DRUG STUDY
DRUG INDICATION
1. ESTROGEN
 Treatment of moderate to
severe vasomotor symptoms
 Ogen
due to menopause.
 Ortho-Est
 Treatment of moderate to
 Premarin
severe symptoms of vulvar and
vaginal atrophy due to
menopause. When prescribing
solely for the treatment of
symptoms of vulvar and vaginal
atrophy, topical vaginal products
should be considered.
 Treatment of hypoestrogenism
due to hypogonadism, castration
or primary ovarian failure.
 Prevention of postmenopausal
osteoporosis. When prescribing
solely for the prevention of
postmenopausal osteoporosis,
therapy should only be
considered for women at
significant risk of osteoporosis
non-estrogen medications
should be carefully considered.
SIDE EFFECT DRUG INTERACTION
 chest pain or heavy feeling,
pain spreading to the arm or
shoulder, nausea, sweating,
general ill feeling;
 sudden numbness or
weakness, especially on one
side of the body;
 sudden headache, confusion,
problems with vision, speech,
or balance;
 pain or swelling in your lower
leg;
 abnormal vaginal bleeding;
 pain, swelling, or tenderness
in your stomach;
 jaundice (yellowing of the skin
or eyes); or
 a lump in your breast.
 nausea, vomiting, loss of
appetite;
 swollen breasts;
 acne or skin color changes;
 decreased sex drive,
impotence, or difficulty having
an orgasm;
 migraine headaches or
dizziness;
 vaginal pain, dryness, or
discomfort;
NURSING CONSIDERATION
Assessment & Drug Effects
1. Accelerated  See nursing
prothrombin time, implications under
partial thromboplastin estradiol.
time, and platelet  Monitor for and
aggregation time; report breakthrough
increased platelet vaginal bleeding.
count; increased  Assess for relief of
factors II, VII antigen, menopausal
VIII antigen, VIII symptoms.
coagulant activity, IX,  Lab tests: Monitor
X, XII, VII- X complex, serum phosphatase
II-VII- X complex, and levels with prostate
beta- cancer.
thromboglobulin;
decreased levels of Patient & Family Education
anti-factor Xa and
antithrombin III,  Do not use tampons
decreased while on vaginal
antithrombin III cream therapy.
activity; increased  Intravaginal
levels of fibrinogen administration: For
and fibrinogen self-administration,
activity; increased wash hands well
plasminogen antigen before and after
and activity. application, and
2. Increased thyroid- avoid contact of
binding globulin (TBG) denuded areas with
levels leading to the cream.
increased circulating  Do not use tampons
 swelling of your ankles or feet; total thyroid hormone while on vaginal
 depression; or levels as measured by cream therapy. Pull
 changes in your menstrual protein-bound iodine plunger out of barrel
periods, break-through (PBI), T4 levels (by and wash applicator
bleeding. column or by in warm soapy water
radioimmunoassay) or after use. Do not
T3 levels by place plunger in hot
radioimmunoassay. T3 or boiling water.
resin uptake is  Note: Sudden
decreased, reflecting discontinuation of
the elevated TBG. vaginal cream after
Free T4 and free T3 high dosage or
concentrations are prolonged use may
unaltered. Women on evoke withdrawal
thyroid replacement bleeding.
therapy may require  Review patient
higher doses of package insert (PPI).
thyroid hormone.  Do not breast feed
3. Other binding proteins while taking this
may be elevated in drug.
serum, (for example,
corticosteroid binding
globulin (CBG), SHBG,
leading to increased
circulating
corticosteroids and
sex steroids,
respectively. Free
hormone
concentrations, such
as testosterone and
estradiol, may be
decreased. Other
plasma proteins may
 be increased
(angiotensinogen/reni
n substrate, alpha-l-
antitrypsin,
ceruloplasmin).
4. Increased plasma
high-density
lipoprotein (HDL) and
HDL cholesterol
subfraction
concentrations,
reduced low-density
lipoprotein (LDL)
cholesterol
concentration,
increased triglycerides
levels.
5. Impaired glucose
tolerance.

