Drugs for UTI & Oral Contraceptives Flashcards Preview

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Flashcards in Drugs for UTI & Oral Contraceptives Deck (95):
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Bacteriostatic, bactericidal

Urinary antiinfectives
Sulfonamides
Fluoroquinolones
Penicillins
Third generation cephalosporins

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Urinary antiinfectives

Nitrofurantoin (furadantin, macrodantin)

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Sulfonamides

Trimethoprim-sulfamethoxazole (bactrim)

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Fluoroquinolones

Nalidixic acid (NegGram) ciprofloxacin (cipro)

4

Third generation cephalosporins

Cefixime (maxipime)

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Treats gram positive and negative

Nitrofurantoin (macrobid)

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What does nitrofurantoin (macrobid) inhibit?

Bacterial enzymes and metabolism

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Side effects of nitrofurantoin (macrobid)

Dizziness, HA, drowsiness, rust colored or brown urine, rash, pruritus, GI distress, superinfection, peripheral neuropathy, hepatotoxicity, Steven Johnson syndrome, blood dyscrasias

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Nursing interventions for nitrofurantoin (macrobid)

Take with food, avoid antacids, don't crush or open capsules, shake liquid suspension, rinse mouth after taking, don't drive or operate dangerous equipment, INCREASE Fluids, cranberry juice, plums, protein, and vit C

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Urinary antiinfective that treats chronic UTI and is bacteriocidal

Methenamine hippurate (hiprex)

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What is methenamine hippurate (hiprex) effective for?

Pseudomonas and E. coli

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Caution for methenamine hippurate (hiprex)

Not to be taken with sulfonamides because it may cause crystalluria

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Client teaching for methenamine hippurate (hiprex)

Consume acidic foods and fluids

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Urinary analgesic, relieves pain, burning sensation, frequency, urgency

Phenazopyridine (pyridium)

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Side effects of phenazopyridine (pyridium)

GI upset, red-orange urine, blood dyscrasia, nephrotoxicity, hepatotoxicity

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Urinary stimulant / treat hypotonic bladder

Bethanechol (urecholine)

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Action of bethanechol (urecholine)

Increases bladder tone of detrusor muscle

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Contraindication of bethanechol (urecholine)

Peptic ulcer

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Side effect of bethanechol (urecholine)

GI distress, dizziness, fainting

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Urinary antispasmodic

Oxybutynin (ditropan)

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Action of oxybutynin (ditropan)

Direct action on smooth muscles to relieve spasms

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Side effects of oxybutynin (ditropan)

Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation

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Caution for oxybutynin (ditropan)

Avoid in narrow-angle glaucoma, cardiac, renal, hepatic, prostate problems

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Urinary antimuscarinics

Tolterodine tartrate (detrol)

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Action of tolterodine tartrate (detrol)

Control overactive bladder

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Side effects of tolterodine tartrate (detrol)

Drowsiness, tachycardia, dizziness, fainting, blurred vision, dry mouth, constipation

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Caution for tolterodine tartrate (detrol)

To be avoided of client has narrow angle glaucoma or cardiac, renal, hepatic, prostate problems

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PDE5 inhibitors

Levitra, cialis, Viagra

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Taken for erectile dysfunction/improves blood flow to penis

PDE5 inhibitor

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When do you take PDE5 inhibitor

30 min prior to sex, lasts several hours

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Caution PDE5 inhibitor

Not for pts taking nitrates

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Side effect of PDE5 inhibitor

Stuffy nose and headache

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A client with a lower UTI has been prescribed nitrofurantoin. What side effect would nurse teach client to expect?

Brown, discolored urine

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A client entering the med clinic has been diagnosed with overactive bladder. Which med would nurse expect to be ordered?

Tolterodine tartrate (detrol)

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Combined hormone contraception

Contain a synthetic version of estrogen and a compound known as progestin

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Most commonly used estrogen

Ethinyl estradiol

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Older form of estrogen found in higher dose oral combination products

Mestranol

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Derivative of the steroid testosterone and have progesterone like effects

Progestin

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What dose do you use for contraception?

The lowest effective dose that successfully prevents conception should be used

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What is the action of the estrogen component of combined hormone contraceptive?

Inhibits ovulation by preventing the formation of a dominant follicle which inhibits stimulation of luiteinizing hormone.

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Action of progestin component

Suppresses LH surge, makes cervical mucus thick and hostile to sperm penetration. Ovulation inhibited, pregnancy does not occur.

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Oral contraception absorption and metabolized

Ingested daily, absorbed by gastrointestinal tract and metabolized by liver

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Combined oral contraceptive effective rate

98% accounting for user error

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Increased estrogenic activity side effects

Cyclic breast changes, dysmenorrhea, menorrhagia (heavy periods), chloasma (hyper pigmentation of skin), and VTE, nausea, vomiting, edema, leg cramps, hypertension

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Side effects of decreased estrogenic activity

Amenorrhea and spotting, dyspareunia (painful sex) and nervousness

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Side effects of increased progestational activity

Breakthrough bleeding (BTB) and headaches, increased appetite, weight gain, oily skin and scalp, acne, excess hair growth, decreased breast size

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When does Breakthrough bleeding occur?

Active pill cycle of combined oral contraceptives (COC). More common at start of COC use and when women changes COC type of pill

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What do majority of women on COC products experience

Shorter, lighter periods, decreased blood loss, decreased uterine cramps, elimination of mittelschmerz, reduces incidence if pelvic inflammatory disease

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Three types of COC

Monophasic, biphasic, and triphasic

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Fixed ratio of estrogen to progestin throughout cycle

Monophasics

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Amount of estrogen is fixed but amount of progestin varies

Biphasics

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Reduced in first half to provide proliferation of endometrium and increased in second half to promote secretory development of endometrium.

Biphasic, this simulates normal process of menstruation with no ovulation.

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Newest COC/amount of either estrogen or progesterone varies throughout cycle in different ratios during three stages.

Triphasic

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How are COC packaged?

21 day or 28 day tablet packs

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21 days of active pill followed by 7 pill free days

21 day pack

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21 days of active pill followed by 7 days of inert or counter pills

28 day package

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When is pseudomenstruation or withdrawal bleeding?

During hormone free period while taking counters or during 7 day pill free period

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What is withdrawal bleeding caused by?

Level of estrogen and progestin decreases allowing for breakdown of endometrial lining

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Continuous dosing COC products

91 day regimen/84 days active pill, and 7 days of inert pills

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For continuous COC how often is there withdrawal bleeding?

4 times a year

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Who may benefit from continuous COC?

Women with menstrual disorders such as menorrhagia (heavy period), metrorrhagia (irregular bleeding between periods), endometriosis, dysmenorrhea, PMS, and ovarian cyst formation.

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What increases the risk of circulatory disorders?

Estrogen component

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First day start method

Contraception product initiated first day of menstruation. No backup method needed (condoms or diaphragm)

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Sunday start method

Start contraception on Sunday following first day of menstruation or on Sunday if menstruation starts that day. Use backup if started after day 5 of menstruation.

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Quick start method

Start day receive prescription. Use back up method for 7 days if started after day 5 of menstruation.

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Miss one tablet of COC product

Take tablet as soon as realized
Take next pill as scheduled

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Miss two tablets of COC

Take 2 tabs for 2 days with next tab as scheduled
Use back up method of contraception for rest of cycle

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Miss 3 tab of COC

Discontinue present pack and allow for withdrawal bleeding. Start a new pkg of tablets 7 days after the last tab was taken. Use another form of contraception until tabs have been taken for 7 consecutive days.

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Miss one or more tabs of progestin only products

Take tab as soon as realized and follow with next tablet at regular time, PLUS use backup method for 48 hrs

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Contraception with no estrogen

Progestin-only contraception

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Advantages of progestin only

Safe, ease of use, spontaneity of sexual intercourse and reversibility.

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Disadvantages to progestin only

Higher incidence of irregular bleeding and spotting and possibility of depression, mood changes, and fatigue.

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Progestin only oral contraceptive pill four mechanisms of action

1) alteration in cervical mucus, making thick and viscous, blocking sperm
2) interference with the endometrial lining, making implantation difficult
3) decreased peristalsis in Fallopian tubes, slowing transport of ovum
4) in 50% of cycles, interference with LH surge inhibiting ovulation

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Side effects of progestin deficiency

Dysmenorrhea, bleeding late in cycle, heavy menstrual flow with clots, or amenorrhea

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How long should a women in transitional period of menopause take contraceptives?

Until menstruation has ceased 1 year

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Natural alternatives for menopause

Soy, isoflavones from soy, Actaea racemosa or black cohosh, vitamin E, evening primrose

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What do natural alternatives treat for menopause?

Menopause symptoms especially hot flashes

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Bioidentical hormone therapy for menopause

Estrogen-like compounds that have been derived from plants. Most common is soy and Mexican yam root.

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What are the most commonly commercially available compounds?

Estrone, estradiol, estriol, testosterone, and micronized progesterone

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Benefits of bioidentical hormones

Limited side effects, reduced risk of exacerbating the growth of bread cancer cells, equal osteoporosis prevention benefits, decrease in cardiovascular effects

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Two commonly prescribed bioidentical products

Tri-est and Bi-est

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What do estrogen and progestin do in hormone therapy

Estrogen relieves symptoms of menopause while progestin protects uterine endometrium from hyperplasia

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What forms are hormone therapy available?

Oral preparations, transdermal applications, and vaginal preparations

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Types of vaginal preparations

Creams, suppositories, pellets, or rings. Only secrete estrogen

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Three types of estrogen used in hormone therapy

Natural, conjugated equine estrogens (CEE) and synthetic

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Where is estrogen absorbed and metabolized?

Absorbed in GI tract and metabolized by liver necessitating daily doses when oral products are nonesterified

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Drug used for benign prostate hyperplasia

5-alpha-reductase inhibitors and alpha-adrenergic blocking agents

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Side effects of 5-alpha-reductase inhibitors

Decreased libido and erectile dysfunction

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Side effects of alpha-adrenergic blocking agents

Hypotension, dizziness, fatigue

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What must you consider before giving an alpha-adrenergic blocking agent to a client?

It also is used to control blood pressure, so to prevent hypotension ask client for list of their meds before adding another antihypertensive drug

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Drug to treat poly cystic ovarian syndrome

Metformin. It treats insulin resistance, regulates menstrual period and increases possibility of ovulation

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Pharmacological management of endometriosis

Combined hormone contraceptive products, progestational products, gonadotropin inhibitors and Gn-RH agonists,

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Herbal treatment of PMS

Vitamin B6 and increased calcium and chaste berry

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Antidepressants and anti anxiety Meds for PMS

SSTI Meds: Prozac, Zoloft, Paxil, and celexa

For severe: Xanax, Valium, BuSpar, and Ativan

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Hormonal therapy for PMS

Progesterone, medroxyprogesterone acetate,
Long term: orthoevra and nuvaring