drugs used in hormonal disorders supplementation

1. Drugs used for Hormonal
Disorders and
supplementation, contraception
and medical termination of
pregnancy.

2. INC Syllabus
• Insulin & Oral Hypoglycemics.
• Thyroid supplements & Suppressants.
• Anabolic Steroids.
• Uterine stimulants & Relaxants.
• Oral contraceptives.
• Other estrogens – Progesterone Preparations.
• Corticotrophins & Gonadotropins.
• Adrenalin.
• Prostaglandin.
• Calcitonin's.
• Calcium salts.
• Calcium regulators.
Androgen &
Abortifacient

3. Antidiabetic Drugs: Insulin
•Antidiabetic drugs that treat diabetes
mellitus y lowering glucose levels in the
blood.
•Insulin: Insulin is synthesized in the ꞵ
(Beta) cells.Action of insulin is
converting glucose levels in the blood.

4. Mechanism of action
•In liver, insulin increases glucose uptake and
glycogen synthesis.
•In muscle – Increases glucose uptake and
utilization.
•In adipose tissue – increases glucose uptake and
storage as a fat and glycogen.
•It reduces breakdown of fats and protein also.

5. Drug examples and doses
S. No. Drugs Doses
1 Ultra short acting
Insulin apparat, Insulin ispro
15-30 min, (4-6 hrs.) 0.5to0.8
units/kg/day SC 15 min before meal.
2 Short acting
Regular insulin.
30-60 mins, (6-8hrs.)
3 Intermediate acting
Neutral protamine Hagedorn
1-2hrs, (20-40hrs)
4 Long acting
Ultra leute, Protamine zinc.
4-6hrs, (24-36hrs)

6. Indications/ uses
•Diabetes mellitus.
•Diabetic ketoacidosis.

7. Adverse effects
•Overdose may lead to hypoglycemia (Anxiety,
sweating, tremor, convulsions, coma)
•Local reaction (Swelling, erythema, stinging
sometimes).
•Allergy (Urticaria, angioedema, anaphylaxis)
•Edema.

8. Contraindications
•Hypoglycemia.
•Special precautions with the patients of renal
and hepatic impairment and pregnancy,
lactation (insulin impairment tend to fall
during the 1st trimester, increase during the
2nd trimester & 3rd trimesters)

9. Drug interactions
•Insulin cause a disulfiram like reaction
(abdominal cramps, nausea, vomiting flushing,
headache, hypoglycemia) when used with
alcohol.
•Use of insulin with corticosteroids, thiazide
diuretics, and thyroid preparations may cause
hyperglycemia.

10. Nursing responsibilities
• Nurse should know that repeated dose of insulin at the same site
may produces atrophy of the subcutaneous tissue, hence it is
advised to change the site of insulin injection.
• Assess the allergic reactions if there, due to change type of
insulin.
• Do not shake the insulin vial, instead roll it between hands.
• Should know that stress, fever, trauma, infection and surgery may
increase insulin requirements.
• Nurse should know that only regular insulin can be administered
I/V if needed in an emergency.
• Monitor the patients blood glucose.

11. Contd.
•Assess the patients for signs and symptoms of
hypoglycemia or hyperglycemia.
•Teach the patient how to take insulin injection by self.
Rotate ineffective sites and dispose of use syringes.
•Insulin can not be given orally because it is destroyed by
the enzymes of the gut.

12. Antidiabetic Drugs: Oral Hypoglycemics
•These are the drugs which can be
given orally and produce lowering
of blood sugar are called oral
hypoglycemic drugs.

13. Mechanism of the action
•These drugs act by increasing the secretion
of insulin so these are effective in those
patients in whom functional tissue (ꞵ Beta
cells of islets of Langerhans) are completely
destroyed. They increase the peripheral
utilization of glucose also as well as
increasing sensitivity of tissue to insulin.

14. Drug examples & doses
S. No. Drugs Doses
Sulfonylureas
1 Chlorpropamide 250-500 mg OD
2 Tolbutamide 100-500 mg OD
3 Glibenclamide 2.5- 20 mg OD
4 Glipizide 2.5-5mg OD
Biguanides
5 Metformin 500 mg orally BD or 850 mg OD (Max. dose 2550 mg/day)
6 Phenformin 200-400 mg BD orally.
Thiazolidinediones
7 Pioglitazone 7.5 to 60 mg daily.
8 Rosiglitazone 4.8 mg daily.

15. Indications/uses
•Hyperglycemia/ Diabetic mellitus.
•Biguanides are used along with insulin and
sulfonylureas to produce a better control of blood
sugar.
•They also reduce body weight.

16. Adverse effects
• Hypoglycemia in overdose.
• Nausea/vomiting.
• Diarrhea/ constipation.
• Paresthesia's.
• Hypersensitivity.
• Jaundice due to chlorpropamide.
• Flatulence.
• Headache.
• Weight gain (due to sulfonylureas )

17. Contraindications/precautions
• Type – I DM.
• Pregnancy.
• Diabetic coma.
• Ketoacidosis.
• Lactations.
• Severe infections and trauma.
• Renal, hepatic and thyroid impairment.
• Special precautions with ꞵ (Beta) blockers.An after prolong period of exercise.
• Acute chronic metabolic acidosis.
• Acute and chronic diseases which may causes tissue hypoxia especially cardiac or
respiratory failure.
• MI/Shock.

18. Drug interactions
•Concurrent use of antidiabetics with
beta-blocker may produce sign and
symptoms of hypoglycemia.

19. Nursing Responsibilities
•Monitor regularly blood glucose level.
•Assess adverse reactions during the therapy.
•Maintain I/O charts.
•Respiratory rate and the character of respiration should
be checked and recorded. Avoid alcohol intake during
drug therapy.
•Drugs should be administer just after food is taken.

20. Thyroid supplements
•Thyroid glands synthesizes two
hormones (Thyroxine & tri-
iodothyronine) these hormones are
released due to the action of thyroid
stimulating hormone (TSH) About
80 micrograms of thyroid hormones
are secreted per day.

21. Mechanism of action
•These drugs control the metabolic rate of tissues
and accelerate heat production and oxygen
consumption.
•Synthetic thyroid hormones have the same
physiologic effects as natural hormones, they
result in T3 activity and are used to replace
hormonal deficit or suppress hormone
production.

22. Drug examples and doses
S. No. Drug Doses
1 Levothyroxine sodium
(Synthroid)
25 – 125 mcg/day.
2 Liothyronine sodium 0.005 – 0.1 mg dose.
3 Thyroxine sodium 0.0005 – 0.5 mg daily
4 Thyroid USP 30 – 240 mg daily.

23. Indication / uses
•In primary and secondary hypothyroidism
(including cretinism, myxedema) as thyroid
hormone replacement.
•Hypothyroidism caused by functional deficiency.
•Partial and total absence of thyroid glands.
•May be used with antithyroid drugs to treat
thyrotoxicosis to prevent goitrogenesis and
hypothyroidism.

24. Contraindications/ precautions.
•Acute MI or thyrotoxicosis.
•Cautiously used in patient with heart
disease, hypertension, diabetes mellites,
myxedema or adrenal insufficiency.

25. Adverse effect
•Hyperthyroidism.
•Arrythmias.
Nervousness.
•Heat tolerance.
•Weight loss.
•Decreased bone
density.
•Tachycardia.
•Palpitations.
•Sweating.
•Insomnia.
•Headache.
•Partial hair loss.

26. Drug interactions
•They may increase the effects of
anticoagulants.
•May impair the effects of ꞵ (Beta)
blocker.
•May increase theophylline level.

27. Nursing Responsibilities
• Nurse should mind that administer thyroid hormone in
morning to prevent insomnia.
• Instruct to the patient to take the drug 1hour before the meals
and 2hour after the meals to improve drug absorption.
• Instruct to the patient to notify prescriber if headache,
nervousness, diarrhea, or other unusual events occur.
• Teach the patient about the importance of complying with
therapy.
• Caution the patient not to change brands of medication
because potency may differ among brands.

28. Anti-thyroid Drugs – Thyroid Suppressants
•These drugs used in hyperthyroidism
(thyrotoxicosis) when overproduction of
hormone by the thyroid gland initially
high dosages are required after few
weeks when the patient is euthyroid, the
dosages may be gradually reduced.
Treatment should be continued for 18
months to reduce the chance of relapse.

29. Mechanism of action
•They inhibit T3 & T4 synthesis (Iodine).
•Also inhibit the synthesis of thyroid
hormones (Propylthiouracil PTU and
Methimazole).
•It limits thyroid hormone secretion by
destroying thyroid tissue (Sodium iodide.

30. Drug examples and doses
S. No Drugs Examples
1 Iodine Lugol’s iodine
2 Methimazole 15-30 mg daily
3 PTU (propylthiouracil) 50-300 mg daily
4 Sodium Iodide 0.70 to 100 Mci (Microcurie) in
capsule form
5 Thyroxine 25-200 mcg daily.

