Chapter 34: Women's Health Flashcards

1
Q

Bisphosphonates (e.g., alendronate) are to be taken exactly

as prescribed; that is

A

the drug is taken at least 30 minutes
before the first morning beverage, food, or other medication
and with at least 6 to 8 oz of water. Emphasize the importance
of remaining upright for at least 30 minutes after taking
the medication to prevent esophageal and GI adverse
effects. Esophageal irritation, dysphagia, severe heartburn,
and retrosternal pain must be reported to the prescriber
immediately to help prevent severe reactions.

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2
Q

Conjugated estrogens are used for menopausal symptoms and
are given orally every day; however, other uses of these estrogens
may require different doses and a different dosage schedule/regimen.

A

Emphasize the expected adverse effects such as edema,
nausea, diarrhea/constipation, breakthrough uterine bleeding,
chloasma (facial skin discoloration), hirsutism, tender breasts,
and headaches. Encourage the patient to report the following
conditions: elevated blood pressure, severe headaches with
changes in vision and vomiting, abdominal pain, and edema.

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3
Q

Uterine stimulants

A

(sometimes called oxytocic drugs) include

ergot derivatives, prostaglandins, and oxytocin

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4
Q

Uterine relaxants

A

(often called tocolytic drugs) are used to
stop preterm labor and maintain pregnancy by halting uterine
contractions.

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5
Q

Progesterone is the principle secretory product of the corpus
luteum and has progestational effects.

A

These include promotion
of tissue growth and secretory activity in the endometrium following
the estrogen-driven proliferative phase of the menstrual
cycle. This important secretory process is required for endometrial
egg implantation and maintenance of pregnancy.

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6
Q

There are three major endogenous estrogens: estradiol, estrone,
and estriol.

A

All are synthesized from cholesterol in the ovarian
follicles and have the basic chemical structure of a steroid,
known as the steroid nucleus. For this reason, they are sometimes
referred to as steroid hormones.

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7
Q

Estrogens can decrease the activity of the

A

oral anticoagulants,
and the concurrent administration of rifampin and St. John’s
wort can decrease their estrogenic effect.

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8
Q

ESTROGENS: COMMON

ADVERSE EFFECTS

A

Cardiovascular Hypertension, thrombophlebitis, edema
Gastrointestinal Nausea, vomiting, diarrhea, constipation
Genitourinary Amenorrhea, breakthrough uterine bleeding,
enlarged uterine fibromyomas
Dermatologic Chloasma (facial skin discoloration; also
called melasma), hirsutism, alopecia
Other Tender breasts, fluid retention, decreased
carbohydrate tolerance, headaches

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9
Q

All of the progestin products produce the same physiologic

responses as those produced by progesterone itself.

A

These
responses include induction of secretory changes in the endometrium,
including diminished endometrial tissue proliferation;
an increase in the basal body temperature; thickening of
the vaginal mucosa; relaxation of uterine smooth muscle; stimulation
of mammary alveolar tissue growth; feedback inhibition
(negative feedback) of the release of pituitary gonadotropins
(FSH and LH); and alterations in menstrual blood flow, especially
in the presence of estrogen

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10
Q

Progestins are useful in the treatment

A

of functional uterine
bleeding caused by a hormonal imbalance, fibroids, or uterine
cancer; in the treatment of primary and secondary amenorrhea;
in the adjunctive and palliative treatment of some cancers
and endometriosis; and, alone or in combination with estrogens,
in the prevention of conception.

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11
Q

PROGESTINS: COMMON

ADVERSE EFFECTS

A

Gastrointestinal Nausea, vomiting
Genitourinary Amenorrhea, spotting
Other Edema, weight gain or loss, rash, pyrexia,
somnolence or insomnia, depression

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12
Q

The most serious undesirable effects of progestin use

A

include liver
dysfunction, commonly manifested as jaundice, thrombophlebitis,
and thromboembolic disorders such as pulmonary embolism.

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13
Q

Estrogen-
progestin combinations, often referred to as “the
pill,” are oral contraceptives

A

that contain both estrogenic and
progestational steroids. The most common estrogenic component
is ethinyl estradiol, a semisynthetic steroidal estrogen. The
most common progestin component is norethindrone

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14
Q

Educate patients about the need

to use alternative birth control methods for at least 1 month

A

during and after taking any of the following drugs: antibiotics
(especially penicillins and cephalosporins), barbiturates,
isoniazid, and rifampin.

