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NurseReview.Org Pharmacology Endocrine Drugs


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NurseReview.Org Pharmacology Endocrine Drugs

  1. 1. Pharmacology of the Selected Endocrine Drugs
  2. 2. Fig. 10.9
  3. 3. Fig. 10.10
  4. 4. Fig. 10.11a
  5. 6. Fig. 10.12a
  6. 7. Fig. 10.12b
  7. 9. Fig. 10.14
  8. 10. Fig. 10.17
  9. 11. Fig. 10.18
  10. 12. Fig. 10.19
  11. 13. Endocrine Medications <ul><li>Hormonal replacement </li></ul>
  12. 14. ADH
  13. 15. Endocrine Medications <ul><li>Anti-diuretic hormones </li></ul><ul><li>Enhance re-absorption of water in the kidneys </li></ul><ul><li>Increases water permeability in the renal collecting ducts </li></ul><ul><li>Also stimulates VASOCONSTRICTION and increases the blood pressure </li></ul>
  14. 16. Endocrine Medications <ul><li>Therapeutic Indications </li></ul><ul><li>Hormonal replacement </li></ul><ul><li>Used in diagnostic procedure </li></ul><ul><li>Used to control the hemorrhage in variceal bleeding </li></ul><ul><li>Treatment of enuresis </li></ul>
  15. 17. Endocrine Medications <ul><li>Used in DI </li></ul><ul><li>1. Desmopressin and Lypressin intranasally </li></ul><ul><li>2. Pitressin IntraMuscularly </li></ul>
  16. 18. Endocrine Medications <ul><li>Anti-diuretic hormones </li></ul><ul><li>SIDE-effects </li></ul><ul><li>Flushing and headache </li></ul><ul><li>Water intoxication </li></ul><ul><li>CVS: heart block, MI </li></ul><ul><li>Renal: hyponatremia </li></ul><ul><li>Gangrene due to vasoconstriction </li></ul>
  17. 19. Thyroid Medications
  18. 20. Thyroid Medications <ul><li>Thyroid hormones </li></ul><ul><li>These products are used to treat the manifestations of hypothyroidism </li></ul><ul><li>Replace hormonal deficit in the treatment of HYPOTHYROIDSM </li></ul>
  19. 21. Thyroid Medications <ul><li>Thyroid hormones </li></ul><ul><li>Levothyroxine (Synthroid) </li></ul><ul><li>Liothyroxine (Cytomel) </li></ul><ul><li>Thyroid dessicated </li></ul><ul><li>Liotrix (Thyrolar) </li></ul>
  20. 22. Thyroid Medications <ul><li>Thyroid hormones: Actions </li></ul><ul><li>Replaces both T3 and T4 </li></ul><ul><li>Increases metabolic rate </li></ul>
  21. 23. Thyroid Medications <ul><li>Thyroid hormones: Actions </li></ul><ul><li>Increase the metabolic rate </li></ul><ul><li>Increase O2 consumption </li></ul><ul><li>Increase HR, RR, BP </li></ul>
  22. 24. Thyroid Medications <ul><li>Thyroid hormones: Indications </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Diagnostic suppression test </li></ul>
  23. 25. Thyroid Medications <ul><li>Thyroid hormones </li></ul><ul><li>Side-effects </li></ul><ul><li>Nausea and Vomiting </li></ul><ul><li>Signs of increased metabolism= tachycardia, hypertension, cardiac arrhythmias, anxiety, headache, tremors, palpitations </li></ul>
  24. 26. Thyroid Medications <ul><li>Thyroid hormones : Nursing responsibility </li></ul><ul><li>1. Monitor weight, VS </li></ul><ul><li>2. Instruct client to take daily medication the same time each morning WITHOUT FOOD </li></ul><ul><li>Monitor blood tests to check the activity of thyroid </li></ul>
  25. 27. Thyroid Medications <ul><li>Thyroid hormones: Nursing responsibility </li></ul><ul><li>3. Advise to report palpitation, tachycardia, and chest pain </li></ul><ul><li>4. Instruct to avoid foods that inhibit thyroid secretions like cabbage, spinach and radishes </li></ul>
  26. 28. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>The thyroid becomes oversaturated with iodine and stop producing thyroid hormone </li></ul>