31. Indications/uses
•Hyperthyroidism.
•Thyroid carcinoma.
•Use for thyroid blocking.

32. Contraindications/precautions
•Pregnancy and breast feeding.
•Hypersensitivity to iodides.

33. Adverse effects
•Iodine may cause hypothyroidism, diarrhea,
hypersensitivity.
•Iodism (Characterized by abdominal pain, vomiting, rash,
sore throat, salivary glands.
•Methimazole and PTU may cause nausea, vomiting,
agranulocytosis and rash.
•Bone marrow depression, acute leukemia, anemia,
radiation sickness, chest pain, itching, neck tenderness or
swelling, cough, thinning of hair, may be occur due to
intake of sodium iodide.

34. Drug interactions
•Hypothyroidism may occur due to
use of lithium with iodine.
•Methimazole & PTU may increase
the effects of anticoagulants.

35. Nursing responsibilities
•Nurse should give advise to the patient to take drug at
consistent time 1 hour before or 2 hours after meals
because food may affect drug absorption.
•Asses for signs and symptoms of overdose
(hypothyroidism) and under dose (Thyrotoxicosis).
•Teach the patient to avoid such foods containing iodine and
other products containing iodine.
•Advise to avoid aspirin and drugs containing iodine.
•Monitor the patients serum thyroid levels and thyroid
function test results.

36. Anabolic Steroids
•These are synthetic androgens with
strong anabolic and weak
androgenic activity. They capable of
building up proteins in bones and
other tissues.

37. Mechanism of action
•They reverse catabolic or tissue
depleting process and promote body
tissue building process.Also they inhibit
release of testosterone through inhibition
of pituitary luteinizing hormone.

38. Drug examples & doses
S. No Drugs Doses
1 Nandrolone decanoate
(Deca-durabolin)
50-200 mg injection
2 Oxandrolone 2.5 to 10 mg orally 2-4 times
daily.
3 Oxymetholone 1-5 mg /per kg /day orally.

39. Indications/uses
•In chronic illness.
•To accelerate rebuilding to tissues.
•To promote growth in hypogonadal children and pituitary
dwarfs.
•Carcinoma of breast in females.
•Oxymetholone is used to treat anemia.
•Oxandrolone is used to promote weight gain after weight
loss from catabolic disorders such as surgery, trauma,
arthritis, chronic infections, and osteoporosis.

40. Contraindications/ precautions
•Prostate cancer and breast cancer in male.
•Hypersensitivity.
•Hypocalcemia.
•Precautiously given to elder patients because they
may be increase risk of development of prostate
hypertrophy and prostate carcinoma.

41. Adverse effect
•Virilization, acne, are the
most common adverse
effects in females.
•Oligospermia, due to
inhibition of testicular
function.
•Chronic priapism.
•Change in libido.
•Hoarseness or deepening
of voice.
•Edema and fluid retention.
•Nausea / vomiting.
•Gynecomastia.
•Impotence.
•Menses irregularities.
•Blood lipid changes.
•Diarrhea.

42. Drug interactions
•They may increase the effects of
anticoagulants.

43. Nursing responsibilities
•Should warn athletes’that the use of anabolic steroids
to improve physical appearance or athletic
performance is contraindicated and that adverse
effects may be serious and irreversible.
•Should warn to men and women about these drugs
adverse effects.
•Monitor glucose levels in patients with diabetes
carefully because glucose tolerance may be altered in
these patients.

44. Uterine stimulants (Uterotonics/Oxytocic's)
•Uterine stimulants or uterotonic’s are the drugs
which increase the frequency and intensity of the
contractions of uterus.
•These drugs are used to induce (start) or augment
(speed) labor, facilitate uterine contractions
following a miscarriage to induce abortion or
reduce hemorrhage.

45. Mechanism of action
•They increase uterine
motility by directly
stimulating uterine and
smooth muscle contraction.

46. Drug example and doses.
S. No. Drugs Doses
1 Oxytocin 2-5 unit for induction, 10-20
units for controlling PPH.
2 Prostaglandin (Dinoprostone) 0.5 mg gel/3gm (2.5ml)
3 Ergot alkaloids
o Ergonovine maleate.
o Methylgonovine maleate
(Methergine)
1. to 0.4 mg IV.
2. mg IM/IV/orally.

47. Indications / uses
•To treat PPH (postpartum hemorrhage).
•Induction of labor.
•Increase milk letdown reflex.
•For abortion.

48. Contraindication / precautions
•Maternal hypertension.
•Obstetrical emergency.
•Unfavorable fetal positions.
•Fetal distress.

