Unit 4: Pharm: Chapter 40

Question 1

Estrogen Contraindications

Answer 1

with undiagnosed atypical vaginal bleeding, breast cancer, or any estrogen-dependent cancer, all of which could be exacerbated by the drug;
history of thromboembolic disorders, including cerebrovascular accident;
patients who are heavy smokers, because of the increased risk of thrombus and embolus development; or with hepatic dysfunction, because of the effects of estrogen on liver function.
contraindicated during pregnancy due to the risk of serious fetal defects.

Question 2

Sex Horome

Answer 2

Female sex hormones include estrogens and progestins (the endogenous female hormone progesterone and its various derivatives).
Most comply used in combination medications

Question 3

Progestins Contraindications

Answer 3

imilar to those for estrogens.
in the presence of endometriosis or pelvic surgery because of the effects of progestins on the vasculature of the uterus.

caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of potential exacerbation of these conditions.

Question 4

Drugs Affexcting the Female Reproductive System: Children

Answer 4

Due to effects on closure of the epiphyses, they should be used only with great caution in growing children.
If oral contraceptives are prescribed for teenage patients, the smallest dose possible should be used and the child should be monitored carefully for metabolic and other effects.

Question 6

Combination Drugs for Menopause

Answer 6

Drugs containing estrogen and progestin for relieving the S&S for patients with intact uterus.

Benefits: reduction in the risk of osteoporosis. However, risk of endometrial cancer, stroke, DVT, and dementia associated with use of these drugs.
Not indicated for use to decrease coronary artery disease.
PO or Patch

Question 7

Contraceptives: Forms and Dosing

Answer 7

Available as monophasic, biphasic, triphasic, and quadriphasic preparations.
Monophasic dosing: one tablet orally for 21 days, beginning on day 5 of menstrual bleeding (day 1 of the cycle is the first day of menstrual bleeding).
If missed take asap, use back up contraceptives

Question 8

Levonorgestrel

Answer 8

Morning after pill
Take one tab with 72 hours after intercourse and second tab 12 hrs later

Question 9

Herbal and Alternative Therapies for Menopause

Answer 9

Black cohosh: No clear evidence of benefit, but some people have reported reduced symptoms; some evidence of use causing liver problems
Borage: May help relieve menopausal symptoms and act as anti-inflammatory; not for long-term use; use caution with seizure disorders or liver impairment
Chaste tree: May decrease anxiety and other menopausal symptoms; may cause increased blood pressure, avoid use with antihypertensives or beta-blockers; may cause rash and itching
Clary sage: Used as topical oil; may decrease hot flashes and have antidepressant-like effects; may slow development of osteoporosis; may cause sedation, avoid use with alcohol; not for internal use
Devil’s claw: May help to alleviate joint pain; increases stomach acid and may interfere with many prescription drugs; use with caution

Question 10

Herbal and Alternative Therapies Cont>

Answer 10

Dong quai: Has been used in traditional Chinese medicine for years; causes photosensitivity, avoid exposure to the sun; do not use with warfarin, increased bleeding can occur
False unicorn root: Do not use with estrogen or progestins, may alter uterine effects and cause uterine contractions
Ginseng: May help mood, enhance sleep, and increase overall sense of well-being; does not relieve hot flashes
Red clover: No clear evidence of benefit, but some people report reduced symptoms; do not combine with HRT because of risk for increased estrogenic effects
Soy: Do not use with calcium, iron, or zinc products; may decrease effects of estrogen, raloxifene, and tamoxifen—alert the health care provider if combining these drugs
Wild yam: Contains progesterone, do not use with HRT; may cause increased blood glucose and other toxic effects; do not combine with disulfiram or metronidazole, severe reaction may occur

Question 11

Treating Dyspateunia During Menopause

Answer 11

drug: ospemifene (Osphena), is an estrogen agonist/antagonist. PO OD
Increases the risk of endometrial cancer and of CV events including stroke, myocardial infarction, and deep-vein thrombosis.
The drug is contraindicated with any undiagnosed genital bleeding, known or suspected estrogen-dependent cancers, active thromboembolic disease, or known or suspected pregnancy.

Question 12

Dysparenunia

Answer 12

Painful intercourse associated with vaginal dryness and changes that occur due to menopause

Question 13

Estrogens Adverse Effects

Answer 13

Involve the GU tract: breakthrough bleeding, menstrual irregularities, dysmenorrhea, amenorrhea, and changes in libido.
Other include: fluid retention, electrolyte disturbances, headache, dizziness, mental changes, weight changes, and edema.
GI: nausea, vomiting, abdominal cramps and bloating, and colitis.
Potentially serious GI effects, including acute pancreatitis, cholestatic jaundice, and hepatic adenoma, have been reported with the use of estrogens

Question 14

Progestins Adverse Effects

Answer 14

Similar to systemic effects of estrogens
Patch: skin irritation
Gel: headache, nervousness, constipation, breast enlargement, and perineal pain. Intrauterine devices are associated with abdominal pain, intensified endometriosis symptoms, abortion, PID, and expulsion of the intrauterine device.
Vaginal use is associated with local irritation and swelling.

Question 15

Estrogens Drug to Drug Interactions

Answer 15

Inducers or inhibitors of CYP3A4 effects drug metabolism
Decreased levels with drugs that exchange hepatic function
Corticosteroids
Warfarin other Anticoagulation
Thyroid meds
PO diabetes meds
Smoking due to increased risk of thrombi and embolism.
Grape fruit can increase levels

Question 16

Progestins Drug to Drug Interactions

Answer 16

Interaction with barbiturates, carbamazepine, phenytoin, griseofulvin, penicillins, tetracyclines, or rifampin may reduce the effectiveness of progestins.
Use another method of contraception if birth control is needed.
St. John’s wort can affect the metabolism of progestins and can make progestin-containing contraceptives less effective.

Question 17

Estrogens Receptor Modulatos

Answer 17

Some treatment of breast cancer
Treatment and prevention of osteoporosis in post menopausal and reduce risk of Breast CA.

Question 18

Estrogen Receptor Modulators Adverse Effects

Answer 18

Raloxifene: GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes.
Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation.
Venous thromboembolism and pulmonary emboli have occurred with use of raloxifene.
Increased risk of stroke in post menopausal with CHD.

Question 19

Fertility Drugs

Answer 19

Stimulate reproductive system with primary ovarian failure who cannot get pregnant after 1 year.

work either directly to stimulate follicles and ovulation or stimulate the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova.

Question 20

Chorionic Gonadotropin

Answer 20

Induction of final follicular maturation and ovulation induction in infertile females.
Maintains follicle and horome production, treats patient with functioning ovaries whose partner who are fertile.

Question 21

Ocytocics

Answer 21

Stimulate contraction of the uterus; they can be used to induce labor or terminate pregnancy depending on the specific medication and clinical situation.
Some are used to control uterine bleeding.

Question 22

Oxytocics Contraindications and Cautions

Answer 22

avoid hypersensitivity reactions and with cephalopelvic disproportion, unfavorable fetal position, and complete uterine atony, which could be compromised by uterine stimulation. Oxytocin is used during lactation because of its effects on milk ejection, but the baby should be evaluated for any adverse effects associated with the hormone.
Caution should be used in patients with coronary disease and hypertension