PHARMACOLOGY . COLLEGE OF NURSING STUDENT COUNCIL | REFERENCE No: 2022-212-PHAIMO2 cvsarea ACADEMICS COMMITTEE AY 2022.2028 | TRANSCRIBED BY: UK. Candelaria. 202! CONTRIBUTORS: x needed only during the second trimester, the time when the fetus begins to store iron. eee meee eee eee cece eee ‘SAMPLE OF IRON PRODUCTS Ferrous sulfate (Fer-In-Sol, Feosol, Fero-Gradumet. MoMron, Fer-Iron) Reproductive and Gender-Related Drugs ‘Therapeutic Drugs and Use of Herbs x Ferrous Gluconate (Fergon) Therapeutic rs a * Ferrous fumarate (Fumasorb, Femiton, Feosta, B. Folic Acid Fumerin) C. Multiple Vitamins L_ Drugs for Minor Discomfort PHARMACOKINETICS & PHARMACODYNAMICS "A Nausea ard Vornt Baia PHARMACOKINETICS Lee oer + Absortion PO Is 5%-20% in intestines cron Increased absorption with ascorbic acid /. Drugs that Decrease Uterine Muscle Contractility * Decreased absorption with eggs, milk, coffee, and (Preterm Labor) bees Labor, Delivery, and Neonatal Drugs Druge for Woe’ on's Hex 2 PHARMACODYNAMICS Vil. Drugs for Men's Health and Reproductive Peak raticulocyiosis Is 5-10/daya. Drugs for Hemoglobin values increseein'24 weeks. ee SIDE EFFECTS OF IRON SUPPLEMENT = L = = = Nausea Ea * Vorsiing * Constipation Ty Sos x nutonal supplementation e.9 ron, wtamins, and Eigasti pain minerals ie cia % treatment of nausea and vomiting, gastric acidity, Se emia ern and mild discomforts. See rc ae NURSING IMPLICATIONS TSS EE x "absomton is promoted when taken win orange x Folic Acid juice or other sources of vitamin C. x pence IE x Admbiser with food I gasi iiation occurs. Use straw when taking the Nquld for (2.9 elie) {UURONSUPPLEMENT SS eee, gpa wth ose nee. ont x Admpistor separately wih dugs. Ike. antacks, methyldopa, penaling, quinolone and ttracycines. Used as hematinic * twice the normal amount of iron is needed to meet * Do not administer with milk, cereal, tea, coffee or fetal and maternal daily requirements. eggs. x RDAof ron: 18mg (nonreanant) Rio known as Vitamin 8 or Folate ‘Supplemental: 60-120mg/ day (at risk) FG pecs outcome prearaney, CANDELARIA REFERENCE NO: 2022-212-PHRMO2| 1 of 8Prevents spontaneous abortion or birth defects (¢.9.. neural tube defects), premature birth, low birth weight, and premature separation of the placenta (abruptio placenta). RDA: 180 mog and must be acquired from food sources, ‘Supplementation: 0.4-0.8 mg a month before pregnancy and 2-3 months of pregnancy. Side Effects: Uncommon Includes: allergic bronchospasm x rash x pruritus erythema general malaise ‘May cause urine to tum intense yellow Routinely recommended. Preparations generally supply vitamins A, D, E, C, B complex (B1, B, B3, B5, B6, B12), Iron, calcium, and other minerals. ‘Most effective when taken with meals. ‘Some can be teratogenic or toxic when taken in large amounts. ‘Nausea and Vomiting Heartburn Constipation Pain ‘Also known as morning sickness (88% occurence). Severe occurrence: hyperemesis gravidarum (1-3% occurrence) Cause: Increased level of hCG, Estrogen and progesterone * No single hormonal profile accurately predicts development of nausea and vomiting in pregnancy * Elevated serum concentrations of estrogen and progesterone have been implicated x High hCG levels are not consistently associated with nausea and vomiting (UpToDate) NON-PHARMACOLOGIC MEASURES FOR NVP x Eating crackers or dry toast. Avoid high-fat / highly seasoned foods ‘SFF Drinking fluids in bet. meals rather than with meals Drinking apple juice or flat carbonated drinks bet meals Eating high protein bedtime snack Cessation of smoking x Taking iron supplement at bedtime MECLIZINE (ANTIVERT, BONAMINE) % Blocks CTZ which acts on vomiting center. x Common SE is drowsiness