Chapter 34: Women's Health Flashcards
Bisphosphonates (e.g., alendronate) are to be taken exactly
as prescribed; that is
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.
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.
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.
Uterine stimulants
(sometimes called oxytocic drugs) include
ergot derivatives, prostaglandins, and oxytocin
Uterine relaxants
(often called tocolytic drugs) are used to
stop preterm labor and maintain pregnancy by halting uterine
contractions.
Progesterone is the principle secretory product of the corpus
luteum and has progestational effects.
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.
There are three major endogenous estrogens: estradiol, estrone,
and estriol.
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.
Estrogens can decrease the activity of the
oral anticoagulants,
and the concurrent administration of rifampin and St. John’s
wort can decrease their estrogenic effect.
ESTROGENS: COMMON
ADVERSE EFFECTS
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
All of the progestin products produce the same physiologic
responses as those produced by progesterone itself.
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
Progestins are useful in the treatment
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.
PROGESTINS: COMMON
ADVERSE EFFECTS
Gastrointestinal Nausea, vomiting
Genitourinary Amenorrhea, spotting
Other Edema, weight gain or loss, rash, pyrexia,
somnolence or insomnia, depression
The most serious undesirable effects of progestin use
include liver
dysfunction, commonly manifested as jaundice, thrombophlebitis,
and thromboembolic disorders such as pulmonary embolism.
Estrogen-
progestin combinations, often referred to as “the
pill,” are oral contraceptives
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
Educate patients about the need
to use alternative birth control methods for at least 1 month
during and after taking any of the following drugs: antibiotics
(especially penicillins and cephalosporins), barbiturates,
isoniazid, and rifampin.
ORAL CONTRACEPTIVES:
COMMON ADVERSE EFFECTS
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
Several drug classes are used for the treatment of existing
osteoporosis
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
Osteoclasts
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.
Indications
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
The most common
adverse effects of bisphosphonates are headache, gastrointestinal
(GI) upset, and joint pain. However, the bisphosphonates
are usually well tolerated.
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
FERTILITY DRUGS: MOST
COMMON ADVERSE EFFECTS
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
During childbirth, oxytocin
stimulates uterine contraction,
and during lactation it promotes the movement of milk from the mammary glands to the nipples
When the prostaglandin concentrations increase during
the final few weeks of pregnancy
mild myometrial contractions,
commonly known as Braxton Hicks contractions,
are stimulated
progesterone antagonist mifepristone (Mifeprex), also
known as the “abortion pill.”
This drug also stimulates uterine
contractions and is used to induce elective termination
of pregnancy.
OXYTOCIC DRUGS: MOST
COMMON ADVERSE EFFECTS
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