49. Adverse effects
•Nausea / vomiting.
•Hypertension.
•Hypoxia.
•Brady cardia.
•Intracranial hemorrhage.

50. Drug interactions.
•Concurrent use with dopamine and
other constrictors may increases
peripheral vasoconstriction and may
also called severe hypertension.

51. Nursing responsibilities
•Nurse should assess patients blood pressure, pulse rate
urine output.
•Uterine contractions, vaginal bleeding.
•Monitor fetal heart rate.
•Know that oxytocin is given IV only when inducing labour.
•Know that hypocalcemia may decrease the patient’s
response to ergot alkaloids so administer IV calcium if
necessary.

52. Uterine Relaxants (Tocolytics)
•These drugs are useful to
relax uterine muscle and
decrease uterine contractions.

53. Mechanism of action
•They exert ꞵ (beta)
adrenergic agonist effects on
uterine smooth muscle
thereby inhibiting uterine
contractions.

54. Drug examples and doses
S. No. Drugs Doses
1 Salbutamol 2.5- 7.5 mg orally every 6hr. 10-20μgm /min IV
infusion.
2 Magnesium sulfate 1gm IM 6hrly (4doses)
3 Nifedipine 10-40 mg
4 Prostaglandin
inhibitors
(Indomethacin)
0.1 to 0.2 mg/kg IV dose.
5 Ritodrine 40 mg every 8hr.
6 Terbutaline 2.5-7.5 mg orally every 6h. 10-20 μgm/min (Max
80 μgm)

55. Indications/uses
•To prevent premature labour from
29-36weeks of gestation.
•At the risk of miscarriage.
•To delay or postpone labour.

56. Contraindications
•Ruptured membranes.
•Hypertension.
•Fetal distress. Pre-eclampsia.
•Abruption placenta.
•Pregnancy of less than 20 weeks.

57. Adverse effects
Maternal effects are:
•Hypotension.
•Widening pulse
pressure.
•Tachycardia.
•Electrolyte
imbalances.
Fetal effects are:
•Increase heart rate.
•Hypocalcemia.
•Hypotension.

58. Drug interactions
•Use of terbutaline with (ꞵ beta)
adrenergic blockers affect uterine
inhibiting action of terbutaline.
•Pulmonary edema may occur with
combination use of corticosteroids and
terbutaline.

59. Nursing responsibilities
•Nurse should place the patient in a left
lateral recumbent position to promote
venous return to the heart and decrease
hypotension.
•Nurse should monitor the patient and
fetus closely for adverse effects.

60. Oral contraceptives
•Oral contraceptive are prescription
medications that prevent pregnancy
contain hormones (estrogen and
progesterone alone)

61. Mechanism action
•Hormonal birth control medications prevent pregnancy
through the following ways.
1. By blocking ovulations (Blockage the release of eggs
from ovaries)
2. By changing the endometrium (lining of uterus) so that if
connect support a fertilized egg.
3. By altering the fallopian tubes so that they cannot
effectively more eggs towards the uterus.
4. By altering mucus in the cervix which makes it hard for
sperm to travel further.

62. Drug examples
•Estrogens:
1. Ethynyl
Estradiol.
2. Mestranol.
•Progesterone:
1. Norethynodrel.
2. Norethindrone acetate.
3. Norgestrel.
4. Norethindrone.
5. Desogestrel.
6. Levonorgestrel (1500mcg one
tb taken as soon as possible
after unprotected intercourse
up to 72 hours)

63. Adverse effects
•Dizziness.
•Light headed-ness.
•Bloating.
•Severe
Depression.
•Headache.
•Stomach upset
•Nausea.
•Thrombophlebitis

64. Contraindications/precautions
•Preexisting cardiovascular
disease, cautiously use in obesity
and hypercholesteremia and in
smokers.

65. Drug interactions.
•Rifampicin.
•Barbiturates.
•Phenytoin.
•Carbamazepine.
These may decrease the effects of pills.

66. Nursing Responsibilities
•Nurse should obtain a complete health history
including cigarette smoking and history to determine
possible drug interactions and allergies.
•Assess cardiovascular status, including hypotension,
history of MI, Cerebrovascular accident, or
thromboembolic disease.
•Monitor for development of breast or other estrogen
dependent tumors, estrogen may cause tumor growth
or proliferation.
•Tablets should be taken approximately at the same
time each day.

