Transcript File

Reproductive System Drugs
OB will cover cover uterine relaxants, drugs to
induce labor & fertility drugs
Marylou V. Robinson PhD FNP
Drugs Affecting the Female
Reproductive System
1.
2.
3.
4.
5.
6.
7.
Contraceptives
Estrogen (Premarin)
Estrogen-progestin combos (EPT)
HRT
Medroxyprogesterone (Depro-Provera)
SERMs
IUDs
Cycle Overview (pg. 768)
Estrogen
•
Negative-feedback on ant. Pituitary
hormones luteinizing hormone (LH)
& follicle-stimulating hormone
(FSH)
• Rapid peak in LH causes
ovulation in middle of cycle
(between follicular & luteal
phases)  quick LH  to nl
post-ovulation
• Makes ruptured follicle
(corpus luteum) make
progesterone
•
FSH makes follicles produce
estrogen in follicular phase 
estrogen  causes FSH 
Progesterone
•Increases mostly during
luteal phase while being
made by corpeus luteum
•fertilized ovum implant
doesn’t occur  corpeus
luteum atrophy  
progesterone & estrogen
production
•menses (approx. days 1-5
of 28-day cycle)
• secretions but makes
them more viscous and
difficult for sperm to travel
thru

Estrogens (pg. 769), KNOW
• Premenopausal women: most estrogen (also progesterone)
production occurs in ovaries (post-menopausal, decline then
production cessation in ovaries)
– Small amounts made in peripheral tissues: liver, fat, bone (also
placenta w/ progesterone during pregnancy)
– Also affects bone, blood vessels, liver, heart & CNS
– Main endogenous estrogen = estradiol (others include estrone &
estriol)
– Synthetic estrogens identical to endogenous ones
• Function: female maturation, female reproductive organs,
metabolic actions
• Action:  synthesis of DNA, RNA & protein in estrogensensitive tissues
– Na and water retention,  cholesterol

Approved Estrogen Uses (pg. 776)
1.
2.
OCPs: estrogen thickens cervical mucus barrier &  vaginal acidity to block
fertilization, also exerts negative feedback on LH & FSH (prevents follicular
maturation & ovulation)
Menopause HRT (estrogen deficiency, Turner’s): manage vasomotor symptoms
(hot flush, night-sweat) that don’t go away w/in first few months
– most common non-contraceptive use
– Short-term safe, long-term use discouraged D/T risks
3.
Urogenital atrophy: urethra/vagina have highest concentration of estrogen
receptors
– Degenerate post-menopause when estrogen 
– Urethra: incontinence, urinary frequency
– Vagina: dryness, pain w/ intercourse  topicals preferred (lower estrogen blood
concentrations
4.
Osteoporosis (secondary) PPX:  risk after ovarian removal or menopause, when
estrogen  accelerates bone reabsorption  12% bone loss shortly after
menopause 
– Estrogen can moderately slow bone reabsorption & osteoporosis, doesn’t really reverse
bone loss & stopping estrogen HT will just cause the 12% bone loss to happen anyway
– Osteoporosis drugs work better and are generally safer
– NEVER GIVE THESE FOR BONE HEALTH ALONE (TOO MANY SE)

Estrogen SE
• Stomach cramps or gas
• HA, n/v (less with non-PO routes and/or taken w/ food
or HS)
• Some women: migraines somewhat during ovulation D/T
estrogen 
• decreased libido
• Fluid retention: edema of LE (lower extremity), breast
pain & enlargement  also WEIGHT GAIN (5 lbs) 
• Estrogens activate RAAS  possible bloating, weight gain, HTN

Cautions with Estrogen
• Risk of endometrial CA with prolonged use: estrogens cause
endometrial proliferation/hyperplasia when used alone (in women w/
uterus) may become CA (esp. post-menopausal women)
• Hormone combos greatly  risk: progesterone opposes estrogen-caused
hyperplasia & decreases endometrial proliferation
• Admin: assess for endometrial carcinoma if “benign” bleeding persists pasts
first 6 months of TX or begins after prolonged use
• Somewhat-similar to breast cancer: they’re both estrogen-sensitive tissues
• Should not be given to lactating women ( milk production)
• Could also feminize male babies or cause severe acne & development of
secondary sex characteristics in female babies
• Preg Cat X: not dangerous but useless during pregnancy
• Baseline liver labs before therapy: benign hepatic adenoma risk w/ OCPs
(can still rupture & cause fatal bleeding)
• Also drug use or Hepatitis concerns
• Increases lipid levels: LDL
• Increases heartburn/GERD: relaxes cardiac sphincter
• Increases gallbladder stones: risk of cholecystitis D/T chronic gallstones
greatest in postmenopausal women on HRT > 5 years
• Estrogen & OCPs precipitate gallstones & gallbladder disease already present

