Drugs used in hormonal disorders & supplementation etc

The Nursing students are more benefited because slides prepared as per the INC syllabus

1. Unit XI – Drugs used for Hormonal Disorders and supplementation, contraception and medical termination of pregnancy. – 3 Hrs. Mr. Dipti Y. Sorte

2. INC Syllabus Insulin & Oral Hypoglycemics. Thyroid supplements & Suppressants. Anabolic Steroids. Uterine stimulants & Relaxants. Oral contraceptives. Other estrogens – Progesterone Preparations. Corticotrophins & Gonadotropins. Adrenalin . Prostaglandin. Calcitonin's. Calcium salts. Calcium regulators . Androgen & Abortifacient

3. Antidiabetic Drugs: Insulin Antidiabetic drugs that treat diabetes mellitus y lowering glucose levels in the blood. Insulin : Insulin is synthesized in the ꞵ (Beta) cells. Action of insulin is converting glucose levels in the blood.

4. Mechanism of action In liver, insulin increases glucose uptake and glycogen synthesis. In muscle – Increases glucose uptake and utilization. In adipose tissue – increases glucose uptake and storage as a fat and glycogen. It reduces breakdown of fats and protein also.

5. Drug examples and doses S. No. Drugs Doses 1 Ultra short acting Insulin apparat, Insulin ispro 15-30 min, (4-6 hrs.) 0.5to0.8 units/kg/day SC 15 min before meal. 2 Short acting Regular insulin. 30-60 mins, (6-8hrs.) 3 Intermediate acting Neutral protamine Hagedorn 1-2hrs, (20-40hrs) 4 Long acting Ultra leute, Protamine zinc. 4-6hrs, (24-36hrs)

6. Indications/ uses Diabetes mellitus. Diabetic ketoacidosis.

7. Adverse effects Overdose may lead to hypoglycemia (Anxiety, sweating, tremor, convulsions, coma) Local reaction (Swelling, erythema, stinging sometimes). Allergy (Urticaria, angioedema, anaphylaxis) Edema.

8. Contraindications Hypoglycemia. Special precautions with the patients of renal and hepatic impairment and pregnancy, lactation (insulin impairment tend to fall during the 1 st trimester, increase during the 2 nd trimester & 3 rd trimesters)

9. Drug interactions Insulin cause a disulfiram like reaction (abdominal cramps, nausea, vomiting flushing, headache, hypoglycemia) when used with alcohol. Use of insulin with corticosteroids, thiazide diuretics, and thyroid preparations may cause hyperglycemia.

10. Nursing responsibilities Nurse should know that repeated dose of insulin at the same site may produces atrophy of the subcutaneous tissue, hence it is advised to change the site of insulin injection. Assess the allergic reactions if there, due to change type of insulin. Do not shake the insulin vial, instead roll it between hands. Should know that stress, fever, trauma, infection and surgery may increase insulin requirements. Nurse should know that only regular insulin can be administered I/V if needed in an emergency. Monitor the patients blood glucose.

11. Contd. Assess the patients for signs and symptoms of hypoglycemia or hyperglycemia. Teach the patient how to take insulin injection by self. Rotate ineffective sites and dispose of use syringes. Insulin can not be given orally because it is destroyed by the enzymes of the gut.

12. Antidiabetic Drugs: Oral Hypoglycemics These are the drugs which can be given orally and produce lowering of blood sugar are called oral hypoglycemic drugs.

13. Mechanism of the action These drugs act by increasing the secretion of insulin so these are effective in those patients in whom functional tissue (ꞵ Beta cells of islets of Langerhans) are completely destroyed. They increase the peripheral utilization of glucose also as well as increasing sensitivity of tissue to insulin.

14. Drug examples & doses S. No. Drugs Doses Sulfonylureas 1 Chlorpropamide 250-500 mg OD 2 Tolbutamide 100-500 mg OD 3 Glibenclamide 2.5- 20 mg OD 4 Glipizide 2.5-5mg OD Biguanides 5 Metformin 500 mg orally BD or 850 mg OD (Max. dose 2550 mg/day) 6 Phenformin 200-400 mg BD orally. Thiazolidinediones 7 Pioglitazone 7.5 to 60 mg daily. 8 Rosiglitazone 4.8 mg daily.

