Your SlideShare is downloading. ×
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Ppt chapter046
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Ppt chapter046

582

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
582
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
40
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction to Clinical Pharmacology Chapter 46- Male and Female Hormones
  • 2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Male Hormones: Uses • Androgen therapy used as: Replacement therapy • Anabolic steroid: Uses • Androgen hormone inhibitors: Uses
  • 3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Male Hormones: Adverse Reactions • Androgens: – In men •Breast enlargement; Testicular atrophy •Inhibition of testicular function; Impotence •Enlargement of penis; Jaundice; Male pattern baldness – In women- receiving androgen preparation for breast carcinoma •Amenorrhea; Virilization
  • 4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Male Hormones: Adverse Reactions (cont’d) • Anabolic Steroids: – Virilization; Nausea; Diarrhea; Fluid and electrolyte imbalances – Testicular atrophy; Jaundice; Anorexia; Muscle cramps • Androgen hormone inhibitor: – Impotence; Decreased libido; Decreased volume of ejaculate
  • 5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Male Hormones: Contraindications and Precautions • Male hormones and hormone inhibitors: Contraindicated: – Hypersensitivity to drugs; Liver disorders; Cardiac disease; Prostate gland disorders • Anabolic steroids: – Contraindicated to enhance physical appearance or athletic performance – Used cautiously: Risk of prostate enlargement and prostate cancer
  • 6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Male Hormones: Interactions Interactant Drug Effect of Interaction Oral anticoagulants Increased antidiuretic effect Imipramine and androgen Increased risk for paranoid behavior Sulfonylureas and anabolic steroids Increased risk for hypoglycemia
  • 7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Androgens: Take and record vital signs and weight; Review tests; Note abnormalities – Anabolic steroids: Evaluate and record physical, nutritional status before starting therapy; assess weight, blood pressure, pulse, respiratory rate – Androgen hormone inhibitor: Ask about symptoms of BPH; Record all symptoms in patient’s chart
  • 8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont’d) • Ongoing assessment: – Weigh patient with advanced breast carcinoma daily or as ordered – Notify primary health care provider: Significant increase or decrease in weight – Take vital signs every 4 to 8 hours; Evaluate response to drug therapy based on original assessment findings
  • 9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Expected outcomes – Optimal response to therapy – Support of patient needs related to the management of adverse reactions – Understanding of and compliance with the prescribed therapeutic regimen Nursing Process: Planning
  • 10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses • Excess fluid volume • Disturbed body image
  • 11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy: – Demonstrate placement of the tablet •Warn the patient not to swallow the tablet but to allow it to dissolve in the mouth •Remind patient not to smoke or drink water until tablet is dissolved
  • 12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Monitoring and managing patient needs: – Excess fluid volume: Monitor fluid and electrolyte disturbances; Daily comparison of patient’s preadministration weight with current weights; Symptoms to note; Report findings – Disturbed body image: Suggest wearing of wig if hair loss occurs and makeup for mild skin pigmentation
  • 13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Educating the patient and the family: – Androgens •Notify if nausea, vomiting, swelling of legs, or jaundice occurs •Oral tablets: Take with food or snack •Buccal tablets: Place tablet between cheek and molars- dissolve in mouth •Testosterone transdermal system: Apply according to directions
  • 14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Educating the patient and the family: Anabolic steroids (cont’d): – Take drug with food or meals – Keep primary health care provider or clinic visits – Androgen hormone inhibitor: Take drug without regard to meals – Inform primary health care provider if sexual partner is or may become pregnant
  • 15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • Therapeutic response is achieved • Adverse reactions: Identified and reported • Patient and family demonstrate: Understanding of the drug regimen • Patient verbalizes: Understanding of treatment modalities and importance of continued follow-up care
  • 16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Uses • Estrogens are used to: – Relieve moderate to severe vasomotor symptoms of menopause – Female hypogonadism; Atrophic vaginitis – Osteoporosis in women post menopause – Palliative treatment: Advanced prostatic carcinoma – Advanced breast carcinoma
  • 17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Uses (cont’d) • Progestins used: – Treatment of amenorrhea, endometriosis, functional uterine bleeding – Oral contraceptives • Contraceptive Hormones: – Regulating menstrual cycle and decreased blood loss – Treatment of: Iron deficiency anemia, dysmenorrhea
  • 18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Adverse Reactions • Estrogens: – Central nervous system – Dermatologic – Gastrointestinal – Genitourinary – Local – Ophthalmic – Miscellaneous