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15
Q

ORAL CONTRACEPTIVES:

COMMON ADVERSE EFFECTS

A

Cardiovascular Hypertension, edema, thromboembolism, pulmonary
embolism, myocardial infarction
Central nervous Dizziness, headache, migraines, depression, stroke
Gastrointestinal Nausea, vomiting, diarrhea, anorexia, cramps, constipation,
increased weight, cholestatic jaundice
Genitourinary Amenorrhea, cervical erosion, breakthrough bleeding,
dysmenorrhea, breast changes

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16
Q

Several drug classes are used for the treatment of existing

osteoporosis

A

the bisphosphonates, the selective estrogen
receptor modulators (SERMs), the hormones calcitonin and
teripartide, and most recently, denosumab. Currently available
bisphosphonates used for osteoporosis prevention and treatment
include alendronate, ibandronate, risedronate, and the
once-a-year injection zoledronic acid

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17
Q

Osteoclasts

A

are bone cells that break down bone,
causing calcium to be reabsorbed into the circulation; this
resorption eventually leads to osteoporosis if not controlled or countered by adequate new bone formation.

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18
Q

Indications

A

Raloxifene is primarily used for the prevention of postmenopausal
osteoporosis. The bisphosphonates are used in both the prevention and treatment of osteoporosis. Teriparatide is used
primarily for the subset of osteoporosis patients at highest risk
of fracture (e.g., those with prior fracture), and calcitonin is
used for treatment of osteoporosis

19
Q

The most common
adverse effects of bisphosphonates are headache, gastrointestinal
(GI) upset, and joint pain. However, the bisphosphonates
are usually well tolerated.

A

There is a risk of esophageal burns
with these medications if they become lodged in the esophagus
before reaching the stomach. For this reason the patient
must take these medications with a full glass of water and must
remain sitting upright or standing for at least 30 minutes afterward

20
Q

FERTILITY DRUGS: MOST

COMMON ADVERSE EFFECTS

A

Cardiovascular Tachycardia, deep vein thrombosis, hypovolemia
Central nervous Dizziness, headache, flushing, depression, restlessness,
anxiety, nervousness, fatigue
Gastrointestinal Nausea, bloating, constipation, vomiting, anorexia
Other Urticaria, ovarian hyperstimulation, multiple pregnancy
(twins or more), blurred vision, diplopia,
photophobia, breast pain

21
Q

During childbirth, oxytocin

A

stimulates uterine contraction,

and during lactation it promotes the movement of milk from the mammary glands to the nipples

22
Q

When the prostaglandin concentrations increase during

the final few weeks of pregnancy

A

mild myometrial contractions,
commonly known as Braxton Hicks contractions,
are stimulated

23
Q

progesterone antagonist mifepristone (Mifeprex), also

known as the “abortion pill.”

A

This drug also stimulates uterine
contractions and is used to induce elective termination
of pregnancy.

24
Q

OXYTOCIC DRUGS: MOST

COMMON ADVERSE EFFECTS

A

Cardiovascular Hypotension or hypertension, chest pain
Central nervous Headache, dizziness, fainting
Gastrointestinal Nausea, vomiting, diarrhea
Genitourinary Vaginitis, vaginal pain, cramping
Other Leg cramps, joint swelling, chills, fever, weakness,
blurred vision

25
Q

Preterm labor

A

is defined as substantial uterine contractions
which could progress to delivery and occur prior to the 37th
week of pregnancy.

26
Q

Drugs given to

inhibit labor and maintain the pregnancy are called tocolytics

A

Terbutaline is a beta-adrenergic drug (see Chapter 18) and used
to be the drug of choice for preterm labor. It works by directly
relaxing uterine smooth muscle.

27
Q

Mg slows contractions…. Magnesium sulfate is also used in pregnancy
induced hypertension.

A

Calcium gluconate must be readily available

to reverse magnesium toxicity if it occurs

28
Q

The current recommendations for the management of preterm

labor include the use of

A

nonsteroidal antiinflammatory agent,
indomethacin (see Chapter 44), and the calcium channel blocker,
nifedipine (see Chapter 23). Indomethacin is the most effective
tocolytic currently available and works by inhibiting prostaglandin
activity. Nifedipine inhibits myometrial activity by blocking
calcium influx.

