Shared Flashcard Set


Nursing 212
Columbia College Exam 3
Not Applicable

Additional Pharmacology Flashcards




medroxyprogesterone (Provera)
Depo- contraception, uterine bleeding
inhibits the secretion of pituitary gonadotropins which prevents follicular maturation and ovulation, stimulates the growth of mammary tissue and has an antineoplastic action against endometrial cancer
treats uterine bleeding, secondary amenorrhea, endometrial cancer, renal cancer
prevents pregnancy for 3 months, concern about its use in women under 25 yoa, shouldn't use longer than 2 years due to potential for bone density loss.
AE: amenorrhea, spotting, change in menstrual flow, change in cervical erosion and secretions, edema, pyrexia, depression, somnolence or insomnia, N/V
taken PO and parenterally
Desmopressin 473, 476
• prevents polydypsia, polyuria, dehydration (diabetes insipidus)
• Category: Pituitary Drugs, Desmopressin is a synthetic vasopressin
• Indications: Used to treat polydipsia (excessive thirst), polyuria and dehydration in patients with diabetes insipidus caused by a deficiency of the endogenous ADH. Because of its vasoconstrictor properties, it is useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage. Because of its effects on various blood-clotting factors, desmopressin is also useful in the treatment of hemophilia A and type I von Willebrand’s disease. Also used for management of nocturnal enuresis.
• Mechanism of Action: Mimic the actions of the naturally occurring antidiuretic hormone (ADH). Increases water resorption, and concentrates urine, reducing water excretion. Desmopressin causes a dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor, and tissue plasminogen activator.
• Contraindications: Even small amounts of pituitary drugs can initiate major physiologic changes and so should be used with special caution in patients with acute or chronic illnesses such as migraine headaches, epilepsy and asthma.
• Adverse Effects: Increased blood pressure, fever, vertigo, headache, nausea, heartburn, cramps, uterine cramping, nasal irritation and congestion, tremor, sweating (table 30-3)
• Interactions: carbamazepine, causes enhanced desmopressin effects. Lithium, alcohol demecloycline, reduces desmopressin effets.
Somatropin 475
• Growth hormone, stimulates skeletal muscle growth
• Category: Pituitary drugs, mimics the human growth hormone (GH)
• Indications: Effective in stimulating skeletal growth in patients with an inadequate secretion of normal endogenous GH, such as those with hypopituitary dwarfism, and also used for wasting associated with human immunodeficiency virus infection.
• Mechanism of Action: Promotes growth by stimulating carious anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores and retention of sodium, potassium, and phosphorus. Promote linear growth in children who lack normal amounts of the endogenous hormone.
• Adverse Effects: headache, hyperglycemia, hypothyroidism, hypercalciuria, rash, urticaria, development of antibodies to growth hormone, inflammation at injection site, flulike syndrome (table 30-4)
vasopressin 475
• powerful vasoconstrictor used in hypotensive emergencies
• Category: Pituitary Drugs, performs all the physiologic functions of ADH, produced by the hypothalamus. (Basically the same as Desmopressin (the synthetic form), I will list the info that is different)
• Indications: Vasopressin is a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). Its use is also called for in the Advanced Cardiac Life Support guidelines for treatment of pulseless cardiac arrest. Used to stop bleeding of esophageal varices.
• Contraindications: patients with know hypersensitivity, Pregnancy category C. Should be used with caution in patients with seizure disorders, asthma, cardiovascular disease, and renal disease. IV infiltration may lead to severe vasoconstriction and localized tissue necrosis, so nurses should watch the IV site closely for any signs of infiltration.
• Interactions: Fludrocortisone-enhanced antidiuretic effect. Demeclocycline, norepinephrine, lithium – reduced antidiuretic effect
basics of pituitary hormone deficiency 473
• negative feedback system. Hypothalamus/pituitary glands
• The pituitary gland and the hypothalamus work together as the neuroendocrine system
• Hormone secretion is regulated by a negative feedback loop. The glands monitor the amount of hormone circulating and either increase or decrease their output in response.
• Deficiency can result from problems with the glands or problems with the signaling involved in the negative feedback loop
• Pituitary drugs are generally used as a replacement drug therapy to make up for a hormone deficiency.
• Pituitary drugs either mimic or antagonize the natural effects of the pituitary hormones
Basics of thyroid hormone replacement 481
• body can’t live without hormones from thyroid
• Thyroid hormone replacement is used to treat hypothyroidism
• Hypothyroidism can result in a dysfunction of the thyroid gland (primary), the pituitary gland (secondary) or the hypothalamus (tertiary)
• Can be natural (thyroid, desiccated) or synthetic (levothyroxine, liothyronin, liotrix)
• Mechanism of Action: Thyroid replacement drugs work in the same manner as the endogenous thyroid hormones. They work to induce changes in the metabolic rate, including the rate of protein, carbohydrate, and lipid metabolism, and to increase oxygen consumption, body temperature, blood volume, and overall cellular growth and differentiation. Also increases the heart’s sensitivity to catecholamines and increases cardiac output. Increase renal blood flow and glomerular filtration rate, which results in a diuretic effect.
• Indications: Thyroid drugs are given to replace what the thyroid gland itself cannot produce to achieve normal thyroid hormone levels. Used to treat all forms of hypothyroidism. Can be used for the diagnosis of suspected hyperthyroidism and the prevention or treatment of goiters. Also used as replacement therapy for patients whose thyroid gland has been removed or destroyed because of cancer or hyperthyroidism. Hypothyroidism during pregnancy should be treated or else fetal growth may be retarded.
• Contraindications: Known drug allergy, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism
• Adverse Effects: adverse effects usually result from overdose. The most significant is cardiac dysrhythmia with the risk for life-threatening or fatal irregularities. Other more common ones listed in table 31-2 on page 482
• Interactions: mat enhance the activity of oral anticoagulants, diabetic patients may need to increase their dose of hypoglycemic drugs, may decrease digitalis levels. More listed in table 31-3 on page 482
Levothyroxine 482
• thyroid drug makes symptoms of hypothyroid disappear
• Category: Thyroid drug, basically includes all the info from “basics of thyroid hormone replacement” but I will add what is different for levothyroxine. Pregnancy category A
• Levothyroxine or T4 is the most commonly prescribed synthetic thyroid hormone and is generally considered the drug of choice
• Levothyroxine is 100% T4 so it is more predictable than natural forms and liotrix.
• Its half life is long enough that is only needs to be administered once a day
• Available in oral and parenteral forms
• Switching between brands can destabilize treatment
• Medication Error Potential: levothyroxine is dosed in micrograms, not milligrams, writing dose in milligrams would result in a thousandfold overdose
pt education re: antithyroid drugs 486
• Antithyroid drugs are better tolerated when taken with meals or a snack. These drugs should be given at the same time everyday to maintain consistent blood levels and they should never be withdrawn abruptly
• Do not take OTC drugs without first checking with physician
• Patients taking antithyroid drugs should avoid eating foods high in iodine such as tofu and other soy products, turnips, seafood, iodized salt, and some breads. These foods may interfere with the effectiveness of the drug
• Illnesses, weight gain, cold intolerance, fever, sore throat, mouth ulcers or sores, skin eruptions, unusual bleeding or bruising, and depression should be reported to the prescriber immediately
• Should be avoided during pregnancy. Pregnancy category D
Indications and responses to holding oral anti-diabetic drugs 493ish
• ck blood glucose levels before given. Give 30 min before meals.
• Schedule of insulin administration may need to be altered as meal schedules change or the patients is unable to eat or keep food down
Insulin 493
• it regulates blood sugar Levels
• Patients with type 2 diabetes are generally not prescribed insulin until other measures – namely, lifestyle changes and oral drugs therapy – no longer provide adequate glycemic control
• Requires the patient to be highly educated in the administration of the drug
• Indications: used to treat both type 1 and type 2 diabetes, but each patient requires customization of the dosing regimen for optimal glycemic control
• There are many drug interactions with insulins which patients should be educated about
• Careful attention is required for children and pregnant women on insulin therapy
• Insulin is administered subcutaneously
• Injection sites should be rotated before switching to a different part of the body
• Sliding-scale insulin dosing can be used for special/severe cases
Proper admin of adrenal drugs 515
• clears nasal pass. B4 giving nasal corticosteroids.