  • 19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Adverse Reactions • Progestin: • Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea • Breast tenderness, edema, weight increase or decrease • Acne, chloasma, melasma, insomnia, mental depression • Contraceptive hormones: • Vary depending on estrogen or progestin content
  • 20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Contraindications and Precautions • Contraindicated: Hypersensitivity to drugs; Breast cancer; Estrogen-dependent neoplasms; Undiagnosed abnormal genital bleeding; Thromboembolic disorder • Precautions: – Estrogens: patients with gallbladder disease, hypercalcemia, cardiovascular disease, and liver impairment – Progestins: patients with history of migraine headaches, epilepsy, asthma, cardiac or renal impairment
  • 21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Female Hormones: Interactions Interactant Drug Effect of Interaction Estrogens Oral anticoagulants Decreased anticoagulant effect Tricyclic antidepressants Increased effectiveness of antidepressant Barbiturates or rifampin Increased risk for breakthrough bleeding Hydantoins Increased risk for breakthrough bleeding and pregnancy
  • 22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Interactant Drug Effect of Interaction Progestins Anticonvulsants, barbiturates, or rifampin Decreased effectiveness of progestin Penicillins or tetracyclines Decreased effectiveness of oral contraceptives Female Hormones: Interactions (cont’d)
  • 23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment • Preadministration assessment: – Obtain complete health history •Menstrual history; Thrombophlebitis or other vascular disorders •Smoking; Liver diseases – Enter in patient’s record: General evaluation of patient’s physical and mental status if treated for cancer
  • 24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Ongoing assessments: – Outpatients: Obtain blood pressure, pulse, respiratory rate, weight • Question patient regarding any adverse drug effects, as well as result of drug therapy • Weigh patient and report steady weight gain or loss Nursing Process: Assessment (cont’d)
  • 25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Assessment (cont’d) • Hospitalized patients: – Take vital signs daily – Observe adverse drug reactions: Liver or cardiovascular system – Weigh patient weekly; Report significant weight gain or loss – Observe and evaluate signs: Response to therapy in patients with breast or prostate cancer
  • 26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Planning • Expected outcome – Optimal response to therapy – Support of patient needs related to the management of adverse reactions – Reduction in anxiety – Understanding of and compliance with prescribed therapeutic regimen
  • 27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses • Individual Effective Therapeutic Regimen Management • Excess Fluid Volume • Ineffective Tissue Perfusion • Imbalanced Nutrition • Anxiety
  • 28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Promoting an optimal response to therapy: – Estrogens: Give instructions on proper use when - given vaginally for atrophic vaginitis – Contraceptive hormones: Monophasic oral contraceptives: Administered on 21-day regimen – Contraceptive implant system: Capsules provide contraceptive protection for 5 years; May be removed
  • 29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins • Promoting an optimal response to therapy (cont’d): – Medroxyprogesterone acetate contraceptive injection •Synthetic progestin used in the treatment of abnormal uterine bleeding and secondary amenorrhea •Also used as contraceptive Nursing Process: Implementation
  • 30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Monitoring and managing patient needs: – Individual effective therapeutic regimen management: Monitor patient with diabetes taking female hormones – Excess fluid volume: Weigh hospitalized patient daily; Keep accurate record of intake and output; Encourage ambulation – Imbalanced nutrition: Encourage diet with adequate amounts of protein and carbohydrates, low in fats
  • 31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): – Ineffective tissue perfusion: Monitor patient for signs of thromboembolic effects – Anxiety: Explain that taking progestin counteracts negative effect of estrogen- can prevent estrogen-induced cancer of uterus
  • 32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Educating the patient and family: – Estrogens and Progestins: Notify •Pain in legs, chest or abdomen; Shortness of breath •Lumps in breast; Vision or speech disturbances; Weakness or numbness in limbs – Oral contraceptives: Report •Retention or edema; Blurred vision; Chest pain; Yellowed skin or eyes
  • 33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Implementation (cont’d) • Educating the patient and family (cont’d): – Estradiol transdermal system •Procedure – Intravaginal application: Use applicator correctly, wash applicator after each use in warm water with mild soap and rinse well
  • 34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Evaluation • Therapeutic effect is achieved • Adverse reactions: Identified; Reported; Managed using appropriate nursing interventions • Anxiety is reduced • Patient verbalizes: Understanding of dosage regimen; Importance of continued follow-up care; Importance of complying with the prescribed therapeutic regimen
  • 35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation

×