29
Q

Estrogen-only hormones are to only be given after the following
disorders and conditions have been ruled out:

A

any
estrogen-dependent cancer, undiagnosed abnormal vaginal
bleeding, active thromboembolic disorders such as stroke
or thrombophlebitis, or a history of these disorders.

30
Q

hormonal replacement

is not recommended for women with

A

histories of endometrial
cancer; in women with breast cancer, estrogen therapy
has not been proved safe and may raise recurrence risk

31
Q

Drugs that may have their therapeutic
effects decreased if taken concurrently with oral contraceptives
include

A

antiepileptic drugs, beta blockers, hypnotics, antidiabetic
drugs, warfarin, theophylline, tricyclic antidepressants,
and vitamins.

32
Q

with progestins, assess for a history

A

of liver/
gallbladder disease, thrombophlebitis, and thromboembolic
disorders due to possible adverse effects

33
Q

Assess patients

for the drug interaction between bisphosphonates and

A

calcium
supplements and/or antacids (decreased absorption) as well as
aspirin and NSAIDs (potential for additive GI irritation)

34
Q

NURSING DIAGNOSES pg559

A
  1. Decisional conflict related to the risks versus benefits of
    postmenopausal estrogen replacement therapy
  2. Acute pain related to adverse effects and improper dosing of
    SERM
  3. Noncompliance related to lack of information and experience
    with daily dosing of oral contraceptives
35
Q

Megestrol,
a synthetic progestin, is often indicted for palliative reasons or
for management of

A

anorexia, cachexia, or weight loss that is
unexplained in AIDS patients. It is given orally as ordered and
given to maximize appetite

36
Q

With oral bisphosphonates,

emphasize

A

the need to take the medication upon rising
in the morning with a full glass (6 to 8 oz) of water at least
30 minutes before the intake of any food, other fluids, or other
medication. In addition, emphasize that the patient remain
upright in either a standing or sitting position for approximately
30 minutes after taking the drug to help prevent esophageal
erosion or irritation

37
Q

Inform the patient taking the SERM

raloxifene that the drug must be

A

discontinued 72 hours before
and during prolonged immobility. Therapy may be resumed,
as ordered, once the patient becomes fully ambulatory

38
Q

fertility drugs

A

The therapeutic effects of fertility drugs include successful
conception. Adverse reactions include tachycardia, deep vein
thrombosis, hypovolemia, CNS depression, nausea, vomiting,
ovarian hyperstimulation, blurred vision, and photophobia.

39
Q

osteoporosis drugs

A

Therapeutic effects of osteoporosis drugs include increased
bone density and prevention or management of osteoporosis.
Adverse effects of SERMs are hot flashes, leg cramps, leukopenia,
headache, GI upset, joint pain, and esophageal burns
if the drug is lodged in the esophagus before reaching the
stomach.

40
Q

oxytocin and other uterine stimulants

A

Therapeutic effects of oxytocin and other uterine stimulants include stimulation of labor and control of postpartum bleeding.
Adverse effects may include hypotension or hypertension, chest pain, nausea, vomiting, blurred vision, and fainting

41
Q

tocolytics

A

The primary therapeutic effect of tocolytics includes absence of preterm labor. Adverse maternal effects may include vasodilation and increase in heart rate, and fetal side effects include possible
intrauterine growth retardation.

42
Q

estrogens

A

Therapeutic effects of estrogens may range from prevention
of pregnancy to a decrease in menopausal symptoms to a reduction
in the size of a tumor. Adverse effects of estrogens may
include hypertension, thromboembolism, edema, amenorrhea,
nausea, vomiting, facial skin discoloration, hirsutism, breast
tenderness, and headaches.

43
Q

progestins

A

Therapeutic responses to progestins
include a decrease in abnormal uterine bleeding and the
disappearance of menstrual disorders (e.g., amenorrhea). The adverse effects of progestins include jaundice, thrombophlebitis, liver dysfunction, and thromboembolic disorders. Adverse effects associated with oral contraceptives include hypertension,
edema, thromboembolism, headaches, migraines, depression,
stroke, nausea, vomiting, amenorrhea, and breakthrough
bleeding.