone only

Question 27

BBW: loss of bone mineral density

Answer 27

Some are progestin only

Question 28

Pregnancy/lactation (Category X) - trying prevent pregnancy with lot meds so making uterus inhabitable for child and if pregnant causes lot probs Hx of cardiovascular disease related to clotting (DVT, MI, CVA) - blood clots reoccuring thing; excess estrogen effect on body that makes higher propensity to form blood clots Smoking – increased risk of thrombus formation; risk substantially increased; imp part pat teaching Antibiotics – make contraceptives less effective, make sure to use other method to prevent pregnancy; d-d interaction Black box warning: - risks very high/detrimental to that happen

Answer 28

Female hormones: Contraindications and Warnings

Question 29

Increased risk of cardiovascular events (DVT, PE, MI, ischemic CVA) - can be life threatening Increased risk of endometrial and breast cancer

Answer 29

Black box warning: - risks very high/detrimental to that happen

Question 30

Sev diff effects that can happen Breakthrough bleeding/menstrual irregularities - effect menstrual cycles; not post-menopausal Changes in libido Fluid retention (edema, headaches, dizziness) GI effects (nausea/vomiting, abdominal cramps, bloating) Thromboembolism (DVT/PE/CVA) - risk blood clots

Answer 30

Female hormones: adverse effects

Question 31

B = Breakthrough bleeding E = Edema G = GI effects E = Embolism L = Lost libido (S) = Stop smoking - counsel to do this because increases risk of blood clot C = contraceptives less effective with antibiotics C = cardiovascular events, increased risk

Answer 31

Acronym for Female Hormones: BEGEL(S) with Cream Cheese for AE

Question 32

Assess: Interventions:

Answer 32

Nursing action for female hormones

Question 33

Gen assessment Pay special attention to anything relating woman’s health Age, lifestyle, menstrual cycle like; (pre/post menopausal), child-bearing status, wellness exams (staying up), cancer screenings; change in hormones Risk for cardiovascular events, especially thromboembolism (increased risk or not)

Answer 33

Assess:

Question 34

Counsel tobacco smokers on smoking cessation - risk higher with those who smoke in having CV events Educate route, timing, adverse effects - if not want get pregnant need take effectively May take with food if GI distress occurs

Answer 34

Interventions:

Question 35

Oral contraception: pill must be taken at the same time each day; missed dose follow package directions and use alternate form of contraception for 7 days to not get pregnant Contraceptives less effective when taking antibiotics; use alternate

Answer 35

Educate route, timing, adverse effects - if not want get pregnant need take effectively

Question 36

Bone mineral density decreases - puts pat at higher risk for fractures

Answer 36

Review Osteoporosis

Question 37

Increases bone mineral density without stimulating the endometrium; modulates effects of endogenous estrogen at specific receptor sites to help increase bone mineral density

Answer 37

MoA: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)

Question 38

Prevention and treatment of osteoporosis in postmenopausal women

Answer 38

Indications: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)

Question 39

Pregnancy/lactation, hx. DVT or smoking

Answer 39

Contraindications: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)

Question 40

Venous thromboembolism, vaginal bleeding - Not have all same effects as estrogen in entire body but mimics effects - most imp is causes risk for blood clots

Answer 40

AE: - Estrogen Receptor Modulators: Prototype: Ralozifene (Evista)

Question 41

Commonly seen Slows bone resorption

Answer 41

MoA: - Bisphosphonates: Prototype: alendronate (Fosamax)

Question 42

Osteoporosis

Answer 42

Indications: - Bisphosphonates: Prototype: alendronate (Fosamax)

Question 43

Oral daily or weekly

Answer 43

Route/dose: - Bisphosphonates: Prototype: alendronate (Fosamax)

Question 44

Esophageal or gastric ulcer, esophagitis

Answer 44

Contraindications: - Bisphosphonates: Prototype: alendronate (Fosamax)

Question 45

Nausea, diarrhea, esophageal erosion (biggest AE to esophagus - very hard on lining of GI tract - biggest prob is causes this but can do lot things to minimize effect on pat), headache

Answer 45

Adverse effects: - Bisphosphonates: Prototype: alendronate (Fosamax)

Question 46

Teach-take in AM with full glass water 30 min prior to food or drink, sit upright for at least 30 minutes after admin - minimize risk reflux back into esophagus - no food because minimizes absorption; limit use to 5 years (really long half-life) then take off med for at least another 5 years/longer because med keeps working to prevent or keep working on osteoporosis; imp to know how take med correctly to min esophageal erosion that can occur

Answer 46

Nursing: - Bisphosphonates: Prototype: alendronate (Fosamax)