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Nursing 2590 > Exam 1 Women's Health Chapter 52 > Flashcards

Exam 1 Women's Health Chapter 52 Flashcards

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1
Q

What are the 3 types of birth control?

A
  1. Combined Hormonal Therapy - CHC
  2. Progestin Only Products -POP
  3. Alternatives
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2
Q

What are the three types of of CHC
(combined hormonal therapy)?

A
  1. Combined ORAL Contraceptives -COC
  2. Transdermal Patch
  3. Transvaginal Ring
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3
Q

What type of birth control is COC (Combined Oral Therapy)

A

COC (oral) is a type of
CHC Combined Hormonal Therapy

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4
Q

Endometriosis is

A

Abnormal location of endometrial tissue outside the uterus

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5
Q

Dysmenorrhea is

A

also known as cyclic pelvic pain

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6
Q

Dysfunctional uterine bleeding is

A

a classification of irregular bleeding

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7
Q

Polycystic ovarian syndrome is

A

A disorder in the metabolism of androgens and estrogens

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8
Q

Premenstrual Syndrome is

A

Collection of cyclic physical and mood alterations

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9
Q

Womens’ reproductive life begins with ___ and continues through _____

A

Menarche and menopause

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10
Q

Drospirenone is an analog of _________

A

Spironlactone (K+ sparing diuretic) can create Hyperkalemia
It is a progestin (synthetic progesterone)
used in birth control
ONE - COMMON ENDING
drospirenONE
spironlactONE

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11
Q

If minipill delayed for more than 3 hours, use back up contraception for ___ hours

A

48

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12
Q

Inhibition of FSH and LH secretion results in ___

A

anovulation and amenorrhea

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13
Q

GnHR agonists inhibits the release of GnRH creating a

A

HYPO estrogenic environment

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14
Q

NO ORAL contraceptives

A

38 year old with breast cancer

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15
Q

Who should use CHC with caution

A

smokers and diabetics

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16
Q

woman on CHC misses one dose what to do

A

take now, back on schedule for next one

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17
Q

Conjugated estrogen side effects

A

acne,
breast tenderness,
fluid retention,
leg cramps,
nausea

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18
Q

What drugs interact with conjugated estrogen birth control pills?

A

Phenobarbital (seizures)
Topiramate (seizures)
Aspirin - (may prevent early thrombus , thins blood)

think PAP

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19
Q

Etonogestrel transvaginal ring falls out, what to do

A

if less than 3 hours, rinse and return

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20
Q

The patient is taking a COC birth control pill.
What symptom to call HCP for ?
COC =Combined oral contraceptives

A

Headache

think H - HCP=Headache

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21
Q

Progestin HT will reduce the risk of ______ cancer

A

cervical and endometrial

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22
Q

What causes Break Through Bleeding (BTB)

A

lower progesterone
why? progesterone helps maintain the lining of the uterus

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23
Q

How effective is CHC?

A

92-93%

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24
Q

CHC is a combination of what two hormones?
____ and ______

A

EE (ethinyl estridiol) - ONLY 1 type
and PROGESTIN (synthetic progesterone) 6-7 types

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25
Q

MAIN PROBLEMS WITH higher doses of ESTROGEN

A

BLOOD CLOTS -VTE, Stroke, and MI.

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26
Q

Side effects of higher dose ESTROGEN

A

Think MORE Of EVERYTHING
1. cyclic breast changes
2. dysmenorrhea (painful periods)
3. menorrhagia (heavy periods)
4. chloasma (hyperpigmentation)
5. Blood clots - VTE, stroke, MI

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27
Q

Overall goal of CHC is to use the ____ amount of estrogen as possible. highest or lowest amount

A

Overall goal of CHC is to use the LEAST amount of estrogen as possible. 20-35 micrograms

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28
Q

3 ways CHC’s work?

