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FNP Review > Ch. 9 GU/Repro > Flashcards

Ch. 9 GU/Repro Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

What are examples of combined hormonal contraceptives?

A

COCs
Vaginal ring (Nuvaring)
Patch (Ortha Evra)

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2
Q

How do combined hormonal contraceptives work?

A

Steady levels of estrogen and progesterones trick the pituitary gland into thinking you are pregnant –> stops releasing hormones that stimulate ovulation

Progestin: inhibits ovulation by suppressing LH, thickening the endocervical mucus, and thinning the endometrium.

Estrogen: ovulation is inhibited by suppression of FSH and LH and alteration of endometrial cellular structure

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3
Q

When does fertility return after stopping COC?

A

Fertility returns promptly.

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4
Q

What are non-contraceptive benefits of CHCs?

A

-Decreased risk of ovarian, endometrial, and colon cancer
- Decreased dysmenorrhea
- Helps acne
- Helps hirsutism
- Lighter periods / decreased IDA
- Decreased rates of ovarian cysts

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5
Q

Common adverse effects of CHCs

A
  • Breakthrough bleeding (highest reason for drop out)
  • Nausea
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6
Q

Absolute CI for CHC use

A
  • Current breast cancer
  • Postpartum <21 days
  • Acute hepatitis
  • Migraine WITH aura
  • Age 35+ AND smoking 15+ cigarettes per day
  • HTN (>160/100)
  • History of DVT/PE AND 1+ risk factor for recurrent DVT/PE
  • Known clotting / thrombotic disorder
  • Hx ischemic heart disease or stroke
  • Mod or severely impaired cardiac function
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7
Q

Common COC medication interactions

A
  • Anti-epileptics (phenytoin, carbamazepine, topiramate)
  • St. John’s Wort
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8
Q

Patient education: missing COCs

A
  • Pill missed 12+ hours but only one pill missed in a day: Take today’s pill immediately. No additional or emergency contraception needed. Continue with pack.
  • More than one pill is missed: Take today’s pill and the last forgotten pill today (two tabs in one day). If she has at least 7 more active pills in pack - take the rest of the active pills, skip the placebo pills, and start the next pack without interruption + use condoms/abstain x7 days. OR they can take the pills as in the pack and use condoms until she has taken 7 days of active pills.
  • Should also encourage emergency contraception if she had unprotected sex in last 7 days.
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9
Q

How do progestin-only pills / Depo work?

A

Thickening of the endocervical mucus to prevent sperm from reaching uterus / upper genital tract

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10
Q

When does fertility return after stopping depo?

A

Delayed - usually 6-12 months after discontinuation.
Recommended for women who do not wish to get pregnant in next 18 months.

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11
Q

Common side effects of POPs

A

bleeding irregularity - prolonged flow or amenorrhea

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12
Q

Depo adverse effects

A

weight gain
loss of bone density with prolonged use (not to be used for >2 years)
irregular bleeding during first few months

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13
Q

When does fertility return after removing nexplanon?

A

Soon - typically ovulation returns within 7 days of removal

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14
Q

Nexplanon common adverse effects

A

Irregular bleeding
Headaches

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15
Q

Copper IUD common adverse effects

A

increase in menstrual bleeding
upper reproductive tract infections

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16
Q

how long is the copper IUD effective?

A

10 years

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17
Q

how long is nexplanon effective?

A

3 years

18
Q

when should Plan B be taken?

A

recommended 72 hours after coitus, but effective up to 120 hours after

19
Q

how long does perimenopause last?

A

typically lasts 4 years but can range from a few months to 10 years

20
Q

what is the average age of menopause?

A

51.3 years

21
Q

when is a woman considered to be in menopause?

A

when she has not had a naturally occurring period for 12 months

22
Q

Perimenopause: clinical presentation

A

-menstrual irregularities (heavier or lighter, less or more frequent)
-vasomotor symptoms (hot flashes, trouble sleeping, mood changes)
-vaginal atrophy

23
Q

what causes hot flashes?

