Transcript Chapter 13 lesson 3 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
13
Gynecologic and Obstetric
Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. Describe what drugs are used to treat
endometriosis, dysmenorrhea, and abnormal
menstruation.
2. Describe the types of drugs used to treat
vaginal infections and sexually transmitted
diseases.
3. When given the name of a well-known OBGYN generic drug, identify its trade name.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
4. When given the generic and trade names of
an OB-GYN drug, identify what drug
category it belongs to and what disease it is
used to treat.
5. When given an OB-GYN drug category,
identify several generic and trade name
drugs in that category.
6. When given an ending common to several
generic drugs, identify the related drug
category.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Postpartum
Bleeding
• After delivery of the baby and placenta,
the uterine muscle contracts strongly.
 Closes blood vessels from the site of
placental separation
• Postpartum bleeding
 Due to uterine relaxation or atony
 Results in increased bleeding at the site
of placental separation
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Postpartum
Bleeding
• Drugs stimulate the uterine muscles to
contract.




Carboprost (Hemabate)
Oxytocin (Pitocin)
Ergonovine (Ergotrate)
Methylergonovine (Methergine)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Postpartum
Depression
• Hormonal changes of pregnancy and
delivery can cause depression in some
women.
• Drugs discussed in chapter 16
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Endometriosis
• Endometrial tissue
 From the uterus travels through the
fallopian tubes
 Implants on the outer surfaces of:
• Ovaries
• Abdominal organs
• Walls of the pelvic cavity
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Endometriosis
• Endometrial tissue
 Sloughs off during menstruation
• Forced upward through the fallopian
tubes by uterine contractions (because of
a retroflexed position of the uterus),
instead of downward through the cervix
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Endometriosis
• Endometrial tissue
 Remains alive and sensitive to hormonal
changes
 During each menstrual cycle
• Tissue thickens then sloughs off.
• Forms more implants in the abdominal
cavity along with old blood and tissue
debris
• Forms adhesions between abdominal
organs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Endometriosis
• Endometriosis causes:
 Pelvic pain and inflammation
 Cyst formation on the ovaries
 Blockage of the fallopian tubes
• Hormone drugs
 Used to suppress the menstrual cycle
for several months during which time
the endometrial implants shrink and
fade
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Endometriosis
•
•
•
•
•
Danazol
Goserelin (Zoladex)
Leuprolide (Lupron Depot)
Nafarelin (Synarel)
Norethindrone (Aygestin)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Did You Know?
• Danazol is also used to treat fibrocystic
breast disease, precocious puberty, and
gynecomastia in males.
• Goserelin is also used to treat breast
and prostate cancer.
• Leuprolide is also used to treat uterine
fibroids.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat
Dysmenorrhea
• Dysmenorrhea
 Painful menstrual cramps
 Caused by an increase in prostaglandins
 Cause the uterus to contract painfully
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat
Dysmenorrhea
• Treated with:
 Over-the-counter or prescription
analgesic drugs (nonsteroidal antiinflammatory drugs)
 COX-2 inhibitor drugs that inhibit the
action of prostaglandins
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat
Dysmenorrhea
•
•
•
•
•
•
•
Celecoxib (Celebrex)
Diclofenac (Cataflam, Flector, Voltaren)
Ibuprofen (Advil, Motrin)
Ketoprofen
Meclofenamate
Mefenamic acid (Ponstel)
Naproxen (Aleve, Midol Extended
Relief, Naprosyn)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Premenstrual
Syndrome
• Premenstrual syndrome (PMS)
 Characterized by:
•
•
•
•
Dysmenorrhea
Breast tenderness
Edema from fluid retention ("bloating")
Mild mood changes
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Premenstrual
Syndrome
• Premenstrual syndrome (PMS)
 Treated with combination drugs that
contain:
• Analgesic drug for dysmenorrhea
• Diuretic drug to treat fluid retention
• Antihistamine with a weak diuretic effect
and sedative effect
 Over-the-counter trade name drugs
include Midol.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Premenstrual Syndrome Video
Click on the screenshot to view a video on the topic of PMS.
Return to Directory
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Midol is a well known, over-the-counter
trade name drug for treating
dysmenorrhea.
• However, it is important to note that
different trade names of Midol actually
contain different generic drugs.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drug Alert
• Midol Maximum Strength Cramp
Formula contains the analgesic drug
ibuprofen.
• Midol Extended Relief contains the
analgesic drug naproxen.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Midol Maximum Strength Menstrual,
Midol Maximum Strength PMS, and
Midol Teen Maximum Strength are
combination drugs that contain the
analgesic drug acetaminophen and a
diuretic drug to decrease edema.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used To Treat Abnormal
Menstruation
• Amenorrhea (the absence of
menstruation)
• Menorrhagia (abnormally heavy
mensturation)
• Progesterone drugs act directly on the
tissues of the endometrium to restore a
normal menstrual cycle.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used To Treat Abnormal
Menstruation
• Medroxyprogesterone (Provera)
• Norethindrone (Aygestin)
• Progesterone (Crinone)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
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Drugs Used to Treat Vaginal
Infections
• Applied vaginally
• Manufactured in the form of:
 Creams/ointments
 Suppositories
 Vaginal tablets
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Yeast infections
 Caused by Candida albicans
 Infection is known as candidiasis.
