Please enable JavaScript.
Coggle requires JavaScript to display documents.
Endo/Pulm Quiz 6 - Coggle Diagram
Endo/Pulm Quiz 6
alendronate (Fosamax, Binosto)
common ADRs: fever, flu-like syndrome, gastric ulcer
rare ADRs: osteonecrosis of the jaw, esophageal cancer, immune hypersensitivity, arrhythmia, fractures
interactions: Al/Ca/Mg/Fe-containing products (decreased bisphosphonate absorption)
indications: postmenopausal osteoporosis prophylaxis/treatment, male osteoporosis treatment, GC-induced osteoporosis, Paget disease
class: bisphosphonate
efficacy: increased BMD (T-score), decreased incidence of bone fractures
toxicity: baseline SCr, calcium, phosphorous, severe skin rash, difficulty swallowing, swelling, tooth problems, severe pain
counseling: swallow non-effervescent tablet whole with a large glass (240 mL) of plain H20 only. Dissolve 1 effervescent tablet in 120 mL of room temperature plain water only (not mineral or flavored); once effervescence stops, wait ≥ 5 min at stir the solution for ~10 s and then drink; remain upright at least 30 min after you swallow the tablet before you eat or drink anything or take any other medicines; this helps body absorb medicine; do not lie down for at least 30 min after taking this medicine, and do not lie down until after you have eaten some food
conjugated estrogens (Premarin)
common ADRs: weight change, HA, migraine, depression, disorder of menstruation, breast pain
rare ADRs: heart disease, HTN, MI, breast cancer, DM, hypercalcemia, VTE, anaphylaxis, CVA, cervical cancer, malignant neoplasm of endometrium or corpus uteri, ovarian cancer, PE
interactions: CYP3A4/5/1A2 inhibitors/inducers, levothyroxine (estrogen increases serum TBG, reducing free thyroxine resulting in hypothyroid effect)
efficacy: resolution of clinical signs of abnormal bleeding or hot flashes or other symptoms, prevention of osteoporosis
indications: abnormal vasomotor function (menopause), atrophy of vagina or vulva, postmenopausal osteoporosis prophylaxis, female hypogonadism syndrome, primary ovarian failure
toxicity: monitor BMD; conduct diagnostic evaluation to rule out malignancy in the event of persistent or recurring vaginal bleeding
class: estrogen hormone
counseling: discuss potential long-term Acs of HT including MI, stroke, DVT, PE, and breast cancer; take at bedtime to minimize side effects; take with or without meals
estradiol oral (Estrace)
common ADRs: none
rare ADRs: heart disease, MI, DM, VTE, anaphylaxis, CVA, PE, breast, endometrial or ovarian cancer
interactions: CYP3A4/5/1A2/P-gp inducers/inhibitors
efficacy: improvement in menoapuse symptoms; improved BMD for postmenopausal osteoporosis
indication: abnormal vasomotor function (menopause), atrophic vulva or vagina (menopause), breast cancer (metastatic, for palliation only), carcinoma of prostate (advanced, androgen dependent, for palliation only), decreased estrogen level secondary to hypogonadism/castration/or primary ovarian failure, prophylaxis of postmenopausal osteoporosis
toxicity: annual physical examination including cervial cytology (Pap smear) and breast exam
class: estrogen
counseling: report abnormal vaginal bleeding or S/S of thromboembolic disorder; do not smoke during therapy, as this increases risk of thromboembolic events
estradiol transdermal patch (Alora, Climara, Minivelle, Menostar, Vivelle-DOT)
common ADRs: edema, application site irritation
rare ADRs: heart disease, MI, DM, VTE, anaphylaxis, CVA, PE, breast, endometrial or ovarian cancer
interactions: CYP3A4/5/1A2/P-gp inducers/inhibbitors
efficacy: improvement in menopause symptoms; improved BMD, decreased menopausal osteoporosis
indications: abnormal vasomotor function or atrophic vagina or vulva (menopause), postmenopausal osteoporosis prophylaxis
toxicity: annual physical examination including cervical cytology (Pap smear) and breast exam
class: estrogen
counseling: report abnormal vaginal bleedings or S/S of thromboembolic disorder; do not smoke during therapy, as this increases risk of thromboembolic events; place patch on clean, dry skin, preferably on the lower abdomen, upper quadrant of the buttock, or outer aspect of the hip; do not apply to breasts or wasteline; rotate sites of application with 1 week allowed between applications to a particular site