x Patients should avoid alcoholic beverages, tranquilizers, sedatives, and narcotics. H1-Receptor Antagonist * Weak antiemetic activity % Blocks the histamine receptors in the voriting center of the brain, which is the nucleus tractus solitarius x Particularly useful for the prevention or treatment of motion sickness %_ Taken prior to travel * ADVERSE EFFECTS: x sedation, confusion, dry mouth, urinary retention PROMETHAZINE (PHENARGAN) % Blocks post synaptic _mesolimbic dopaminergic receptors in the brain. x SE: Dizziness, drowsiness, excitation x Pharmacologic Tx for NVP METOCLOPRAMIDE (PLASIL, NAUSIL) % Blocks dopamine receptor in CTZ of the CNS. x AR- Restlessness, drowsiness, diarrhea PROMETHAZINE (PHENARGAN) REGS inecenee eines Inhibition of dopamine receptors acting on the regulation of gastrointestinal motlity % Dopamine receptor antagonist—stimulate gastric matllity and emptying — antiemetic effects * ADVERSE EFFECTS: x Extrapyramidal effects, Hypotension, QT interval prolongation Metoclopramide DOXYLAMINE SUCCINATE AND PYRIDOXINE HCL x Safe and well-tolerated by patients PHENOTHIAZINE x Administered only in severe cases (hyperemesis gravidarum) 2 HEARTBURN x Also known as pyrosis ‘A burning sensation in the epigastric and sternal regions with reflux of acidic contents. Common in 2™ & 3° trimester. Decreased motility in the gastrointestinal tract Increased progesterone (hormone of pregnancy) Causes: ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 2 of 8x Increased progesterone x Decreased gastric emptying time x Sitting or lying down after meal Limiting size of meals ‘Avoid highly seasoned or greasy foods ‘Avoiding gas forming foods Eating slowiy and chewing thoroughly Avoiding citrus juices Drinking adequate fluids but not with meals Avoid reciining immediately after meal ALUMINUM HYDROXIDE x Neutralization of gastric acicity. x SIE — Constipation x AR— Dehydration MAGNESIUM HCL AND ALUMINUM HYDROXIDE x Neutralization of gastric acidity and anti flatulence x AR —constipation/diarthea % Liquid form is the most commonly used ANTACIDS (ALUMINUM HYDROXIDE, MAGNESIUM. HYDROXIDE) React with gastric hydrochloric acid to form salt and water Neutralizes acid for up to 2 hours Should not be given within 2 hours of doses of tetracycline, fluoroquinolones, itraconazole, and iron All of these drugs are dependent on the pH of the body to be absorbed % Fluoroquinolones and Tetracycline are antibiotics and are not being given to pregnant patients because they can cause adverse reactions to the fetus like inhibition of cartilage development and bone growth ‘ADVERSE EFFECT: % Aluminum hydroxide: Constipation x Magnesium hydroxide: Osmotic diarrhea 3 CONSTIPATION, Frequent occurrence in pregnancy. Cause: hormonal changes causing decreased GI motility x Non-pharmacologic Mgt: x Increased fluid intake % Increase dietary fiber intake x Moderate physical activity x Pharmacologic tx: bulk-forming preparations % ex. Docusate Na REMINDER: (CONSTIPATION) % Use occasionally: x Mik of magnesia x Magnesium citrate x Lactulose x Sorbitol x Bisacodyl x Senna % Should be avoided: x Mineral il Due to headache, sinus congestion, eye strain, backache, joint pain and round ligament pain. * Non-pharmacologic tx: x rest and relaxation techniques x promote calming environment % use of ice packs or warm compress use of proper body mechanics x Pharmacologic tx: Acetaminophen We ea as ;ONTRACTILITY (PRETERM LABOR) Drug therapy to decrease uterine muscle contraction Goal: x inhibit uterine contraction x delay delivery x allow safe transport of patient to an appropriate facility if needed % Allow time for administration of glucocorticoids (promote fetal lung