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ethinyl estradiol with norethindrone
(Ortho-Novum 1/35)
Mechanism of action: to inhibit release of FSH and LH, thus preventing ovulation
Primary use: as contraceptive, for improvement in menstrual cycle regularity, to decrease incidence of dysmenorrhea
- Adverse effects: edema, nausea, abdominal cramps, dysmenorrhea,breast tenderness, fatigue, Skin rash, acne, headache, weight gain, midcycle breakthrough bleeding, vaginal candidiasis, photosensitivity,
- changes in urinary patterns
Serious cardiovascular side effects more common in smokers
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conjugated
estrogens (Premarin) and conjugated estrogens with medroxyprogesterone
(Prempro)
Mechanism of action: replacement for female sex hormones, to exert positive metabolic effects
Primary use: for postmenopausal replacement therapy
Also to treat abnormal uterine bleeding due to hormonal imbalance
Adverse effects: nausea, fluid retention, edema, breast tenderness, abdominal cramps and bloating, acute pancreatitis, appetite changes, acne, mental depression, decreased libido, headache, fatigue, nervousness, weight gain
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medroxyprogesterone
(Provera)
Mechanism of action: Inhibits effect of estrogen on uterus, restores normal hormonal balance
Primary use: to treat dysfunctional uterine bleeding, secondary amenorrhea, contraception
May also be given IM for palliation of metastatic uterine or renal carcinoma
Adverse effects: breakthrough bleeding, breast tenderness, weight gain, depression, hypertension, nausea, vomiting, dysmenorrhea, and vaginal candidiasis
Most serious side effect: increased risk for thromboembolic disease
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oxytocin (Pitocin, Syntocinon)
- Mechanism of action: to induce labor by increasing frequency and force of uterine
- contractions
Primary use: as drug of choice for inducing labor
- Adverse effects: Complications in fetus include dysrhythmias or intracranial
- hemorrhage
Serious complications in mother may include uterine rupture, seizures, coma
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testosterone base (Andro)
Mechanism of action: Stimulates RNA synthesis and protein metabolism
Primary use: for treatment of hypogonadism in males
Adverse effects: virilization, salt and water often retained, causes edema, liver damage, acne and skin irritation
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sildenafil (Viagra)
- Mechanism of action: Relaxes smooth muscle in corpus cavernosum, blocks
- enzyme phosphodiesterase-5, allows increased blood flow into penis
Primary use: to treat erectile dysfunction
Adverse effects: Most serious is hypotension, headache, dizziness, flushing, rash, nasal congestion, diarrhea, dyspepsia, UTI, chest pain, indigestion, blurred vision, changes in color perception, priapism
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finasteride
(Proscar)
Mechanism of action: Inhibits 5-alpha-reductase
Primary use: Promotes shrinkage of enlarged prostates, also prescribed to promote hair regrowth
Adverse effects: sexual dysfunction, impotence, diminished libido, ejaculatory dysfunction
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Plan B – levonorgestrel
May be administered within 72 hours after unprotected sex
Prevents implantation of fertilized egg
Two doses, 12 hours apart; most effective when taken within 120 hours (5 days) of unprotected sex
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misoprostol (Cytotec)
Pharmacological abortion
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oxytocin (Pitocin, Syntocinon)
Mechanism of action: to induce labor by increasing frequency and force of uterine contractions
Primary use: as drug of choice for inducing labor
Adverse effects: Complications in fetus include dysrhythmias or intracranial hemorrhage. Serious complications in mother may include uterine rupture, seizures, coma
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magnesium slufate (tocolytic)
Use: Prolong pregnancy
Adverse effects: complete heart block, circulatory collapse, respiratory paralysis
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bromocriptine (parlodel)
reduction of high prolactin levels
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clomiphene (clomid, milophene, serophene)
Drug of choice for female infertility due to lack of ovulation
- Stimulates release of LH
- Results in maturation of increased number of ovarian follicles
- Promotion of follicle maturation and ovulation
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GnRH Antagonists
Prevention of premature ovulation or control of endometriosis
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GnRH Analogs/Agonists
Suppression of FSH and control of endometriosis
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Androgens vs. Anabolic Steriods
Used to treat hypogonadism; increase libido and correct erectile dysfunction
VS.
- Testosterone-like compounds
- Frequently abused by athletes, even though illegal
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epinephrine (Adrenaline, Epinephrine)
Action – alpha1, alpha2, beta1, and beta2 agonist
Potent Inotropic – force of contractioins
Use – in emergencies anaphylaxis, bronchospasm, cardiac arrest, potent vasoconstrictor
Route – inhaled, SQ, IV, topically (lidocaine)
Side Effects – A/N/V, tremors, tachycardia, pulmonary edema, HTN
Precautions – (b/c it increases all of these) use cautiously with HTN, BPH, DM, Hyperglycemia, Hyperthyroidism
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Norephinephrine (Levophed)
Similar to epi
Does NOT stimulate beta2
Does not cause hypoglycemia
Cardiac and critical care
Hypotension, shocky states – cardiac arrest, potent vasoconstrictor
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pseudoephedrine (Sudafed and others)
Stimulate alpha1 and beta2 – “spills over to others”
Used topically to tx rhinitis and sinus congestion
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phenylephrine (Neo-Synephrine, Allerest, Dristan, Dimetapp)
Mechanism of action: potent vasoconstrictor - decongestant
To stimulate the sympathetic nervous system directly/indirectly
Produce many of the same responses as the anticholinergics
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clonidine (Catapress)
Used primarily as antihypertensive agents.
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isoproterenol (Isoprel)
Action – stimulates beta1&2 receptors
Use – bronchospasm, asthma, bronchitis, emphysema, CHF, heart block, shock and cardiac arrest
Contraindicated – CAD, DM, tachycardia, tachydysrhythmias, sensitivity to SNS stimulation
Adverse effects – N/V, tachycardia, dysrhythmias, hypertension, hypotension
Nsg Resp – start with small doses and increase slowly as tolerated, monitor pt
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dopamine (Intropin)
Mimics endogenous dopamine – stimulates Beta1 receptors, some Alpha1 too
Action – dose related
Low doses – increased renal perfusion Moderate doses – increase force of heart High doses – vasoconstriction, increased BP, decreased renal perfusion
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dobutamine (Dobutrex)
Similar to dopamine in action, increased contractility, increased SV
Used to increase cardiac output, and tx CHF and cardiogenic shock
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albuterol sulfate (Proventil, Ventolin)
Selective for beta 2 receptors
Use – tx bronchospasm, asthma, rapid short acting – rescue inhaler
Route – inhaled, PO
Side effects – tremor, tachycardia, dysrhythmia, dizziness
Nsg Resp – avoid use with HTN, severe cardiac disease, avoid taking with MAOIs – psych/antidepressant, do not use w/increase BP
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metaproterenol sulfate (Alupent, Metaprel)
Similar to albuterol
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prazosin (Minipress)
Mechanism of action: to inhibit the sympathetic nervous system
Primary use: hypertension, dysrhythmias, angina, heart failure, benign prostatic hypertrophy, narrow-angle glaucoma
Adverse effects: dizziness, drowsiness, headache, loss of energy and strength, palpitations, dry mouth, 1st dose syncope
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doxazosin mesylate (Cardura)
Similar to prazosin
Used for HTN and BPH, longer acting
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phentolamine mesylate (Regitine)
Use – PVD, and tx tissue necrosis from extravasation of certain meds
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propranolol HCL (Inderol)
Use – tx dysrhythmias, HTN, angina, MI, migraine prophylaxis
Action – blocks beta1 and beta2 adrenergic receptor sites
Side effects – bradycardia, H/A, fatigue, hyper/hypoglycemia, blood dyscrasias, laryngospasm, sexual disfunction
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Pilocarpine HCL (Pilocar)
Has limited usage. Constricts the pupils
Use – tx Glaucoma
Side effects – stinging/burning topically
Also causes systemic side effects
Antidote – atropine sulfate
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bethanechol (Urecholine)
Mechanism of action: to the cholinergic (muscarinic) receptor
Uses: urinary retention, abdominal distention
Adverse effects: N/V/D, flushing, salivation, sweating, increased muscle tone, urinary frequency, bradycardia, orthostatic hypotension miosis, abd discomfort, muscle weakness, acute asthmatic attach, heart block, cardiac arrest
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Nicotine (Habitrol, Nicoderm, Nicotrol)
Use – smoking cessation, nicotine replacement.