Assessment & Drug Effects

2. Estrogen It is used in the prevention of  Hot flashes 1. Cholestyramine  Lab tests: Periodically
osteoporosis in postmenopausal women  leg cramps monitor bone
Receptor and to reduce the risk of invasive breast  peripheral edema, Concomitant administration of density, liver
Modulators cancer in postmenopausal women with  flu syndrome cholestyramine with EVISTA is function, and plasma
osteoporosis and in postmenopausal  arthralgia not recommended. Although lipids; with
 clomiphene women at high risk for invasive breast  sweating not specifically studied, it is concurrent oral
 Duavee cancer  rare: venous thromboembolic anticipated that other anion anticoagulants,
 Evista events exchange resins would have a carefully monitor PT
similar effect. EVISTA should and INR.
not be co-administered with  Monitor carefully for
other anion exchange resins and immediately
report S&S of
 2. Warfarin thromboembolic
events.
If EVISTA is given  Do not give drug
concomitantly with warfarin concurrently with
or other warfarin derivatives, cholestyramine;
prothrombin time should be however, if
monitored more closely when unavoidable, space
starting or stopping therapy the two drugs as
with EVISTA widely as possible.

3. Other Highly Protein- Patient & Family Education

Bound Drugs
 Contact physician
EVISTA should be used with immediately if
caution with certain other unexplained calf pain
highly protein-bound drugs or tenderness occurs.
such as diazepam, diazoxide,  Avoid prolonged
and lidocaine. Although not restriction of
examined, EVISTA might affect movement during
the protein binding of other travel.
drugs. Raloxifene is more than  Drug does not
95% bound to plasma proteins prevent and may
induce hot flashes.
 Do not take drug
with other estrogen-
containing drugs.
 Tell prescriber if you
are taking drugs to
lower your
cholesterol.
 Do not breast feed
while taking this
drug.

3. Progestins  Prevention of pregnancy
 Relief from premenstrual (PMT)
 Norethisterone symptoms including headache,
 Norgestimate migraine, breast discomfort,
 levonorgestrel water retention or changed
behaviour before a period is due
 Abnormal, heavy or continuous
bleeding from the womb (not
related to a heavy period)
 Heavy bleeding during a period
 Painful periods
 Endometriosis (a painful
condition caused by tissue that
usually lines the womb growing
outside the womb)
 Swelling of the face, hands or
feet, wheezing, difficulty
breathing, or an intense itchy
skin rash which may be caused
by a severe allergic reaction
 Signs and symptoms of a
blood clot which may include
severe pain or tenderness or
swelling in the calf of one or
both legs, unexpected chest
pain, shortness of breath or
coughing up blood,
unexpected numbness,
tingling, weakness, severe
headache, dizziness, fainting,
fitting, problems with eyesight
or speech or unexpected
stomach pain
 Painful or inflamed leg veins
 Changes in your sense of
taste, smell or touch
 A crushing type of chest pain
or heaviness in your chest
 Migraine or your existing
migraine worsens
 Persistent headaches
 Swelling or tenderness in the
Some drugs can make
norethindrone less effective,
which may result in
pregnancy. Before using
norethindrone, tell your
doctor if you are using any of
the following drugs:
 griseofulvin (Fulvicin,
Grisactin);
 rifampin (Rifadin,
Rifater, Rifamate,
Rimactane);
 St. John's wort;
 ketoconazole (Nizoral)
or itraconazole
(Sporanox);
 a barbiturate such as
amobarbital (Amytal),
butabarbital (Butisol),
mephobarbital
(Mebaral),
secobarbital (Seconal),
or phenobarbital
(Luminal, Solfoton); or
 HIV medicines such as
amprenavir
Assessment & Drug Effects
 Monitor for S&S of
thrombophlebitis
(see Appendix F).
 Withhold drug and
notify physician if any
of the following
occur: Sudden,
complete, or partial
loss of vision,
proptosis, diplopia,
or migraine
headache.
Patient & Family Education
 Wait at least 3 mo
before becoming
pregnant after
stopping the minipill
to prevent birth
defects. Use a barrier
or nonhormonal
method of
contraception until
pregnancy is desired.
 If you have not taken
all your pills and you
miss a period,
consider the
possibility of
 upper part of your tummy
 Yellowing of the skin or whites
of your eyes (this may be a
sign of jaundice)
 Large increase in blood
pressure
 Pregnancy
 Recurrence of earlier
depression
(Agenerase), pregnancy after 45 d
atazanavir (Reyataz), from the last
tipranavir (Aptivus), menstrual period;
indinavir (Crixivan), stop using progestin-
saquinavir (Invirase), only contraceptive
lopinavir/ritonavir until pregnancy is
(Kaletra), ruled out.
fosamprenavir  If you have taken all
(Lexiva), ritonavir your pills and you
(Norvir), or nelfinavir miss 2 consecutive
(Viracept). periods, rule out
pregnancy and use a
barrier or
nonhormonal
method of
contraception before
continuing the
regimen.
 Review package
insert to ensure you
understand how to
use norethindrone.
 Promptly report
prolonged vaginal
bleeding or
amenorrhea.
 Learn and do breast
self-examination.
 Keep appointments
for physical checkups
(q6–12mo) while you
are taking hormonal
birth control.
 Do not breast feed
 while taking this
drug.