  27. 29. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>Drugs used to BLOCK the thyroid hormones and treat hyperthyroidism </li></ul><ul><li>Inhibit the synthesis of thyroid hormones </li></ul>
  28. 30. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>1. Methimazole (Tapazole) </li></ul><ul><li>2. PTU (prophylthiouracil) </li></ul><ul><li>3. Iodine solution- SSKI and Lugol’s solution </li></ul>
  29. 31. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications: Indications </li></ul><ul><li>Grave’s dosease </li></ul><ul><li>Thyrotoxicosis </li></ul>
  30. 32. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications: </li></ul><ul><li>Absorption is good orally </li></ul>
  31. 33. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>Side-effects of thionamides </li></ul><ul><ul><li>N/V, drowsiness, lethargy, bradycardia, skin rash </li></ul></ul><ul><ul><li>GI complaints </li></ul></ul><ul><ul><li>Arthralgia, myalgia </li></ul></ul><ul><ul><li>AGRANULOCYTOSIS </li></ul></ul><ul><ul><ul><li>Most important to monitor </li></ul></ul></ul>
  32. 34. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>Side-effects of Iodine solutions Lugol’s </li></ul><ul><ul><li>Most common adverse effects is HYPOTHYROIDISM </li></ul></ul><ul><ul><li>Iodism= metallic taste, burning in the mouth, sore teeth and gums, diarrhea, stomach upset </li></ul></ul>
  33. 35. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>Nursing responsibilities </li></ul><ul><li>1. Monitor VS, T3 and T4, weight </li></ul><ul><li>2. The medications WITH MEALS to avoid gastric upset </li></ul>
  34. 36. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications Nursing responsibilities </li></ul><ul><li>3. Instruct to report SORE THROAT or unexplained FEVER </li></ul><ul><li>4. Monitor for signs of hypothyroidism. </li></ul><ul><ul><li>Instruct not to stop abrupt medication </li></ul></ul>
  35. 37. ANTI-Thyroid Medications <ul><li>ANTI-THYROID medications </li></ul><ul><li>Lugol’s Solution </li></ul><ul><li>Used to decrease the vascularity and size of the thyroid (in preparation for thyroid surgery) </li></ul><ul><li>T3 and T4 production diminishes </li></ul><ul><li>Given per orem, can be diluted with juice, administered WITH foods </li></ul><ul><li>Use straw to decrease staining </li></ul><ul><li>Monitor iodism </li></ul>
  36. 38. Steroids
  37. 39. STEROIDS <ul><li>Replaces the steroids in the body </li></ul><ul><li>Cortisol, cortisone, betamethasone, and hydrocortisone </li></ul>
  38. 40. STEROIDS <ul><li>These drugs enter the cells and bind to receptors </li></ul><ul><li>They inhibit the enzyme phospholipase </li></ul>
  39. 41. STEROIDS <ul><li>Corticosteroids are used topically and locally to achieve the desired anti-inflammatory effects at a particular site </li></ul><ul><li>Examples: </li></ul><ul><li>Prednisone </li></ul><ul><li>Bethamethasone </li></ul><ul><li>Prednisolone </li></ul><ul><li>Fludrocortisone </li></ul>
  40. 42. STEROIDS <ul><li>Side-effects </li></ul><ul><ul><li>HYPERglycemia </li></ul></ul><ul><ul><li>Increased susceptibility to infection (immunosuppression) </li></ul></ul><ul><ul><li>Hypokalemia </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><ul><li>Peptic ulceration </li></ul></ul>
  41. 43. STEROIDS <ul><li>Side-effects </li></ul><ul><ul><li>If high doses- osteoporosis, growth retardation, peptic ulcer, hypertension, cataract, mood changes, hirsutism, and fragile skin </li></ul></ul>
  42. 44. STEROIDS <ul><li>Nursing responsibilities </li></ul><ul><li>1. Monitor VS, electrolytes, glucose </li></ul><ul><li>2. Monitor weight edema and I/O </li></ul>
