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Pharm 2 > pharm and womens health > Flashcards

pharm and womens health Flashcards

1
Q

what are the two primary female hormones

A

estrogen and progesterone

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2
Q

where are the primary hormone primarily produced

A

ovaries

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3
Q

where are the primary hormones secondarily produced

A

adrenal cortex

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4
Q

where are there small amounts of estrogen and progesterone

A

liver, kidney, brain, skeletal muscles, testes, and adipose

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5
Q

describe how cholesterol is involved with estrogen and progesterone

A

they are synthesized by cholesterol

cholesterol is modified into these hormones and is then released into the blood stream

cholesterol -> progesterone -> androgens, testosterone, androstenedione -> estrogen -> released in bloodstream (response to stimulation of anterior pituitary gonadoreopic hormones - FSH, LH)

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6
Q

what is the primary goal of estrogen and progesterone

A

prepare for pregnancy and maintain pregnancy

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7
Q

name 3 ovarian estrogens

A

estradiol, estrone, estriol

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8
Q

describe nonpregnant progesterone

A

secreted by corpus luteam last half of cycle

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9
Q

describe pregnant progesterone

A

maintains pregnancy and prepares breast for lactation

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10
Q

describe the menstrual cycle

A

days 1-14: follicular phase
days 15-28: luteal phase (ovulation)

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11
Q

name three common reproductive health problems in women

A
  • PMS
  • endometriosis
  • menopause
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12
Q

describe PMS

A

symptoms so severe they interfere with ADLs and relationships

premenstrual dysphoric disorder (PMDD) - extreme PMS

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13
Q

describe endometriosis

A
  • most common GYN prob in the US
  • chronic cramping and pelvis pain
  • endometrial tissue growing outside of uterine cavity
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14
Q

describe menopause

A
  • deficiences in sex hormones
  • absence of menses for 1 year
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15
Q

what is first line drug therapy for PMS and PMDD

A

may use antidepressants

SSRIs or SNRIs

these are good bc PMS and PMDD are hormone related

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16
Q

what is second line drug therapy for PMS and PMDD

A

oral contraceptives

progestins

these regulate hormones and signs and sx

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17
Q

if main symptoms of PMS and PMDD are anxiety and insomnia, what drug therapy may be used

A

benzodiazepines like alprazolam

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18
Q

describe drug therapy for endometriosis

A

used to manage symptoms
- NSAIDS (for pain)
- hormonal contraceptives (low dose oral or hormonal IUD)
- GnRH agonists

treatment is based on severity of symptoms, response to treament, costs of treatment, and contraceptive needs

19
Q

describe drug therapy for menopause

A
  • hormone replacement therapy (HRT) - estrogen
  • this is controversial due to the adverse effects
  • only use for severe symptoms like vasomotor symptoms (hot flashes/night sweats), atrophic vaginitis (vaginal dryness/itching), and to prevent post menopasal osteoporosis
20
Q

what are estrogens used for

(drug therapy wise)

A
  • used to replace low/missing hormones
  • birth control
  • menopause
  • replacement therapy
  • slow bone loss in osteoporosis
  • palliative care for metastatic breast cancer, prostate cancer
21
Q

estrogen used for drug therapy

give an example of an estrogen used for drug therapy

A

conjugated estrogen

22
Q

estrogen used for drug therapy

describe the pharmacokinetics for estrogens

A
  • oral - slowly released
  • transdermal patches (avoid the first pass effect and are able use a lower dose and avoid some adverse effects)
23
Q

estrogen used for drug therapy

describe the actions of estrogens

A
  • circulate to target cell
  • affects primarily the reproductive system
24
Q

estrogen used for drug therapy

what are some adverse effects of estrogens

A
  • thromboembolic conditions (CVA, DVT, PE, MI)
  • mestrual effects
  • GI effects
  • fluid retention

black box warnings for cancer, clots, and dementia

25
Q

estrogen used for drug therapy

what are some contraindications of estrogens

A
  • thromboembolic disorders
  • vaginal/uterine bleeding
  • CV disease
  • tobacco use
  • family history of breast/reproductive cancer
26
Q

