• Miscarriage 
• Fetal anomalies - prevention of prego during tx
• Sperm - irreversible sterility in MALES - sperm banking perhaps. 

Excessive uric acid levels in the blood

• formed by the breakdown of DNA following cell death
• can cause damage to kidneys
• to treat: increase fluid intake and Allopurinol (decreases the production of uric acid) 

mech. of action: disrupt processses related to synthesis of DNA

• cells that are undergoing replication (can't kill dormant cells)
• high growth fraction tissues

Cyclosphamide (Cytoxan)

Administration: prodrug that is converted to active form in the liver, delayed onset of action, may be given PO, take with food

Adverse effects: ***Bone marrow supression***, Nausea&vomiting, alopecia, hemorrhagic cystitis (drug can settle in the bladder and cause hemorrhaging) - hydrate to prevent

Platinum Compounds:

Cisplatin (Platinol-AQ)

mech. of action: similar to alkylating agents, produce DNA cross links, cell-cycle phase non-specific

Uses: Ovarian and testicular cancer, advanced bladder cancer,

Adv. effects: **Dose limiting toxicity to kidneys** (treat w/ extensive hydration and diuretics), highly emetogenic - 1 hr after, lasting 1-2 days

Breast cancer treatment 

Treatment: 

• Principal treatment is surgury and radiation
• adjuvant treatment is cemo therapy and Cytotoxic agents** and hormonal therapy!

Hormonal Agents

Tamoxifen (Nolvadex)

Blocks receptors for estrogen 

• Gold standerd - only works against cancer cells that are estrogen receptor positive
• Good drug but very very bad side effects

Actions:

Blocks receptor on some tissue and activates them on others

Uses: Blocks estorgen receptors on cancer cells, prevents activation by estradiol 

Benifits:

Increased bone density,

Decreased LCL's 

Adverse effects;

hot flashesm, fluid retention, nausea, vomit, risk of endometrial cancer****

Aromatase Inhibitor

Arimidex (Anastrozole)

Arimidex

• Used to treat Estrogen Related- postive breast canver in postmenopausal women
• can only be used in post menopausal women
•   and more effective than tamoifen

Asthemia - (weakness/fatigue)

Nausea

Headacha

Hot flushes 

25S% of women experience join pain***

Normal BP

Pre hypertension

Stage 1 hypertension

Stage 2 hypertesion

120/80

120-139/80-89

140-159/90-99

160+/100+

hypertension with no identifiable cause

Can be successfully treated (not cured)

An elevation of BP brought on by identifiable primary cause

• cure is possible if primary cause is treated
• can be managed with meds

Lifestyle Modifications:

• weight loss
• sodium restrictin
• DASH diet
• alcohol restriction
• aerobic exercises
• smoking cessation
• maintenance of postassium and calcium intake

Systems to regulate BP

• sympathetic NS
• renin-angiotensin-aldosterone system (RAAS)
• the kidney

Thiazide Diuretics

Ex. Hydrochlorothiazide (HCTZ)

Uses: reduce blood volume (initial antihypertensive effects), reduce arterial resistance (reduced vascular resistance develops over time and is responsible for long-term antihypertensive effects)

Adv. effects : hyperkalemia, dehydration, hyperglycemia, hyperuricemia (high uric acid in blood)

High-ceiling loop diuretics

Lasix

Reduces BP by reducing blood volume and promoting vasodilation

use w/ pts who need greater diuresis than thiazides provide (low GFR)

Adv. effects: Hypokalemia, dehydration, hyperglycemia, hyperuricemia, may cause hearing loss (ototoxicity)

Potassium-sparing diuretics

Spironolactone (Aldatone)

Adv. effects: Hyperkalemia

Contraindications: **don't use w/ ACE inhibitors**, angiotensin II receptor blockers, or aldosterone antagonists, all of which promote hyperkalemia

Beta Blockers

Propranolol (Inderal), Metoprolol (Lopressor)

Action: decreases HR and contractility --> decreased CO

decreases renin release from kidneys (RAAS system)

Adv. effects: Bradycardia, decreased AV conduction, reduced contractility

*don't use in pts w/ 2nd or 3rd degree heart block

*special care w/ heart failure

*avoid use in asthmatics

Alpha Blockers

Doxazosin (Cardura), Terazosin (Hytrin)