  43. 45. STEROIDS <ul><li>Nursing responsibilities </li></ul><ul><li>3. Protect patient from infection </li></ul><ul><li>4. Handle patient gently </li></ul><ul><li>5. Instruct to take meds WITH MEALS to prevent gastric ulcer formation </li></ul>
  44. 46. STEROIDS <ul><li>Nursing responsibilities </li></ul><ul><li>6. Caution the patient NOT to abruptly stop the drug </li></ul><ul><li>7. Drug is tapered to allow the adrenal gland to secrete endogenous hormones </li></ul>
  45. 47. STEROIDS <ul><li>Evaluation: </li></ul><ul><li>The drugs are effective if there is: </li></ul><ul><li>Relief of signs and symptoms of inflammation </li></ul><ul><li>Return of adrenal function to normal </li></ul>
  46. 48. DM Drug therapy
  47. 49. DRUG THERAPY and MANAGEMENT <ul><li>Usually, this type of management is employed if diet modification and exercise cannot control the blood glucose level. </li></ul>
  48. 50. DRUG THERAPY and MANAGEMENT <ul><li>These agents are employed to control the blood glucose level </li></ul><ul><li>They can be insulin and oral agents </li></ul><ul><li>These are given to replace the hormone in the body </li></ul><ul><li>If hormone is still present BUT decreased, Oral agents are given </li></ul>
  49. 51. Diabetes Mellitus <ul><li>DRUG THERAPY and MANAGEMENT </li></ul><ul><li>Because the patient with TYPE 1 DM cannot produce insulin, exogenous insulin must be administered for life. </li></ul>
  50. 52. Diabetes Mellitus <ul><li>DRUG THERAPY and MANAGEMENT </li></ul><ul><li>TYPE 2 DM may have decreased insulin production, ORAL agents that stimulate insulin production are usually employed. </li></ul>
  51. 53. Diabetes Mellitus <ul><li>PHARMACOLOGIC INSULIN </li></ul><ul><li>This may be grouped into several categories according to: </li></ul><ul><li>1. Source- Human, pig, or cow </li></ul><ul><li>2. Onset of action- Rapid-acting, short-acting, intermediate-acting, long-acting and very long acting </li></ul>
  52. 54. Diabetes Mellitus <ul><li>PHARMACOLOGIC INSULIN </li></ul><ul><li>This may be grouped into several categories according to: </li></ul><ul><li>3. Pure or mixed concentration </li></ul><ul><li>4. Manufacturer of drug </li></ul>
  53. 55. Diabetes Mellitus <ul><li>GENERALITIES </li></ul><ul><li>1. Human insulin preparations have a shorter duration of action than animal source </li></ul>
  54. 56. Diabetes Mellitus <ul><li>GENERALITIES </li></ul><ul><li>2. Animal sources of insulin have animal proteins that may trigger allergic reaction and they may stimulate antibody production that may bind the insulin, slowing the action </li></ul>
  55. 57. Diabetes Mellitus <ul><li>3. ONLY Regular insulin can be used INTRAVENOUSLY! </li></ul>
  56. 58. Diabetes Mellitus <ul><li>4. Insulin are measured in INTERNATIONAL UNITS or “iu” </li></ul><ul><li>5. There is a specified insulin injection calibrated in units </li></ul>
  57. 59. Diabetes Mellitus <ul><li>Mixed insulin are also available </li></ul><ul><li>The msot common of which is the 70-30 insulin </li></ul><ul><li>Made up of :70% NPH and 30% regular insulin in the vial </li></ul>
  58. 60. Comparison of Insulin Peak action 10-20 hrs 4-8 hrs Ultra-lente Long Acting 6-8 hrs to 12 hrs 1 ½ to 2 hrs NPH and Lente Intermediate acting 2-4 hrs 1 hour Regular Insulin RAPID acting 1 hour 15 minutes Lispro ULTRA-acting PEAK Onset Example Insulin Type
  59. 61. Diabetes Mellitus <ul><li>RAPID ACTING INSULIN </li></ul><ul><li>Lispro (Humalog) and Insulin Aspart (Novolog) </li></ul><ul><li>Produces a more rapid effect and with a shorter duration than any other insulin preparation </li></ul>
  60. 62. Diabetes Mellitus <ul><li>RAPID ACTING INSULIN </li></ul><ul><li>ONSET- 5-15 minutes </li></ul><ul><li>PEAK- 1 hour </li></ul><ul><li>DURATION- 3 hours </li></ul><ul><li>Instruct patient to eat within 5 to 15 minutes after injection </li></ul>