Assessment & Drug Effects

 Monitor for
abnormal bleeding. If
it occurs, full
diagnostic measures
4. Fertility Drugs Indicated only in patients with Contraindicated are crucial. Report it
demonstrated ovulatory dysfunction immediately.
 Clomiphene who meet the conditions described  abnormal vaginal/uterine  Ospemifene  Monitor for visual
 Clomid below: bleeding, ospemifene, disturbances. Their
 Serophene.  breast tenderness or clomiphene. Either occurrence indicates
1. Patients who are not pregnant. discomfort, increases effects of the need for a
2. Patients without ovarian cysts. It  headache, the other by complete
should not be used in patients  nausea, pharmacodynamic ophthalmologic
with ovarian enlargement  vomiting, synergism. evaluation. Drug will
except those with polycystic  diarrhea, Contraindicated. be stopped until
ovary syndrome. Pelvic  flushing, symptoms subside.
examination is necessary prior  blurred vision or other visual Serious - Use Alternative  If clomiphene is
to the first and each subsequent disturbances, or Monitor Closely continued more than
course of treatment.  ovarian enlargement 1 y, patient should
3. Patients without abnormal presenting as abdominal or  Benazepril have an
vaginal bleeding. If abnormal pelvic pain, tenderness, clomiphene, ophthalmologic
vaginal bleeding is present, the pressure, or swelling. benazepril. Either examination at
patient should be carefully  Clomid may increase the regular intervals.
increases effects of
evaluated to ensure that likelihood of multiple births. the other by  Pelvic pain indicates
neoplastic lesions are not  Ovarian hyperstimulation the need for
pharmacodynamic
present. syndrome (OHSS) may occur: synergism. Use immediate pelvic
4. Patients with normal liver ovarian enlargement, severe Caution/Monitor. examination for
 function. GI symptoms, abdominal diagnostic purposes.
swelling, shortness of breath, Increases risk of
In addition, patients should be evaluated pleural effusions, decreased hypotension. Patient & Family Education
in regard to the following: urination. Seek medical care if
these symptoms develop.  Take the medicine at
1. Estrogen Levels. Patients should  shortness of breath, same time every day
have adequate levels of  seizures, to maintain drug
endogenous estrogen (as  stroke, or levels and prevent
estimated from vaginal smears,  chest pain. forgetting a dose.
endometrial biopsy, assay of  Missed dose: Take
urinary estrogen, or from drug as soon as
bleeding in response to possible. If not
progesterone). Reduced remembered until
estrogen levels, while less time for next dose,
favorable, do not preclude double the dose,
successful therapy. then resume regular
2. Primary Pituitary or Ovarian dosing schedule. If
Failure. CLOMID therapy cannot more than one dose
be expected to substitute for is missed, check with
specific treatment of other physician.
causes of ovulatory failure.  Incidence of multiple
3. Endometriosis and Endometrial births during
Carcinoma. The incidence of clomiphene use is
endometriosis and endometrial reportedly increased
carcinoma increases with age as to 6 times normal
does the incidence of ovulatory and appears to
disorders. Endometrial biopsy increase with dose
should always be performed increases.
prior to CLOMID therapy in this  Patient who is going
population. to respond usually
4. Other Impediments to ovulates 4–10 d after
Pregnancy. Impediments to last day of treatment.
pregnancy can include thyroid  Report these
disorders, adrenal disorders, symptoms: hot
 hyperprolactinemia, and male flushes resembling
factor infertility. those associated with
5. Uterine Fibroids. Caution should menopause; nausea,
be exercised when using vomiting, headache.
CLOMID in patients with uterine Appropriate drug
fibroids due to the potential for therapy may be
further enlargement of the prescribed.
fibroids. Symptoms disappear
after clomiphene is
discontinued.
 Reported promptly
yellowing of eyes,
light-colored stools,
yellow, itchy skin,
and fever
symptomatic of
jaundice.
 Stop taking
clomiphene if
pregnancy is
suspected. Contact
physician for a
confirmatory
examination.
 Because of the
possibility of light-
headedness,
dizziness, and visual
disturbances, do not
perform hazardous
tasks requiring skill
and coordination in
an environment with
variable lighting.