maturation) % Glucocorticoids - promotes lung maturation by creating surfactants x Includes: x betasympatho-mimetics (terbutaline) x calcium antagonist (magnesium sulfate) % non-steroidal antiinflammatory drugs or NSAIDs (indomethacin) x Terbutaline(Brethine, Bricany!) x Stimulates beta2 receptors in the uterine smooth muscle to relax x Route - SQ/PO x AR: Tremors, malaise, weakness. Dyspnea, tachycardia, increase SBP (mother) Tachycardia, Hypoglycemia (fetus) Calcium antagonist and CNS depressant. Relaxes smooth muscles of the uterus, Magnesium Sulfate (Magneon, Magwell) Route : IViIM CI: MG, renal impairment, MI AR: Flushing, feeling of increase warmth, perspiration, dizziness, headache, lethargy ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 3 of 8AR: Heavy eyelids, Inc HR, x SIE Fetus ~ hypotonia, lethargy 24 — 48 hours. (for example, indomethacin) x During that period, doctors can administer other drugs to help ensure the baby is born as healthy as possible. Nonsteroidal anti-infiammatory drugs (NSAIDs) are a type of tocolytic. NSAIDs include ibuprofen (Motrin) and indomethacin (Indocin). Indomethacin is the most frequently used NSAID for preterm labor. x Cl: systemic mastocytosis, % increased risk of bleeding due to clotting disorder. x AR: heart attack, stroke, skin changes NURSING CONSIDERATIONS x Monitor VS, FHR and uterine activity x Monitor I and O. x Assess deep tendon reflexes and clonus before initiation of treatment. x Monitor Respiration x Antidote: Calcium Gluconate (Calgonate, Kalcinate, Cal-G, Cal_Gluy- It plays a role in normal cardiac function, renal function, respiration, blood coagulation, and cell membrane and capillary permeability. x AR — Phiebitis "Nursing Alert — always check your Vee x Prevention and cessation of PTL. % Client at risk for PTL (24 ~ 34 weeks gestation) x Fetal lung maturation x Surfactant development * Dexamethasone( Decadron, Dexasone, Cordex 5, Dabrin, Decan,Dexavit, Dexicort, Doxam) x AR — Insomnia, Nervousness, increased appetite, headache, hypersensitivity reaction. CORTICOSTEROIDS/GLUCOCORTICO! (DEXAMETHASONE/BETAMETHASONE) Given Matemally before birth, exogenous surfactant for infant Treatment for Neonatal Respiratory Distress ‘Syndrome x Surfactant deficiency > 1 Surface Tension — Alveolar Collapse (‘Ground-glass” appearance of lung fields) ‘Methyldopa ( Aldomet ) MOA ~ stimulate central alpha-adrenergic receptors Route - PO Cl MAOIs x AR- peripheral edema, NV, nasal congestion, dry mouth drug fever x > Hydralazine (Apresoline) x Hydralazine apparently lowers blood pressure by exerting a peripheral vasodilating effect through a direct relaxation of vascular smooth muscle. x > Magnesium SO4 (Magneon, Magwell) METHYLDOPA (a2 AGONIST) x | sympathetic outflow, | total peripheral resistance (allows your by from a vasoconstricted state to be vasodilated) but also | heart rate x Indicated for moderate to severe hypertension x Side Effects: Edema), CNS depression, (+) Coombs test % Drug Interactions: | a2 agonist ant-hypertensive if combined with tricyclic antidepressants HYDRALAZINE x Potent vasodilator % Not the first line med for HTN x | Total Peripheral Resistance via arteriolar (pressure is highest here) dilation x Indication: Moderate to Severe Hypertension x Side Effects: SLE-ike symptoms (syster erythematosus), Edema, Reflex Tachycardia lupus LABETALOL, % Used for both chronic pre-existing hypertension and pre-eclampsia This is given to patients who already has HTN prior to pregnancy x New onset hypertension with either proteinuria or end-organ dysfunction after 20 weeks’ gestation (caused by the baby itself) % Caused by abnormal placental spiral arteries endothelial