67. •Spotting, bleeding may occur 1-2 first days of the cycle, if
continue notify the physician.
•For the 21 day regimen, tablet is taken daily beginning on
day 5 of the cycle (No tablet are taken for 7 days).
•For the 28 day regimen tablet are taken for the first 21 days
following by 7 days of iron containing tablet.
•If a woman fails to take one or more tablets the following
recommendations should be followed:
1. If 1 tablet is missed, it should be taken as soon as it is
remembered alternatively 2 tablets can be taken the
following day.

68. 2.If 2tablet are missed, 2 tablet can be taken each day for 2 days
alternatively 2tablet can be taken on the day the missed tablets
are remembered with the second missed tablet being discarded.
3.If 3 tablets are missed, a new medication cycle should be
initiated 7days after the last tablet was taken & additional
contraceptive method should be used until the start of the next
menstrual period.
4.Advise the client if she develops pain in the legs or chest,
dizziness to discontinue the therapy and notify the physician.
Advise the patient prior to initiate therapy that there is high risk
for cancer of breast.
- Instruct the client to avoid smoking.

69. Other estrogens – Progesterone Preparations
•Estrogens: Estrogen is responsible for
growth and development of vagina,
uterus, fallopian tube and also secondary
sexual characteristics, distribution of
body fat and accumulation around hip
and breasts growth of axillary and pubic
hair.

70. Mechanism of action
•They stimulate the endogenous
hormone to restore hormonal
balance and treat hormone
sensitive tumor.

71. Drug examples and doses:
S. No. Drugs Doses
Natural estrogens
1 Estradiol 1-5mg IM/0.45 – 2mg orally.
2 Estriol 0.1% vaginal cream, gel
3 Estrone Vaginal cream.
Synthetic Estrogens
4 Mestranol 0.05 to 1mg od.
5 Hexoestrol 1mg once a week
6 Stilbestrol 0.025 mg transdermal.

72. Indication /uses
• To provide contraception.
•To control menopausal symptoms.
• To treat hormonal deficiency.
• In atrophic vaginitis.
•Breast cancer and Breast engorgement.
• During menopause.
• Menstrual conditions (Amenorrhea, Dysmenorrhea,
Menorrhagia).
• To restore positive calcium balance in post menopausal
osteoporosis.

73. Contraindications/ precautions
•Embolism.
•Breast Cancer.
•Pregnancy.
•Maternal hypertension.
•Thrombophlebitis.
•History of CVA.
•Obstetric Emergencies.
•Unexplained abnormal genital bleeding.

74. Adverse Effects.
•Nausea/Vomiting.
•Diarrhea.
•Weight gain.
•Edema and breast engorgement due to sodium and
water retention.
•Development of endometrial carcinoma.
•Thromboembolic disorder.
•General malaise and dizziness.

75. Drug interactions
•Antibiotics such as penicillin's,
sulfonamides, tetracyclines alter normal G.I.
flora, decreasing the effect of estrogen.
•Estrogen decreases the effects of barbiturates
anti-convulsions, antidiabetics and oral
anticoagulants.

76. Nursing responsibilities
•Nurse should assess the patient for edema, blood
pressure, weight and cholesterol and triglycerides
levels.
•Nurse should warn the patient not to smoke while
taking these drugs because smoking increases the risk
of thromboembolism.
•Teach the patient about the importance of complying
with therapy.

77. Other estrogens – Progesterone Preparations
•Progestins: Progesterone is the
natural progestins. It is secreted
by ovary and also synthesized by
placenta, adrenals and testes.

78. Physiological functions of progesterone.
•Preparation of endometrium for
implementation of fertilized ovum.
•Metabolic changes like increase in body
temperature.
•Maturation and secretary changes of
endometrium.
•Production of secretory endometrium and
maintenance of pregnancy.

79. Mechanism of action.
•They stimulates the
endogenous hormones to
restore hormonal balance and
treat hormone sensitive
tumor.

80. Drug examples and doses
S. No Drugs Examples
1 Progesterone 5-10mg IM for 8
consecutive days.
2 Hydroxy progesterone caproate -
3 Medroxy progesterone acetatic -
4 Ethisterone 20-75 mg as per
requirement.
5 Nor ethisterone 2.5-10mg orally OD.
6 Norgestrel 30 mcg – 0.3mg.

81. Indications / uses.
•To treat habitual and threatened abortion.
•To relieve premenstrual tension.
•To treat dysfunctional uterine bleeding.
•To induce menstruation in amenorrhea.
•As an oral contraceptives.
•To regulate and restore menstrual cycle.
•Endometriosis.

82. Contraindication/precautions
•Embolism.
•Breast cancer.
•Pregnancy.
•Maternal hypertension.
•Thrombophlebitis.
•History of CVA.
•Obstetric emergencies.
•Unexplained abnormal genital bleeding.

83. Adverse effects
•Nausea / vomiting.
•Weight gain.
•Diarrhea.
•Edema and breast engorgement due to sodium and
water retention.
•Development of endometrial carcinoma.
•Thromboembolic disorder.
•General malaise and dizziness.

84. Androgen
•They blocks the action of
male hormones, thus act as a
antiandrogens. They used in
the treatment of female
hirsutism and hypersexuality
in the male.

85. Mechanism of action
•These are compounds which antagonize
or inhibit the actions of androgen also
they inhibit steroid 5 – alpha reduce
which is an enzyme that converts
testosterone into 5 – alpha –
dihydrotestosterone (DHT)

86. Drug examples & Doses
S. No. Drugs Doses
1 Nandrolone decanoate
(Deca – durabolin)
50 – 200mg injection
2 Oxandrolone 2.5 – 10mg orally 2to4 times
daily.
3 Oxymetholone 1 – 5 mg/kg/day orally.

87. Indication / uses
•To treat BPH.
•Male hypersexuality.
•To treat androgenic alopecia.
(Male pattern baldness)

88. Contraindications/precautions
•Hypersensitivity.
•Children.
•Women.
•Pregnancy.

89. Adverse effects
•Erectile dysfunction.
•Breast tenderness and enlargement.
•Hypersensitivity reaction.
•Decreased libido.
•Testicular pain.

90. Nursing Responsibilities
•Nurse should warn that women who are may
become pregnant should not come in contact with
crushed or broken tablets because of the risk to
the male fetus.
•Warn men that they may have a decrease volume
of ejaculate during therapy and impotence or
decrease libido in female may occur.

91. Abortifacients – Drug used for Abortion
•Adrug used to cause
abortion is called
abortifacients.

92. Mechanism of Action
•They compete with progesterone at
the sites of progesterone receptors
leads to inactivity of progesterone
and termination of pregnancy (
Progesterone useful to maintain the
pregnancy.)

93. Drug examples and doses
S. No Drugs Examples
1 Oxytocin 2-5 units for induction, 10-20
unit for controlling PPH.
2 Prostaglandin
(Dinoprostone)
0.5 mg gel/3gm (2,5ml)
3 Ergot alkaloids
- Ergonovine maleate.
- Methylgonovine maleate
( Methergine)
1. to 0.4mg IV.
2. mg IM/IV/orally.

94. Indications/uses
•To treat PPH.
•Induction of labour.
•Increase letdown reflex.
•For abortion.

95. Contraindications/precautions
•Maternal hypertension.
•Unfavorable fetal positions.
•Obstetrical emergencies.
•Fetal distress.

96. Adverse effects
•Nausea/vomiting.
•Hypertension.
•Hypoxia.
•Bradycardia.
•Intracranial hemorrhage.

97. Drug interactions
•Concurrent use with dopamine
and other vasoconstrictors may
increases peripheral
vasoconstriction and also may
cause severe hypertension.

98. Nursing responsibilities
•Nurse should assess patients blood
pressure, pulse rate, urine output, uterine
contractions, vaginal bleeding.
•Monitor fetal heart rate.
•Know that oxytocin is given IV only
when inducing labor.

99. Gonadotropins – releasing Hormone (GNRH)
•GNRH is released from nerve cells
in the brain. It controls the
production of luteinizing hormone
and the follicle stimulating hormone
from the pituitary gland.

100. Mechanism of action
•They are gonadotropin-releasing
hormone (GnRH) agonists that at
first stimulate the release of
pituitary gonadotropins, FSH &
LH resulting an increase in
steroidgenesis.

101. Drug Examples
•Gonadorelin.
•Goserelin.
•Histrelin acetate.
•Nafarelin acetate.

102. Indication/uses
•Endometriosis.
•Primary hypothalamic
amenorrhea.
•Prostate cancer.

103. Contraindication/precautions.
•Drug hypersensitivity.
•Undiagnosed abnormal
vaginal bleeding.
•Precautiously in pregnancy
and breast feeding.

104. Adverse effects
•Headache.
•Nausea.
•Constipation.
•Vaginitis.
•Hot flushes.
•Vomiting.
•Emotional instability.
•Loss of libido.

105. Nursing Responsibilities
• Nurse should closely monitor cardiac status during Goserelin
therapy.
• Nurse should monitor hydration status to prevent fluid loss from
vomiting.
• Nurse should monitor blood and urine glucose levels because these
drugs increase serum glucose levels.
• Monitor client’s knowledge level of proper administration (Incorrect
use may lead to pregnancy).
• Nurse should encourage compliance with follow up treatment
because follow up is necessary to avoid serious adverse effects. Eg.
PAP’s smear, self breast exams, mammograms.