ibandronate (Boniva)
interactions: Al/Ca containing products/H2 blockers/PPIs (decreased bisphosphonate absorption)
common ADRs: indigestion, backache, respiratory tract infections
indications: postmenopausal osteoporosis treatment/prophylaxis
rare ADRs: osteonecrosis of jaw, esophageal cancer, esophageal ulcers, immune hypersensitivity, arrhythmia, bone fractures, severe muscle pain
class: bisphosphonate
efficacy: increased BMD; decreased incidence of bone fractures
toxicity: baseline SCr, Ca, P; seek medical attention if severe skin rash, difficulty swallowing, swelling, tooth problems, or severe pain
counseling: take medicine as soon as out of bed in the AM, before eat or have anything to drink; swallow tablets whole with large glass (240 mL) of plain water only (not mineral water, coffee, juice, or any other liquid); do not take medicine while still in bed, do not take at bedtime; wait at least 60 min after swallow tablet before eat or drink anything or take any other medicines; this will help body absorb the medicine; do not lie down for at lest 60 min after taking this medicine and do not lie down until after have eaten some food
progesterone (Prometrium)
common ADRs: weight change, HA, amenorrhea, breast tenderness, abdominal pain
rare ADRs: thromboembolism, thrombophlebitis, osteoporosis
interactions: CYP2C19/3A4/5 inducers/inhibitors, warfarin (progesterone may increase or decrease warfarin effectiveness; mechanism unknown)
efficacy: resolution of clinical signs of abnormal bleeding or symptoms being managed with this products; successful pregnancy
indications: prevention of estrogen-induced endometrial hyperplasia, secondary physiologic amenorrhea, assisted reproduction for infertile women
toxicity: BP monitoring and annual breast exam; diagnostic evaluation to rule out malignancy in event of persistent or recurring vaginal bleeding
class: progestin hormone
counseling: menstrual bleeding should occur 3-7 days after last dose; report if menstruation does not occur within 7 d after last dose; for vaginal formulation, avoid using other vaginal drugs within 6 h before or 6 h after using progesterone
raloxifene (Evista)
common ADRs: hot flashes, arthralgia, flu-like symptoms
rare ADRs: edema, hypertriglyceridemia, VTE, CVA, PE
interactions: bile acid sequesterants (reduced absorption of raloxifene)
efficacy: DEXA scan (BMD) if used for osteoporosis, mammogram, absence of breast cancer if used for breast cancer prevention
indications: breast cancer (invasive, in postmenopausal women at high risk, prophylaxis), postmenopausal osteoporosis (prevention or treatment)
toxicity: weight gain, SOB, symptoms of stroke, DVT; TGs
class: selective estrogen receptor modulator
counseling: increases the risk of blood clots, especially during the first 4 mo of therapy; avoid sitting for long periods and be aware of the symptoms of DVT; if taking for osteoporosis, consider calcium and vitamin D supplementation
risendronate (Actonel, Atelvia)
common ADRs: rash, abdominal pain, constipation, diarrhea, nausea, indigestion, backache, UTI
rare ADRs: osteonecrosis of the jaw, hypersensitivity reaction
interactions: Al/Ca containing products/H2 blockers/PPIs (decreased bisphosphonate absorption)
efficacy: increased BMD, decreased incidence of fractures, normalization of alkaline phosphatase (Paget's)
indications: postmenopausal osteoporosis, Paget disease, GC induced osteoporosis prevention and treatment, male osteoporosis
toxicity: baseline SCr, Ca; assess for skin rash, chest pain, difficulty in swallowing, swelling, tooth problems, pain with urination, severe pain
class: bisphosphonate
counseling: take as soon as out of bed in the AM, before eat or have anything to drink; swallow tab whole 240 mL of plain water only (not mineral water, coffee, juice, or any other liquid); do not chew tablet; do not take medicine while still in bed and do not take it at bedtime; wait at least 30 min after swallow tablet before eat or drink anything or take any other medicines; do not lie down for at least 30 min after taking this medicine, and do not lie down until after have eaten some food