Pharm - Gastro/Genito/Repro

Gastrointestinal,
Genitourinary & Reproductive

Heather Miller, MSN, RN

Objectives

• Explain the expected therapeutic effects of gastrointestinal, genitourinary and reproductive medications.

• Summarize the pharmacological action of gastrointestinal, genitourinary and reproductive medications.

• Monitor for common adverse effects of gastrointestinal, genitourinary and reproductive medications.

• Apply the concept of safe medication administration and dosage calculation when administering gastrointestinal, genitourinary and reproductive medications.

• Reinforce client education regarding gastrointestinal, genitourinary and reproductive medications.

• Determine if the gastrointestinal, genitourinary and reproductive medications are appropriate for the client.

• Monitor for potential interactions that can cause adverse or life-threatening effects when administering gastrointestinal, genitourinary and reproductive medications.

Gastrointestinal

• Peptic ulcer disease (PUD)

• Gastroesophageal Reflux Disease

• Nausea

• Constipation

• Diarrhea

• Inflammatory Bowel Disease

Peptic Ulcer Disease

Famotidine

• Treats ulcers, heartburn, dyspepsia, GERD

• Confusion, agranulocytosis, pneumonia

• PO - with or without food; at least 1hr before antacids

• Take as prescribed; avoid ETOH, NSAIDs

• Caution with renal/hepatic impairment and elderly

• Antacids decrease absorption

Omeprazole

• Prevents & treats ulcers, GERD, erosive esophagitis

• Osteoporosis, hypomagnesemia, abdominal pain

• PO, before first meal

• Consume adequate Ca and Vit D; drink fluids; weight-bearing exercises

• Caution with liver dysfunction

• Phenytoin, warfarin increase levels; St. John's wort decreases levels

Sucralfate

• Treat duodenal ulcers - like a bandaid

• Constipation

• PO, 1hr before meal & HS (4xd); no antacids w/n 30m

• Increase fiber, fluid, & exercise

• Caution with renal failure, DM, swallow difficulty

• Decreases absorption of phenytoin, warfarin, fluoroquinolones

Magnesium Hydroxide

• Treat PUD and GERD

• Diarrhea

• PO, up to 4xdaily; not w/n 1-2hr of interacting meds

• Report abdominal pain (unk), s/s GI bleed

• Caution with hypercalcemia and hypophosphatemia

• Decreases absorption of dig, salicylates, fluoroquinolones

Nausea

Ondansetron

• Treats nausea d/t radiation, chemo, post-op

• Serotonin syndrome; Stevens-Johnson; constipation; dizziness

• PO or IV

• Safety; hydration; mild analgesic for headache

• Caution with hepatic disease and abdominal surgery

• SSRI, SNRI, TCA, MAOI = serotonin syndrome

Metoclopramide

• Treats nausea d/t radiation, chemo; increase GI motility

• Sedation; extrapyramidal reactions, restless; diarrhea

• PO, IM, IV; add diphenhydramine reduces EPS

• Safety; hydration; monitor anxiety, rigid muscle, hyperthermia

• Caution older, heart failure, asthma

• Phenothiazine increases EPS; APAP, ASA, diazepam negate effects

Multiple Choice

Your client has decreased peristalsis, which results in gastric stasis. Which of the following drugs would help with gastric motility?

• Magnesium hydroxide

• Metoclopramide

• Bisacodyl

• Polyethylene glycol

Constipation

Polyethylene glycol

• Osmotic; increases peristalsis - large, soft stool

• Diarrhea, electrolyte imbalance, cramping

• Daily for 7days; fully dissolve in 4-8oz fluid

• Report diarrhea, rectal/GI bleed

• Contraindicated with bowel obstruction or perforation

• Interacts with stimulant laxatives and loop diuretics

Docusate Sodium

• Treats constipation, fecal impaction

• Diarrhea, rash, throat irritation

• PO with 8oz water

• Increase fluids & exercise; report abd. distention; stop if diarrhea

• Contraindicated with GI obstruction or perforation

• No laxatives w/n 2hrs of administration

Diarrhea

Loperamide

• Decrease intestinal peristalsis = fewer, smaller, harder stool

• Anticholinergic; constipation; arrhythmias

• PO; do not exceed 16mg/d; stop after 48hrs

• Safety; candy, gum; hydrate

• Contraindicated with glaucoma, GI bleed; caution with BPH

• Interacts with cimetidine, erythromycin, quinine

Inflammatory Bowel Disease

Sulfasalazine

• Treats Crohn's, ulcerative colitis

• Fever, rash, headache; agranulocytosis, anemias

• PO, with food; urine, skin color change

• Monitor n/v, diarrhea; wear sunscreen

• Contraindicated with anemias, aganulocytosis, renal failure

• Interacts with iron and antibiotics

Multiple Choice

While caring for a client with cancer and is taking opioids for pain relief, the client received a new prescription for docusate sodium PO daily. Which of the following therapeutic effects of docusate sodium should the nurse expect?