dysfunction, vasoconstriction, ischemia x ECLAMPSIA - pre-eclampsia with seizures. x Treatment: IV Magnesium ~— sulfate, antihypertensives, immediate delivery MAGNESIUM SULFATE, x Calcium antagonist and CNS depressant, Relaxes smooth muscles Route: IV/IM % Contraindication: Renal Impairment, Myocardial Infarction x Adverse Reaction: Flushing, Feeling of Increase Warmth, Perspiration, Dizziness, Headache, Lethargy, In Fetus: Hypotonia, Lethargy x NURSING CONSIDERATIONS: % Monitor vital signs, Fetal Heart Tone, and Uterine Activity % Monitor input and output ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 4 of 8% Assess deep tendon reflex and clonus before initiation of treatment % Monitor respiration x ANTIDOTE: CALCIUM GLUCONATE LABOR, DELIVERY, AND NEONATAL DRUGS x Drugs for pain control (To be discussed Analgesia/Anesthesia) x Drugs that enhance uterine muscle contractility x Examples: x ergonovine (Ergotrate) - postpartum & postabortion uterine atony x methylergonovine ( Methergine ) - promote Uterine involution % oxytocin ( Pitocin, Syntocinon ) induce labor & promote uterine contractions after labor * ‘nasal_form - stimulates milk “let down in lactating mothers x OXYTOCIN (FIRST-LINE UTEROTONIC) x Posterior pituitary hormone x Given as a dilute solution by continuous IV infusion or as IM injection (20 units or 2 ml in 1 liter at 10-20 mifmin for a few minutes until Uterus becomes well contracted, then reduce to 4-2 milmin) x OTHER UTEROTONICS x METHYLERGONOVINE © MALEATE = — Contraindication: Hypertension x CARBETOCIN ~ Synthetic oxytocin analog x CARBOPROST - Synthetic prostaglandin analog, Contraindicated in pts with Bronchial Asthma ACTIONS AND INDICATIONS x Directly affect the neuroreceptor sites to stimulate contraction of the uterus. x Indicated for prevention & treatment of uterine atony after delivery. % Diagnostic agent to test abnormal fetal heart rates ( oxytocin challenge) & to treat breast engorgement. CONTRAINDICATIONS x known allergies to oxytocics x cephalopelvic disproportion x complete uterine atony % early pregnancy, lactation & CS ADVERSE EFFECTS uterine hypertonicity and spasm » uterine rupture x postpartum hemorrhage x fetal HR NURSING RESPONSIBILITIES % Ensure fetal position & cephalopelvic proportions % Regulate oxytocin therapy between contractions if given to stimulate labor. % Monitor blood pressure periodically during & af administration % Monitor FHR if given during labor x Provide nasal oxytocin at bedside with bottle sitting upright Discontinue at any sign of uterine hypertonicity, % Provide thorough patient education ‘The surfactant mixture is an essential group of molecules to support air breathing. % Indicated for preterm infants, with immature lungs and are surfactant deficient to avoid respiratory distress syndrome after being born. Replacement of natural surfactant therapy can improve limits of viability of preterm infants. x Example: x Survanta (Beractant) x Infasurf (Calfactant) x Curosurf (Poractant alfa) x Route - ET x Dosing should be slowed or stopped if: x Becomes dusky color x Agitated x Transient bradycardia x 02 sat increased more than 95% TES devt of female repro system & sec. sex characteristics, release of pituitary FSH & LH improves blood circulation thru capillary dilatation fluid retention (bloated feeling) CHON anabolism thins the cervical mucus inhibit ovutation prevent postpartum breast discomfort proliferation of endometrial lining conserve Ca & P & for bone formation ‘Types of Estrogen: Estradiol, Estriol, Estrone + Estradiol ~ predominant estrogen that occurs during the fertile age of the female + Estriol - predominant during pregnancy + Estrone - predominant