106. Prostaglandin
•Prostaglandin released by mast
cell in the body as a result of a
number of stimuli like ( tissue
damage, inflammation).

107. Mechanism of action
•They act as mediator of inflammation
especially the prostaglandin of E series
(PGE2).
•It is responsible for inflammatory
reactions.
•They also cause contraction of uterine
muscles.

108. Drug examples & Doses
S. No. Drugs Doses
1 Dinoprost 5 mg/ml injection from in 10ml, 30ml.
2 Dinoprostone 20 mg vaginal suppository

109. Indication / uses
•Induction of labour.
•Termination of pregnancy (abortion)
•To prevent closure of patent ductus
arteriosus in new born.
•As a vasodilator in Raynaud’s disease.
•To treat erectile disfunction.

110. Contraindications/precautions
•Hypersensitivity to prostaglandins.
•Patient in whom oxytocic's are
generally contraindicated.
•History of pelvic inflammatory disease.
•Renal and hepatic disease.
•Special precautions in pregnancies.

111. Adverse effects
•Temporary redness of face.
•Slow heart beat.
•Abnormally low blood pressure.
•Decreased blood platelets.
•Kidney problems causing a decrease amount
of urine to be passed.
•Bloody urine.

112. Calcitonin's
•Calcitonin (Thyrocalcitonin) is a
hormone produced by C cell in the
thyroid gland. The main action of
calcitonin is on the bone it is naturally
occurring hormone. It helps to regulate
calcium levels in the body and is
involved in the process of bone building.

113. Mechanism of action
•It increases deposition of calcium and phosphate in the
bone and lowers levels in the blood so it inhibit
effectively calcium reabsorption by binding to specific
receptor on the osteoclasts, and inhibit there action.
•In the kidneys it decreases the re-absorption of both
calcium and phosphate on the proximal tubules. Its
overall effect is to decrease the plasma calcium
concentration. Secretion is determined mainly by the
plasma calcium concentration.

114. Dose example
•Paget’s disease: SC Human 0.5mg/dl or 2-3
times/weak or 0.25mg/dl up to 0.5mg bid.
•Hypercalcemia: SC/IM salmon 4IU/kg 12h, may
increase to 8IU/kg q6h if needed.
•Postmenopausal osteoporosis: SC/IM salmon
100IU/dl Intranasal 1spray (200IU) daily
alternate nostril.

115. Indication / uses
•Used to treat Hypercalcemia and Paget's disease
of the bone.
•Used in women with osteoporosis to help reduce
bone loss.
•Calcitonin may relieve pain caused by spinal
compression fractures.

116. • Headache.
• Eye pain.
• Feverish sensation.
• Hypersensitivity reactions.
• Anaphylaxis.
• Urinary frequency.
• Chest pressure.
• Chills.
• Weakness.
• Paresthesia's.
• Tender palms & Soles.
Adverse effects• Dizziness.
• Nasal congestion.
• Shortness of breath.
• GI: Transient nausea.
• Vomiting.
• Anorexia.
• Unusual taste
sensation.
• Abdominal pain.
• Diarrhea.
• Skin: Inflammatory
reactions at infection site.
• Flushing of face & hands.
• Pruritis of ear lobes.
• Edema of feet.
• Skin rashes.
• Urogenital: Nocturia.
• Diuresis.
• Abnormal urine sediment.

117. Contraindication / precautions
•Hypersensitivity reaction to calcitonin and allergic to
any ingredient in calcitonin – Solomon spray.
•Precautiously with pregnant or breast feeding.
•Cautiously used if taking any prescription or non
prescription medicine, herbal preparation, or dietary
supplement.
•Cautiously used in renal impairment osteoporosis,
pernicious anemia, Zollinger-Ellison syndrome.

118. Drug interactions
•May decrease sr. lithium levels.

119. Nursing responsibilities
• Nurse should give following education.
1. Use the subcutaneous route for self administration.
2. Watch for redness, warmth or swelling at injection site and report to
physician, as these may indicate an anti-inflammatory reaction. The transient
flushing that commonly occurs following injection of calcitonin, particularly
during early therapy may be minimized by the administrating the drug at
bedtime. Consult physician.
3. Maintain your drug regimen even though symptom have been ameliorated to
prevent early relapses.
4. Ensure that you feel comfortable using the nasal pump properly. Notify
physician if significant nasal irritation occurs.
5. Consult physician before using OTC preparation. Some super vitamins,
hematinics & antacids contain calcium and vitamin D. (vitamin may
antagonize calcitonin effects.

120. Calcium salts
•It is essential for maintenance of normal function
og nerve, muscles, skeletal system and
permeability of cell membranes and capillaries.
•Necessary for activation of many enzymes,
contraction of cardiac, skeletal and smooth
muscles, nerve impulses, respiration and blood
coagulation.
•Normal calcium serum concentration is 9-10.2
mg/dl.

121. Dose example & doses
S. NO. Drugs Doses
1 Calcium Carbonate 1.25 – 1.5gm 1-3 times daily
2 Calcium gluconate 500 – 2000mg orally 2to4 times a day.

122. Indication / uses
• Acute hypocalcemic tetany
secondary to renal failure.
• Hypoparathyroidism.
• Premature infants.
• To treat depletion of
electrolytes.
• During cardiac resuscitation.
• To reduce spasm (renal &
intestinal)
• To relief sensitivity reactions of
insect bite.
• Chronic Hypoparathyroidism.
• Osteoporosis.
• Osteomalacia.
• Ricket’s.
• Myasthenia gravis.
• Supplement for pregnant
women.

123. Contraindication / precautions
•Digitized patients.
•Some renal & Cardiac
patients.
•Cancer with bone metastasis.

124. Adverse effects
•Hypercalcemia characterized by lassitude.
•Skeletal muscle weakness.
•Renal calculi.
•Constipation and gastrointestinal irritation may
occur.
•By IV route side effects are venous irritation,
tingling sensation, feeling of heat chalky taste.

125. Nursing responsibilities
• Nurse should know that oral administration of drug given 1-1.5hr after meals
because alkalis and large amount of fat decrease the absorption of calcium.
• Nurse should know if the client has difficulty in swallowing large tablets,
obtain a calcium in water suspension by diluting the calcium in hot water then
cooled by administration.
• Observe vital signs closely for evidence of bradycardia & hypotension during
IV route.
• Prevent any leakage of medication into the tissue since it is extremely
irritating.
• Rotate the injection sites if drug given by IM route.
• Obtain baseline renal function.
• In case of hypocalcemic tetany, provide safety precautions to prevent injury.

126. MTP – Medical termination of pregnancy.
•Abortion is the deliberate termination of pregnancy,
most often performed during the first 28 weeks.
•Abortion is by definition a failure.
•Failure can be the result of mother’s lack of access to
care, failure of the contraceptive method, failure to
use contraceptive method, failure to use
contraceptives or failure of the normal reproductive
process leading to fetal anomalies, fetal death, or
maternal illness.

127. Definition – Medical termination of pregnancy act.
•The MTP act enacted by the
government of India came into force
in 1972. under this, act termination
of pregnancy is permitted within the
framework of the law which
requires certain condition.

128. Pre-requisite of the MTP
•MTP can be performed only by a registered
medical practitioner qualifies to perform the
operation.
•It can be undertaken only in the hospital or clinic
duly recognized under the law.
•The MTP procedure can be performed only for
specified indications up to 20 weeks of
pregnancy. These include medical, eugenic,
humanitarian and social ground.

129. Pre-requisite of the MTP (continued)
•In termination of pregnancy up to 12 week, the
opinion of one registered medical practitioner is
required. However to terminate a pregnancy between
12 to 20 weeks, it is mandatory to obtain the
opinions of two registered medical practitioners.
•Written concerned of the patient aged 18yrs or above
is valid. However in case of minors or persons of
unsound mind, written consent of the guadian is
required.

130. Methods of MTP in 2nd Trimester
• Medical Methods:
1. Extra amniotic installation.
Ethacridine lactate
(Emcredil)
Hypertonic saline 20%
Prostaglandins.
1. Intra amniotic installation.
Ethacridine lactate
(Emcredil)
Hypertonic saline 20%
Urea, Mannitol.
•Surgical Methods:
1. D&E (Dilation &
Curettage)
2. Aspirotomy.
3. Hysterotomy.

131. References
1. Dr. P
.K. Panwar, Essentials of pharmacology for nurses,AITBS pub. 2017,
India, Pg no. 135 – 158.
2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for
nurses, Jaypee pub. 2016 India Pg no 460 – 556.
3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. 492, 361, 301 – 353.
4. Shirish N. Daftary, Sudip Chakravarti Holland & Brews Manual of
obstetrics, elsevier pub. 2005 India Pg no. 461.
5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009
India 24 – 30.
6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India
1st edition, Pg no 171 – 196.