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Testosterone produced by testes, ovaries, and adrenal cortex. Primary androgen in both genders. : Primary estrogen and progestional are estradiol and progesterone. Both made in ovaries maturation of reproductive organs & 2 sex characteristics. Menstruation results from progesterone toward end of cycle Menopausal symptoms result from estrogen levels. Clinical uses of hormone preparations: Hormone deficiencies and oppositional treatment of hormone-dependent cancers. Postmenopausal HRT: Benefits include vasomotor symptom relief and prevention of osteoporosis. Risks include embolic events and cancers. Oral contraceptives suppress ovulation using ethinyl, estradiol, and norethindrone OC risks are minimal except in smokers and those with Hx of embolic events. Oxytocics are uterine stimulants used to induce or assist labor; Tocolytics are used to delay preterm labor.
Oxytocics
strength, frequency, and duration of uterine contractions Methergine: Emergency intervention for serious postpartum hemorrhage Oxytocin: Labor induction or enhancement // Delivery of afterbirth // Control of postpartum bleeding // Fetal stress testing // Milk letdown (intranasal) Adverse Effects: Methergine: Hypertensive crisis (IV): Headache, nausea, BP Oxytocin: Uterine rupture {Relax myometrium Mg(SO4)} Contraindications/Precautions: (?) Methergine: Hypertension Methergine: Cardiovascular, renal, or hepatic failure. Oxytocin: unripened cervix, Hx of multiples, uterine surgery // immature lungs, cephalopelvic disproportion, prolapsed umbilical cord, fetal distress. Interactions: Vasopressors hypertension Education: Use infusion pump and gradually rate contractions longer than 60 sec, freq > q 2-3 min infusion
Tocolytic Medications
Expected Action:
Delay of preterm labor Tremors, anxiety, headache (2 skeletal muscle side effects)
Concurrent use of adrenergic agonists additive effects Concurrent use of MAOIs Hypertension
Androgens
Proto: testosterone (Delatestryl) Others: fluoxymesterone (Halotestin), methyl testosterone (Oreton), danazol (Danocrine) Growth and maturation of sex organs and 2 sex characteristics. Promotes skeletal muscle growth. Therapeutic Uses: Hypogonadism in androgen-deficient men Delayed puberty Palliative treatment of androgen-responsive breast cancer Adverse Effects: Hypercalcemia ( breast cancer treatment) CV risks: LDL, HDL, edema Hepatotoxicity : Acne, facial hair, gynecomastia, impotence, priapism : Deeper voice, unusual hirsutism, clitoral enlargement, menstrual irregularities Contraindications/Precautions: (X) Pregnancy Prostate cancer Liver, heart, or renal failure Interactions: Hepatotoxic drugs: risk of liver damage Warfarin, oral hypoglycemics, and glucocorticoids androgen effects on metabolism can levels of these. Education: Report weight gain > 2 lb/week. Expected Action:
Estrogens
Expected Action:
Proto: conjugated equine estrogens (Premarin) Others: estradiol (Estrace), estradiol hemihydrate (Vagifem)
Growth and maturation of reproductive tract and 2 sex characteristics. They bone resorption and LDL. At high levels they suppress release of FSH.
Therapeutic Uses:
Dysfunctional uterine bleeding & endometriosis Prostate cancer Contraception Risk for estrogen-dependent breast cancer Feminization, impotence, libido in Breast cancer Pt. or family Hx of heart disease Phenytoin toxicity Apply patches to trunk
Prolonged estrogen endometrial / ovarian cancers (Give progestins, too) Emboli ( risk from smoking)
Contraindications/Precautions:
(X) Pregnancy
Progesterones
Expected Action:
Induce favorable conditions for fetal development and maintain pregnancy. in progesterone levels menstruation. Therapeutic Uses: Counter adverse effects of estrogen in HRT for treatment of dysfunctional uterine bleeding, amenorrhea, endometriosis, and endometrial cancer. Adverse Effects: Breast cancer Edema Thromboembolic events Breakthrough bleeding, amenorrhea, breast tenderness Contraindications/Precautions: (X) Breast cancer Hx of thromboembolic, cardiovascular, cerebrovascular disease. Undiagnosed vaginal bleeding Interactions: Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all of oral contraceptives. Education: Anticipate withdrawal bleeding for 3-7 days
Oral Contraceptives
Expected Action:
fertility by inhibiting ovulation, thickening cervical mucous, and making lining of endometrium less favorable to implantation.
Therapeutic Uses: Adverse Effects:
(X) Pregnancy
Hx of thrombophlebitis and cardiovascular events Family history or risk factors for breast cancer
Interactions:
OC of warfarin and oral hypoglycemics Carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, tetracycline, penicillin all of oral contraceptives. Take for 21 days followed by 7 days with no drug 1 missed dose: Take 2 next time / 2 missed doses: double-up x 2 days
Education:
Antineoplastic Agent
(1 of 2)
Expected Action:
Hot flashes
Bone pain
Antineoplastic Agents
(2 of 2)
Receptor Modulators (SERMs) Tamoxifen competes estrogen estrogen effects Therapeutic Uses: Breast cancer Breast cancer prevention Adverse Effects: Hot flashes Bone pain Hyperlipidemia Hypercalcemia: Patients with bone metastases risk for hypercalcemia Contraindications/Precautions: (X) Pregnancy and lactation History of DVT Interactions: Warfarin: anticoagulant effect Antineoplastic agents: antineoplastic effects (nausea, vomiting, neutropenia) Education: Give with food or fluid if gastric upset occurs Omit missed doses Monitor for weight gain and peripheral edema
Expected Action:
Erectile Dysfunction
vardenafil (Levitra)
Augments effects of nitric oxide released during stimulation blood to corpus cavernosum penile erection.
Therapeutic Uses: Adverse Effects:
MI, sudden death: Evaluate and monitor cardiovascular history and health
Contraindications/Precautions:
(?)
Cardiovascular disease
Ketoconazole, erythromycin, cimetidine, ritonavir, grapefruit: Inhibit sildenafil metabolism plasma level of sildenafil.
Education: