Mosby ch 33-35 – Flashcards
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A chronic disease of hyposecretion of steroids
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Addison's disease
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The inner portion of the adrenal gland
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medulla
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the outer portion of the adrenal gland
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cortex
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general term for any of the natural or synthetic adrenocortical hormones
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corticosteroids
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a metabolic disorder characterized by abnormally increased secretion of the adrenocortical steroids
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Cushing's disease
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corticosteroid hormones that regulate carbs, protein, and lipid metabolism
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glucocorticoids
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corticosteroid hormones that regulate electrolyte and water balance
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mineralocorticoids
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an acute life-threatening state of severe adrenocortical insufficiency
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Adrenal crisis
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an example of a mineralocorticoid
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Aldosterone, desoxycorticosterone, fludrocortisone
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an example of glucocorticoid
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prednisolone
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This estrogen product contains a combination of natural estrogen compounds equivalent to the average estrogen composition of the urine of pregnant mares.
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premarin
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This synthetic progestin is primarily used in the palliative management of recurrent, inoperable, or metastatic endometrial or breast cancer and is also used as an appetite stimulant for cancer patients.
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Megestrol (Megace)
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This drug is the synthetic form of an endogenous hormone and is used to induce or augment labor.
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oxytocin
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An oral bisphosphonate that is indicated for the prevention and treatment of osteoporosis
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Alendronate (Fosamax)
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This cervical gel is used to improve cervical inducibility, or "ripening," near or at term in women who need induced labor.
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Dinoprostone (Protin E2, Cervidil, Prepidil)
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A SERM that is used for the prevention of postmenopausal osteoporosis.
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Raloxifene (Evista)
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This progestin is used to treat uterine bleeding, secondary amenorrhea, and endometrial cancer.
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Medroxyprogesterone
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This tocolytic is used to prevent preterm labor, but it may also be used as a bronchodilator in the symptomatic treatment of bronchial asthma.
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Uterine relaxants; Terbutaline (Brethine)
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This fertility drug is used to induce maturation of the ovarian follicle.
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Clomiphene (Clomid)
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The trade name for a progestin-only, long-acting injectable contraceptive drug.
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Depo-Provera
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Although I am an androgen, I can be used by women for the treatment of endometriosis or fibrocystic breast disease.
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Danazol
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I am the trade name for the transdermal patch form of testosterone that is applied to the scrotal skin.
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Testoderm
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I am the trade name for the topical form of testosterone that is applied to skin on the back, abdomen, upper arms, or thighs.
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Androderm
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I was the first phosphodiesterase inhibitor used for erectile dysfunction.
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Sildenafil (Viagra)
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I am a 5-alpha-reductase inhibitor used to reduce symptoms of benign prostatic hyperplasia.
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Finasteride (Proscar
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negative feedback loop
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A feedback loop that causes a system to change in the opposite direction from which it is moving
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positive feedback loop
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Situation in which a change in a certain direction provides information that causes a system to change further in the same direction. Compare negative feedback loop.
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tocolytic
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Uterine relaxant
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oxytocics
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uterine stimulants
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Predisone
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most common oral drug. Intermediate acting. Antiinflammitory and immunosuppressant
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aminoglutethimide (Cytadren)
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...
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Oxytocin
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Used to induce labor at or near full term, and to enhance labor when contractions are weak and ineffective. Prevent or control postpartum uterine bleeding, completes an incomplete abortion, promotes milk ejection during lactation. May have vessopressin and antidiuretic effects. If contrations are more frequent then 2 min. and last longer than 1 min. the treatment should be stopped. Pt. placed on left side with I.V. fluids.
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Brethine
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Terbutaline (Brethine):"unlabeled use" beta-adrenergic, relaxes the uterine smooth muscle, stopping premature labor. Pt. should be places in left lateral recumbent position to minimize hypotension, increase renal blood flow, and fetus blood flow.
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methergine
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Uterine stimulant, ergot alkaloid, reduces likelihood of postpartum uterine hemorrhage. Not used before delivery of placenta
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Pergonal
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Fertility drug Stimulate ovulation in patients with ovarian dysfunction and resultant infertility. Used in conjunction with chorionic gonadotropin to stimulate spermatogenesis in male patients with infertility
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Danazol
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Treatment of moderate endometriosis that is unresponsive to convential therapy. Palliative therapy of fibrocystic breast disease Prophylaxis of hereditary angioedema
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Fosamax
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Bisphosphonates- osteoperosis Alendronate (Fosamax): nonestrogen, nonhormonal option for prevetion of bone loss. My reduce hip fracture(51%), spinal fracture(47%), wrist fracture(48%). Tx. Of Pagets disease in women. *take first thing in morning with 8oz of water and remain upright for 30 minutes afterwards. All other drugs and food need to wait 30 min.* Dosed daily or weekly
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Evista
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SERM-Osteoperosis- increase bone density Raloxifene (Evista): prevention of postmenopausla osteoporosis. Not recommoned for women near menopause, adverse effect is hot flashes.
