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Pharmacology ATI > Genitourinary and Reproductive > Flashcards

Genitourinary and Reproductive Flashcards

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1
Q

Why is progesterone included with estrogen for treating menopause?

A

It protects from increased risk of endometrial cancer
(estrogen only is fine if prior hysterectomy)

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2
Q

Estrogen hormone replacement therapy

Prototype

A

conjugated equine estrogen (Premarin)
transdermal Estradiol (FemPatch, Estraderm, Climara)
estradiol cream (Estrace)
estradiol intravaginal tabs (Vagifem)

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3
Q

Estrogen hormone replacement therapy

MOA

A

Binds to estrogen receptors in breasts, genitals, hypothalamus and pituitary gland
Provides small, stable amount of estrogen to prevent menopause symptoms

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4
Q

Estrogen hormone replacement therapy

Adverse Effects

A

Nausea
HTN (increased angiotensin and aldosterone)
Water retention
Endometrial hyperplasia (increased risk of endometrial and ovarian cancers)
Thromboembolic events

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5
Q

Estrogen hormone replacement therapy

Teaching

A
  • Quit smoking
  • Monitor for pain, redness, and swelling in leg, dypsnea, chest pain
  • Stop 4 weeks before surgery due to thromboembolic event risk
  • Monitor vaginal bleeding (may indicate cancer)
  • Nausea goes away with time
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6
Q

Estrogen hormone replacement therapy

Admin

A

Continuous use and at same time daily to avoid bleeding
Cream or intravag tabs at bedtime

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7
Q

Estrogen hormone replacement therapy

Contraindications

A
  • hx of thromboembolic events
  • Breast, ovarian, endometrial, or vaginal cancer
  • Undiagnosed vag bleeding
  • Liver disease
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8
Q

Estrogen hormone replacement therapy

Common interactions

A

Decreased effect with St. John’s Wort, anticonvulsants, some antibiotics
Reduces effectiveness of warfarin and diabetes meds
Increase levels of diazepam, chlordiazepoxide, TCAs, and theophylline

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9
Q

Estrogen and progesterone hormone replacement therapy

Indication

A

Severe menopause symptoms: hot flashes and vaginal atrophy
Prevents menopausal osteoporosis

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10
Q

Estrogen and progesterone hormone replacement therapy

Prototype

A

conjugated estrogen and medroxyprogestrone acetate (Prempro)
transdermal estradiol and norethindrone (CombiPatch)

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11
Q

Estrogen and progesterone hormone replacement therapy

MOA

A

Estrogen binds to target tissues to prevent menopause symptoms.
Progesterone antagonizes tissue growth in endometrium caused by estrogen

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12
Q

Estrogen and progesterone hormone replacement therapy

Adverse effects

A

Even greater risk of thromboembolic event
Increased risk for vaginal bleeding, weight gain, breast cancer

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13
Q

GrH agonist

Prototype

A

Leuprolide (Lupron)
Nafarelin (Synarel)

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14
Q

GrH agonist

classification

A

Gonadotropin releasing hormone antineoplastic

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15
Q

GrH agonists

MOA

A

Stimualates secretion of FSH and LH from pituitary gland, which increases estrogen and progesterone.
After several weeks, FSH and LH drop drastically to the point of monopausal hormone levels
This allows endometrium to shrink

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16
Q

GrH agonists

Indication

A

Endometrial hyperplasia
Endometriosis

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17
Q

GrH agonists

Adverse effects

A

Hot flashes
Headache
Vaginal dryness
Bone loss

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18
Q

GnRH agonists

Interventions

A
  • Therapy limited to 6 mo to prevent osteoporosis
  • Bone density scanning if must last longer
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19
Q

GnRH agonists

Admin

A

Intramuscular injection

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20
Q

GnRH agonists

Instructions

A
  • Perform weight bearing exercises daily and take calcium and vit D
  • Lube for vaginal dryness
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21
Q

GnRH agonists

Contraindications

A

Pregnancy
Abnormal vag bleeding
Metastatic brain cancer
Allergy to benzoyl alcohol

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22
Q

Progesterone

Prototype

A

medroxyprogesterone acetate (Provera)
norethindrone (Micronor)