15. Indications/uses Hyperglycemia/ Diabetic mellitus. Biguanides are used along with insulin and sulfonylureas to produce a better control of blood sugar. They also reduce body weight.

16. Adverse effects Hypoglycemia in overdose. Nausea/vomiting. Diarrhea/ constipation. Paresthesia's. Hypersensitivity. Jaundice due to chlorpropamide. Flatulence. Headache. Weight gain (due to sulfonylureas )

17. Contraindications/precautions Type – I DM. Pregnancy. Diabetic coma. Ketoacidosis. Lactations. Severe infections and trauma. Renal, hepatic and thyroid impairment. Special precautions with ꞵ (Beta) blockers. An after prolong period of exercise. Acute chronic metabolic acidosis. Acute and chronic diseases which may causes tissue hypoxia especially cardiac or respiratory failure. MI/Shock.

18. Drug interactions Concurrent use of antidiabetics with beta-blocker may produce sign and symptoms of hypoglycemia.

19. Nursing Responsibilities Monitor regularly blood glucose level. Assess adverse reactions during the therapy. Maintain I/O charts. Respiratory rate and the character of respiration should be checked and recorded. Avoid alcohol intake during drug therapy. Drugs should be administer just after food is taken.

20. Thyroid supplements Thyroid glands synthesizes two hormones (Thyroxine & tri-iodothyronine) these hormones are released due to the action of thyroid stimulating hormone (TSH) About 80 micrograms of thyroid hormones are secreted per day.

21. Mechanism of action These drugs control the metabolic rate of tissues and accelerate heat production and oxygen consumption. Synthetic thyroid hormones have the same physiologic effects as natural hormones, they result in T 3 activity and are used to replace hormonal deficit or suppress hormone production.

22. Drug examples and doses S. No. Drug Doses 1 Levothyroxine sodium (Synthroid) 25 – 125 mcg/day. 2 Liothyronine sodium 0.005 – 0.1 mg dose. 3 Thyroxine sodium 0.0005 – 0.5 mg daily 4 Thyroid USP 30 – 240 mg daily.

23. Indication / uses In primary and secondary hypothyroidism (including cretinism, myxedema) as thyroid hormone replacement. Hypothyroidism caused by functional deficiency. Partial and total absence of thyroid glands. May be used with antithyroid drugs to treat thyrotoxicosis to prevent goitrogenesis and hypothyroidism.

24. Contraindications/ precautions. Acute MI or thyrotoxicosis. Cautiously used in patient with heart disease, hypertension, diabetes mellites, myxedema or adrenal insufficiency.

25. Adverse effect Hyperthyroidism. Arrythmias. Nervousness. Heat tolerance. Weight loss. Decreased bone density. Tachycardia. Palpitations. Sweating. Insomnia. Headache. Partial hair loss.

26. Drug interactions They may increase the effects of anticoagulants. May impair the effects of ꞵ (Beta) blocker. May increase theophylline level.

27. Nursing Responsibilities Nurse should mind that administer thyroid hormone in morning to prevent insomnia. Instruct to the patient to take the drug 1hour before the meals and 2hour after the meals to improve drug absorption. Instruct to the patient to notify prescriber if headache, nervousness, diarrhea, or other unusual events occur. Teach the patient about the importance of complying with therapy. Caution the patient not to change brands of medication because potency may differ among brands.

28. Anti-thyroid Drugs – Thyroid Suppressants These drugs used in hyperthyroidism (thyrotoxicosis) when overproduction of hormone by the thyroid gland initially high dosages are required after few weeks when the patient is euthyroid, the dosages may be gradually reduced. Treatment should be continued for 18 months to reduce the chance of relapse.

29. Mechanism of action They inhibit T3 & T4 synthesis (Iodine). Also inhibit the synthesis of thyroid hormones (Propylthiouracil PTU and Methimazole). It limits thyroid hormone secretion by destroying thyroid tissue (Sodium iodide.

30. Drug examples and doses S. No Drugs Examples 1 Iodine Lugol’s iodine 2 Methimazole 15-30 mg daily 3 PTU (propylthiouracil) 50-300 mg daily 4 Sodium Iodide 0.70 to 100 Mci (Microcurie) in capsule form 5 Thyroxine 25-200 mcg daily.