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(Teriparatide) Forteo
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ONLY Stimulates bone growth. rDNA parathyoid hormone Tx: osteoperosis for women at HIGH risk
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Finasteride (Proscar)
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higher strengths for BPH (may take 3-6 months) lower doses for male baldness patterns. Contraindicated with pregnant women should wear gloves** Do not handle crushed or broken tablets Pregnant Category X
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Viagra/Cialis/Levitra
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Sexual dysfunction Contraindicated with use of Nitrates
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Flomax
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BPH May cause hypotension. Change positions slowly
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List patient teaching tips for corticosteroids.
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-meds should be taken exactly as ordered -never stop abruptly- adrenal crisis -clear nasal passage before nasal spray -wear gloves for topical application of meds -usually take in the AM with meals of food -avoid alcohol, aspirin, NSAIDS -Missed doses should be taken as soon as remembered without double dosing -way to prevent falls with long term use -FLUDROCORTISONE-take with meals -any wt gain- 2lbs/day or 5 lbs/week report -Maintain a low-sodium, high-potassium diet -Rinse mouth
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List the administration routes for corticosteroids.
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adrenal steroid inhibitor- systemic glucocorticoid- topical, systemic (NEVER subQ), PO, IV, IM, rectal mineralocorticoid- systemic (PO)
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What is the link between corticosteroids and osteoporosis?
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long term use may lead to osteoporosis
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What are glucocorticosteriods used for?
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inhibit or help control inflammatory and immune response adrenocortical deficiency adrenogenital syndrome bacterial meningitis cerebral edema collagen disease dermatologic disease (psoriasis, eczema) GI diseases Endrocrine disorders Exacerbation of asthma and COPD organ transplant palliative management of leuckemia's lymphomas autoimmune diseases allergic reaction, allergic rhinitis spinal cord injury
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List the adverse/side effects of glucocorticosteriods.
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suppresses the immune system heart failure cardiac edema increased BP convulsions H/A vertigo mood swings nervousness insomnia "steroid psychosis" growth suppression Cushing's irregular periods carb intolerance hyperglycemia peptic ulcers pancreatitis abd distention fragile skin petechial ecchymosis facial errytherma poor wound healing hirsutism urticaria muscle weakness loss of muscle mass osteoporosis
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List the therapeutic effects of glucocorticosteriods.
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Carb metabolism - protein metabolism - lipid metabolism - inflammitory and immune response - regulation of arterial B/P - maintain normal nerve excitability - maintain muscle strenght - maintain open airways - decrease viscosity of gastric mucus
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Cushing's disease vs Addison's disease
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Addision's : -under secretion - decrease NA, blood glucose - increase K dehydration & wt loss TX: Fludrocortisone Cushing's : -over secretion -increase Na -decrease K -water retention and muscle weakness redistribution of fat from periphery to face, shoulders, trunk, abd "moon face"
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List contraindications for use of estrogens.
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allergy, estrogen dependent cancer undiagnosed abnormal vaginal bleeding, pregnancy, active or history thrombolytic disorder (stroke, thrombophlebitis)
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List indications for use of oral contraceptives.
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*prevent pregnancy TX: of endometriosis and hypermenorrhea produce cyclic bleeding in amenorrhea prevent ovarian cyst and cancer Plan B- 72 window
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List patient teaching for oral contraceptives.
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Take at same time everday -1 missed dose take as soon as rememberer and use back up contraception does not protect against STD or HIV/AIDS with antibiotics, barbituarates, griseofullin, isoniazide or rifampin- NEED back up St John's Wort may decrease effectiveness
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List the uses for androgen therapy.
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primary or secondary hypogonadism erectile dysfunction various anemias mestastatic breast cancer increase BP and BPH male/female androgenetic alopecia postpubertal cryptochidism postpartum breast engorgement male hypogonadism inoperable breast cancer hereditary angioedema fibriocystic breast cancer endometriosis
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List the therapeutic/adverse effects of androgens in males receiving hormone therapy.
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