Action: Prevents vasoconstriction by preventing stimulation of alpha 1 receptors on arterioles and veins - reduces peripheral resistance and venous return = both decrease CO, eventually... :)

Adv. effects: Orthostatic hypotension (esp. w/ initial dose)

*NOT FIRST LINE THERAPY

**Use for pts w/ BPH and hypertension**

ACE Inhibitors

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Prinivil)

Action: prevents formation of angiotensin II

*Slows kidney injury in DM pts w/ renal damage

Adv. effects: persistent cough**, 1st dose hypotension, angioedemia, hyperkalemia (avoid K+ supplements and K+ sparing diuretics)

1. Lasix - thiazide
2. Beta Blockers
3. ACE inhibitors
4. Calcium channel blockers = last choice!

African Americans: drug Bidil (vasodilator, works w/ genetic make up)

1. lifestyle modification
2. Sodium restriction
3. Diuretics
4. Bidil

Preeclampsia

Eclampsia

Preeclampsia

• drug of choice : Hydralazine
• birth as treatment

• Most effective drugs for lowering LDLS
• Evevates HDL
• Should be taken during the evening because the liver produces cholesterol at night

• Must effective at increasing HDL
• Reduces LDL and TG

Adverse effects

• flushing
• Gi upset
• Itching 
• Hepatotoxicty
• Headache

Questran (Cholestryamine)

Bile acid Sequestrants

Administration - take a couple hours after other meds to ensure absorption of other meds

Adverse efffects-

• constipation
• flatulence 
• Binds fat soluble vitamins (deficiency of fat soluble vitamins)

Angina Pain occurs when cardiac oxygen supply is

insufficeint to meet oxygen demands

Administration

• keep away from heat, moisture and keep in orginal bottom away from the light
• take one tablet sublingually with onset of chest pain, if pain persist after five min call 911 take another tab, if pain still persists take only one more tab (up to three tabs in fifteen minutes only)

Adverse effects

• Headache (b/c of max blood flow
• Orthostatic Hypotension
• Sncope (fainting) - can happen without standing up 
• Relfex tachycardia

Anti Coagulation

Aspirin

Inhibits platelet aggregation 

Adverse effects, 

• you know them!!!!!! if you don't you should fail pharm

mechanism of action: causes irreversible blockade of ADP receptors on platelets, preventing ADP stimulated aggregation

Uses: Pts that do NOT tolerate aspirin

Anticoagulant 

Heparin

Administration: parenteral, b/c unable to cross membranes

Monitoring: aPTT (activated partial thromboplastin time)

-if very high there won't be any clotting - greater risk of bleeding out

Indications: Venous thrombosis, Pulmonary embolism, mural thrombosis after MI, post thrombolytic coronary rethrombosis, unstable angina, acute MI

Contraindications:

Antidote: Protamine sulfate

Adverse Effects: Hemorrhage, thrombocytopenia, osteoporosis, alopecia, hypoaldosteronism

Anticoagulants

Coumadin

Administration: PO

Monitoring: PT/INR - PT=prothrombin time, INR=international normalized ration

Indications: Long term prophylaxis of thrombisis - DVT, PE, prevent thromboembolism in pts w/ prosthetic heart valves, prevent thrombsis in a-fib

Contraindications: don't use in emergencies!, don't combine w/ any other drug that binds to albumin b/c it will be knocked off

Adverse effects: Hemorrhage (reverse w/ vit. K)

• educated pt. about blood in stool, bloody nose, bruising, and safe hygiene (razor, toothbrush)
• any food w/ vitamin K

Anticoagulants

Low Molecular Weight Heparin

(LMW heparin)

Administration: sub Q, 1-2x/day b/c long half-life

Monitoring: none needed b/c more biologically active at lower dosages and more therapeutically predictable than regular heparin

Thrombolytics (Clot busters)

Streptokinase (Streptase), Alteplase (tPA), Reteplase, Urokinase, Tenecteplase (TNKase)

Administration: most effective if started w/in 4-6 hrs of MI/stroke

Adverse effects: *Bleeding, antibody production, fever, hypotension