  61. 63. Diabetes Mellitus <ul><li>REGULAR INSULIN </li></ul><ul><li>Also called Short-acting insulin </li></ul><ul><li>“ R” </li></ul><ul><li>Usually Clear solution administered 30 minutes before a meal </li></ul>
  62. 64. Diabetes Mellitus <ul><li>REGULAR INSULIN </li></ul><ul><li>ONSET- 30 minutes to 1 hour </li></ul><ul><li>PEAK- 2 to 4 hours </li></ul><ul><li>DURATION- 4 to 6 hours </li></ul>
  63. 65. Diabetes Mellitus <ul><li>INTERMEDIATE ACTING INSULIN </li></ul><ul><li>Called “NPH” or “LENTE” </li></ul><ul><li>Appears white and cloudy </li></ul>
  64. 66. Diabetes Mellitus <ul><li>INTERMEDIATE ACTING INSULIN </li></ul><ul><li>ONSET- 2-4 hours </li></ul><ul><li>PEAK- 4 to 6-12 hours </li></ul><ul><li>DURATION- 16-20 hours </li></ul>
  65. 67. Diabetes Mellitus <ul><li>LONG- ACTING INSULIN </li></ul><ul><li>“ UltraLENTE” </li></ul><ul><li>Referred to as “peakless” insulin </li></ul>
  66. 68. Diabetes Mellitus <ul><li>LONG- ACTING INSULIN </li></ul><ul><li>ONSET- 6-8 hours </li></ul><ul><li>PEAK- 12-16 hours </li></ul><ul><li>DURATION- 20-30 hours </li></ul>
  67. 69. Diabetes Mellitus <ul><li>HEALTH TEACHING </li></ul><ul><li>Regarding Insulin SELF- Administration </li></ul><ul><li>1. Insulin is administered at home subcutaneously </li></ul>
  68. 70. Diabetes Mellitus <ul><li>HEALTH TEACHING Regarding Insulin SELF- Administration </li></ul><ul><li>2. Cloudy insulin should be thoroughly mixed by gently inverting the vial or ROLLING between the hands </li></ul>
  69. 71. Diabetes Mellitus <ul><li>HEALTH TEACHING Regarding Insulin SELF- Administration </li></ul><ul><li>3. Insulin NOT IN USE should be stored in the refrigerator, BUT avoid freezing/extreme temperature </li></ul>
  70. 72. Diabetes Mellitus <ul><li>4. Insulin IN USE should be kept at room temperature to reduce local irritation at the injection site </li></ul>
  71. 73. Diabetes Mellitus <ul><li>5. INSULIN may be kept at room temperature up to 1 month </li></ul>
  72. 74. Diabetes Mellitus <ul><li>6. Select syringes that match the insulin concentration. </li></ul><ul><ul><li>U-100 means 100 units per mL </li></ul></ul>
  73. 75. Diabetes Mellitus <ul><li>7. Instruct the client to draw up the REGULAR (clear) Insulin FIRST before drawing the intermediate acting (cloudy) insulin </li></ul>
  74. 76. Diabetes Mellitus <ul><li>8. Pre-filled syringes can be prepared and should be kept in the refrigerator with the needle in the UPRIGHT position to avoid clogging the needle </li></ul>
  75. 77. Diabetes Mellitus <ul><li>9. The four main areas for insulin injection are- ABDOMEN, UPPER ARMS, THIGHS and HIPS </li></ul>
  76. 79. Diabetes Mellitus <ul><li>Insulin is absorbed fastest in the abdomen and slowest in the hips </li></ul><ul><li>Instruct the client to rotate the areas of injection, but exhaust all available sites in one area first before moving into another area. </li></ul>
  77. 80. Diabetes Mellitus <ul><li>10. Alcohol may not be used to cleanse the skin </li></ul><ul><li>11. Utilize the subcutaneous injection technique- commonly, a 45-90 degree angle. </li></ul>
  78. 81. Diabetes Mellitus <ul><li>12. No need to instruct for aspirating the needle </li></ul><ul><li>13. Properly discard the syringe after use. </li></ul>
  79. 82. Diabetes Mellitus <ul><li>T-I-E </li></ul><ul><li>T est blood  I nject insulin  E at food </li></ul>
  80. 83. Diabetes Mellitus <ul><li>ORAL HYPOGLYCEMIC AGENTS </li></ul><ul><li>These may be effective when used in TYPE 2 DM that cannot be treated with diet and exercise </li></ul><ul><li>These are NEVER used in pregnancy! </li></ul>