31. Indications/uses Hyperthyroidism. Thyroid carcinoma. Use for thyroid blocking.

32. Contraindications/precautions Pregnancy and breast feeding. Hypersensitivity to iodides.

33. Adverse effects Iodine may cause hypothyroidism, diarrhea, hypersensitivity. Iodism (Characterized by abdominal pain, vomiting, rash, sore throat, salivary glands. Methimazole and PTU may cause nausea, vomiting, agranulocytosis and rash. Bone marrow depression, acute leukemia, anemia, radiation sickness, chest pain, itching, neck tenderness or swelling, cough, thinning of hair, may be occur due to intake of sodium iodide.

34. Drug interactions Hypothyroidism may occur due to use of lithium with iodine. Methimazole & PTU may increase the effects of anticoagulants.

35. Nursing responsibilities Nurse should give advise to the patient to take drug at consistent time 1 hour before or 2 hours after meals because food may affect drug absorption. Asses for signs and symptoms of overdose (hypothyroidism) and under dose (Thyrotoxicosis). Teach the patient to avoid such foods containing iodine and other products containing iodine. Advise to avoid aspirin and drugs containing iodine. Monitor the patients serum thyroid levels and thyroid function test results.

36. Anabolic Steroids These are synthetic androgens with strong anabolic and weak androgenic activity. They capable of building up proteins in bones and other tissues.

37. Mechanism of action They reverse catabolic or tissue depleting process and promote body tissue building process. Also they inhibit release of testosterone through inhibition of pituitary luteinizing hormone.

38. Drug examples & doses S. No Drugs Doses 1 Nandrolone decanoate (Deca- durabolin ) 50-200 mg injection 2 Oxandrolone 2.5 to 10 mg orally 2-4 times daily. 3 Oxymetholone 1-5 mg /per kg /day orally.

39. Indications/uses In chronic illness. To accelerate rebuilding to tissues. To promote growth in hypogonadal children and pituitary dwarfs. Carcinoma of breast in females. Oxymetholone is used to treat anemia. Oxandrolone is used to promote weight gain after weight loss from catabolic disorders such as surgery, trauma, arthritis, chronic infections, and osteoporosis.

40. Contraindications/ precautions Prostate cancer and breast cancer in male. Hypersensitivity. Hypocalcemia. Precautiously given to elder patients because they may be increase risk of development of prostate hypertrophy and prostate carcinoma.

41. Adverse effect Virilization, acne, are the most common adverse effects in females. Oligospermia, due to inhibition of testicular function. Chronic priapism. Change in libido. Hoarseness or deepening of voice. Edema and fluid retention. Nausea / vomiting. Gynecomastia. Impotence. Menses irregularities. Blood lipid changes. Diarrhea.

42. Drug interactions They may increase the effects of anticoagulants.

43. Nursing responsibilities Should warn athletes’ that the use of anabolic steroids to improve physical appearance or athletic performance is contraindicated and that adverse effects may be serious and irreversible. Should warn to men and women about these drugs adverse effects. Monitor glucose levels in patients with diabetes carefully because glucose tolerance may be altered in these patients.

44. Uterine stimulants (Uterotonics/Oxytocic's) Uterine stimulants or uterotonic’s are the drugs which increase the frequency and intensity of the contractions of uterus. These drugs are used to induce (start) or augment (speed) labor, facilitate uterine contractions following a miscarriage to induce abortion or reduce hemorrhage.

45. Mechanism of action They increase uterine motility by directly stimulating uterine and smooth muscle contraction.

46. Drug example and doses. S. No. Drugs Doses 1 Oxytocin 2-5 unit for induction, 10-20 units for controlling PPH. 2 Prostaglandin (Dinoprostone) 0.5 mg gel/3gm (2.5ml) 3 Ergot alkaloids Ergonovine maleate. Methylgonovine maleate (Methergine) 0.1 to 0.4 mg IV. 0.2 mg IM/IV/orally.

47. Indications / uses To treat PPH (postpartum hemorrhage). Induction of labor. Increase milk letdown reflex. For abortion.

