Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (254 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(me-drox′ee-proe-jess′te-rone)
Depo-Provera, Depo-sub Q Provera, Gen-Medroxy
, Provera
Func. class.:
Antineoplastic, hormone, contraceptive
Chem. class.:
Progesterone derivative
Do not confuse:
medroxyPROGESTERone
/methylPREDNISolone
Provera
/Premarin/Covera
Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation; antineoplastic action against endometrial cancer
Uterine bleeding (abnormal); secondary amenorrhea; prevention of endometrial changes associated with estrogen replacement therapy (ERT); contraceptive; inoperable, recurrent, metastatic endometrial/ renal cancer
Unlabeled uses:
Hot flashes; symptoms of menopause; paraphilia (men); hot flashes (men) with prostate cancer
Pregnancy (X), hypersensitivity, reproductive cancer, genital bleeding (abnormal, undiagnosed), missed abortion, stroke, cerebrovascular disease, cervical cancer, hepatic disease, uterine/vaginal cancer
Black Box Warning:
Breast cancer, MI, stroke, thromboembolic disease, thrombophlebitis
Precautions:
Breastfeeding, hypertension, asthma, blood dyscrasias, gallbladder disease, CHF, diabetes mellitus, bone disease, depression, migraine headache, seizure disorders, renal/hepatic disease, family history of cancer of breast or reproductive tract, bone mineral density loss, ocular disorders, AIDS/HIV, alcoholism, children, hyperlipidemia
Black Box Warning:
Cardiac disease, dementia, osteoporosis
Calculator
• Adult:
PO
5-10 mg/day × 5-10 days
• Adult:
PO
5-10 mg/day × 5-10 days starting on 16th or 21st day of menstrual cycle
• Adult:
PO
5-10 mg daily × 10-14 or more days/mo (sequential estrogen); 2.5-5 mg daily (continuous estrogen)
• Adult:
IM
(contraceptive inj) 150 mg q12wk;
SUBCUT
(depot SUBCUT Provera 104 inj) 104 mg q3mo
• Adult:
IM
400 mg-1 g (using 400 mg/ml depot inj susp) weekly
• Adult (female):
PO
20 mg/day;
IM
150 mg monthly
• Adult (male):
IM
Depot 150 or 400 mg
Available forms:
Tabs 2.5, 5, 10 mg; inj susp, 150, 400 mg/ml; depot-SUBCUT inj: 104 mg/0.65 ml
•
Give without regard to food
•
Visually inspect particulate matter and discoloration before use
•
IM only,
never
IV
•
Instruct patient on risks and warnings associated with hormonal contraceptives (see Patient Information)
•
The possibility of pregnancy should be excluded before giving the first dose of medroxyprogesterone or whenever more than 14 wk has passed since the last dose
•
Do not dilute
•
Shake vigorously immediately before administration
•
Inject deeply into the gluteal or deltoid muscle; Aspirate before injection to avoid injection into a blood vessel
•
IM only,
never
IV
•
Instruct patient on risks and warnings associated with progestin use (see Patient Information)
•
Shake vigorously immediately before use
•
When multidose vials are used, take special care to prevent contamination
•
Inject deeply into the gluteal or deltoid muscle; aspirate before injection
SUBCUT route
depo-subq provera 104 contraceptive injection suspension
only
•
For subcut only,
never
give IM or IV
•
Instruct patient on risks and warnings associated with hormonal contraceptives (see Patient Information)
•
Shake vigorously for at least 1 min before use
•
Inject the entire contents of the prefilled syringe subcut into the anterior thigh or abdomen, avoiding bony areas and the umbilicus; gently grasp and squeeze a large area of skin in the chosen injection area, ensuring that the skin is pulled away from the body; insert the needle at a 45-degree angle; inject until the syringe is empty; this usually requires 5-7 sec; following use, press lightly on the injection site with a clean cotton pad for a few seconds; do not rub the area
CNS:
Dizziness, headache, migraines, depression, fatigue, nervousness
CV:
Hypotension, thrombophlebitis, edema,
thromboembolism, stroke, PE, MI
EENT:
Diplopia
GI:
Nausea
, vomiting, anorexia, cramps, increased weight,
cholestatic jaundice,
abdominal pain
GU:
Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, breast changes,
gynecomastia, testicular atrophy, impotence
, endometriosis,
spontaneous abortion,
vaginitis, libido increased/decreased
INTEG:
Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma, photosensitivity, injection site reaction
META:
Hyperglycemia
MS:
Decreased bone density
SYST:
Angioedema, anaphylaxis
PO:
Duration 24 hr; excreted in urine and feces; metabolized in liver
Decrease:
medroxyPROGESTERone action—aminoglutethimide, carBAMazepine, phenytoins, PHENobarbital, rifampin
Decrease:
bone mineral density—anticoagulants, corticosteroids
Increase:
LFTs, HDL, triglycerides
Decrease:
GTT, HDL
•
Pelvic exam, Pap smear before treatment, periodically
Severe allergic reaction, angioedema;
have EPINEPHrine and rescusitative equipment available
•
Weight daily; notify prescriber of weekly weight gain >5 lb; bone mineral density
•
B/P at beginning of treatment and periodically
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Hepatic studies: ALT, AST, bilirubin periodically during long-term therapy
•
Edema, hypertension, cardiac symptoms, jaundice
•
Mental status: affect, mood, behavioral changes, depression
Black Box Warning:
This product should not be given to those with breast cancer, MI, stroke, thromboembolic disorders
•
Bone mineral density loss:
in those taking anticoagulants, corticosteroids with Depo-Provera or Depo-sub Q Provera
Black Box Warning:
Use of product shown to increase dementia in women ≥65 yr old; use may increase osteoporosis in long-term treatment; those who smoke also at greater risk; adequate calcium and vit D should be taken
•
Storage in dark area
•
Therapeutic response: decreased abnormal uterine bleeding, absence of amenorrhea
•
To avoid sunlight or to use sunscreen; photosensitivity can occur
To report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, sudden change in speech/coordination, numbness or stiffness in legs, chest pain; males to report impotence, gynecomastia
•
To report suspected pregnancy (X); fertility returns 6-12 mo after discontinuing
Black Box Warning:
Long-term use decreases bone density; exercise, calcium supplements can help lessen osteoporosis