  81. 84. Diabetes Mellitus <ul><li>ORAL HYPOGLYCEMIC AGENTS </li></ul><ul><li>There are several agents: </li></ul><ul><ul><li>Sulfonylureas </li></ul></ul><ul><ul><li>Biguanides </li></ul></ul><ul><ul><li>Alpha-glucosidase inhibitors </li></ul></ul><ul><ul><li>Thiazolidinediones </li></ul></ul><ul><ul><li>Meglitinides </li></ul></ul>
  82. 85. Diabetes Mellitus <ul><li>ORAL HYPOGLYCEMIC AGENTS </li></ul><ul><li>These drugs are given per orem and are effective only in type 2 DM </li></ul><ul><li>Common adverse effects include: </li></ul><ul><ul><li>Hypoglycemia </li></ul></ul><ul><ul><li>Diarrhea, jaundice, nausea and heartburn </li></ul></ul><ul><ul><li>Anemia , photosensitivity </li></ul></ul>
  83. 86. Diabetes Mellitus <ul><li>ORAL HYPOGLYCEMIC AGENTS </li></ul><ul><li>General Nursing Consideration </li></ul><ul><li>Observe for manifestations of hypoglycemia </li></ul><ul><li>Assess for allergic reaction </li></ul><ul><li>Instruct to take the medication at the same time each day </li></ul><ul><li>Caution to avoid taking other drugs without consultation with physician </li></ul>
  84. 87. Diabetes Mellitus <ul><li>ORAL HYPOGLYCEMIC AGENTS </li></ul><ul><li>General Nursing Consideration </li></ul><ul><li>5. THESE medications SHOULD NEVER be given to pregnant women, so rule out pregnancy </li></ul><ul><li>6. Instruct to wear sunscreen </li></ul><ul><li>7. Advise to bring simple sugar to be taken when hypoglycemic episodes occur </li></ul>
  85. 88. Diabetes Mellitus <ul><li>SULFONYLUREAS </li></ul><ul><li>MOA- stimulates the beta cells of the pancreas to secrete insulin </li></ul><ul><li>Classified as to generations- first and second generations </li></ul>
  86. 89. Diabetes Mellitus <ul><li>SULFONYLUREAS </li></ul><ul><li>FIRST GENERATION- Acetoheximide, Chlorpropamide, Tolazamide and Tolbutamide </li></ul><ul><li>SECOND GENERATION- Glipizide, Glyburide, Glibenclamide, Glimepiride </li></ul>
  87. 90. Diabetes Mellitus: Sulfonylureas <ul><li>The most common side –effects of these medications are Gastro-intestinal upset and dermatologic reactions. </li></ul><ul><li>HYPOGLYCEMIA is also a very important side-effect </li></ul><ul><li>Given 30 minutes before meals- breakfast </li></ul>
  88. 91. Diabetes Mellitus: Sulfonylureas <ul><li>Chlorpropamide has a very long duration of action. This also produces a disulfiram-like reaction when taken with alcohol </li></ul><ul><li>Second generation drugs have shorter duration with metabolism in the kidney and liver and are the choice for elderly patients </li></ul>
  89. 92. Diabetes Mellitus <ul><li>BIGUANIDES </li></ul><ul><li>MOA- Facilitate the action of insulin on the peripheral receptors </li></ul><ul><li>These can only be used in the presence of insulin </li></ul>
  90. 93. Diabetes Mellitus <ul><li>BIGUANIDES= “ formin” </li></ul><ul><li>They have no effect on the beta cells of the pancreas </li></ul><ul><li>Metformin (Glucophage) and Phenformin are examples </li></ul>
  91. 94. Diabetes Mellitus: Biguanides <ul><li>The most important side effect is LACTIC ACIDOSIS! </li></ul><ul><li>These are not given to patient with renal impairment </li></ul>
  92. 95. Diabetes Mellitus: Biguanides <ul><li>These drugs are usually given with a sulfonylurea to enhance the glucose-lowering effect more than the use of each drug individually </li></ul>
  93. 96. Diabetes Mellitus <ul><li>ALPHA-GLUCOSIDASE INHIBITORS </li></ul><ul><li>MOA- Delay the absorption of glucose in the GIT </li></ul><ul><li>Result is a lower post-prandial blood glucose level </li></ul><ul><li>They do not affect insulin secretion or action! </li></ul><ul><li>Side-effect: DIARRHEA and FLATULENCE </li></ul>
