Pharmacology Clear & Simple Chapter 20 PDF

Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 20 Reproductive and Urinary System Medications Copyright ©2022 F.A....

Pharmacology Clear & Simple, A Guide to Drug Classifications and Dosage Calculations, Fourth Edition. Chapter 20 Reproductive and Urinary System Medications Copyright ©2022 F.A. Davis Company  Learning Outcomes  Define key terms.  List actions of reproductive hormones: FSH, LH, and ICSH.  Describe how contraceptives work.  Describe the effects of estrogens, progestins, agents for cervical ripening, oxytocin, tocolytics, ovulation stimulants, androgens, diuretics, BPH medications.  Discuss the relation of diuretics to electrolyte imbalances. Copyright ©2022 F.A. Davis Company  Key Terms  Androgen  Interstitial cell-  Benign prostatic stimulating hypertrophy (BPH) hormone  Enuresis (ICSH)  Estrogen  Luteinizing  Follicle-stimulating hormone (LH)  Progestin hormone (FSH)  Hormone  Sexually replacement transmitted disease therapy (HRT) (STD)  Tocolytic Copyright ©2022 F.A. Davis Company  The Reproductive System  Gonadotropic hormones Responsible for optimal functioning of testes and ovaries Pituitary gland secretes ‒ Follicle-stimulating hormone (FSH): Regulates sperm and egg production Copyright ©2022 F.A. Davis Company  The Reproductive System (continued)  Gonadotropic hormones (continued) Pituitary gland secretes ‒ Luteinizing hormone (LH)  Triggers the release of the egg  Promotes secretion of estrogen and progesterone ‒ Interstitial cell-stimulating hormone (ICSH)  Male equivalent of LH  Regulates testosterone production Copyright ©2022 F.A. Davis Company  Contraceptive Medications  When estrogen and progestin are administered, the body stops producing these hormones.  Contain such low doses of hormones that ability to conceive is inhibited Inhibition of ovulation Inhibition of fertilization Prevention of implantation Prevention of fetal growth Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_1)  Contraceptive pill (“the pill”) Provides differing amounts of estrogen and progestin during the menstrual cycle Monophasic pills ‒ Constant amount of hormone for first 21 days of cycle  Ethinyl estradiol and norgestrel (Cryselle 28, Lo/Ovral 28, Ogestrel-28)  Ethinyl estradiol and norethindrone (Aranelle, Ortho-Novum) Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_2)  Biphasic pills Provide a constant dose of estrogen but two different doses of progestin in the monthly cycle Allows lining of uterus to develop normally during menstrual cycle ‒ Ethinyl estradiol and norethindrone (Jenest- 28) ‒ Ethinyl estradiol and desogestrel (Apri, Ortho-Cept) Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_3)  Triphasic pills Contain varying amounts of estrogen and progestin in three different strengths during the cycle ‒ Ethinyl estradiol and norethindrone (Aranelle, Ortho-Novum 7/7/7) ‒ Ethinyl estradiol and levonorgestrel (Alesse, Portia) Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_4)  Mini pill Contains only progestin Slightly less effective ‒ Progestin (Errin, Provera)  Contraceptive pill symptoms Symptoms of pregnancy Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_5)  Postcoital high-dose estrogen When contraception fails or has not been used properly Prevents pregnancy ‒ Levonorgestrel emergency contraceptive (Plan B) ‒ Ethinyl estradiol and levonorgestrel (Preven) Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_6)  Contraceptive ring Flexible ring containing estrogen and progestin Inserted into vagina every month Removed after 3 weeks to allow for normal menstruation Prevents ovulation, fertilization, and implantation Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_7)  Contraceptive implant Hormone prevents ovulation, inhibits sperm from reaching uterus, and prevents implantation of egg Small plastic rod placed in upper arm Good for up to 3 years ‒ Etonogestrel (Implanon) Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_8)  Intrauterine device (IUD) Levonorgestrel intrauterine