during menopausal stage INDICATIONS x Atophic vaginitis and kraurosis vulvae ( atrophy of the female genitalia) associated w/ menopause HR KX ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 5 of 8female gestation & primary ovarian failure female hypogonadism Prevention of postpartum breast engorgement the risk of coronary artery disease (CAD) reward osteoporosis in postmenopausal women EXAMPLES estrol (Ortho DienestroN) ical agent x Estradiol (Estrace, Climara ) * contraceptive pils % Conjugated estrogens (Prenarin) x postmenopausal treatment x _Esterified estrogen ( Estratab ) CONTRAINDICATIONS known allergies to estrogen idiopathic vaginal bleeding Breast CA estrogen — dependent can: thromboembolic disorders hepatic dysfunction ADVERSE EFFECTS x Systemic : Fluid retention, Dizziness, Electrolytes imbalance Wt. changes Breakthrough bleeding (spotting) Menstrual irregularities Dysmenorthea ‘Amenorrhea Changes in libido NURSING RESPONSIBILITIES x Administer as prescribed, w/ food if Gl upset is severe x Provide analgesic for relief of headache x Encourage at least annual PE, including pelvic ‘exam, Pap smear, breast exam x Provide thorough H.T. x used as contraceptive in combination with estrogen, to treat amenorrhea & functional uterine bleeding % useful in the treatment of specific cancers with specific receptor site sensitivity LEVONORGESTEREL, MEDROXYPROGESTERONE, ETONOGESTREL, NORETHINDRONE, MESGESTROL x Bind progesterone receptors, growth and ‘vascularization of endometrium, thicken cervical mucus x CLINICAL USE: % Contraception (forms include pill, intrauterine device, implant, depot injection) x Endometrial cancer % Abnormal uterine bleeding EXAMPLES x hydroxyprogesterone (Hyiutin) * for amenorthea & produce secretory endometrium % _levonogestrel ( Norplant system) % used in an implant system to prevent pregnancy x medroxyprogesterone ( Curretab / Depo-Provera) * Oral (amenorrhea and abnormal uterine bleeding) % Parenteral (cancer tx and contraceptive) ACTIONS AND INDICATIONS Transform the proliferative endometrium into a secretory endometrium x Inhibit FSH & LH and preventing maturation & ovulation x Inhibit uterine contractions CONTRAINDICATIONS x known allergies to estrogen x pregnancy & lactation % idiopathic vaginal bleeding x Breast & genital CA, x estrogen — dependent cancer x Hx of thromboembolic disorders including CVA % hepatic dysfunction x PID x sTD x endometrium and pelvic surgery ADVERSE EFFECTS thromboembolic disorders BIP wt. gain headache stimulate follicle dé ovaries x are combined w/ HCG to maintain the follicles once ovulation has occurred & ovulation in functioning EXAMPLES ganirelix ( Antagon )* injectable x inhibits premature LH surges in women undergoing controlled ovaries stimulation x chorionic gonadotropin ( Chorex, Pregnyl ) x stimulate ovulation by acting & affecting FSH & LH release chorionic gonadotropin alfa (Ovidrel) clomiphene ( Clomid ) folitopin alfa ( Gonal—F ) menotropins ( Pergonal, Humegon ) ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 6 of 8ACTIONS AND INDICATIONS x Acts directly or stimulates the hypothalamus to FSH & LH levels and stimulates ovarian follicular dev't & ‘maturation of ova. treat infertility in women ‘CONTRAINDICATIONS presence of primary ovarian failure thyroid or adrenal dysfunction ovarian cysts pregnancy & lactation thromboembolic & respiratory diseases ‘ADVERSE EFFECTS ovarian overstimulation risk of multiple births & birth defects headache fluid retention uterine bleeding ovarian enlargement gynecomastia NURSING RESPONSIBILITIES ‘Assess health status ‘Complete pelvic examination Check uterine estrogen & estradiol levels Discontinue at any sign