  94. 97. Diabetes Mellitus <ul><li>Examples of AGI are Acarbose and Miglitol </li></ul><ul><li>They are not absorbed systemically and are very safe </li></ul><ul><li>They can be used alone or in combination with other OHA </li></ul>
  95. 98. Diabetes Mellitus <ul><li>Side-effect if used with other drug is HYPOGLYCEMIA </li></ul><ul><li>Note that sucrose absorption is impaired and IV glucose is the therapy for the hypoglycemia </li></ul>
  96. 99. Diabetes Mellitus <ul><li>THIAZOLIDINEDIONES </li></ul><ul><li>MOA- Enhance insulin action at the receptor site </li></ul><ul><li>They do not stimulate insulin secretion </li></ul>
  97. 100. Diabetes Mellitus <ul><li>THIAZOLIDINEDIONES </li></ul><ul><li>Examples- Rosiglitazone, Pioglitazone </li></ul><ul><li>These drugs affect LIVER FUNCTION </li></ul><ul><li>Can cause resumption of OVULATION in peri-menopausal anovulatory women </li></ul>
  98. 101. Diabetes Mellitus <ul><li>MEGLITINIDES </li></ul><ul><li>MOA- Stimulate the secretion of insulin by the beta cells </li></ul><ul><li>Examples- Repaglinide and Nateglinide </li></ul>
  99. 102. Diabetes Mellitus <ul><li>MEGLITINIDES </li></ul><ul><li>They have a shorter duration and fast action </li></ul><ul><li>Should be taken BEFORE meals to stimulate the release of insulin from the pancreas </li></ul>
  100. 103. Diabetes Mellitus <ul><li>MEGLITINIDES </li></ul><ul><li>Principal side-effect of meglitinides- hypoglycemia </li></ul><ul><li>Can be used alone or in combination </li></ul>
  101. 104. Reproductive Hormones <ul><li>Gonadal hormones include agents that affect the female and male reproductive cycle </li></ul><ul><li>Female hormones include ESTROGENS, PROGESTINS and ovarian hormones </li></ul><ul><li>Male hormones include ANDROGENS and anabolic steroids </li></ul>
  102. 105. Reproductive Hormones <ul><li>The GENERAL Mechanism of Action </li></ul><ul><li>These hormones interfere with the normal cycle of hormone balance </li></ul>
  103. 106. Reproductive Hormones <ul><li>INDICATIONS </li></ul><ul><li>FEMALE: Hormonal replacement therapy, oral contraception, treatment of infertility and management of some tumors </li></ul><ul><li>MALE: replacement therapy, metabolic stimulators and treatment of some tumors </li></ul>
  104. 107. Reproductive Hormones <ul><li>Estrogens </li></ul><ul><li>Conjugated estrogen </li></ul><ul><li>Estradiol </li></ul><ul><li>Ethinyl estradiol </li></ul><ul><li>Diethylstilbesterol (DES) </li></ul><ul><li>Clomiphene </li></ul>
  105. 108. Reproductive Hormones <ul><li>Progestins </li></ul><ul><li>Medroxyprogesterone acetate (Provera) </li></ul><ul><li>Megestrol </li></ul><ul><li>Norethindrone </li></ul><ul><li>Levonorgestrel (Norplant) </li></ul><ul><li>Norgestrel </li></ul><ul><li>Norethindrone acetate </li></ul>
  106. 109. Reproductive Hormones <ul><li>Androgens </li></ul><ul><li>Testosterone cypionate </li></ul><ul><li>Methyltestosterone </li></ul><ul><li>Fluoxymesterone </li></ul><ul><li>Aqueous testosterone </li></ul>
  107. 110. Reproductive Hormones <ul><li>Oral Contraceptive Pills </li></ul><ul><li>Two types are available: Combination estrogen and progesterone AND progestins only </li></ul>
  108. 111. Reproductive Hormones <ul><li>Oral Contraceptive Pills: DYNAMICS </li></ul><ul><li>Inhibits OVULATION by altering the hypothalamus and gonadotropin axis </li></ul><ul><li>Alters the MUCUS to prevent sperm entry </li></ul><ul><li>Alters the uterine endometrium to prevent implantation </li></ul><ul><li>Suppresses the ovaries </li></ul>