• Decreased drowsiness

• Relief of constipation

• Relief from nausea

• Decreased cancer pain

Multiple Choice

A nurse is reinforcing teaching to a client with a new prescription for sucralfate. Which of the following statements should the nurse make regarding how to administer the medication?

• "Take this medication with your first meal."

• "Take this medication when you are experiencing heartburn."

• "Take this medication 1-2 hours before chemotherapy."

• "Take this medication before meals and at bedtime."

Multiple Choice

Contraindications for this drug include: sulfonamide allergy; agranulocytosis, folate deficiency

Interventions: monitor folate, CBC; vital signs; skin assessment

• sulfasalazine

• mesalamine

• ondansetron

• famotidine

• Oral contraceptive

• Hormone Replacement therapy

• Infertility

• Benign Prostatic Hypertrophy

• Erectile Dysfunction

​

Reproduction

Oral Contraceptive

Ethinyl estradiol/Drospirenone

• Suppresses FSH, LH - constant estrogen; prevents ovulation

• Thromboembolism; abnormal uterine bleeding; HTN; hyperkalemia

• PO, same time every day

• Monitor BP; s/s DVT, pulmonary embolism, MI; no smoking

• Report leg swelling & edema, unusual bleed or changes in menses

• Decreases effects of hypoglycemics, phenytoin, St. John's wort

Hormone Replacement

Conjugated Equine Estrogen

• Substitutes estrogen in small, stable amounts; decreases menopausal symptoms

• Increased risk for ovary or endometrial cancer; HTN; nausea

• Take same time daily; vaginal cream @ HS

• Monitor/report leg pain, swelling; s/s PE, MI

• Caution with cardiac history, DM; no smoking

Infertility

• Clomiphene - stimulates LH, FSH

• Oxytocin - stimulates onset & progression of labor

• Methylergonovine - causes strong uterine contractions to stop hemorrhage

• Terbutaline - stops uterine contractions

• Magnesium sulfate - treats seizures d/t preeclampsia; DTRs

• Betamethasone - stimulates fetal lung maturity

Benign Prostatic Hypertrophy

Finasteride

• Decreases testosterone production = regressed prostate tissue

• Decreased libido & PSA; gynecomastia

• PO; 12 months for full effect; life-long therapy

• Baseline PSA; counseling

• Regular prostate exams; report gynecomastia

• Teratogenic; caution with urinary obstruction

Tamsulosin

• Treats BPH; relaxes prostate & bladder outlet = increased urination, decreased BPH s/s

• Ejaculatory problems; dizziness, headache

• PO, daily at same time; 30 minutes after meal

• Monitor BP; safety

• Caution with hypotension, renal impairment, syncope

• Antihypertensives increase hypotensive effects

Erectile Dysfunction

Sildenafil

• Sustains erection

• Priapism!; sudden loss of vision, hearing; headache, dizziness

• PO, 1hr before sex; high-fat delays effects

• Lasts up to 4hrs; no nitrates w/n 24hrs!

• Caution with cardiac, unstable angina, hepatic disease

• Increased risk for hypotension with nitro (severe), BPH meds

Poll

A client is receiving instruction from the nurse regarding tamsulosin (Flomax) for treatment of BPH. Which of the following adverse reactions should the nurse include?

• Erectile dysfunction

• Edema

• Retrograde ejaculation

• Tremor

Multiple Choice

A client asks the nurse why nitrates are contraindicated with his new prescription for sildenafil (Viagra). Which is the best response by the nurse?

• "Nitrates can lead to fatal hypotension."

• "There is not a real good answer to that question."

• "Because the doctor feels you are too old for sexual activity."

• "Nitrates reduce the effectiveness of sildenafil."

• Oxybutynin - relaxes bladder, allows urine to stay in bladder

• Mydriasis, blurred vision, fever, dizziness

• Bladder overdistention, UTIs

• PO, patch

• Candy, gum; increase fluid, fiber

• CI - glaucoma, GI/GU obstruction

• Grapefruit juice increases toxicity

Genitourinary - Overactive Bladder

Multiple Choice

A client experiencing incontinence is started on oxybutynin (Ditropan). Which of the following statements will indicate to the nurse that the patient requires further teaching?

• "I have been taking frequent breaks at work because of this heat."

• "I will have regular eye exams."

• "I seem more constipated now that I'm taking this medication."

• "I know this medication will turn my urine bright orange."