Skip to content
Past Exams

NR568 Final Exam Study Guide Week 5 to 8

Detailed nursing notes on hormone replacement therapy (HRT), including indications, estrogen vs. progestin use, local vs. systemic options, and prevention of osteoporosis in menopausal women.

Preview 4 of 12 pages

See the first 4 pages exactly as they appear in the document.

  1. Page 1
    Read page 1 as text

    NR568 Final Exam Study Guide Week 5 Prevention of osteoporosis with hormone replacement therapy- HT reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. Unfortunately, when HT is stopped, bone mass rapidly decreases by approximately 12%. ****Hence to maintain bone health, HT must continue lifelong.*** HT should be considered only for women with significant risk for osteoporosis, and only when that risk outweighs the risks of HT. A person on HT and pts, in general, should practice primary prevention of bone loss by ensuring adequate calcium and vitamin D intake, regular weight-bearing exercise, and avoiding 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-only HRT can be given to someone with a hysterectomy. Progestin is required to prevent estrogen-associated endometrial hyperplasia Local vs. systemic estrogen options and why one would be chosen over the other- intravaginal preparations are most helpful in treating symptoms associated with local estrogen deficiency, such as vaginal and vulvar atrophy; these preparations are associated with a lower risk of systemic effects progesterone is contraindicated in women who have undergone a hysterectomy but required in women with an intact uterus who have undergone hormone replacement therapy IV administration is generally limited to acute, emergency control of heavy uterine bleeding. One of the two available vaginal rings (Estring) are used only for local effects, primarily treatment of vulval and vaginal atrophy associated with menopause. The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot flashes and night sweats) as well as local effects (e.g., treatment of vulval and vaginal atrophy). o Peri-menopausal estrogen therapy (ET) - remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. 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 a progestin (estrogen/progestin therapy [EPT]). The purpose of estrogen in both regimens is to control menopausal symptoms by replacing estrogen that was lost owing to menopause Transdermal estrogen therapy has fewer adverse effects.- The total dose of estrogen is greatly 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

  2. Page 2
    Read page 2 as text

    NR568 Final Exam Study Guide Types: Emulsion (Estrasorb) Spray (Evamist) Gels (EstroGel, Elestrin, Divigel) Patches (Alora, Climara, Estraderm, Menostar, Vivelle-Dot, Oesclim ) Osteoporosis, osteopenia, and hormone replacement therapy (HRT) o Selective estrogen receptor modulator (SERM)- Are drugs that activate ERs in some 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 of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer, uterine cancer, and thromboembolism) Bazedoxifene - Duavee (conjugated estrogens/bazedoxifene) for prevention of vasomotor symptoms and osteoporosis in postmenopausal women with a uterus. Duavee is the first drug to combine estrogen with an estrogen agonist/antagonist (bazedoxifene). The bazedoxifene component of Duavee reduces the risk for excessive growth of the lining of the uterus that can occur with the estrogen component. Contraindications to taking Duavee are the same as for other estrogen-containing products. □ Management of oral contraceptives (OCs) o How 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 use non-hormonal forms of contraception until 7 active tablets of the new brand have been taken o How to initiate treatment (when in the cycle is it best to start- may vary based on the type of contraceptive Use 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. o What teaching needs to be done- Take pill around the same time daily Among women of higher weight, efficacy is somewhat reduced. Report leg tendemess/pain/redness, SOB, headaches/migraines, sudden chest pains, visual changes. If a mini pill is missed by more than 3 hours, take it immediately and use backup for at least 2 days If one or more pills are missed in the first week, take one pill as soon as possible and then continue with the pack. Use an additional form of contraception for 7 days. If one or two pills are missed during the second or third week, take one pill as soon as possible and then continue with the active pills in the pack but skip the placebo pills and go straight to a new pack once all the active pills have been 2

  3. Page 3
    Read page 3 as text

    NR568 Final Exam Study Guide taken. If three or more pills are missed during the second or third week, follow the same instructions given for missing one or two pills but use an additional form of contraception for 7 days. What baseline data is needed?- Baseline Data: Assess for history of hypertension, diabetes, thromboembolism, cerebrovascular or cardiovascular disease, breast cancer. Urine pregnancy test. Monitoring: No routine monitoring required. o Contraindications for OCs- Absolute contraindications Thrombophlebitis, thromboembolic disorders, cerebral vascular disease, coronary occlusion, or a past history of these conditions, or a condition that predisposes to these disorders Abnonnal liver function Known or suspected breast cancer Undiagnosed abnormal vaginal bleeding Known or suspected pregnancy Smokers older than 35 years Relative contraindications Hypertension Cardiac disease Diabetes History of cholestatic jaundice of pregnancy Gallbladder disease Uterine leiomyoma Epilepsy migraine o How to achieve an extended cycle with oral contraceptives- Skipping the placebo pills, which is SAFE to do What 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 time Using NH contraceptives (i.e condoms) the first 7 days on new medications o Be able to evaluate a patient scenario and suggest an appropriate birth control method (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 p450 system may increase OC metabolism. o Recall examples of CYP450 inhibitors and inducers from NR565 (Chapter 4 in textbook)- INHIBITORS: grapefruit, amiodarone, fluconazole, fluoxetine, metronidazole, ritonavir, trimethoprim/sulfamethoxazole. INDUCERS: carbamazepine, phenobarbital, phenytoin, rifampin 3

  4. Page 4
    Read page 4 as text

    NR568 Final Exam Study Guide o How does this impact prescribing of OCs? Benefits and drawbacks of progestin-only contraception- less effective and are more likely 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 that women discontinue them. What are the most effective forms of contraception?- Extremely Effective Etonogestrel subdermal implant (Nexplanon) Surgical sterilization Female: tubal ligation Male: vasectomy Intrauterine devices Copper T 380A (ParaGard) Levonorgestrel T (Mirena) Very Effective Oral contraceptives Combination pills Progestin-only pills Intramuscular medroxyprogesterone acetate (Depo-Provera) Vaginal contraceptive ring (NuvaRing) Contraceptive patch (Ortho Evra) 8 Testosterone replacement o Administration- Patches are applied once daily to the upper arm, thigh, back, or abdomen. Testosterone gel can be prescribed as well Used for hypogonadism, replacement therapy, and delayed puberty in males o Benefits- treatment restores libido, increases ejaculate volume, and supports the expression of secondary sex characteristics o Patient Teaching- treatment will not restore fertility o good handwashing is required after application o cover application site with clothing after medication has dried o wash the application site before skin-to-skin contact with another person o females and children may experience negative effects from exposure to testosterone o if cross-contamination occurs, wash the affected area with soap and water to prevent absorption o Treatment of delayed puberty - reflects a familial pattern of delayed puberty and does not indicate pathology. prescribe a limited course of androgen therapy off label if the psychologic pressures of delayed 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 purpose 4

8 more pages in the full document

Unlock it once and it stays in your library, ready to chat with or turn into flashcards.

Unlock the full document

More Nursing study materials

See all

Study this document with CramX

Once it is in your library, every tool can work from it.