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23
Q

Progesterone

Indication

A

Endometriosis
Abnormal bleeding
Palliative tx for advanced uterine cancer

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24
Q

Progesterone

MOA

A

Antagonizes estrogen from causing endometrial growth

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25
# LH and FSH stimulants Prototype
clomiphene (Clomid)
26
# LH and FSH stimulants Class
Ovulatory stimulants
27
# LH and FSH stimulants MOA
Inhibits estrogen receptors on pituitary and increases GnRH release from the hypothalamus GnRH stimulates LH and FSH release, causing more follicle maturation and ovulation
28
# LH and FSH stimulants Adverse effects
Vasomotor effect (hot flashes) Breast engorgement GI upset Visual disturbance Ovarian enlargement Multiple gestation
29
# LH and FSH stimulants Instructions
* cold compresses for hot flashes * report pelvic pain * report vision changes
30
# LH and FSH stimulants Admin
PO once daily for 5 days after start of menses Take at same time every day
31
# LH and FSH stimulants Contraindications
Pregnancy (teratogenic) Primary ovarian failure Uterine bleeding Liver disease Uncontrolled thyroid disease Thrombophlebitis
32
# Ovulation Stimulant Prototype
human chorionic gonadotropin (Pregnyl)
33
# Ovulation Stimulant Indication
Infertility
34
# Ovulation Stimulant MOA
Causes ovulation by stimulating secretion of LH
35
# Ovulation Stimulant Adverse effects
Ovarian rupture from hyperstimulation CNS symptoms: irritable, headache, fatigue
36
# Ovulation Stimulant Interventions
* Monitor for hyperstimulation: abdominal pain and swelling * Monitor for ovarian rupture: sudden, sharp pelvic pain, nausea, vomiting, weakness
37
# Ovulation Stimulant Admin
* Confirm maturation of the follicle via intravaginal sonography * Reconstitute and admin via IM * Give 7-9 days after last dose of clomiphene if taking
38
# Ovulation Stimulant Contraindications
Pituitary tumor Dysfunctional uterine bleeding Adrenal insufficiency Uncontrolled thyroid disease
39
# Antihyperprolactinemia Prototype
cabergoline bromocriptine (Parlodel)
40
# Antihyperprolactinemia Indication
Infertility
41
# Antihyperprolactinemia MOA
Increases available dopamine, which causes the pituitary gland to secrete less prolactin Less prolactin increases secretion of HcG, which stimulates LH and FSH to produce ovulation
42
# Antihyperprolactinemia Adverse effects
Pulmonary fibrosis Pericardial fibrosis Valvular disorders Retroperitoneal fibrosis Nausea, dizziness, headache
43
# Antihyperprolactinemia Interventions
Monitor serum prolactin levels monthly until reach a normal level
44
# Antihyperprolactinemia Contraindications
Uncontrolled hypertension
45
# Oxytocin Class
uterine stimulants
46
# Oxytocin prototype
oxytocin (Pitocin)
47
# Oxytocin MOA
Mimics natural oxytocin released by the pituitary Causes uterine contraction and milk ejection
48
# Oxytocin adverse effects
Uterine hyperstimulation = uterine rupture and death Hypertensive crisis Water intoxication (ADH effect)
49
# Oxytocin Interventions
* Monitor length, strength, and frequency of contractions * Monitor FHR * Monitor BP * Monitor I&Os for water intoxication * Monitor for nausea, headache * If contractions longer than 1 minute or are more frequent than every 2 min, or resting uterine pressure is greater than 15-20 mmHg = turn on side, stop infusion, administer oxygen, prepare uterine relaxant
50
# Oxytocin Admin
* IV infusion * Increase by 1-2 mL/min every 30-60 min until contractions last up to 1 min and occur every 2-3 min. * Cervic should be dilated 2-3 cm and effaced before admin
51
# Oxytocin Contraindications
* Unripe cervix * Placental abnormalities * Herpes * Fetal distress * Fetal lung immaturity * Breech or transverse * Umbilical cord prolapse * Cephalopelvic disproportion
52
# Ergot alkaloids Prototype
methylergonovine (Methergine)
53
# Ergot alkaloids Indication
Prevent and treat postpartum hemorrhage
54
# Ergot alkaloids MOA
Stimulate smooth muscle in uterus
55
# Ergot alkaloids Adverse effects
rare: hypertension, stroke, nausea, cramps, arrhythmias, seizures
56
# Ergot alkaloids Interventions
Monitor BP, HR, and seizures
57
# Ergot alkaloids Admin
* Check BP prior to admin * IM every 2 hours or orally for 2-7 days * IV over 1 min * Assess slowing of vaginal bleeding
58
# Ergot alkaloids Contraindications
Induced labor Threatened miscarriage Hypertension
59
# Synthetic prostaglandins Indication
Promotes softening, dilating, and effacement of the cervix
60
# Synthetic prostaglandins Prototype
dinoprostone (Cervidil) misoprostol (Cytotec)
61
# Synthetic prostaglandins MOA
Activates collagenase, which breaks down collegan complex that keeps cervix firm and closed Softens the cervix and allows contractions to start
62
# Synthetic prostaglandins Adverse effects
Amniotic fluid embolism Uterine rupture Chills Hypotension Nausea
63
# Synthetic prostaglandins Admin
1. Gel in prefilled syringe administered through cervix with endocervical catheter with pt lying supine (pillow under hip) for 30 min. Start oxytocin 6-12 hours after last dose 2. Pouch contained drug placed at cervix while pt lies supine for 2 hours. Pouch removed with attached tape when active labor begins
64

Pharmacology ATI (19 decks)

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