Pharm session 14:

Last Pharm session!!!

 

Session 14

 

Estrogens

  • Estrogen
    • increase synthesis of DNA, and proteins.
    • can cause Na retention and lower cholesterol
    • For estrogen deficiency, osteoporosis prevention and health
    • SE: WEIGHT GAIN, changes in menses pattern
    • gain about 5lbs of weight from the medication.
    • cautions: endometrial cancer with use over 2 years, do not give to breast feeding women, effects liver, clotting(MI, Stroke), bladder stones,
    • contraindications: breast cancer, abnormal vaginal bleeding, Thrombophlebitis, PE, hyperCa, endometriosis
    • smoking can increase cardiac issues and chance of stroke.

 

  • Progestin (megace)
    • changes the thickness of the endometrial lining for the embryo to attach to
    • suppression of ovulation during pregnancy
    • increase appetite which is helpful in anorexia and HIV
    • For hormone imbalance, to start bleeding or stop vaginal bleeding
      • about the same dose for starting and stopping bleeding

 

Contraceptives

  • older meds had higher amounts of the hormones, which caused higher levels of side effects
  • lower dose now and based on a thin teenager, so less effective in a heavier people
  • tested originally in male beagle dogs
  • Action: inhibit FSH and LH secretion, impairs implantation, increases cervical mucus to hinder sperm.
  • SE: gallstones, acne, increased clotting, changes in menses, weight gain
  • can help with anemia but lessening vaginal bleeding.
  • protection against pregnancy if the person remembers to take it
  • Phasic – the number of times that the progestin increases from one to three (mono, bi, tri)
  • Seasonale meds are 3 months on then three months off developed for Sally Wright so that she could go to space.

 

  • YAZ is similar to aldosterone(diuretic) , higher risks of clotting, there is a link to glaucoma after taking for two years. Get your ocular changes checked.

 

non pill contraceptives

  • NuvaRing
    • insert for 3 wk
    • take out after menses
    • higher risk of clot than PO

 

  • Patches
    • change wkly, three in a box
    • do not put on the breast
    • Higher risk of clot than PO
  • long acting progestin only
    • Implanon – inserted in the arm (3-5 years)
    • Depo – Provera (IM injection every 3 months) can cause BONE LOSS
    • IUD (5 years)
    • side effects: vaginal bleeding MM pain, wt gain

 

Other

  • Low-dose progestogens
    • no estrogen and less effective,
    • for during breast feeding

 

Patient education

  • miss one tab – take one now
  • miss two – take two each of the next two days
  • miss three – stop and use a different contraceptive until period.
  • Indomethacin will close the ductus arteriosus so do not take it during pregnancy

 

Postmenopausal help

 

  • Estrogen
  • SSRI
  • Herbals do not have evidence
  • SERMs help bones but increases hot flashes.
    • Ospemifene (osphena)
  • Addyi
    • antidepressant
    • not an immediate impact take for 3 months
    • viagra for women
    • low % of benefit

 

  • can take hormone replacement for 5 years if the woman starts during menopause.

 

Testosterone

 

  • schedule II drug
  • useful for osteoporosis to increases the building blocks for bone growth
  • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
  • administration
    • PO, IM, patches, skin gel
  • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
  • monitor

 

  • what group of HTN meds can reduce BPH
    • alpha blockers

 

many drugs lower the labido of a man

many herbals for this but none are proven.

 

  • Alprostadil (prostaglandin)
    • injection into the corpus cavernosus

 

ED drugs

  • sildenafil (Viagra)
    • action: increase cGMP levels, relaxes smooth muscle, increases blood flow to the erection
    • PO one hour before activity
    • a pilot cannot take this 6-8 hr before a flight because there are changes in color vision. cannot see runway lights correctly.
    • report blue color changes!
    • drink 2L of water a day
    • can develop dependence if taken when they do not need to.
  • Levitra
    • does not need alpha blocker meds
  • Cialis
    • works for 36 hours
    • 5mg daily, or 20mg prn
      • NOT interchangeable!!
      • can cause a heart attack if taking the 20mg daily.

 

Renal disease

 

epogen – for anemia reversal

 

Alu hydroxide(antacid), Ca acetate – to bind extra phosphate

 

calcitriol (rocaltrol) – vitamin D supplement, activated vit D

 

HyperK – arrhythmia issues, causes spiked T wave,

  • Kayexalate – cation exchange resin, binds K and takes it out of the system.
  • Given in enama form and can cause a vagal response slowing down the heart.
  • Insulin can decrease K levels

 

Diuretics – loop and osmotic to deal with fluid balance

 

Na Bicarbonate – to make the pH more basic

  • watch out for the interactions with other meds in the IV line causing the line to clot up and not be patent.
  • can hold on to water, so cardiac, pulmonary, and

 

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