48. Contraindication / precautions Maternal hypertension. Obstetrical emergency. Unfavorable fetal positions. Fetal distress.

49. Adverse effects Nausea / vomiting. Hypertension. Hypoxia. Brady cardia. Intracranial hemorrhage.

50. Drug interactions. Concurrent use with dopamine and other constrictors may increases peripheral vasoconstriction and may also called severe hypertension.

51. Nursing responsibilities Nurse should assess patients blood pressure, pulse rate urine output. Uterine contractions, vaginal bleeding. Monitor fetal heart rate. Know that oxytocin is given IV only when inducing labour. Know that hypocalcemia may decrease the patient’s response to ergot alkaloids so administer IV calcium if necessary.

52. Uterine Relaxants (Tocolytics) These drugs are useful to relax uterine muscle and decrease uterine contractions.

53. Mechanism of action They exert ꞵ (beta) adrenergic agonist effects on uterine smooth muscle thereby inhibiting uterine contractions.

54. Drug examples and doses S. No. Drugs Doses 1 Salbutamol 2.5- 7.5 mg orally every 6hr. 10-20 μ gm /min IV infusion. 2 Magnesium sulfate 1gm IM 6hrly (4doses) 3 Nifedipine 10-40 mg 4 Prostaglandin inhibitors (Indomethacin) 0.1 to 0.2 mg/kg IV dose. 5 Ritodrine 40 mg every 8hr. 6 Terbutaline 2.5-7.5 mg orally every 6h. 10-20 μ gm/min (Max 80 μ gm)

55. Indications/uses To prevent premature labour from 29-36weeks of gestation. At the risk of miscarriage. To delay or postpone labour.

56. Contraindications Ruptured membranes. Hypertension. Fetal distress. Pre-eclampsia. Abruption placenta. Pregnancy of less than 20 weeks.

57. Adverse effects Maternal effects are : Hypotension. Widening pulse pressure. Tachycardia. Electrolyte imbalances. Fetal effects are : Increase heart rate. Hypocalcemia. Hypotension.

58. Drug interactions Use of terbutaline with (ꞵ beta) adrenergic blockers affect uterine inhibiting action of terbutaline. Pulmonary edema may occur with combination use of corticosteroids and terbutaline.

59. Nursing responsibilities Nurse should place the patient in a left lateral recumbent position to promote venous return to the heart and decrease hypotension. Nurse should monitor the patient and fetus closely for adverse effects.

60. Oral contraceptives Oral contraceptive are prescription medications that prevent pregnancy contain hormones (estrogen and progesterone alone)

61. Mechanism action Hormonal birth control medications prevent pregnancy through the following ways. By blocking ovulations (Blockage the release of eggs from ovaries) By changing the endometrium (lining of uterus) so that if connect support a fertilized egg. By altering the fallopian tubes so that they cannot effectively more eggs towards the uterus. By altering mucus in the cervix which makes it hard for sperm to travel further.

62. Drug examples Estrogens : Ethynyl Estradiol. Mestranol. Progesterone: Norethynodrel. Norethindrone acetate. Norgestrel. Norethindrone. Desogestrel. Levonorgestrel (1500mcg one tb taken as soon as possible after unprotected intercourse up to 72 hours)

63. Adverse effects Dizziness. Light headed-ness. Bloating. Severe Depression. Headache. Stomach upset Nausea. Thrombophlebitis

64. Contraindications/precautions Preexisting cardiovascular disease, cautiously use in obesity and hypercholesteremia and in smokers.

65. Drug interactions. Rifampicin. Barbiturates. Phenytoin. Carbamazepine. These may decrease the effects of pills.

66. Nursing Responsibilities Nurse should obtain a complete health history including cigarette smoking and history to determine possible drug interactions and allergies. Assess cardiovascular status, including hypotension, history of MI, Cerebrovascular accident, or thromboembolic disease. Monitor for development of breast or other estrogen dependent tumors, estrogen may cause tumor growth or proliferation. Tablets should be taken approximately at the same time each day.

67. Spotting, bleeding may occur 1-2 first days of the cycle, if continue notify the physician. For the 21 day regimen, tablet is taken daily beginning on day 5 of the cycle (No tablet are taken for 7 days). For the 28 day regimen tablet are taken for the first 21 days following by 7 days of iron containing tablet. If a woman fails to take one or more tablets the following recommendations should be followed: 1. If 1 tablet is missed, it should be taken as soon as it is remembered alternatively 2 tablets can be taken the following day.