A

FSH and LH Suppression
1. Ovulation prevention
2. Mucus - Increase cervical mucus (sperm do not like it)
3. Uterine Lining - affects it, thinner

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29
Q

How does COC’s work

A

Same as CHCs
1. NO EGG -Ovulation prevention
2. MORE MUCOUS -Increase cervical mucus (sperm do not like it)
3. THINNER LINING -Uterine Lining - affects it, thinner

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30
Q

LACK OF ESTROGEN CAN CAUSE

A

amenorrhea/spotting

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31
Q

INCREASED PROGESTERONE can cause

A
  1. weight gain
  2. depression
  3. fatigue
  4. dec. libido
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32
Q

DECREASED PROGESTERONE can cause

A
  1. BTB - break through bleeding
  2. headaches

progesterone helps to maintain the lining of the uterus

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33
Q

CHC PRODUCTS - COC key points

A

MUST take a pill everyday.
21 days the pills are estrogen/progesterone and 7 days placebo (menstruation)
Extended cycle options

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34
Q

CHC PRODUCTS- Transdermal Patch

A

NOT effective over 198 pounds
Change patch once a week for three weeks,
no patch one week (period)
Inc. risk of VTE

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35
Q

If you weight 200 lbs, what method of CHC will not work for you?

A

Transdermal patch

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36
Q

CHC PRODUCTS - Transvaginal Ring

A

Self insert during first 5 days of period
Leave in 21 days, remove when next period comes.
Back up contraceptive first 7 days and if it comes out.

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37
Q

Why choice CHC that is not oral?

A

Avoid first pass WHICH WILL DECREASE. N/V
Adherence

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38
Q

Transvaginal Ring side effects

A

vaginal discharge
irritation
infection
smoking inc. side effects

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39
Q

COC. Combined oral contraceptives

A

Different types
Varying amounts of progesterone
Side effects. -Withdrawal bleeding
less side effects than others

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40
Q

DROSPIRENONE - how it works

A

DROSPIRENONE - a type of progesterone in COC (YaZ)
Adrenal gland releases aldosterone which holds onto Na and H20 and releases K+.
This drug decreases the amount of aldosterone released so more Na/H2O is released and K+ stays, leading to hyperkalemia and dec BP.
DROSPIRENONE - HYPERKALEMIA

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41
Q

DROSPIRENONE - contraindications

A

History of VTE
Hyperkalemia
Hypotension

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42
Q

CHC - Advantages

A

Dec. ovarian cysts
Dec. menstrual symptoms
Easy to use
Dec. inc of PID
Dec risk of certain cancers - endometrial/cervical
dec. acne

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43
Q

CHC - Disadvantages

A

Risk of STD
Need Medical follow up
Risk of PG due to compliance
Side Effects/Adverse Reactions

44
Q

CHC - Side Effects

A

Weight Gain at the beginning
Headache/Nausea
BTB
Chloasma - hyperpigmentation with estrogen
Vaginal discharge/irritation with the ring

45
Q

CHC- ADVERSE Reactions/Risks

A

DVT, PE, MI, stroke
Breast malignancy
Hyperkalemia - with Drosperinone

46
Q

CHC - Contraindications

A

Pregnant
*History of VTE
History of CAD, PE, stroke - Progesterone only
*Liver disease
*Breast Cancer that is premenapausal
Breastfeeding first 3 months and dec. amount of milk
Smoking
Older than 35 not recommended

47
Q

IMPORTANT
CHC Drug INTERACTIONS
LESS EFFECTIVE WITH THESE

A

Hydantoins seizures
Phenobarbital
Penicillin - antibiotic
Rifampicin - tb

48
Q

CHC - herbals NOT to use

A

Black Cohosh
St. John’s Wort
Don Quai
Red Clover
Chasteberry

49
Q

A woman with a history of liver disease and
breast cancer is being treated for a deep vein thrombosis.
She is inquiring about birth control.
Would you
consider her a candidate for Combined Hormonal
Contraception?

A

NO

50
Q

A patient taking ortho-novum, a CHC product,
reports taking black cohosh to minimize
premenstrual symptoms. Which of the following is
the nurse’s best response?
* A. “Combining both agents will assure a decrease
in PMS symptoms
* B. “If combining, increase the dose of black
cohosh.”
* C. “The ortho-novum may not prevent pregnancy
when combined with this herb.”

A

C. “The ortho-novum may not prevent pregnancy
when combined with this herb.”

51
Q

Progestin Only Pills (POP) Mechanism

A

Ovulation not consistently inhibited
Inc. in cervical mucous
Dec. in lining of the ulterus
Do not contain estrogens
Option for women who cannot take CHC (estrogen)
every pill has a hormone in it

52
Q

POP side effects

A

VTE
Chance of PG except with depo shot if on time
Wt. gain
inc acne
BTB
Depression
Dec. effectiveness of ABX
Not for over 35 or smoker

53
Q

POP Compliance

A

Must take within a 3 hour window each day.
Always have a new pill pack ready

54
Q

POP types

A

POP pills
Injection
Implant
IUD

55
Q

Biggest difference between CHC and POP?

A

POP does NOT consistently inhibit ovulation.

56
Q

POP - 4 main things to remember

A

Does not consistently inhibit ovulation
compliance necessary - 3 hour window
No periods but BTB
Each pill has a hormone

57
Q

POP The Shot what is it called?

A

Medroxyprogesterone is the type of progesterone
Called Depo-Provera. DMPA. every 13 weeks
If you miss the window by more than 2 weeks
need extra protection

58
Q

POP the Shot - how does it work

A

prevents ovulation, inc cervical mucus
thins lining of the uterus
no ovulation and no period

59
Q

POP the shot. side effects

A

Dec bone density inc risk of osteoporosis

60
Q

POP the shot. TEACHING

A

Take Calcium, D3
weight bearing exercises (walking, running, wt. lifting yoga not swimming

61
Q

ETONOGESTREL IMPLANT
(NEXPLANON). how long is it good for, who implants it

A

Three years
must be done by trained HCP

62
Q

ETONOGESTREL IMPLANT (NEXPLANON).
who should not use it ?

A

BMI greater than 30 (greater than 198 pounds)

63
Q

Levonorgesterol
Intrauterine Device (IUD). How long is it good for.

A

good for 3-5 years

64
Q

Levonorgesterol
Intrauterine Device (IUD). TEACHING

A

Ck the string
call HCP -
Fever or bleeding perferation pid, Temperature

65
Q

ALTERNATIVE METHODS OF
CONTRACEPTION

A

NO HORMONES
Spermicides
Barrier Methods - condoms (male or female)
Intrauterine devices
-ParaGard - copper impeded sperm migration -10 years of protection

66
Q

What birth control works REALLY, REALLY well?

A

Implant
IUD
COPPER IUD
Sterilization
1/100 chance of getting pregnant

67
Q

What birth control works PRETTY well?

A

The Pill
The Patch
The Ring
The Shot

68
Q

What birth control does not work well?

A

Withdrawal
Fertility awareness
internal condom
condom

69
Q

Birth Control - Patient teaching

A

Nursing - no CHC in first 3 months, dec. in breast milk
Nursing - can get the shot immediately
Adv and Disadvan of hormonal BC
Risk of Smoking
Missed Pills
Mammos and breast exam
Drug interactions - abx, rimfampin
ACHES -s/s of VTE

70
Q

ACHES -
Serious complications of birth control pills

A

A -abdominal pain
C - chest pain, shortness of breath
H - Headache - sudden and persistent
E - Eye problems - vascular acciendt or inc. bp
S - severe leg pain - blood clot - one leg usually

71
Q

Is Menopause a disease?

A

No it is a process
perimenopause - beginning to dec. estrogen and progesterone
why see HCP - to ease symptoms
Lasts about 5 years

72
Q

Menopause s/s

A

Lighter menstrual flow,
hot flashes,
vaginal dryness,
HA,
irritability,
insomnia,
bone loss

73
Q

Menopause treatment options

A
  1. Hormonal Replacement Therapy
  2. Complementary and alternative medicine
  3. Prescription non-hormonal agents
74
Q

Menopause - HRT
2 types of hormonal treatment

A

Estrogen ONLY
Estrogen/Progestin

75
Q

Menopause - HRT
Estrogen ONLY treatment is only for women who have ________uterus

A

NO INTACT UTERUS
Why? if there is a uterus there will be an overgrowth of the lining and incr. the risk of endometrial cancer.

76
Q

Menopause - HT
Patients with an intact uterus can use
ESTROGEN ONLY Treatment.
TRUE OR FALSE

A

FALSE
Only those who have NO intact uterus.