A

thought to be due to shifting levels of multiple biological substrates, especially elevated FSH

24
Q

Pharmacologic management of menopausal symptoms

A
  • HT - estrogen supplements - ACOG recommends using lowest dose for shortest amount of time. ALWAYS give with progesterone if patient has uterus (risk of endometrial cancer)
  • low dose SSRI/SNRI (ex: sertraline, venlafaxine)
  • gabapentine
  • low dose COCs can be used for women who continue to menstruate but are having vasomotor sx
  • topical estrogen (cream, ring, tablet)
25
Q

CI to postmenopausal HT

A

-unexplained vaginal bleeding
- acute liver disease
- chronic impaired liver function
- Thrombotic disease
- Endometrial cancer
- current, past, or suspected breast cancer
- high risk cardiovascular disease

26
Q

non-pharmacologic management of menopausal symptoms

A
  • avoid spicy foods
  • avoid alcohol
  • loose fitted clothing
  • cool room / climate control
  • avoid cigarette smoking
  • avoid hot showers/baths
27
Q

what causes BV?

A

occurs when there is a disruption of the normal vaginal flora (usually lactobacilli) which allows for overgrowth of anaerobes

28
Q

risk factors for BV

A

-recent abx
- douching
- tub bathing (esp with bubble bath)
- OTC intravaginal hygiene product use
- IUD
- frequent sexual intercourse
- presence of other STIs

29
Q

BV s/sx

A
  • thin gray vaginal discharge
  • amine or fishy vaginal odor

Less common: vulvovaginal irritation, dysuria

30
Q

BV treatment in symptomatic non-pregnant adults

A

metronidazole 500mg BID x7 days OR metronidazole gel QD x5 days

31
Q

BV treatment in symptomatic pregnant adults

A

metronidazole 500mg BID x7 days OR clindamycin 300mg BID x7 days

32
Q

BV diagnosis

A

history: risk factors (douching, bubble baths, recent abx, frequent intercourse, IUD)

PE: thin gray discharge, usually no inflammation

wet prep / vaginal swab + clue cells

33
Q

risk factors for candida vulvovaginitis

A
  • recent abx
  • high dose estrogen therapy
  • pregnancy
  • immunosuppression (ex: HIV)
  • diabetes
34
Q

candida vulvovaginitis s/sx

A
  • vulvovaginal itching/burning
  • thick white/yellow curd-like discharge
  • vulvovaginal excoriation and redness
35
Q

candida vulvovaginitis diagnosis

A

history: risks - recent abx, DM, immunosuppressed, pregnant, high dose estrogen therapy

PE: vulvovaginal redness/excoriation, thick white/curd discharge, itching

Micro: hyphae and pseudohyphae on wet prep

36
Q

vulvovaginitis treatment

A

-fluconazole 150mg PO single dose
- miconazole (Monistat suppository OTC) 1200mg single dose vaginally
- Monistat vaginal cream OTC 1 applicator-ful at bedtime x7 days

Lots of creams/suppositories OTC. Can choose any based on patient preference.

37
Q

what is trichomoniasis?

A
  • a common STD
  • caused by motile protozoan “trichomonads vaginalis”
38
Q

adverse outcomes of untreated trichomoniasis vaginalis

A
  • adverse pregnancy outcomes
  • infertility
  • postoperative infections
  • cervical neoplasia
  • increase risk of HIV transmission
39
Q

trichomoniasis s/sx

A

females: dysuria, itching, vulvovaginal irritation, dyspareunia, yellow/green vaginal discharge, cervical petechialhemorrhages (strawberry spots)

males: usually no symptoms

40
Q

trichomoniasis diagnosis

A

wet mount: flagellated, motile organisms and large number of PMNs

41
Q

trichomoniasis treatment

A
  • metronidazole PO one time dose OR metronidazole x7 days

*partners needs to be treated.
*both partners should refrain from sex until therapy completed and symptoms resolved.

42
Q
A

FNP Review (2 decks)

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