system (Mirena) ‒ Contains progestin ‒ Placed in uterus by physician ‒ Hostile to sperm, makes implantation of egg difficult ‒ May be left in place for 5 years Copper IUD ‒ Naturally toxic to sperm ‒ May be left in place for 10 years Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_9)  Transdermal contraceptive patches Ethinyl estradiol and norelgestromin (Ortho Evra patch) New patch applied weekly for 3 weeks Fourth week no patch, allowing for normal menstruation  Hormonal contraceptive risks Formation of blood clots (women older than 35 years) Risk of smoking increases clot risk Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_10)  Barrier devices Condoms Diaphragms Used in combination with spermicides containing nonoxynol-9 (Encare, Conceptrol) Only method effective against sexually transmitted diseases Copyright ©2022 F.A. Davis Company  Contraceptive Medications (continued_11)  Mifepristone (Mifeprex) Originally known as RU-486 Blocks hormone progesterone Used during first 7 weeks since last menstrual period Given orally in physician’s office If still pregnant after 3 days, additional dose given and rechecked in 2 weeks Contraindicated in patients on blood thinners Copyright ©2022 F.A. Davis Company  Clicker Question Plan B is an example of: A. Contraceptive IUD B. Contraceptive implant C. Post-coital contraceptive D. Spermicide Copyright ©2022 F.A. Davis Company  Clicker Question (continued_1) Answer: C Levonorgestrel emergency contraceptive (Plan B) is used when contraception fails or is inadequate. Copyright ©2022 F.A. Davis Company  Hormone Replacement Therapy (HRT) in Women  Used for women experiencing menopause  Replaces hormones that are no longer naturally produced  If uterus removed Estrogen  If uterus intact Estrogen combined with progestin Copyright ©2022 F.A. Davis Company  Hormone Replacement Therapy (HRT) in Women (continued_1)  Oral estrogen HRT Estrace Premarin  HRT estrogen cream Estrace Dienestrol  HRT estrogen patch Estraderm Vivelle Copyright ©2022 F.A. Davis Company  Hormone Replacement Therapy (HRT) in Women (continued_2)  Combination estrogen/progestin Prempro: Pill Climara-Pro: Patch  Women also produce small amounts of testosterone Replacement relieves symptoms of menopause Combination estrogen/testosterone ‒ Covaryx: Pill ‒ Estratest: Pill Copyright ©2022 F.A. Davis Company  Hormone Replacement Therapy (HRT) in Women (continued_3)  HRT benefits Decreases bone loss and cardiovascular dysfunction  HRT risk Increased risk of breast cancer Increased risk of stroke and blood clots  Treatment is a personal decision Copyright ©2022 F.A. Davis Company  Hormone Replacement Therapy in Men  Prostate cancer Estrogen decreases testosterone levels  Male menopause (decreased testosterone levels)  Testosterone replacement Possible decrease in heart disease, diabetes, death AndroGel: Rubbed into skin daily Copyright ©2022 F.A. Davis Company  Clicker Question (continued_2) Male menopause involves an increase in testosterone production. A. True B. False Copyright ©2022 F.A. Davis Company  Clicker Question (continued_3) Answer: False Copyright ©2022 F.A. Davis Company  Medications for Abnormal Uterine Bleeding  Estrogen/progesterone as oral contraceptives Corrects hormonal imbalance that typically causes abnormal uterine bleeding  Progestins Regulate the rhythm and amount of menstruation Copyright ©2022 F.A. Davis Company  Medications for Abnormal Uterine Bleeding (continued)  Gonadotropin-releasing hormone agonists Suppress build-up of endometrial lining by suppressing estrogen Monthly injections for no more than 6 months ‒ Leuprolide (Eligard, Lupron) ‒ Goserelin (Zoladex) Copyright ©2022 F.A. Davis Company  Labor Medications  Cervical ripening agents Example: Dinoprostone (Prepidil) Applied topically to cervix Softens cervix to prepare for labor If labor does not begin within 6 hours, second dose given  Oxytocin (Pitocin, Syntocinon) Pituitary hormone causing uterus to contract IV administration in a controlled setting May also be given postpartum to control Copyright ©2022 F.A. Davis Company  Labor Medications (continued_1)  Tocolytics Slow or stop uterine contractions Used to prevent premature birth Allows fetus to mature (especially lungs) Terbutaline (Brethine) ‒ IV drip with monitoring of mother to monitor for complications ‒ Short-term use (24 to 48 hours) under close supervision Copyright ©2022 F.A. Davis Company  Labor Medications (continued_2)  Tocolytics (continued) Magnesium sulfate ‒ Given IV to treat preeclampsia and slow premature labor ‒ May prevent possibility of cerebral palsy in preterm infant ‒ Side effects  Hypotension, cardiac arrhythmias, and weakness Copyright ©2022 F.A. Davis Company  Labor Medications (continued_3)  Nifedipine (Adalat CC, Procardia) Oral calcium channel blocker Relaxes smooth muscles of the uterus Used when cervix minimally dilated and amniotic sac intact Preferably used short term (24 to 48 hours) Copyright ©2022 F.A. Davis Company  Labor Medications (continued_4)  Indomethacin (Indocin) Strong NSAID given IV, PO, or PR Use limited to less than 7 days to minimize effects on developing fetus Not for use during last 2 months of pregnancy due to effects on cardiac development of fetus Copyright ©2022 F.A. Davis Company  Clicker Question (continued_4) Brethine is an example of this type of drug: A. Cervical ripening agent B. Tocolytic C. Labor enhancer D. Ovulation stimulant Copyright ©2022 F.A. Davis Company  Clicker Question (continued_5) Answer: B Terbutaline (Brethine) is a tocolytic used to slow or stop uterine contractions. Copyright ©2022 F.A. Davis Company  Infertility Medications  Ovulation stimulants Clomiphene (Clomid, Serophene) ‒ Increase the hormones FSH and LH, which initiate ovulation ‒ When no obvious cause for infertility ‒ Oral medication with minimal side effects Copyright ©2022 F.A. Davis Company  Infertility Medications (continued_1)  Menotropins (Humegon, Menopur, Repronex) Injection that stimulates follicle ripening and release Used when ovaries are functioning, but hormonal stimulation lacking  Chorionic gonadotropin (Ovidrel, Pregnyl) Injection to stimulate release of mature egg Copyright ©2022 F.A. Davis Company  Infertility Medications (continued_2)  Patient should be prepared for Possibility of failure to conceive Possibility of multiple fetus pregnancy Copyright ©2022 F.A. Davis Company  Medications for Other Female Reproductive Disorders  Premenstrual dysphoric disorder (formerly premenstrual syndrome or PMS) Selective serotonin reuptake inhibitors (SSRIs) Relieve symptoms  Infections caused by sexually transmitted diseases (STDs) Metronidazole (Flagyl): PO or IV for trichomonas Acyclovir (Zovirax): PO or IV for herpes Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility  Androgens Male sex hormones that promote maturation of the male sexual organs and male sexual characteristics  Testosterone Can be used to lower estrogen levels in women with breast cancer, just as estrogen is used to lower testosterone levels in men who have prostate cancer Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_1)  Erectile dysfunction Commonly related to ‒ Atherosclerosis ‒ Diabetes ‒ Stroke ‒ Hypertension ‒ May have psychological roots Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_2)  Erectile dysfunction (continued) Phosphodiesterase type 5 inhibitors ‒ Dilate arteries leading to penis and constrict veins ‒ Dangerous with history of heart disease, stroke, sickle cell anemia, or eye problems Examples ‒ Sildenafil (Revatio, Viagra) ‒ Vardenafil (Levitra, Staxyn) ‒ Tadalafil (Adcirca, Cialis) Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_3)  Erectile dysfunction (continued) Phosphodiesterase type 5 inhibitors (continued) ‒ Taken 30 to 60 minutes prior to sexual activity one time/day ‒ Cialis may be taken orally on a daily basis Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_4)  Alprostadil (Caverject, Edex) Injected into penis or inserted as a urethral pellet Works in 5 to 20 minutes 1 time/day up to 3 times/week Copyright ©2022 F.A. Davis Company  Critical Thinking Why may erectile dysfunction drugs affect the entire cardiovascular system and not act just on the penis? Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_5)  Decreased libido Due to emotional/physiological changes or medications Treatment of emotional/physiological changes or medication changes may improve libido Amphetamines may increase libido, but more common treatment is to discontinue drugs known to cause a decrease in libido if possible Copyright ©2022 F.A. Davis Company  Medications to Treat Erectile Dysfunction, Decreased Libido, and Infertility (continued_6)  Infertility Human chorionic gonadotropin (hCG) ‒ Injection that increases testosterone levels, which increases sperm production Copyright ©2022 F.A. Davis Company  The Urinary System  Functions Filtration of blood Removal of waste products Copyright ©2022 F.A. Davis Company  Diuretics  Also called water pills  Increase excretion of body fluids from kidneys  Loop diuretics Most effective diuretics Act on loop of Henle to inhibit sodium and chloride reabsorption Treat congestive heart failure, renal insufficiency Copyright ©2022 F.A. Davis Company  Diuretics (continued_1)  Potassium loss Supplements needed  Bumetanide (Bumex): PO, IV, IM  Ethacrynic acid (Edecrin): PO, IV  Furosemide (Lasix): PO, IV, IM  Torsemide (Demadex): PO, IV Copyright ©2022 F.A. Davis Company  Diuretics (continued_2)  Thiazide diuretics Block sodium reabsorption and increase water excretion Treat moderate hypertension Supplements for potassium loss ‒ Hydrochlorothiazide (HydroDIURIL): PO ‒ Chlorothiazide (Diuril): PO, IV Copyright ©2022 F.A. Davis Company  Electrolyte Imbalances and Diuretics  Body needs electrolytes to function properly Sodium (Na) Potassium (K): Essential to cardiac functioning Calcium (Ca) Magnesium (Mg)  May be replaced through IV or PO supplements  Diuretics require close monitoring of electrolyte levels Copyright ©2022 F.A. Davis Company  Diuretics (continued_3)  Potassium sparing diuretics Minimize potassium loss Amiloride (Midamor): PO Spironolactone (Aldactone): PO Copyright ©2022 F.A. Davis Company  Diuretics (continued_4)  Osmotic diuretics Used for ‒ ↑ Intracranial pressure ‒ ↑ Intraocular pressure ‒ Anuric stage of acute renal failure ‒ Toxic overdose: Flushes toxins from body Pulls fluid into circulation to be filtered and excreted Mannitol (Osmitrol) ‒ IV under close supervision Copyright ©2022 F.A. Davis Company  Clicker Question (continued_6) The type of diuretic used to treat increased intracranial pressure is: A. Loop B. Thiazide C. Potassium-sparing D. Osmotic Copyright ©2022 F.A. Davis Company  Clicker Question (continued_7) Answer: D Copyright ©2022 F.A. Davis Company  Benign Prostatic Hypertrophy (BPH)  Nonmalignant growth of prostate gland  Constricts urethra, impeding urine flow  Alpha-adrenergic blockers relax smooth muscle Dutasteride (Avodart) Finasteride (Proscar) Tamulosin (Flomax) Copyright ©2022 F.A. Davis Company  Other Medications for Urinary Disorders  Urinary tract infections (UTIs) Pain, urgency, frequency, and blood in urine Treated with ‒ Broad spectrum antibiotics (Bactrim, Augmentin) ‒ Analgesics (Pyridium) ‒ Antispasmodics (methenamine, flavoxate)  Gout Caused by inability of kidneys to clear uric acid from blood See Musculoskeletal Medications for Copyright ©2022 F.A. Davis Company  Other Medications for Urinary Disorders (continued)  Antispasmodics Urinary incontinence ‒ Darifenacin (Enablex) ‒ Tolterodine (Detrol) Enuresis (bed-wetting) ‒ Desmopressin (DDAVP): Nasal or PO ‒ Imipramine (Tofranil): PO Copyright ©2022 F.A. Davis Company  Effects of Medications on Urine Color  Medications such as antibiotics, anticoagulants, and laxatives may cause urine to turn Dark brown Yellow Blue green Orange/yellow Red/pink Copyright ©2022 F.A. Davis Company  Effects of Medications on Urine Color (continued)  Usually no effect on kidneys  Frightening to patients  Check drug handbook for teaching information Copyright ©2022 F.A. Davis Company