5. Oxytocics Pospartum or Postabortion
Hemorrhage
 Ergometrine
 Oxytocin  0.2 mg IM; may repeat in 2-4hr;
 Presoxin not to exceed 5 doses total
 Give IV only in emergency
because of potential for HTN &
CVA
 Alternatively, 0.2-0.4 mg PO q6-
12hr PRN for 48 hr or until
danger of uterine atony has
passed; no more than 1 week
Other Indications & Uses
 Report promptly
excessive weight
gain, signs of edema,
bloating, decreased
urinary output.
 Do not breast feed
while taking this
drug.
Assessment & Drug Effects
 Monitor vital signs
(particularly BP) and
uterine response
during and after
parenteral
 Gastrointestinal: Nausea,  Halothane causes administration of
vomiting, abdominal pain and relaxation of uterine methylergonovine
diarrhea. muscle and may until partum period is
  Central Nervous System: interfere with stabilized (about 1–2
Headache and dizziness. ergometrine action. h).
 Heart: Chest pain, palpitation, Enhanced uterotonic  Notify physician if BP
high blood pressure, shock effect with suddenly increases or
and abnormal heart rhythm. prostaglandins and if there are frequent
 ENT: Ringing in the ear. oxytocin. Concurrent periods of uterine
 Skin: Rashes. admin with CYP3A4 relaxation.
inhibitors may lead to
vasospasm, cerebral Patient & Family Education
ischaemia and/or
ischaemia of  Report severe
extremities. cramping for
 Potentially Fatal:
 Prevention and treatment of Enhanced increased bleeding.
postpartum and postabortion vasoconstrictive  Report any of the
hemorrhage caused by uterine effects with following: Cold or
atony or subinvolution sympathomimetics numb fingers or toes,
and other nausea or vomiting,
vasoconstrictors. chest or muscle pain.
 Do not breast feed
while taking this
drug.

Assessment & Drug Effects

 Monitor for diarrhea;

may be minimized by
giving drug after
meals and at
bedtime. Diarrhea is
6. Abortifacients a common adverse
 diarrhea, Avoid magnesium-containing effect that is dose
 Misoprostol  nausea, antacids (to reduce diarrhea related and usually
 Cytotec This medicine may cause birth defects,  vomiting, risk). Concomitant oxytocic self-limiting (often
 mifepristone loss of the unborn baby, or premature  stomach cramps, agents: not recommended. resolving in 8 d).
birth if you take it while you are  gas,
pregnant. It may also cause the uterus to  constipation, Patient & Family Education
tear (rupture). The chance of a rupture is  headache,
raised as you get further along in  menstrual cramps,  Avoid using
pregnancy, or if you have had uterine  spotting, or concurrent
surgery like a C-section in the past. A  increased or irregular magnesium-
rupture can lead to very bad bleeding, containing antacids
and your uterus may need to be menstruation.
removed. Sometimes, a rupture has because of increased
been deadly. If you are taking incidence of
misoprostol to prevent gastric ulcers, do diarrhea.
not take it if you are pregnant.  Report
postmenopausal
indicated for reducing the risk of NSAID bleeding to
(nonsteroidal anti-inflammatory drugs, physician; it may be
including aspirin)–induced gastric ulcers drug related.
in patients at high risk of complications  Avoid pregnancy
from gastric ulcer, e.g., the elderly and during misoprostol
patients with concomitant debilitating therapy; use an
disease, as well as patients at high risk of effective
developing gastric ulceration, such as contraception
patients with a history of ulcer. Cytotec method while taking
has not been shown to reduce the risk of drug.
duodenal ulcers in patients taking  Drug has
NSAIDs. Cytotec should be taken for the abortifacient
duration of NSAID therapy. Cytotec has property. Contact
been shown to reduce the risk of gastric physician and
ulcers in controlled studies of 3 months' immediately
duration. It had no effect, compared to discontinue drug if
placebo, on gastrointestinal pain or you becomes
discomfort associated with NSAID use. pregnant.
 Do not breast feed
while taking this
drug.