77
Q

Menopause - HT -
What are the types of estrogen only medications

A
  • Conjugated equine estrogen
  • Transdermal estradiol
  • Estradiol Intravaginal Tablets
  • Estradiol Cream
78
Q

Menopause - HT -
What are the types of Estrogen/Progestin medications

A

-Conjugated estrogen and medroxyprogesterone
* Estradiol and norethindrone

79
Q

Contraindications to HT

A

Breast Cancer
Endometrial Cancer
Pregnancy
Thromboembolic disorders
Acute liver disease
CAD
Undiagnosed Vaginal bleeding
Smoking

80
Q

BLACK BOX WARNING FOR HT

Must KNOW THIS…WILL BE ON THE TEST

A

May cause:
CV disorders
breast cancer
endometrial cancer
dementia

81
Q

What is osteoporosis?

A

increased Osteoclast (breaks down bone) activity as compared to Osteoblast (builds bond) activity. Bone density is decreased.

82
Q

Who is most at risk for osteoporosis?

A

White, small framed females.
Men can also get osteoporosis, not just women.

83
Q

What are the 2 interventions?

A

Non-pharm - diet, weight bearing (calcium rich)
Pharm -biosphosphonates, MAB SERMS

84
Q

Teaching for Osteoporosis meds

A

Take with water and stay upright for 30 minutes to prevent esophageal erosion
Calcitonin - allergic rxn

85
Q

When is Magnesium Sulfate (MgS) indicated for use?

A
  1. Preeclampsia or eclampsia L and D. inc. BP
  2. Mg replacement

It relaxes smooth mucsles.

86
Q

How is MgS administered?

A

IV via volumetric pump

87
Q

Adverse RXN to MgS

A

Overdose:
Flushing
hypotension
lethargy
diminished reflexes
respiratory
Think Mag Sags - thinks decrease

88
Q

What is the antidote to MgS

A

Calcium gluconate (IV)

89
Q

Nursing considerations with MgS

A

Monitor:
LOC
VS
FHR (fetal heart rate) and activity
uterine activity
monitor bowel sounds
monitor Mg levels
Assess DTR

90
Q

Recommended calcium intake

A

12-1500da7
D3 4-800 IU

91
Q

Bone builders

A

Osteoblasts

92
Q

First line treatment for osteoporosis

A

Biphosphonates

93
Q

Selective Estrogen receptor Modulators are called….

A

SERMS Osphena, tamoxifen, Evista soltamox
used for osteoporosis and breast cancerThe pharmacology of SERMs i in bone tissue have an agonist type relationship with estrogen receptors in the bone to promote bone growth in postmenopausal osteoporosis.

94
Q

Fracture prevention with steroid use

A

Parathyroid hormone (PTH) anabolic agent

95
Q

Can cause allergic rxn after administration

A

calcitonin

96
Q

Risk of biphosphates

A

esphoygeal erosion

97
Q

Cause reabsorption of bone

A

Osteoclasts

98
Q

Side effect of Denosumab (Prolia) IM

A

Hypocalcemia
osteonecrosis
allergic rxn
unusual thigh bone fractures

99
Q

Name a common SERM used for osteoporosis and how it works

A

Raloxifene
selective estrogen receptor modulator
binds to estrogen receptors and
decreases bone reabsorption
decrease the lifespan of osteoclasts,
decreases bone remodeling, preserving bone mass.
THink EN - like tamoxifen

100
Q

Name a MoAB used for osteoporosis, ‘what it does, and what to asses.

A

Denosumab - dec. osteoclastic activity
Monitor for hypocalcemia, give Ca and D3 with it.

101
Q

What does CALCITONIN do for osteoporosis

A

decrease osteoclastic activity
post-menopausal
watch for allergic rxn

102
Q

Name a Parathyroid hormone and what it does for HT

A

TERIPARATIDE STIMULATES OSTEOBLASTIC activity
Prevents fractures with corticosteroid use.

DIFFERENT FROM Moab, calcitonin, SERMs
which dec. osteoclastic activity

THINK TeraPeritide - PERITIDE = parathyroid

103
Q

What does SERM mean

A

Selective
estrogen
receptor
modulators

104
Q

HT for osteoporosis - is what drug

A

estradiol transdermal system
to balance estrogen which will
diminish menopausal symptoms

105
Q

When is HT used for menopause

A

those who do not tolerate other treatments

106
Q

When using HT for women w/intact uterus what else would you add

A

Progestin

Nursing 2590 (6 decks)

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