Estrogen & CV Risk
•  CV risk: R/T MI, CVA, DVT & pulmonary embolism
– Not PPX: doesn’t slow atherosclerosis or prevent recurrent CVA
– Pt Edu: avoid smoking, exercise regularly, avoid saturated fats,
follow treatments for maintenance of
HTN/DM/hypercholesterolemia
• Coagulation tendencies: estrogen  coagulation-suppressing
factor antithrombin &  levels of clotting factors II, VII, IX, X &
XII
– Only somewhat  levels of factors that break down fibrin in clots
– Combos  venous thromboembolism (VTE) risk in pre/postmenopausal women
– Estrogen alone  risk of MI or CHD in women > age 60
• Tobacco: smoking  risk of serious cardiac events (CVA, TIAs,
thromboembolism, pulmonary embolism)
– Absolute contraindication: risk is higher in women > 35 years of
age
– Estrogen is #1 cause of strokes in women < age 35

Estrogen Contraindications
• Known or suspected BCA: estrogen hasn’t been shown
to cause BCA but promotes estrogen-receptor BCA
cancer growth
– more dose-dependent & R/T older age
– R/O ER-BCA before RX, annual breast exam, annual
mammogram > age 40
• Abnormal vaginal bleeding, endometriosis, uterine
fibroids
• Hypercalcemia (estrogens may  mineral deposits)
• Thrombophlebitis or hx of VTE or pulmonary embolism

Estrogen Preparations
• Estradiol and estrone are natural occurring steroidal estrogens
• Conjugated estrogen (Premarin): natural formulation but
processed (most common)
• Diethylstilbesterol (DES): synthetic estrogen
– Preg Cat X: causes clear cell carcinoma (rare vaginal cancer) in
women who had fetal exposure, off-market
– Male children have risk of testicular cancer
• Transdermal estrogen (Estraderm)
• Vaginal creams
• Compounded mixtures: made by hand into individualized
estrogen mixture (typically topical, also PO)  not
standardized tho
• Synthetic estrogens typically identical, but natural estrogen
may have fewer SE (recent research)

Progesterone and Progestin
• Prototype: progestin
• Action
– Pro-gestational: produce biochemical
changes in the endometrium to prepare for
implantation of embryo (also maintain
uterus during pregnancy)
– Opposes estrogen-mediated endometrium
stimulation
– Suppresses ovulation during pregnancy
– Can increase appetite

Progestin
• Indication
– Female hormonal imbalance
– Amenorrhea, dysmenorrhea, endometriosis
– Combined with estrogen to lower risk of endometrial Ca
– Prevent pregnancy in lactating women (can’t give them
estrogen)

Oral Contraceptives
• Newer, low-dose OCPs have:
– Lower risk for adverse CV effects (stroke,
thromboembolus)
– Decreased risk for ectopic pregnancy
• Low dose formulations are for the thin
teenager.
– Most older and heavier folks they are not as
effective (possibly D/T  blood levels,
sequestration in adipose, altered metabolism)

OCPs
• Estrogens and progestins (various
manufacturers)
• Action
– Inhibit secretion of FSH and LH
– Changes in endometrium that impair ova
implantation
– Increased vaginal mucus to impede passage
of sperm

OCPs
• SE
– Wt Gain,
– Stomach cramps,
Swelling of Face and LE
– HA (esp. aural
migraines)
– Mood alteration
– Gall stones
– Increased clotting
Amenorrhea,
Breakthrough Bleeding,
Menorrhagia,
Acne (androgens)
Insomnia,
Breast Pain,
Increased risk STD
(behavior & more
viscosity can trap STDs
– Hyperglycemia
–
–
–
–
–
–
–

Benefits
• protection against pregnancy
– 98% best use
– 70% in many women
– Less than 50% in teens
• ovarian cysts suppression (PCOS): very painful condition
• iron deficiency anemia resolution ( OCs  heavy menstrual
bleeding   blood loss)
• reduced rheumatoid arthritis (D/T  immune system?):
women feel better w/ RA when pregnant (same as OCPs)
• higher bone density ?