Route – gum, patch, nasal spray
Nsg Resp – avoid tobacco products
varenicline (Chantix) – similar
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Neostigmine (Prostigmin)
Use – tx myasthenia gravis, postop urinary retention, paralytic ileus
Action – blocks enzyme to increase acetylcholine at receptor sites
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Atropine Sulfate
Action – blocks acetylcholine, increases heart rate, paralyzing the iris sphincter
Use – as preoperative medication, antispasmodic drug for tx peptic ulcers, to increase heart rate, to dilate pupils for eye exams
Side effects – dry mouth, blurred vision, constipation, urinary retention, H/A, N, decreased perspiration, dry skin, abd distension, tachycardia, photophobia, hypo/hypertension, impotence, coma
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benztropine (Cogentin)
Used to tx parkinson’s disease and EPS
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ipratropium bromide (Atrovent)
Used with asthma, and rhinorrhea
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scopalamine hydrobromide
(Scopalamine, Hycoscine, Transderm Scop)
Used for motion sickness, preanesthetic
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trihexyphenidyl (Artane)
Dicyclomine HCL (Bentyl)
tiotripoum (Spiriva)
tolterodine (Detrol)
Anticholinergics
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propantheline bromide (Pro-Banthine)
Synthetic anticholinergic
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cyclophosphamide (Cytoxan)
Alkylating Agents
Mechanism of action: Attaches to DNA and disrupts replication
Primary use: to treat wide variety of cancers, including Hodgkin's disease, lymphoma, multiple myeloma, breast cancer, ovarian cancer
Adverse effects: immunosuppressant effects, thrombocytopenia, nausea, vomiting, anorexia, diarrhea, alopecia, hemorrhagic cystitis
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mechlorethamine (Mustargen)
cisplatin (Platinol, Cisplatinum, CDDP)
Nitrosureas (alkylating agents)
carmustine (BCNU)
streptozocin (Zanosar)
lomustine (CeeNU)
Alkylating Agents
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methotrexate (Rheumatrex, Trexall)
Antimetabolites
- Mechanism of action: Blocks synthesis of folic acid
- (vitamin B9) to inhibit replication
- Primary use: to treat choriocarcinoma,
- osteogenic sarcoma, leukemias, head and neck cancers, breast carcinoma, lung
- carcinoma
- Adverse effects: fatal bone marrow toxicity at high doses, hemorrhage and bruising, low
- platelet counts, nausea, vomiting, anorexia, gastrointestinal ulceration, intestinal bleeding
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doxorubicin (Adriamycin)
Antitumor Antibiotics
Mechanism of action: Attaches to DNA, distorts double helical structure and prevents normal DNA and RNA synthesis
Primary use: solid tumors of the lung, breast, ovary, and bladder, and for various leukemias and lymphomas
Adverse effects: cardiotoxicity, dysrhythmias, irreversible heart failure, lower blood cell counts, nausea, vomiting
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daunorubicin (DNR, Cerubidine)
bleomycin (Blenoxane)
Antitumor Antibiotics
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vincristine sulfate (Oncovorin, Oncovin)
vinblastine (Velban)
- Mitotic Inhibitors/Natural Products
- Vinca alkaloids
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paclitaxel (Taxol)
docetaxel (Taxotere)
- Taxanes
- Mitotic Inhibitors/Natural Products
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vincristine (Oncovin)
Mitotic Inhibitors/Natural Products
Mechanism of action: cell cycle–specific (M-phase) agent that kills cancer cells by preventing their ability to complete mitosis
Primary use: treatment of Hodgkin's and non-Hodgkin's lymphomas, leukemias, Kaposi's sarcoma, Wilms' tumor, bladder carcinoma, breast carcinoma
Adverse effects: nervous system toxicity, numbness and tingling in limbs, muscular weakness, loss of neural reflexes, pain, paralytic ileus, constipation, alopecia
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Adrenocorticosteroids
(prednisone, dexamethasone, others)
Androgens (testosterone, FSH, LH)
Estrogens (diethylstilbestrol [DES], estradiol
Progestins megestrol acetate (Megace)
Antiestrogens
Tamoxifen (Nolvadex)
Raloxifen (Evista)
Aromatase inhibitors
letrozole (Femara)
anastroxol (Aramidex)
Hormone/Hormone Antagonists
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tamoxifen
Hormone/Hormone Antagonists
Mechanism of action: Blocks estrogen receptors on breast cancer cells
Primary use: patients with breast cancer. Also given to high-risk patients to prevent disease
Adverse effects: nausea and vomiting, association with increased risk of endometrial cancer and thromboembolic disease, hot flashes, fluid retention, vaginal discharges common
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bevacizumab (Avastatin)
rituximab (Rituxan)
trastuzumab (Herceptin)
Monoclonal antibodies (MABs) – targets and binds to a specific CA cell
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aldesleukin (Proleukin)
Interleukins
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Monoclonal antibodies
(MABs)
Interleukins
Biologic Response Modifiers, Immune Therapies
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interferon alfa-2a (Roferon-A)
interferon alfa-2b (Intron-A)
Interferons
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