NR568 Final Exam Study Guide Week 5 to 8

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NR568 Final Exam Study GuideWeek 5Prevention of osteoporosis with hormone replacement therapy-HT reducespostmenopausal bone loss and thereby decreases the risk for osteoporosis and relatedfractures.Unfortunately, when HT is stopped, bone mass rapidly decreases by approximately12%. ****Hence to maintain bone health, HT must continue lifelong.***HT should be considered only for women with significant risk for osteoporosis, and onlywhen that risk outweighs the risks of HT.A person on HT and pts, in general, should practice primary prevention of bone loss byensuring adequate calcium and vitamin D intake, regular weight-bearing exercise, andavoiding smoking and excessive alcohol use.When and when not to use progestin for hormone replacement therapy and why-combined estrogen-progestin therapy for women with an intact uterus. Estrogen-onlyHRT can be given to someone with a hysterectomy. Progestin isrequiredto preventestrogen-associated endometrial hyperplasiaLocal vs. systemic estrogen options and whyone would be chosen over the other-intravaginal preparations are most helpful in treating symptoms associated with localestrogen deficiency, such as vaginal and vulvar atrophy; these preparations areassociated with a lower risk of systemic effectsprogesterone is contraindicated in women who have undergone a hysterectomy butrequired in women with an intact uterus who have undergone hormone replacementtherapyIV administration is generally limited to acute, emergency control of heavy uterinebleeding.One of the two available vaginal rings (Estring) are used only for local effects, primarilytreatment of vulval and vaginal atrophy associated with menopause.The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot flashesand night sweats) as well as local effects (e.g., treatment of vulval and vaginal atrophy).oPeri-menopausal estrogen therapy (ET) -remains the most effective treatmentoption for relieving perimenopausal and menopausal hot flashes and nightsweats.taken to compensate for the loss of estrogen that occurs during menopause.There are two basic regimens for HT: estrogen alone (ET) and estrogen plus aprogestin (estrogen/progestin therapy [EPT]).The purpose of estrogen in both regimens is to control menopausal symptoms byreplacing estrogen that was lost owing to menopauseTransdermal estrogen therapy has fewer adverse effects.-The total dose of estrogen isgreatly reduced (because the liver is bypassed).There is less nausea and vomiting.Blood levels of estrogen fluctuate less.There is a lower risk for DVT, pulmonary embolism, and stroke.1

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NR568 Final Exam Study GuideTypes:Emulsion (Estrasorb)Spray (Evamist)Gels (EstroGel, Elestrin, Divigel)Patches (Alora, Climara, Estraderm, Menostar, Vivelle-Dot, Oesclim )Osteoporosis, osteopenia, and hormone replacement therapy (HRT)oSelective estrogen receptor modulator (SERM)-Are drugs that activate ERs insome tissues and block them in others.These drags were developed in an effort to provide the benefits of estrogen (e.g.,protection against osteoporosis, maintenance of the urogenital tract, reduction ofLDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer,uterine cancer, and thromboembolism)Bazedoxifene - Duavee (conjugated estrogens/bazedoxifene)for prevention ofvasomotor symptoms and osteoporosis in postmenopausal women with a uterus.Duavee is the first drug to combine estrogen with an estrogen agonist/antagonist(bazedoxifene).The bazedoxifenecomponent of Duavee reduces the risk for excessive growth of thelining of the uterus that can occur with the estrogen component.Contraindicationsto taking Duavee are the same as for other estrogen-containingproducts.□Management of oral contraceptives (OCs)oHow to change patient from one combination oral contraceptive to another.start the new brand on active hormone tablets and skip the pill free interval or usenon-hormonal forms of contraception until 7 active tablets of the new brand havebeen takenoHow to initiate treatment (when in the cycle is it best to start- may vary based onthe type of contraceptiveUse is initiated on day 1 of the menstrual cycle, and one pill is taken daily thereafter.A backup contraceptive method should be used for the first 7 days.oWhat teaching needs to be done-Take pill around the same time dailyAmong women of higher weight, efficacy is somewhat reduced.Report leg tendemess/pain/redness, SOB, headaches/migraines, sudden chestpains, visual changes.If a mini pill is missed by more than 3 hours, take it immediately and use backupfor at least 2 daysIf one or more pills are missed in the first week, take one pill as soon as possibleand then continue with the pack. Use an additional form of contraception for 7days.If one or two pills are missed during the second or third week, take one pill assoon as possible and then continue with the active pills in the pack but skip theplacebo pills and go straight to a new pack once all the active pills have been2

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NR568 Final Exam Study Guidetaken.If three or more pills are missed during the second or third week, follow the sameinstructions given for missing one or two pills but use an additional form ofcontraception for 7 days.What baseline data is needed?-Baseline Data:Assess for history of hypertension, diabetes, thromboembolism, cerebrovascular orcardiovascular disease, breast cancer. Urine pregnancy test.Monitoring:No routine monitoring required.oContraindications for OCs-Absolute contraindicationsThrombophlebitis, thromboembolic disorders, cerebral vascular disease,coronary occlusion,or a past history of these conditions, or a condition thatpredisposes to these disordersAbnonnal liver functionKnown or suspected breast cancerUndiagnosed abnormal vaginal bleedingKnown or suspected pregnancySmokers older than 35 yearsRelative contraindicationsHypertensionCardiac diseaseDiabetesHistory of cholestatic jaundice of pregnancyGallbladder diseaseUterine leiomyomaEpilepsymigraineoHow to achieve an extended cycle with oral contraceptives-Skipping the placebo pills,which is SAFE to doWhat behaviors would make one birth control method more effective over another?Taking pills at same down daily (3 hour window)Starting new pill packs on timeUsing NH contraceptives (i.e condoms) the first 7 days on new medicationsoBe able to evaluate a patient scenario and suggest an appropriate birth controlmethod (type of prescribed contraception: OC, long-term methods, IUD, long-acting reversible contraceptives (LARCs), etc.What effect does CYP450 inhibitors or inducers have on OCs?-inducers of the p450system may increase OC metabolism.oRecall examples of CYP450 inhibitors and inducers from NR565 (Chapter 4 intextbook)- INHIBITORS: grapefruit, amiodarone, fluconazole, fluoxetine,metronidazole, ritonavir, trimethoprim/sulfamethoxazole.INDUCERS: carbamazepine, phenobarbital, phenytoin, rifampin3

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NR568 Final Exam Study GuideoHow does this impact prescribing of OCs?Benefits and drawbacks of progestin-only contraception-less effective and are morelikely to cause irregular bleeding (breakthrough bleeding, spotting, amenorrhea,inconsistent cycle length, variations in the volume and duration of monthly flow).Irregular bleeding is the major drawback of these products and the principal reason thatwomen discontinue them.What are the most effective forms of contraception?-Extremely EffectiveEtonogestrel subdermal implant (Nexplanon)Surgical sterilizationFemale: tubal ligationMale: vasectomyIntrauterine devicesCopper T 380A (ParaGard)Levonorgestrel T (Mirena)Very EffectiveOral contraceptivesCombination pillsProgestin-only pillsIntramuscular medroxyprogesterone acetate (Depo-Provera)Vaginal contraceptive ring (NuvaRing)Contraceptive patch (Ortho Evra) 8Testosterone replacementoAdministration- Patches are applied once daily to the upper arm, thigh, back, orabdomen. Testosterone gel can be prescribed as wellUsed for hypogonadism, replacement therapy, and delayed puberty in malesoBenefits- treatment restores libido, increases ejaculate volume, and supports theexpression of secondary sex characteristicsoPatient Teaching-treatment will not restore fertilityogood handwashing is required after applicationocover application site with clothing after medication has driedowash the application site before skin-to-skin contact with another personofemales and children may experience negative effects from exposure totestosteroneoif cross-contamination occurs, wash the affected area with soap and water toprevent absorptionoTreatment of delayed puberty- reflects a familial pattern of delayed puberty and does notindicate pathology.prescribe a limited course of androgen therapy off label if the psychologic pressures ofdelayed sexual maturation are causing a boy significant distress.In these cases, a limited course of androgen therapy is indicated.Both fluoxymesterone (Androxy, Halotestin) and methyltestosterone(Methitest) are approved for this purpose4

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