  109. 112. Reproductive Hormones <ul><li>Oral Contraceptive Pills: Indicators </li></ul><ul><li>Suppression of ovulation for prevention of pregnancy </li></ul><ul><li>Regulation of menstrual cycle and management of dysfunctional bleeding </li></ul><ul><li>Treatment of endometriosis </li></ul>
  110. 113. Reproductive Hormones <ul><li>Oral Contraceptive Pills: Kinetics </li></ul><ul><li>Easily absorbed orally </li></ul><ul><li>NORPLANT provides 5 years of contraception </li></ul><ul><li>Provera provides 3 months of protection </li></ul><ul><li>Metabolized and excreted in liver </li></ul>
  111. 114. Reproductive Hormones <ul><li>Oral Contraceptive Pills: </li></ul><ul><li>Not to be used in patients with history of, hypertension, thromboemoblic or CVA disease </li></ul><ul><li>Not given in certain cancers </li></ul><ul><li>Contraindicates in pregnancy </li></ul><ul><li>SMOKING should be avoided when under therapy </li></ul>
  112. 115. Reproductive Hormones <ul><li>Oral Contraceptive Pills: Drug Interaction </li></ul><ul><li>Rifampicin, penicillin and tetracycline REDUCE effectiveness of contraception </li></ul><ul><li>Benzodiazepines decrease the levels of OCP </li></ul>
  113. 116. Reproductive Hormones <ul><li>Oral Contraceptive Pills: </li></ul><ul><li>Side effects </li></ul><ul><li>CNS: headache </li></ul><ul><li>CV: Thromboembolic disease, MI, hypertension and pulmonary edema </li></ul><ul><li>NAUSEA and cholestatic JAUNDICE </li></ul><ul><li>Breast tenderness, weight gain, edema, breakthrough bleeding, acne </li></ul>
  114. 117. Reproductive hormones <ul><li>Nursing Considerations </li></ul><ul><li>Assess for risk factors and the ability to comply with medications </li></ul><ul><li>Determine the type of OCP used </li></ul><ul><li>Monophasic pills provide constant dosing of BOTH estrogen and progestin </li></ul><ul><li>Biphasic pills provide constant estrogen but varying progestin doses </li></ul><ul><li>Triphasic pills provide varying Estrogen and Progesterone </li></ul>
  115. 118. Reproductive hormones <ul><li>Nursing Considerations </li></ul><ul><li>3. Teach the common side-effects and re-assure that these will decrease in time </li></ul><ul><li>4. Instruct to use other means of contraception if antibiotics and anticonvulsants are also taken </li></ul><ul><li>5. WARNT the client to avoid smoking because this will increase the risk for embolic episodes </li></ul>
  116. 119. Clomiphene <ul><li>A synthetic, non-steroidal estrogen </li></ul><ul><li>Increases the secretion of gonadotropins and initiates the secretion of FSH and LH </li></ul><ul><li>OVULATION will occur </li></ul><ul><li>Used in the treatment of infertility </li></ul><ul><li>Readily absorbed orally </li></ul>
  117. 120. Clomiphene <ul><li>Side effects can be: </li></ul><ul><li>Risk for Multiple pregnancy </li></ul><ul><li>Nausea, breast discomfort, headache and GI disturbances </li></ul><ul><li>Visual disturbances </li></ul><ul><li>Enlargement of the ovaries </li></ul>
  118. 121. Viagra (Sildenafil) <ul><li>A medication used for penile erectile dysfunction </li></ul><ul><li>Selectively inhibits receptors and enzyme Phosphodiesterase E </li></ul><ul><li>This increases the nitrous oxide levels allowing blood flow into the corpus cavernosum </li></ul>
  119. 122. Viagra (Sildenafil) <ul><li>Contraindicated in patients with bleeding disorders and with penile implants </li></ul><ul><li>Caution: Coronary Artery Disease and concomitant use of nitrates </li></ul><ul><li>Side-effects: PRIAPISM, headache, flushing, dyspepsia, UTI, diarrhea and dizziness </li></ul>
  120. 123. Viagra (Sildenafil) <ul><li>Nursing consideration </li></ul><ul><li>Assess for risk factors </li></ul><ul><li>Instruct to take the drug ONE hour before sexual act </li></ul><ul><li>Drug is taken orally </li></ul>