68. 2. If 2tablet are missed, 2 tablet can be taken each day for 2 days alternatively 2tablet can be taken on the day the missed tablets are remembered with the second missed tablet being discarded. 3. If 3 tablets are missed, a new medication cycle should be initiated 7days after the last tablet was taken & additional contraceptive method should be used until the start of the next menstrual period. 4. Advise the client if she develops pain in the legs or chest, dizziness to discontinue the therapy and notify the physician. Advise the patient prior to initiate therapy that there is high risk for cancer of breast. - Instruct the client to avoid smoking.

69. Other estrogens – Progesterone Preparations Estrogens: Estrogen is responsible for growth and development of vagina, uterus, fallopian tube and also secondary sexual characteristics, distribution of body fat and accumulation around hip and breasts growth of axillary and pubic hair.

70. Mechanism of action They stimulate the endogenous hormone to restore hormonal balance and treat hormone sensitive tumor.

71. Drug examples and doses: S. No. Drugs Doses Natural estrogens 1 Estradiol 1-5mg IM/0.45 – 2mg orally. 2 Estriol 0.1% vaginal cream, gel 3 Estrone Vaginal cream. Synthetic Estrogens 4 Mestranol 0.05 to 1mg od. 5 Hexoestrol 1mg once a week 6 Stilbestrol 0.025 mg transdermal.

72. Indication /uses To provide contraception. To control menopausal symptoms. To treat hormonal deficiency. In atrophic vaginitis. Breast cancer and Breast engorgement. During menopause. Menstrual conditions (Amenorrhea, Dysmenorrhea, Menorrhagia). To restore positive calcium balance in post menopausal osteoporosis.

73. Contraindications/ precautions Embolism. Breast Cancer. Pregnancy. Maternal hypertension. Thrombophlebitis. History of CVA. Obstetric Emergencies. Unexplained abnormal genital bleeding.

74. Adverse Effects. Nausea/Vomiting. Diarrhea. Weight gain. Edema and breast engorgement due to sodium and water retention. Development of endometrial carcinoma. Thromboembolic disorder. General malaise and dizziness.

75. Drug interactions Antibiotics such as penicillin's, sulfonamides, tetracyclines alter normal G.I. flora, decreasing the effect of estrogen. Estrogen decreases the effects of barbiturates anti-convulsions, antidiabetics and oral anticoagulants.

76. Nursing responsibilities Nurse should assess the patient for edema, blood pressure, weight and cholesterol and triglycerides levels. Nurse should warn the patient not to smoke while taking these drugs because smoking increases the risk of thromboembolism. Teach the patient about the importance of complying with therapy.

77. Other estrogens – Progesterone Preparations Progestins : Progesterone is the natural progestins. It is secreted by ovary and also synthesized by placenta, adrenals and testes.

78. Physiological functions of progesterone. Preparation of endometrium for implementation of fertilized ovum. Metabolic changes like increase in body temperature. Maturation and secretary changes of endometrium. Production of secretory endometrium and maintenance of pregnancy.

79. Mechanism of action. They stimulates the endogenous hormones to restore hormonal balance and treat hormone sensitive tumor.

80. Drug examples and doses S. No Drugs Examples 1 Progesterone 5-10mg IM for 8 consecutive days. 2 Hydroxy progesterone caproate - 3 Medroxy progesterone acetatic - 4 Ethisterone 20-75 mg as per requirement. 5 Nor ethisterone 2.5-10mg orally OD. 6 Norgestrel 30 mcg – 0.3mg.

81. Indications / uses. To treat habitual and threatened abortion. To relieve premenstrual tension. To treat dysfunctional uterine bleeding. To induce menstruation in amenorrhea. As an oral contraceptives. To regulate and restore menstrual cycle. Endometriosis.

82. Contraindication/precautions Embolism. Breast cancer. Pregnancy. Maternal hypertension. Thrombophlebitis. History of CVA. Obstetric emergencies. Unexplained abnormal genital bleeding.

83. Adverse effects Nausea / vomiting. Weight gain. Diarrhea. Edema and breast engorgement due to sodium and water retention. Development of endometrial carcinoma. Thromboembolic disorder. General malaise and dizziness.

84. Corticotrophins Assignment

85. Androgen They blocks the action of male hormones, thus act as a antiandrogens. They used in the treatment of female hirsutism and hypersexuality in the male.

86. Mechanism of action These are compounds which antagonize or inhibit the actions of androgen also they inhibit steroid 5 – alpha reduce which is an enzyme that converts testosterone into 5 – alpha – dihydrotestosterone (DHT)

87. Drug examples & Doses S. No. Drugs Doses 1 Nandrolone decanoate (Deca – durabolin ) 50 – 200mg injection 2 Oxandrolone 2.5 – 10mg orally 2to4 times daily. 3 Oxymetholone 1 – 5 mg/kg/day orally.

88. Indication / uses To treat BPH. Male hypersexuality. To treat androgenic alopecia. (Male pattern baldness)

89. Contraindications/precautions Hypersensitivity. Children. Women. Pregnancy.

90. Adverse effects Erectile dysfunction. Breast tenderness and enlargement. Hypersensitivity reaction. Decreased libido. Testicular pain.

91. Nursing Responsibilities Nurse should warn that women who are may become pregnant should not come in contact with crushed or broken tablets because of the risk to the male fetus. Warn men that they may have a decrease volume of ejaculate during therapy and impotence or decrease libido in female may occur.

92. Abortifacients – Drug used for Abortion A drug used to cause abortion is called abortifacients.

93. Mechanism of Action They compete with progesterone at the sites of progesterone receptors leads to inactivity of progesterone and termination of pregnancy ( Progesterone useful to maintain the pregnancy.)

94. Drug examples and doses S. No Drugs Examples 1 Oxytocin 2-5 units for induction, 10-20 unit for controlling PPH. 2 Prostaglandin (Dinoprostone) 0.5 mg gel/3gm (2,5ml) 3 Ergot alkaloids Ergonovine maleate. Methylgonovine maleate ( Methergine) 0.1 to 0.4mg IV. 0.2 mg IM/IV/orally.

95. Indications/uses To treat PPH. Induction of labour. Increase letdown reflex. For abortion.

96. Contraindications/precautions Maternal hypertension. Unfavorable fetal positions. Obstetrical emergencies. Fetal distress.

97. Adverse effects Nausea/vomiting. Hypertension. Hypoxia. Bradycardia. Intracranial hemorrhage.

98. Drug interactions Concurrent use with dopamine and other vasoconstrictors may increases peripheral vasoconstriction and also may cause severe hypertension.

99. Nursing responsibilities Nurse should assess patients blood pressure, pulse rate, urine output, uterine contractions, vaginal bleeding. Monitor fetal heart rate. Know that oxytocin is given IV only when inducing labor.

100. Gonadotropins – releasing Hormone (GNRH) GNRH is released from nerve cells in the brain. It controls the production of luteinizing hormone and the follicle stimulating hormone from the pituitary gland.

101. Mechanism of action They are gonadotropin-releasing hormone (GnRH) agonists that at first stimulate the release of pituitary gonadotropins, FSH & LH resulting an increase in steroidgenesis .

102. Drug Examples Gonadorelin. Goserelin. Histrelin acetate. Nafarelin acetate.

103. Indication/uses Endometriosis. Primary hypothalamic amenorrhea. Prostate cancer.

104. Contraindication/precautions. Drug hypersensitivity. Undiagnosed abnormal vaginal bleeding. Precautiously in pregnancy and breast feeding.

105. Adverse effects Headache. Nausea. Constipation. Vaginitis. Hot flushes. Vomiting. Emotional instability. Loss of libido.

106. Nursing Responsibilities Nurse should closely monitor cardiac status during Goserelin therapy. Nurse should monitor hydration status to prevent fluid loss from vomiting. Nurse should monitor blood and urine glucose levels because these drugs increase serum glucose levels. Monitor client’s knowledge level of proper administration (Incorrect use may lead to pregnancy). Nurse should encourage compliance with follow up treatment because follow up is necessary to avoid serious adverse effects. Eg. PAP’s smear, self breast exams, mammograms.

107. Adrenalin Assignments

108. Prostaglandin Prostaglandin released by mast cell in the body as a result of a number of stimuli like ( tissue damage, inflammation).

109. Mechanism of action They act as mediator of inflammation especially the prostaglandin of E series (PGE 2 ). It is responsible for inflammatory reactions. They also cause contraction of uterine muscles.

110. Drug examples & Doses S. No. Drugs Doses 1 Dinoprost 5 mg/ml injection from in 10ml, 30ml. 2 Dinoprostone 20 mg vaginal suppository

111. Indication / uses Induction of labour. Termination of pregnancy (abortion) To prevent closure of patent ductus arteriosus in new born. As a vasodilator in Raynaud’s disease. To treat erectile disfunction.

112. Contraindications/precautions Hypersensitivity to prostaglandins. Patient in whom oxytocic's are generally contraindicated. History of pelvic inflammatory disease. Renal and hepatic disease. Special precautions in pregnancies.

113. Adverse effects Temporary redness of face. Slow heart beat. Abnormally low blood pressure. Decreased blood platelets. Kidney problems causing a decrease amount of urine to be passed. Bloody urine.

114. Calcitonin's Calcitonin (Thyrocalcitonin) is a hormone produced by C cell in the thyroid gland. The main action of calcitonin is on the bone it is naturally occurring hormone. It helps to regulate calcium levels in the body and is involved in the process of bone building.

115. Mechanism of action It increases deposition of calcium and phosphate in the bone and lowers levels in the blood so it inhibit effectively calcium reabsorption by binding to specific receptor on the osteoclasts, and inhibit there action. In the kidneys it decreases the re-absorption of both calcium and phosphate on the proximal tubules. Its overall effect is to decrease the plasma calcium concentration. Secretion is determined mainly by the plasma calcium concentration.

116. Dose example Paget’s disease: SC Human 0.5mg/dl or 2-3 times/weak or 0.25mg/dl up to 0.5mg bid. Hypercalcemia: SC/IM salmon 4IU/kg 12h, may increase to 8IU/kg q6h if needed. Postmenopausal osteoporosis: SC/IM salmon 100IU/dl Intranasal 1spray (200IU) daily alternate nostril.

117. Indication / uses Used to treat Hypercalcemia and Paget's disease of the bone. Used in women with osteoporosis to help reduce bone loss. Calcitonin may relieve pain caused by spinal compression fractures.

118. Adverse effects Headache. Eye pain. Feverish sensation. Hypersensitivity reactions. Anaphylaxis. Urinary frequency. Chest pressure. Chills. Weakness. Paresthesia's. Tender palms & Soles. Dizziness. Nasal congestion. Shortness of breath. GI: Transient nausea. Vomiting. Anorexia. Unusual taste sensation. Abdominal pain. Diarrhea. Skin: Inflammatory reactions at infection site. Flushing of face & hands. Pruritis of ear lobes. Edema of feet. Skin rashes. Urogenital: Nocturia. Diuresis. Abnormal urine sediment.

119. Contraindication / precautions Hypersensitivity reaction to calcitonin and allergic to any ingredient in calcitonin – Solomon spray. Precautiously with pregnant or breast feeding. Cautiously used if taking any prescription or non prescription medicine, herbal preparation, or dietary supplement. Cautiously used in renal impairment osteoporosis, pernicious anemia, Zollinger-Ellison syndrome.

120. Drug interactions May decrease sr. lithium levels.

121. Nursing responsibilities Nurse should give following education. Use the subcutaneous route for self administration. Watch for redness, warmth or swelling at injection site and report to physician, as these may indicate an anti-inflammatory reaction. The transient flushing that commonly occurs following injection of calcitonin, particularly during early therapy may be minimized by the administrating the drug at bedtime. Consult physician. Maintain your drug regimen even though symptom have been ameliorated to prevent early relapses. Ensure that you feel comfortable using the nasal pump properly. Notify physician if significant nasal irritation occurs. Consult physician before using OTC preparation. Some super vitamins, hematinics & antacids contain calcium and vitamin D. (vitamin may antagonize calcitonin effects.

122. Calcium salts It is essential for maintenance of normal function og nerve, muscles, skeletal system and permeability of cell membranes and capillaries. Necessary for activation of many enzymes, contraction of cardiac, skeletal and smooth muscles, nerve impulses, respiration and blood coagulation. Normal calcium serum concentration is 9-10.2 mg/dl.

123. Dose example & doses S. NO. Drugs Doses 1 Calcium Carbonate 1.25 – 1.5gm 1-3 times daily 2 Calcium gluconate 500 – 2000mg orally 2to4 times a day.

124. Indication / uses Acute hypocalcemic tetany secondary to renal failure. Hypoparathyroidism. Premature infants. To treat depletion of electrolytes. During cardiac resuscitation. To reduce spasm (renal & intestinal) To relief sensitivity reactions of insect bite. Chronic Hypoparathyroidism. Osteoporosis. Osteomalacia. Ricket’s. Myasthenia gravis. Supplement for pregnant women.

125. Contraindication / precautions Digitized patients. Some renal & Cardiac patients. Cancer with bone metastasis.

126. Adverse effects Hypercalcemia characterized by lassitude. Skeletal muscle weakness. Renal calculi. Constipation and gastrointestinal irritation may occur. By IV route side effects are venous irritation, tingling sensation, feeling of heat chalky taste.

127. Nursing responsibilities Nurse should know that oral administration of drug given 1-1.5hr after meals because alkalis and large amount of fat decrease the absorption of calcium. Nurse should know if the client has difficulty in swallowing large tablets, obtain a calcium in water suspension by diluting the calcium in hot water then cooled by administration. Observe vital signs closely for evidence of bradycardia & hypotension during IV route. Prevent any leakage of medication into the tissue since it is extremely irritating. Rotate the injection sites if drug given by IM route. Obtain baseline renal function. In case of hypocalcemic tetany, provide safety precautions to prevent injury.

128. Calcium regulators Assignment

129. MTP – Medical termination of pregnancy. Abortion is the deliberate termination of pregnancy, most often performed during the first 28 weeks. Abortion is by definition a failure. Failure can be the result of mother’s lack of access to care, failure of the contraceptive method, failure to use contraceptive method, failure to use contraceptives or failure of the normal reproductive process leading to fetal anomalies, fetal death, or maternal illness.

130. Definition – Medical termination of pregnancy act. The MTP act enacted by the government of India came into force in 1972. under this, act termination of pregnancy is permitted within the framework of the law which requires certain condition.

131. Pre-requisite of the MTP MTP can be performed only by a registered medical practitioner qualifies to perform the operation. It can be undertaken only in the hospital or clinic duly recognized under the law. The MTP procedure can be performed only for specified indications up to 20 weeks of pregnancy. These include medical, eugenic, humanitarian and social ground.

132. Pre-requisite of the MTP (continued) In termination of pregnancy up to 12 week, the opinion of one registered medical practitioner is required. However to terminate a pregnancy between 12 to 20 weeks, it is mandatory to obtain the opinions of two registered medical practitioners. Written concerned of the patient aged 18yrs or above is valid. However in case of minors or persons of unsound mind, written consent of the guadian is required.

133. Methods of MTP in 2 nd Trimester Medical Methods : Extra amniotic installation. Ethacridine lactate (Emcredil) Hypertonic saline 20% Prostaglandins. Intra amniotic installation. Ethacridine lactate (Emcredil) Hypertonic saline 20% Urea, Mannitol. Surgical Methods : D&E (Dilation & Curettage) Aspirotomy. Hysterotomy.

134. References Dr. P.K. Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017, India, Pg no. 135 – 158. Dr. Suresh k sharma , Textbook of pharmacology, pathology & genetics for nurses, Jaypee pub. 2016 India Pg no 460 – 556. Tara v. Shanbhag , Smita shenoy , Pharmacology preparation manual for undergraduate, Elsevier pub. 2014. Pg no. 492, 361, 301 – 353. Shirish N. Daftary , Sudip Chakravarti Holland & Brews Manual of obstetrics, elsevier pub. 2005 India Pg no. 461. Govind s. mittal , Pharmacology at a glance, Paras medical book pub. 2009 India 24 – 30. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India 1 st edition, Pg no 171 – 196.