of ovarian stimulation Provide women w/ a calendar Tx days Provide thorough patient education RS Sera Seeitaas ‘are male steroid hormones which act as testosterone responsible for the growth & devi of male sex organs & maintenance of secondary sex characteristics EXAMPLES x Testosterone ( Duratest , Testosderm) x primary classic natural androgen that is used today % used for replacement therapy in cases of hypogonadism Fluoxymesterone ( Halotestin ) x For androgen deficiency and treatment of breast CA * Methyltestosterone ANDROGENIC EFFECTS x acne, edema, hirsutism x deepening of the v x oily skin & hair, wt. gain ,breast size, testicular atrophy. ANTIESTROGEN EFFECTS x flushing, sweating x vaginitis, nervousness. x emotional tat NURSING RESPONSIBILITIES x Reconstitute according to manufacturer's direction % Monitor response carefully % Monitor liver function % Provide thorough patient education ANABOLIC STEROIDS x" analog of testosterone % produce tissue-building effects of testosterone with androgenic effect % known to be illegally used for the enhancement of athletic performance. EXAMPLES * oxandrolone ( Oxandrin ) x promote wt gain in debilitated patients * CHON anabolism in pts receiving prolonged corticosteroids therapy x treat certain cancers x stanozolol ( Winstro! ) x for the treatment of hereditary angioedema * oxymetholone ( Anadrol-50 ) x treatment for various anemia CONTRAINDICATION AND ACTIONS x known allergies to the drugs % pregnancy & lactation % use cautiously in pt w/ liver & coronary disorders x prostate & breast CA in males, ADVERSE EFFECTS x virllzation - the development of male physical characteristics (such as muscle bulk, body hair, and deep voice) in a female or precociously in @ boy, typically as a result of excess androgen production, x "excessive growth of body hair (hirsutism)is a ‘common symptom of virlization* inhibition of testicular function Gynecomastia - enlargement of a man's breasts, usually due to hormone imbalance or hormone therapy. testicular atrophy Priapism - is @ prolonged erection of the penis continues hours beyond or isn't caused by sexual stimulation (corpus cavernosum) baldness & changes in libido risk of prostate problems ‘CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 7 of 8NURSING RESPONSIBILITIES % Administer w/ fluids if Gl effects are severe x Monitor endocrine & hepatic function x Arrange for radiographs of the long bones of children every 3 to 6 months ICSE esses eae directly injected on the corpus cavernosum acts locally to relax vascular smooth muscle & promote blood flow into the corpus cavernosum, causing penile erection. exclusively for male use only. selectively inhibits receptors & nitrous oxide levels, allowing blood flow into the corpus cavernosum taken 1 hr. before erection is desired well absorbed, metabolized in the liver & excreted in the urine CONTRAINDICATIONS AND ACTIONS x presence of any anatomical obstruction % cannot be used in penile implants x use cautiously in patient with bleeding disorders, CAD, actual peptic ulcers & Retinitis pigmentosa (RP) is a group of rare, genetic disorders that involve a breakdown and loss of cells in the retina ADVERSE EFFECTS well absorbed, metabolized in the liver & excreted in the urine pain at injection site priapism fibrosis & rash headache dyspepsia ut cannot be taken in combination w/ any organic nitrates = serious cardiovascular & death NURSING RESPONSIBILITIES x Assess the cause of dysfunction before beginning the therapy ‘Monitor patient with vascular disease Instruct patient in the injection of Aprotadil: storage, ete Provide thorough patient education CANDELARIA REFERENCE NO: 2022-212-PHRMO2 | 8 of 8