Estrogen-progestin Combos
– Monophasics: fixed ratio of estrogen and progestin that is
taken for 21 days
• Alesse-28, Ortho-Cyclen, Lo-Ovral
– Biphasic: supplies 2 different amounts of progestin during
the first (follicular) and second (luteal) phases of the
menstrual cycle
• Ortho-Novum
– Triphasic: dose of estrogen is constant while progestin is
progressively increased (three times) for 21 days
• Ortho-Novum 777, Triphasil, Ortho-Tri-Cyclen

Extended Cycle (Seasonale meds)
• Take for 3 months/withdraw for period
(only 3 days off meds)
• Lots of break through bleeding  most
don’t get to 3 months without sudden
onset menses
• Best suggestion is when have bleeding, do
withdraw and then start on own schedule.

Something about those pills
• What is different about YAZ (pg. 788)?
– What diuretic drug is it similar to?
• Yaz = drosperinone + ethinyl estradiol
• Drosperinone: 4th gen progestine & structural analog of
spirolactone (blocks aldosterone), added to  OC fluid retention
– What are the risks?
• Drosperinone also K-sparing (hyerkalemia)  caution using w/
other hyperkalemia-associated drugs (ARBs, ACE inhibitors)
• Greater risk of VTE than other progestins
• What is the link between OCP and glaucoma?
– Raise blood pressure, sodium & water retention (greater
risk for life, along with cataracts)

Rings and Things
• Rings (NuvaRing)
– Insert for 3 weeks  remove for menses
– Clear to the eye
– If fall out, rinse and re-insert (need back-up contraception for
7 days if ring is out > 3 hours during weeks 1-3)
– Better for “discrete” birth control over OCPs
• Patches
– Changed weekly. Three in a box
– Can’t place on breasts (adipose tissue or breast tissue
stimulation): higher BCA risk
– Need back-up contraception for 7 days if patch is off > 24
hours during weeks 1-3)
• Both have higher risk for clotting than pills ( higher
estrogen exposure needed for other routes)

Other Contraceptives
• Low-dose progestogens (mini-pill): do not contain estrogen
- less effective/forgiving (don’t inhibit ovulation as well), most when
just starting these
– Breastfeeding AOK (progestin don’t  milk production)
• Long-acting: progestin-only
– Implanon (capsule implanted in arm)
– Depo-Provera (IM injection q 3 mo)
– IUD (with and without med), pg. 796
– SE: vag bleeding, muscle pain, GI distress, wt gain,
vaginitis, breast discharge

Medroxyprogesterone (Depro-Provera), pg. 796
• Long-acting OC (progestin-only): protects against pregnancy for ≥ 3
months
• Admin: IM (also SQ) q 3 months
– Discontinuing TX delays fertility by ≈ 9 months (up to 2-3 years)
– Starting TX: give during first 5 days nl menses or w/in first 5 days postpartum (if not breastfeeding)/ w/in first 6 weeks post-partum if
breastfeeding
• Mechanism: inhibits gonadotropin secretion
– Inhibits follicular maturation & ovulation
– Thickens cervical mucus
– Thins endometrium  egg implantation less likely
• SE: similar to other progestin-only TX (bloating, HA, depression, 
libido)
– No significant cervical/breast/ovarian CA risk
– Highly bone-bleaching: may cause reversible bone loss, but regular bone
marrow density scans (BMDs) aren’t recommended  need more dairy
& calcium supplements (this is less mitigated as age increases)

Education
• Compliance is important: choosing the right birth control
depends on effectiveness, safety & personal preference
- Patient: life may begin at conception instead of implantation
• Take tablets at the same time every day
– Miss 1 dose: take ASAP
– Miss 2 doses: take 2 tabs/day for the next 2 days
– Miss 3 doses: stop taking, use another form until menses occurs or
pregnancy R/O
– Last 7 tablets are placebo in traditional packs
– Newer branded are only 3-4 days placebo

IUDs (pg. 796)
• Long-term OC
– Copper T380A (Paraguard): doesn’t release meds
– Levonorgestrel-releasing (Mirena): used esp. for menorrhagia (heavy menstrual
bleeding)
– Potentially good option for at-risk teens (less issues of compliance)
• Mechanism: harmless local inflammatory response (spermicidal), does not
prevent ovulation
– Paraguard copper may also prevent implantation (also EC when placed w/in 5
days unprotected sex)
– Mirena endometrial involution & thickening of mucus
• Placed w/in 7 days menses onset: lidocaine & ibuprofen can prevent
cramping
• SE: abd cramping, altered menses (more local, less systemic [lower bone
loss?])
– Paraguard:  monthly bleeding
– Mirena: commonly amenorrhea or light spotting
– PID secondary to STD: only use in women at low risk of STIs (monogamous
couples)
– Greater risk ectopic pregnancy

Mifepristone (RU-486) [Mifeprex] pg. 799
• Progesterone Antagonist (abortifacient): given with misoprostol to stimulate
uterine contraction and aid in expulsion of the tissue dislodged (fetus or
excessive lining)
– Used w/in first 7 weeks of conception
– Safe alternative to surgical abortion
– Also the most effective known emergency contraceptive EC when taken w/in 5
days after sex, but not approved for EC
– MD giving Mifeprex has to be able to perform surgical abortion or curettage
(surgical tissue removal from uterus) if abortion fails
• Abortion requires 3 visits to MD:
– Day 1: get pill
– Day 3: ultrasound to determine if abortion occurred (re-admin Mifeprex if it
didn’t)
– Day 14: ultrasound to confirm pregnancy’s termination (surgical abortion if it
didn’t)
• Bleeding can be severe and require transfusions
– Cannot be used in patients w/ tubal (ectopic) pregnancy, hemorrhagic disorders
or anticoagulant drugs
– Bleeding caused by Mifeprex could mask symptoms of these serious conditions

Levonorgestrel (Plan B), pg. 797
most commonly used ECP
• Levonorgestrel: progestin
• Separate RX or use of pills on hand (formula by
pharmacist)
• Large dose impairs implantation of fertilized egg
– Must be taken w/in 5 days after unprotected sex
– Successful if menstrual bleeding occurs w/in 21 days
– “large dose” still for “avg woman” ≤ 120 lbs
• Doesn’t abort implanted eggs
– Pregnancy = implantation of fertilized egg
• Spike in clotting risks: not recommended for routine use
• No Rx in most states for women ≥ age 17

Why don’t we use indomethacin (Indocin) in
later pregnancy?
• Closes ductus arteriosis in fetus (inhibits prostaglandin synthesis)
• Normally blood goes around fetus’ lungs during pregnancy
• Infants with patent ductus arteriosus (PDA) didn’t have valve
close between aorta & pulmonary artery  indomethacin is used
on them to fix PDA
• NL use: NSAID & antirheumatic
• NSAIDS BAD 4 PREGNANCY

Post-Menopause (pg. 771)
• Estrogen can be used for hot flashes & bone health
– MUST have progestin if have uterus
• SSRI & SNRI have hot flash indication (paroxetine or
venlafaxine):  vasomotor S/S in post-menopause by 
CNS serotonin
• Herbals have no evidence of helping
• Selective estrogen receptor modulator (SERM) [covered
with MSK]: can help with bones (activates estrogen
receptors) & lipids
– Tamoxifen (Nolvadex): can inhibit (cancerous) breast growth
by blocking estrogen receptors
– Blocking estrogen receptors leads to  hot flashes 
– Also has  risk of endometrial cancer & VTE

Clomiphene (Clomid)
• Ovulation Inducer: Preg Cat X
• Use: Induces ovulation in anovulatory women
who desire pregnancy. Requires intact anterior
pituitary, thyroid, and adrenal function.
• Mechanism: Stimulates release of pituitary
gonadotropins, follicle-stimulating hormone,
and luteinizing hormone, resulting in ovulation
and the development of the corpus luteum.
ospemifene (Osphena)
• SERM-like medication (not actually SERM):
hormone, estrogen agonist/antagonist
• Same estrogen issues:
– potential uterine cancer
– Cannot take with hx of blood clots, CA
–  risk HD: cigarette smoking, high BP, high cholesterol,
diabetes, and being overweight during estrogen therapy
• DM patients esp. as risk for clots!

Male Hormonal Meds
1. 5-Alpha reductase inhibitors (Proscar)
2. Phosphodiesterase inhibitors (Viagra)
3. Testosterone (Ch. 65)

Androgens
• Male sex hormones necessary for
development of male sex characteristics
• Primarily testosterone
• Can be given to women with low levels to help
with libido issues
– Bad acne

Testosterone
• Naturally occurring, produced in testes
• Synthetic testosterone in various forms
• Action
– Stimulates synthesis and activity of RNA
– Potent anabolic agents that increase muscular
and skeletal proteins
– Enhanced storage of phosphorus, sulfate,
sodium and potassium

Testosterone
• Indication
– Main: Androgen deficiency, hypogonadism
• Androgen deficiency: S/S & testosterone blood levels < 220 ng/dL
 adjust to mid-normal range (300-450 ng/dL)
• Might reverse ED
– Delayed male puberty
– Treatment of anemia (stimulates erythropoiesis), no strong
impact
• NOT used for infertility, prostate cancer or nodules, HF
• Abuse potential: illegal use for wt gain, muscle
development and strength
– Most androgens Schedule III

Testosterone
• Administration: PO, IM, patches
• SE: Abd pain, insomnia, dizziness, red skin, HA, N/V/D,
depression, pruritus, jaundice (hepatotoxic), libido 
– Females
• Acne, deepening of the voice, increase hair growth or alopecia,
enlarged clitoris, irregular menses
• Androgens can injure female fetus (masculinization)
– Males
• Urinary urgency, gynecomastia, frequent erections
• Salt & water retention may lead to edema
– Children: premature epiphyseal closure (radiograph
hands/wrists biannually)

Testosterone Therapy
• Caution
– Causes fluid retention and hypercholesterolemia 
use carefully w/ cardiac issues or renal disease
•  HDL &  LDL
– DDI: anticoagulants ( warfarin levels)
– May cause prostate enlargement and worsen BPH
– Makes hypercalcemia secondary to metastatic Ca
worse
• Testosterone can promote PCA growth that’s started

Testosterone Therapy
• Baseline ht, wt, and sexual develop. in
children, bone age determination q6mo
• Monitor serum calcium, cholesterol levels,
LFTs, H & H for polycythemia
• Monitor tumor growth
• Older men, monitor for signs of BPH

BPH (pg. 839)
• Prototype: finasteride (Proscar), a 5-Alpha-Reductase Inhibitor
• Action: blocks enzyme that converts testosterone into potent
androgen (DHT) by 70%  causes shrinkage of prostate epithelial
tissue  mechanical obstruction of urethra (results in 6-12 months)
– Doesn’t  blood testosterone levels
– Goal:  urinary symptoms & slow disease progression
– Taken for life
• Use: preferred for men w/ very large BPH (mechanical
obstruction, more epithelial tissue)
– alpha blockers (antihypertensives) for smaller BPH, relax bladder
smooth muscle to  dynamic obstruction (no effect on BPH size)
– Saw palmetto ineffective for BPH
– Finasteride also made as Propecia, used for male-pattern baldness

Finasteride (Proscar) SE
• SE:  libido, impotency, decreased amount of ejaculate,
gynecomastia
• Proscar  PSA (prostate-specific androgen) levels, get baseline
test
– Consider possible prostate cancer if PSA doesn’t  after 6 months
of therapy
• Preg Cat X: alters fetal development of male genitalia
(hypospadias), smaller prostate & seminal vesicles
– Women pregnant with male fetus should not handle the drug
– Manufacturer recommends women who might get pregnant not
handle drug without gloves (can be absorbed thru the skin)

Drugs That Impair Libido and Sexual
Gratification
• Antihistamines
• Anticholinergics
• Antihypertensives
(BB, CCB, diltiazem)
• Antianxiety and
psychotropic drugs
• Antidepressants
• Antifungals
• Opioids
Thiazide diuretics
ETOH
Barbiturates
H2 receptor
antagonists
(cimetidine,
ranitidine)
• Hormones
•
•
•
•

Drugs That Enhance Libido & Sexual Gratification
• None specifically approved but there are substances
that temporarily modify physiologic responses and
perception of enjoyment
• Numerous aphrodisiacs have been tried:
– Cantharis (Spanish fly)
– Yohimbine (from West African tree)
– Opioids: morphine, heroin, cocaine, marijuana, LSD
– Amyl nitrite
– Alprostadil (prostaglandin): injectable into corpus
cavernosus

ED Drugs (pg. 834)
• Prototype: sildenafil (Viagra)
– Phosphodiesterase Type 5 (PDE5) inhibitor
– 1st approved PO drug for ED, 1st-line ED TX
– Not an aphrodisiac
• NL: arousal  PNS  local nitric oxide  nitric oxide
activates cyclic guanosine monophosphate (cGMP)  relaxed
arterial/trabecular smooth muscle  arterial dilation  local
blood flow &  BP  expanded corpus cavernosum 
venous occlusion &  venous outflow  erection
– Goes away when cGMP is removed by PDE5 (enzyme converts
cGMP  guanosine monophosphate)
• Action:  levels of cGMP, a smooth muscle relaxant  inflow
of blood & erection
• Indication: impotence (ED)
– Also pulmonary arterial HTN (PAH)
• Administration: 1 hr before sexual activity (t ½ 4 hours)

Viagra
• SE: HA, nausea, facial flushing, nasal congestion, back pain, flu syndrome, arthralgia,
allergic rxn, priaprism
– Cardiovascular sx (angina, tachycardia, hypotension): could be Viagra (huge vascular
shifting) or sex activity
– Visual changes at higher doses (blurring, blue tint, photosensitivity), nonarteritic Ischemia
Optic Neuropathy (NAION) also possible when blood flow to optic nerve’s blocked (esp. in
men w/ anatomic or vascular risk factors)
• Contraindication: concomitant use of organic nitrates, alpha blockers, CYP3A4
inhibitors
– Nitrates (NTG, nitroprusside): also promote vasodilation via cGMP (nitrates  synthesis &
Viagra slows breakdown), could cause fatal hypotension  must wait 24 hours between
Viagra & nitrate, more if Viagra was taken w/ a CYP3A4 inhibitor that slows elimination
– α-andrenergic blockers: dilate arterioles &  BP combined effect causes significant
postural hypotension
– CYP3A4 inhibitors (also hepatic/renal impairment): ketoconazole, erythromycin,
cimetidine, grapefruit suppress metabolism &  levels
• Education
–
–
–
–
–
Delayed response if taken with high-fat meal (slows liver metabolism, absorption)
Increase fluids to 2000 mL per day can prevent UTI
Seek immediate TX for chest pain, palpitations, sudden sharp HA
Report visual changes “blue”
Seek immediate TX if erection > 4 hours

Other ED meds
• Varendafil (Levitra), pg. 837: similar to Viagra
– Also requires no alpha blocker meds
– DDIs w/ CYP3A4 meds (grapefruit)
• Taldalafil (Cialis), pg. 838: lasts much longer than
Viagra or Levitra
– Provides coverage for 36 hours, therapeutic levels in 2
hours
– Most men use it within 4 hours
– Now available in daily dosing for more spontaneous
lifestyle (only if “get lucky” ≥ 2x/week

Drugs Used in Renal Disease
kidneys = major organ for drug elimination
• Renal dose adjustments: made w/ CCr (creatinine
clearance) or measuring certain drugs’ blood
levels

Multiple Drugs
• Epogen (ethrythropioetin): anemia reversal
• Bind excess phosphates (PO43-) that accumulate in renal
disease
– Aluminum hydroxide (also antiulcer, antacid): binds to phosphate in GI
tract, but has aluminum absorption over time
– Calcium Acetate: binds to excess phosphate & excreted
• Vitamin D supplementation: Calcitriol (Rocaltrol), CKD patients
can’t convert Vitamin D to active form
– Helps body absorb phosphates & calcium from blood instead of
dissolving it from bone or over-compensating PTH
• Diuretics (loop & osmotic): help with fluid balance
• Sodium bicarbonate for acid-base imbalance (metabolic
acidosis): will make basically all drugs inert cement (not work)
– Given IV: binds most other drugs and cannot be mingled in the line
– Encourages severe salt and water retention
– sodium overload (CV workload), gastric acid hypersecretion

Hyperkalemia Issues*
• Serious cardiac risks of rhythm issues
• Spiked T waves on EKGs, possible cardiac arrest
• Confusion, anxiety, paresthesias

Cation-Exchange Resin
• Prototype: sodium polystyrene (Kayexalate)
– Proven to not work!!!!!!
• Indication: elevated serum potassium levels
• Action: given as enema
– Exchanges sodium ions for potassium ions
– K+ binds to the substrate  eliminated via feces
• What can happen to the VS of a patient with vagal
issues (enema)? HR will drop.
– Vagus nerve innervates PNS below neck, i.e., lung, heart,
abd viscera
– Stimulation: bradycardia & arrhythmia

Hyperkalemia Interventions
• Stop K sources of any drugs: K-sparing diuretics &
KCL supplements
• Infuse insulin + glucose to promote uptake into cells
• If acidotic might use NaHCO3 (sodium bicarb.)
• Dialysis
• New drug just approved 11/2014