Assessment & Drug Effects

 Assess vital signs:

Baseline pulse and
BP and before each
dose. If significantly
7. Tocolytics altered from baseline
 Beta-blockers, such as level, consult
 Terbutaline  tremor, Tenormin (atenolol), physician.
 Ritodrine (also called anti-contraction  nervousness, Cartrol (carteolol), Cardiovascular
 Hexoprenaline medications or labor suppressants)  dizziness, Normodyne or adverse effects are
are medications used to suppress  headache, Trandate (labetalol), more apt to occur
premature labor childbirth, and lytic,  drowsiness, Lopressor when drug is given by
capable of dissolving). They are  palpitations, (metoprolol), Corgard SC route or it is used
given when delivery would result in  rapid heart rate, (nadolol), Inderal by a patient with
premature birth. The therapy also  shortness of breath, (propranolol), cardiac arrhythmia.
buys time for the administration of  chest discomfort, Betapace (sotalol),  Most adverse effects
betamethasone, a glucocorticoid drug  nausea, Coreg (carvedilol), or are transient,
which greatly accelerates fetal lung  vomiting, Blocadren (timolol) however, rapid heart
maturity, but takes one to two days to  weakness,  Certain diuretics rate may persist for a
work.  flushed feeling, (water pills) relatively long time.
 sweating,  Other medications for  Be aware that onset
 pain at the injection site, asthma and degree of effect
The suppression of contractions is
 anxiety,  Medicines for a cold, and incidence and
often only partial and tocolytics can
 muscle cramps, and appetite control, severity of adverse
only be relied on to delay birth for
 dry mouth. diabetes, or attention effects of SC
several days. Depending on the
deficit hyperactivity formulation
tocolytic used the mother or fetus
disorder (ADHD) resemble those of
may require monitoring, as for
epinephrine.
instance blood pressure monitoring
 Aerosolized drug
when nifedipine is used as it reduces produces minimal
blood pressure. In any case the risk of cardiac stimulation or
preterm labor alone justifies tremors.
hospitalization.  Be aware that muscle
tremor is a fairly
common adverse
effect that appears to
subside with
continued use.
  Monitor for
symptoms of
hypoglycemia in
neonates born of a
mother who used
terbutaline during
pregnancy.
 Monitor patient
being treated for
premature labor for
CV S&S for 12 h after
drug is discontinued.
Report tachycardia
promptly.
 Monitor I&O ratio.
Fluid restriction may
be necessary. Consult
physician.

Patient & Family Education

 Adhere to
established dosage
regimen (i.e., do not
change dose intervals
or omit, increase, or
decrease the dose).
 Inhalator therapy:
Review instructions
for use of inhalator
(included in the
package).
 Learn how to take
your own pulse and
 the limits of change
that indicate need to
notify the physician.
 Consult physician if
breathing difficulty is
not relieved or if it
becomes worse
within 30 min after
an oral dose.
 Keep appointments
with physician for
evaluation of
continued drug
effectiveness and
clinical condition.
Terbutaline appears
to have a short
clinical period for
sustained
effectiveness.
 Consult physician if
symptomatic relief
wanes; tolerance can
develop with chronic
use. Usually, a
substitute agent will
be prescribed.
 Do not self-dose this
drug, particularly
during long-term
therapy. In the face
of waning response,
increasing the dose
will not improve the
 clinical condition and
may cause
overdosage.
Understand that
decreasing relief with
continued treatment
indicates need for
another
bronchodilator, not
an increase in dose.
 Do not puncture
container, use or
store it near heat or
open flame, or
expose to
temperatures above
49° C (120° F), which
may cause bursting.
Contents of the
aerosol (inhalator)
are under pressure.
 Do not use any other
aerosol
bronchodilator while
being treated with
aerosol terbutaline.
Do not self-medicate
with an OTC aerosol.
 Do not use OTC drugs
without physician
approval. Many cold
and allergy remedies,
for example, contain
a sympathomimetic
 agent that when
combined with
terbutaline may
cause harmful
adverse effects.
 Do not breast feed
while taking/using
this drug.