 Cause white discharge with vaginal
itching
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Vaginal yeast infections
 Treated with these over-the-counter
drugs:
• Butoconazole (Gynazole-1, Mycelex-3)
• Clotrimazole (Gyne-Lotrimin, Mycelex)
• Miconazole (Monistat 3, Monistat 7,
Vagistat-3)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Vaginal yeast infections
 Treated with these over-the-counter
drugs:
•
•
•
•
Nystatin
Sulfanilamide (AVC)
Terconazole (Terazol)
Tioconazole (Monistat 1, Vagistat-1)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Many drugs used to treat candidiasis
end in the suffix –azole.
• Many antifungal drugs also end with
this suffix because yeast and fungi are
closely related.
 Drugs that are effective against one
often are effective against the other.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• Did you notice that the trade name
drugs Monistat 3 and Monistat 7 are
listed with the generic drug miconazole,
but the trade name drug Monistat 1 is
listed with the generic drug
tioconazole?
 This can be a source of confusion.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• The generic drug tioconazole is a
stronger antifungal drug than
miconazole, and only one day of
treatment is needed as compared to
three or seven days of treatment with
miconazole.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drug Alert
• The drug company that manufactures
Monistat chose to keep the same trade
name on all these products (even
though the generic drugs are different).
• The same is true for the drug company
that makes Vagistat.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 13–10 Miconazole (Monistat 3). This topical antiyeast drug is a cream that is
inserted into the vagina by means of an applicator tube. The patient applies one dose
vaginally for three consecutive days to treat a yeast infection. Other antiyeast drugs
require seven days of treatment (miconazole [Monistat 7]) or just one day of treatment
(tioconazole [Monistat 1]).
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Did You Know?
• Nystatin was discovered in 1950 by two
physicians who named the drug for
their employer—the New York State
Department of Health.
• Nystatin is given vaginally to treat
vaginal yeast infections; it is also given
orally ("swish and swallow") to treat
yeast infections in the mouth and
throat (oral candidiasis).
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Bacterial vaginal infections (bacterial
vaginosis)
 Caused by several different bacteria,
including:
• Haemophilus
• Gardnerella
• Corynebacterium
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Vaginal
Infections
• Bacterial vaginal infections (bacterial
vaginosis)
 Topical anti-infective drugs used to treat
bacterial vaginal infections
• Clindamycin (Cleocin)
• Metronidazole (MetroGel-Vaginal)
• Tinidazole (Tindamax)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 13–11 Metronidazole. This drug form is a topical gel that is given by the
intravaginal route, within the vagina. The prefix intra- means within.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for gonorrhea
 Caused by the gram-negative coccus
Neisseria gonorrhoeae
 Can cause painful urination and a thick,
yellow vaginal discharge
 Oral antibiotic drugs from several
different categories are effective in
treating gonorrhea.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for syphilis
 Caused by the gram-negative spirochete
Treponema pallidum
 Can cause:
• Fever
• Rash with a lesion (chancre) in the
genital area that ulcerates and forms a
crust
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for syphilis
 Oral antibiotic drugs from several
different categories are effective in
treating syphilis.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Historical Notes
• In the early 1900s, Paul Ehrlich, a
German chemist, tested 605 separate
arsenic compounds before finding the
first drug known to cure syphilis.
• This drug was nicknamed "the magic
bullet" because of its ability to cure
syphilis, a common but until-then
incurable disease.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for chlamydial infections
 Caused by Chlamydia trachomatis, a
gram-negative coccus
 Symptoms
• Painful urination
• Thin discharge
 Oral antibiotic drugs from several
different categories are effective in
treating chlamydia.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for acquired immunodeficiency
syndrome
 Caused by the human immunodeficiency
virus (HIV), a retrovirus
 HIV invades CD4 lymphocytes in order
to reproduce.
• Large numbers of CD4 lymphocytes are
destroyed
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for acquired immunodeficiency
syndrome
 upsets the CD4 and CD8 lymphocyte
balance
• CD8 lymphocytes then suppress the
immune system
• leaves the patient defenseless against
infection and cancer
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for acquired immunodeficiency
syndrome
 Symptoms
•
•
•
•
•
Fever
Night sweats
Weight loss
Enlarged lymph nodes
Diarrhea
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for genital herpes
 Caused by a herpes simplex virus type 2
infection in the genital area
 Herpes simplex virus type 1 infections
involve other areas of the body,
particularly the mouth and are known as
cold sores.
 Genital herpes lesions are treated
topically and with oral drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for genital warts
 Human papillomavirus causes:
• Common warts (verrucae)
• Genital or venereal warts (condylomata
acuminata)
 Topical drugs used to treat genital warts
are discussed in Chapter 17.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Sexually
Transmitted Diseases
• Drugs for trichomoniasis
 Caused by protozoan Trichomonas
vaginalis.
 Causes a greenish-yellow, frothy vaginal
discharge with a foul odor
 Tinidazole (Tindamax)
• Oral antiprotozoal drug
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved