Chapter 2

Pharmacodynamics- study of interactions between drugs and their receptors and the
events that result in the pharmacologic response.

Pharmacokinetics- study of mathematical relationships among the absorption,

distribution, metabolism, and excretion of drugs.

ADME- Absorption Distribution Metabolism Excretion

Liberated- released from the dosage form before it can be absorbed. Example: breaking
down a capsule in stomach to liberate for absorption.

Metabolism- body inactivates drug

Chapter 3

Geriatrics have less muscle mass, decreased kidney and liver function, higher gastric ph,
slower intestinal transit time, and decreased intestinal blood flow which will alter
medication absorption. Start at 1/3 to ½ of normal adult dose and titrate up.

Women have greater gastric acidity and slower intestinal transit rate which increases time
between drug and intestine. This can increase absorption. Increased risk for toxicity.

Infants have a higher body percentage of water and require higher dose on ml/kg basis of
water soluble drugs than an adult.

Geriatrics at greater risk for drug toxicity because of :

Renal impairment
Hepatic impairment
Polypharmacy
Malnourishment

No aspirin to infants through adolescence because it could cause Reyes syndrome.

Chapter 39 Gonadal hormones

Estrogen cause release of pituitary gonadotropins which cause capillary dilation, fluid
retention, protein metabolism, inhibits ovulation, and inhibits postpartum breast
engorgement.

Progestins inhibit secretion of pituitary gonadotropins preventing maturation of ovarian

follicles which inhibits ovulation.

Side effects of estrogen hormones:

Weight gain, edema, breast tenderness, nausea

Hypertension
Thrombophlybitis
Hyperglycemia
Breakthrough bleeding
Decreases effectiveness of warfarin and thyroid hormone
Can cause phenytoin toxicity because of inhibition of metabolism

Testosterone used to treat breast cancer in post menopausal women.

Monitor for signs of electrolyte imbalances. Testosterone can cause hyperkalemia.

It can cause hypercalcemia in immobile patients and patients with breast cancer.

Can cause premature closure of epiphyseal plate if given to children.

Androgens can create hepatotoxicity. Monitor for: hepatomegaly, anorexia, vomiting,

jaundice, AST,ALT, alkaline phosphase, bilirubin.

Androgens enhance anticoagulation effect of warfarin. Monitor PT & INR and signs of
bleeding.

May cause hypoglycemia. May need to reduce insulin dosage.

Corticosteroids with androgens may cause electrolyte imbalance and fluid retention.
Chapter 40 drugs for obstetrics

Oxytocin should not be used to hasten labor. The contractions created may be harmful to
the mother and child. It should be used for dysfunctional labor and postpartum to reduce
hemorrhage.

Uterine Stimulants

Cervidil (dinoprostone) causes cervical softening and dilation. Used in higher doses it
can increase frequency and strength of uterine contractions. Can cause hypotension!

Cytotec (misoprostol) used off label as cervical ripening agent, induction of labor, and
for postpartum hemorrhage.

Ergonovine maleate- stimulates uterine contractions for postpartum bleeding. Do not

give ergonovine if mother is breastfeeding. May cause hypertension.

Oxytocin (pitocin) drug of choice to induce full term labor. Start at low doses and titrate
up. Absolutely must use fetal heart monitor (tocometer)

--If infant develops distress during oxytocin infusion:

Turn down infusion rate
Put mother on left side lateral
Administer high flow oxygen via non rebreather at 15+ l/min
Call physician immediately

Oxytocin stimulates ADH which may cause excess water accumulation. Monitor I&O.

Blood loss of over 500ML within 24 hours after delivery is classified as hemorrhage

Uterine Relaxants
Commonly used to but time for administration of corticosteroids (betamethazone)to help
increase fetal lung development before delivery.

Magnesium Sulfate- normal serum levels 1.8 – 3 meq/L. When levels higher than
4meq/L it depresses the CNS and produces anticonvulsive effects and smooth muscle
relaxation. Used to inhibit premature labor. At levels between 5-8 patients may become
toxic. Signs are feeling hot all over, flushed skin, diaphoresis, and thirst.
Make sure to monitor Respiratory Rate and deep tendon reflexes.!!! Strict I&O The
antidote is Calcium gluconate or Calcium chloride. Caution in people with impaired renal
function. Do not administer if RR less than 16!!!

Terbutaline sulfate (Brethine)-off label use-Beta agonist produces uterine relaxation

when stimulating beta 2 receptors. Also hits beta 1 receptors and produces tachycardia,
hypertension, hypotension r/t decreased stroke volume, and hyperglycemia.
*may cause hypokalemia

Med to increase ova production

Clomiphene citrate (clomid)- structurally similar to estrogen. Signals pituitary to release
LH and FSH which signal ovaries to release ova. Patient needs to confirm that they arew
not pregnant before starting this med.

RhoGam- Give to Rh negative mother to suppress antibody formation against possible rh

positive child. Blood product so might have cultural concerns. LPN may not be able to
hang it check policy and procedures. Patient may be allergic so have emergency supplies
on hand.

Neonatal ophthalmic ointment

Erythromycin (Ilotycin)- used prophylactically against nesseria gonorrheae and c.
trachomatis. Make sure ointment is for ophthalmic use!! ¼ inch ribbon of ointment in
each eye should be within 2 hours of birth.

Phytonandione (Aquamephyton)- Used to prevent vitamin k deficient bleeding.

Newbornes do not have intestinal flora for first 5-8 days which produce vitamin k used
for clotting factors. Monitor Pt & INR. Too much can lower values.

Fetal Fibronectin test helps predict the possibility of pre term labor

If moms reubella titer is low inoculate right after pregnancy

Neonates given penicillin for prophylaxis against group B strep

Chapter 41 see table ph. 634

Leukorrhea- abnormal white vaginal discharge commonly caused by candida albicans,

trichomonas vaginalis, and gardnerella vaginalis.

Oral birth control Both inhibit ovulation

Estrogens block release of Follicle stimulating hormone (FSH). Prevents ovaries from
developing follicle

Progestins block release of Luteinizing hormone (LH). Prevents release of ova from
follicle.

Both make cervical mucus thick which inhibits sperm migration

Both change endometrial wall which impairs implantation should it occur.

Seasonale- new oral bith control that reduces number of periods to 4 per year. Keep more
constant hormone levels

Always make sure that patient is not pregnant before starting any birth control.

Miss 1 pill= take it as soon as you remember

Miss 2 pills= take 2 when you remember and 2 the next day; may cause spotting
Miss 3 pills= use alternate birth control and start new pill pack on following Sunday

Always mention to healthcare provider or dentist that you are taking birth control.

Birth control increases risk for clotting and DVT and PE. Teach patient S&S

Drugs that reduce effects of birth control:

Antibiotics
Barbituates
Antivirals
St. Johns Wort
Phenytoin

Oral contraceptives decrease anticoagulation effect of warfarin. Increase warfarin if

necessary.

Oral contraceptives have variable effect on benzodiazepines. Check kidney and liver labs
for toxicity.
BPH
Increase in dihydrotestosterone (DHT) causes growth of new prostate cells.

Alpha 1 adrenergic blockers are used to relax the smooth muscle of the bladder and
prostate. These are:
Doxazosin
Terazosin
Alfuzosin
Tamsulosin (flomax)- may cause hypotension and tachycardia

Anti-androgen Agents
Dutasteride (Avodart) Inhibits production of DHT
Side effects: impotence, decreased libido, decreased ejaculatory volume

Finasteride (proscar) Inhibits production of DHT

Side effects: impotence, decreased libido, decreased ejaculatory volume

Erectile dysfunction

Drugs act by enhancing relaxant effect of nitric oxide released in response to sexual
stimulation = smooth muscle relaxation/dilation and increased blood into corpus
cavernosum.

Priapism- erection that will not go away. See doc if over 4 hours.

DO NOT mix erectile dysfunction drugs with nitro for angina. Blood pressure will
plummet due to massive vasodilation and may worsen symptoms.

Avoid all vasodilators including alcohol and hot tubs!

Do not use alpha adrenergic blocking agents with ED pills because of hypotension.