what are progestins used for

A
  • used to prevent hyperplasia of the endometrial lining
  • contraceptives (in combo with estrogen)
  • treat amenorrhea and functional uterine bleeding
  • fertility programs
  • oncology
  • plan B
27
Q

give and example of a progestin

A

medroxyprogesterone acetate

28
Q

describe the pharmacokinetics of progestins

A
  • oral, IM, topical
  • sustained release available
29
Q

describe the actions of progestins

A
  • act on endometrial lining
  • suppress pituitary hormones to inhibit ovulation
  • inhibit spontaneous uterine contractions
30
Q

what are some adverse effects of progestins

A
  • CV complications
  • thromboembolic conditions
  • CNS effects
  • GI upset
  • fluid retention

black box warnings for pregnancy, CV disease, thromboembolic events, dementia

31
Q

what are some contraindications of progestins

A
  • pregnancy/lactation
  • CV disease
  • vaginal bleeding
  • thromboembolic diorders
  • reproductive cancers
32
Q

what are some nursing implications of estrogens and progestins

A
  • identify high risk individuals (medical history, vitals, weight, mammograms/PAP)
  • if using patch, may be applied weekly or biweekly
33
Q

describe patient educations for estrogens and progestins

A
  • monitor weight weekly
  • smoking cessation
  • report unusual vaginal bleeding
  • teach signs and symptoms of thromboembolism (CP, HA, vision changes, leg pain)
34
Q

describe the use of estrogen-progestin combintations

A
  • used for contraception, treatment of PMS/PMDD, and HRT
  • most effective and widely used
35
Q

give an examples of estrogen-progestin combintations

A

conjugated estrogen-medroxyprogesterone

36
Q

describe the pharmacokinetics of estrogen-progestin combintations

A
  • half life varies
  • PO, IM, implant, IUD
37
Q

describe the actions of estrogen-progestin combintations

A

estrogen part prevents pregnancy by:
- inhibiting ovulation
- supressess FSH and LH
- stabilizes endometrium

progestin part prevents pregnancy by:
- thinning endometrium
- slows sperm transport
- thickens cervial mucous
- suppresses LH surge

38
Q

hat are some adverse effects of estrogen-progestin combintations

A
  • CV complications
  • thromboembolic conditions
  • irregular vaginal bleeding
  • CNS effects
  • GI upset
  • fluid retention

black box warnings: smoking, osteoporosis, thromboembolic events

39
Q

what are some contraindications of estrogen-progestin combinations

A
  • smoking
  • women older than 35
  • hx of thromboembolic probs
  • HTN
  • migraines
40
Q

what are some nursing considerations for oral contraceptives

A
  • assess knowledge
  • assess for at risk women
  • assess willingness to comply with med regime
41
Q

describe patient education for oral contraceptives

A
  • several antibiotics and antiseizure meds decrease effectiveness
  • tae at same time each day
  • what to do if missed dose
  • alternate contraception
  • no protection against HIV or STDs
  • s/sx of thrombus
42
Q

a NP prescribes estrogen replacement therapy to relieve severe menopauseal symptoms of hot flashes, which are the result of…

1) insifficient gonadotropin secretion
2) vasomotor instability
3) high levels of estrogen
4) decreased progesterone

A

vasomotor instability

the decrease in estrogen during menopause causes the hypothalamamus to overreact to minor temp changes by suddenly increasing blood flow to the face, neck, and chest

43
Q

after patient teaching of the warning signs associated with combintation hormonal contraception, what statement would result in the nurse providing additional education?

1) breakthough bleeding is a signs of a uterine abnormality
2) i should immediately go the ER if i get a sudden, severe headache that is not relieved with an analgesic and rest
3) severe leg pain and swelling should immediately be reported
4) CV pobs are the most severe adverse effect with oral contraceptives

A

breakthrough bleeding is a sign of a uterine abnormality

irregular bleeding is an adverse effect of the progestin in the combination hormonal contraceptive

Pharm 2 (34 decks)

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