Exam 1 Women's Health Chapter 52 Flashcards
What are the 3 types of birth control?
- Combined Hormonal Therapy - CHC
- Progestin Only Products -POP
- Alternatives
What are the three types of of CHC
(combined hormonal therapy)?
- Combined ORAL Contraceptives -COC
- Transdermal Patch
- Transvaginal Ring
What type of birth control is COC (Combined Oral Therapy)
COC (oral) is a type of
CHC Combined Hormonal Therapy
Endometriosis is
Abnormal location of endometrial tissue outside the uterus
Dysmenorrhea is
also known as cyclic pelvic pain
Dysfunctional uterine bleeding is
a classification of irregular bleeding
Polycystic ovarian syndrome is
A disorder in the metabolism of androgens and estrogens
Premenstrual Syndrome is
Collection of cyclic physical and mood alterations
Womens’ reproductive life begins with ___ and continues through _____
Menarche and menopause
Drospirenone is an analog of _________
Spironlactone (K+ sparing diuretic) can create Hyperkalemia
It is a progestin (synthetic progesterone)
used in birth control
ONE - COMMON ENDING
drospirenONE
spironlactONE
If minipill delayed for more than 3 hours, use back up contraception for ___ hours
48
Inhibition of FSH and LH secretion results in ___
anovulation and amenorrhea
GnHR agonists inhibits the release of GnRH creating a
HYPO estrogenic environment
NO ORAL contraceptives
38 year old with breast cancer
Who should use CHC with caution
smokers and diabetics
woman on CHC misses one dose what to do
take now, back on schedule for next one
Conjugated estrogen side effects
acne,
breast tenderness,
fluid retention,
leg cramps,
nausea
What drugs interact with conjugated estrogen birth control pills?
Phenobarbital (seizures)
Topiramate (seizures)
Aspirin - (may prevent early thrombus , thins blood)
think PAP
Etonogestrel transvaginal ring falls out, what to do
if less than 3 hours, rinse and return
The patient is taking a COC birth control pill.
What symptom to call HCP for ?
COC =Combined oral contraceptives
Headache
think H - HCP=Headache
Progestin HT will reduce the risk of ______ cancer
cervical and endometrial
What causes Break Through Bleeding (BTB)
lower progesterone
why? progesterone helps maintain the lining of the uterus
How effective is CHC?
92-93%
CHC is a combination of what two hormones?
____ and ______
EE (ethinyl estridiol) - ONLY 1 type
and PROGESTIN (synthetic progesterone) 6-7 types
MAIN PROBLEMS WITH higher doses of ESTROGEN
BLOOD CLOTS -VTE, Stroke, and MI.
Side effects of higher dose ESTROGEN
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
Overall goal of CHC is to use the ____ amount of estrogen as possible. highest or lowest amount
Overall goal of CHC is to use the LEAST amount of estrogen as possible. 20-35 micrograms
3 ways CHC’s work?
FSH and LH Suppression
1. Ovulation prevention
2. Mucus - Increase cervical mucus (sperm do not like it)
3. Uterine Lining - affects it, thinner
How does COC’s work
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
LACK OF ESTROGEN CAN CAUSE
amenorrhea/spotting
INCREASED PROGESTERONE can cause
- weight gain
- depression
- fatigue
- dec. libido
DECREASED PROGESTERONE can cause
- BTB - break through bleeding
- headaches
progesterone helps to maintain the lining of the uterus
CHC PRODUCTS - COC key points
MUST take a pill everyday.
21 days the pills are estrogen/progesterone and 7 days placebo (menstruation)
Extended cycle options
CHC PRODUCTS- Transdermal Patch
NOT effective over 198 pounds
Change patch once a week for three weeks,
no patch one week (period)
Inc. risk of VTE
If you weight 200 lbs, what method of CHC will not work for you?
Transdermal patch
CHC PRODUCTS - Transvaginal Ring
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.
Why choice CHC that is not oral?
Avoid first pass WHICH WILL DECREASE. N/V
Adherence
Transvaginal Ring side effects
vaginal discharge
irritation
infection
smoking inc. side effects
COC. Combined oral contraceptives
Different types
Varying amounts of progesterone
Side effects. -Withdrawal bleeding
less side effects than others
DROSPIRENONE - how it works
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
DROSPIRENONE - contraindications
History of VTE
Hyperkalemia
Hypotension
CHC - Advantages
Dec. ovarian cysts
Dec. menstrual symptoms
Easy to use
Dec. inc of PID
Dec risk of certain cancers - endometrial/cervical
dec. acne
CHC - Disadvantages
Risk of STD
Need Medical follow up
Risk of PG due to compliance
Side Effects/Adverse Reactions
CHC - Side Effects
Weight Gain at the beginning
Headache/Nausea
BTB
Chloasma - hyperpigmentation with estrogen
Vaginal discharge/irritation with the ring
CHC- ADVERSE Reactions/Risks
DVT, PE, MI, stroke
Breast malignancy
Hyperkalemia - with Drosperinone
CHC - Contraindications
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
IMPORTANT
CHC Drug INTERACTIONS
LESS EFFECTIVE WITH THESE
Hydantoins seizures
Phenobarbital
Penicillin - antibiotic
Rifampicin - tb
CHC - herbals NOT to use
Black Cohosh
St. John’s Wort
Don Quai
Red Clover
Chasteberry
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?
NO
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.”
C. “The ortho-novum may not prevent pregnancy
when combined with this herb.”
Progestin Only Pills (POP) Mechanism
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
POP side effects
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
POP Compliance
Must take within a 3 hour window each day.
Always have a new pill pack ready
POP types
POP pills
Injection
Implant
IUD
Biggest difference between CHC and POP?
POP does NOT consistently inhibit ovulation.
POP - 4 main things to remember
Does not consistently inhibit ovulation
compliance necessary - 3 hour window
No periods but BTB
Each pill has a hormone
POP The Shot what is it called?
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
POP the Shot - how does it work
prevents ovulation, inc cervical mucus
thins lining of the uterus
no ovulation and no period
POP the shot. side effects
Dec bone density inc risk of osteoporosis
POP the shot. TEACHING
Take Calcium, D3
weight bearing exercises (walking, running, wt. lifting yoga not swimming
ETONOGESTREL IMPLANT
(NEXPLANON). how long is it good for, who implants it
Three years
must be done by trained HCP
ETONOGESTREL IMPLANT (NEXPLANON).
who should not use it ?
BMI greater than 30 (greater than 198 pounds)
Levonorgesterol
Intrauterine Device (IUD). How long is it good for.
good for 3-5 years
Levonorgesterol
Intrauterine Device (IUD). TEACHING
Ck the string
call HCP -
Fever or bleeding perferation pid, Temperature
ALTERNATIVE METHODS OF
CONTRACEPTION
NO HORMONES
Spermicides
Barrier Methods - condoms (male or female)
Intrauterine devices
-ParaGard - copper impeded sperm migration -10 years of protection
What birth control works REALLY, REALLY well?
Implant
IUD
COPPER IUD
Sterilization
1/100 chance of getting pregnant
What birth control works PRETTY well?
The Pill
The Patch
The Ring
The Shot
What birth control does not work well?
Withdrawal
Fertility awareness
internal condom
condom
Birth Control - Patient teaching
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
ACHES -
Serious complications of birth control pills
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
Is Menopause a disease?
No it is a process
perimenopause - beginning to dec. estrogen and progesterone
why see HCP - to ease symptoms
Lasts about 5 years
Menopause s/s
Lighter menstrual flow,
hot flashes,
vaginal dryness,
HA,
irritability,
insomnia,
bone loss
Menopause treatment options
- Hormonal Replacement Therapy
- Complementary and alternative medicine
- Prescription non-hormonal agents
Menopause - HRT
2 types of hormonal treatment
Estrogen ONLY
Estrogen/Progestin
Menopause - HRT
Estrogen ONLY treatment is only for women who have ________uterus
NO INTACT UTERUS
Why? if there is a uterus there will be an overgrowth of the lining and incr. the risk of endometrial cancer.
Menopause - HT
Patients with an intact uterus can use
ESTROGEN ONLY Treatment.
TRUE OR FALSE
FALSE
Only those who have NO intact uterus.
Menopause - HT -
What are the types of estrogen only medications
- Conjugated equine estrogen
- Transdermal estradiol
- Estradiol Intravaginal Tablets
- Estradiol Cream
Menopause - HT -
What are the types of Estrogen/Progestin medications
-Conjugated estrogen and medroxyprogesterone
* Estradiol and norethindrone
Contraindications to HT
Breast Cancer
Endometrial Cancer
Pregnancy
Thromboembolic disorders
Acute liver disease
CAD
Undiagnosed Vaginal bleeding
Smoking
BLACK BOX WARNING FOR HT
Must KNOW THIS…WILL BE ON THE TEST
May cause:
CV disorders
breast cancer
endometrial cancer
dementia
What is osteoporosis?
increased Osteoclast (breaks down bone) activity as compared to Osteoblast (builds bond) activity. Bone density is decreased.
Who is most at risk for osteoporosis?
White, small framed females.
Men can also get osteoporosis, not just women.
What are the 2 interventions?
Non-pharm - diet, weight bearing (calcium rich)
Pharm -biosphosphonates, MAB SERMS
Teaching for Osteoporosis meds
Take with water and stay upright for 30 minutes to prevent esophageal erosion
Calcitonin - allergic rxn
When is Magnesium Sulfate (MgS) indicated for use?
- Preeclampsia or eclampsia L and D. inc. BP
- Mg replacement
It relaxes smooth mucsles.
How is MgS administered?
IV via volumetric pump
Adverse RXN to MgS
Overdose:
Flushing
hypotension
lethargy
diminished reflexes
respiratory
Think Mag Sags - thinks decrease
What is the antidote to MgS
Calcium gluconate (IV)
Nursing considerations with MgS
Monitor:
LOC
VS
FHR (fetal heart rate) and activity
uterine activity
monitor bowel sounds
monitor Mg levels
Assess DTR
Recommended calcium intake
12-1500da7
D3 4-800 IU
Bone builders
Osteoblasts
First line treatment for osteoporosis
Biphosphonates
Selective Estrogen receptor Modulators are called….
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.
Fracture prevention with steroid use
Parathyroid hormone (PTH) anabolic agent
Can cause allergic rxn after administration
calcitonin
Risk of biphosphates
esphoygeal erosion
Cause reabsorption of bone
Osteoclasts
Side effect of Denosumab (Prolia) IM
Hypocalcemia
osteonecrosis
allergic rxn
unusual thigh bone fractures
Name a common SERM used for osteoporosis and how it works
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
Name a MoAB used for osteoporosis, ‘what it does, and what to asses.
Denosumab - dec. osteoclastic activity
Monitor for hypocalcemia, give Ca and D3 with it.
What does CALCITONIN do for osteoporosis
decrease osteoclastic activity
post-menopausal
watch for allergic rxn
Name a Parathyroid hormone and what it does for HT
TERIPARATIDE STIMULATES OSTEOBLASTIC activity
Prevents fractures with corticosteroid use.
DIFFERENT FROM Moab, calcitonin, SERMs
which dec. osteoclastic activity
THINK TeraPeritide - PERITIDE = parathyroid
What does SERM mean
Selective
estrogen
receptor
modulators
HT for osteoporosis - is what drug
estradiol transdermal system
to balance estrogen which will
diminish menopausal symptoms
When is HT used for menopause
those who do not tolerate other treatments
When using HT for women w/intact uterus what else would you add
Progestin