• The best time to give exogenous glucocorticoids is early in the morning because this leads to the least amount of adrenal suppression
• Should never be stopped abruptly
• Fludocortisone should be taken with food to minimize GI upset
• If a dose is missed, take as soon as remembered unless it is close to the time of the next dose, then just skip it and take next dose as normal
Adverse drug interactions with corticosteroids 512
• use with non-potassium –sparing diuretics can lead to severe hypocalcemia and hypokalemia
• Their use with aspirin, other nonsteroidal antiinflamatory drugs, and other ulcerogenic drugs produces additive GI effects and an increased chance of gastric ulcer development
• Their use with anticholinesterase drugs produces weakness in patients with myasthenia gravis
• Their use with immunizing biologicals inhibits the immune response to the biological
• Their use with antidiabetic drugs may reduce the hypoglycemic effects of the latter and results in elevated blood glucose levels
• Others listed on p512
Prednisone drug therapy 513,515
• moon face, buffalo hump, inc. weight in trunk, acne, cataracts.
• Intermediate-acting glucocorticoid
• Preferred oral glucocorticoid for anti-inflammatory or immunosuppressant purposes
• Also used to treat exacerbations of chronic respiratory illnesses such as asthma and chronic bronchitis.
• Inadequate by itself for the management of addison’s disease
• Given PO
Fludrocortisone 513
• BP control, maintain serum potassium levels, blood pH, sodium etc
• Most commonly prescribed mineralocorticoid. Used as a partial replacement therapy for adrenocortical insufficiency in Addison’s disease and in the treatment of salt-losing adrenogenital syndrome.
• Contraindicated- systemic functional infection
• Adverse effect- generally related to water retention and include heart failure, hypertension, and elevated intracerebral pressure (leading to seizures). Other adverse effects include: skin rash, menstrual irregularities, peptic ulcer, hyperglycemia, hypokalemia, potassium loss, muscle pain and weakness, compression bone fractures, glaucoma, and thrombophlebitis, among others
• Interactions- anabolic steroids (increased edema), barbiturates, hydantoins, and rifamycins (increased fludrocortisone clearance), amphotericin B and thiazide and loop diuretics (hypokalemia), anticoagulants (enhanced or reduced anticoagulant activity), antidiabetic drugs (reduced activity leading to hyperglycemia), digoxin (increased risk of neurologic complications)
• Fortunately adverse effects and serious drug interactions secondary to fludrocortisones therapy are uncommon due to the relatively small doses of the drug that are normally prescribed.
• Available only in oral form and a 0.1 mg tablet
• Pregnancy category C
pt. education re estrogen replacement therapy 538
• Estrogens can decrease the activity of oral anticoagulants
• Smoking should be avoided during estrogen therapy
• Can be taken with food to minimize GI upset
• The following should be reported immediately: chest pain, leg pain, blurred vision, headache, stiff neck, neck pain, loss of vision, numbness of extremities, severe headache, edema, yellow discoloration of the skin or sclera, clay-colored stools, and abnormal vaginal bleeding
• Patients should report a weight gain of 2 pounds or more in 24 hours or 5 pounds in 1 week, as well as any breakthrough bleeding, change in menstrual flow or breast tenderness
• Instruct on the importance of and the technique for monthly breast self-examinations
• Weight bearing exercises, stopping smoking and limiting alcohol can help promote fewer adverse effects of drug therapy
Contraindications for the use of estrogen drugs 522
• Known drug allergy, any estrogen-dependant cancer, undiagnosed abnormal vaginal bleeding, pregnancy, and active thromboembolic disorder (stroke, thrombophlebitis) or history of such a disorder
oxytocin (Pitocin) 532
• stimulates uterine contraction for childbirth
• synthetic form of the endogenous hormone oxytocin and has all of its pharmacologic properties
• IV or IM
• Used to induce labor at or near full-term gestation or to enhance labor when uterine contractions are weak and ineffective
• Also used to prevent or control uterine bleeding after delivery and to produce milk ejection during lactation
estradiol transdermal (Estraderm) 524
• treatment in diff. disorders that lead to low estrogen
• treatment in diff. disorders that lead to low estrogen
• 1 patch applied once or twice weekly to lower abdomen
• Used for vasomotor symptoms of menopause
raloxifene (Evista) 529
• prevents postmenopausal osteoporosis (bone density)
• selective estrogen receptor modulators (SERM)
• used primarily for the prevention of postmenopausal osteoporosis
• has positive effects on cholesterol level, but it is not normally used specifically for this purpose
• may not be good drug choice for women near menopause because it’s associated with hot flashes
• oral use only
• adverse effects: hot flashes, leg cramps, leukopenia may occur and predispose patient to various infections
• interactions: cholestyramine and ampicillin decrease the absorption of raloxifene; raloxifene
• can decrease the effects of warfarin
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