Reproductive Flashcards
1
Q
estrogen’s role in the menstrual cycle
A
builds uterine lining
2
Q
FSH’s role in the menstrual cycle
A
stimulates follicle growth
3
Q
LH’s role in the menstrual cycle
A
egg release
4
Q
progesterone’s role in the menstrual cycle
A
maintains lining incase of pregnancy
5
Q
FSH
A
follicle-stimulating hormone
6
Q
LH
A
luteinizing hormone
7
Q
menopause
A
cessation of menses for 12 mos following loss of ovarian activity
8
Q
biologic menopause
A
- natural failure of ovaries
- average age: 51.5 yrs
9
Q
artificial menopause
A
surgical removal of ovaries
10
Q
oophorectomy
A
surgery to remove ovaries
11
Q
climactic period
A
- transition to menopause
- Sx of estrogen deficiency begin
12
Q
How does menopause affect levels of FSH and LH?
A
- they increase
- pituitary is trying to stimulate ovulation
- follicles less sensitive 2/2 ↓ estrogen
13
Q
weaker form of estrogen that becomes primary during menopause
A
estrone
14
Q
What happens when estrone becomes the primary form of circulating estrogen?
A
S/Sx of estrogen deficiency appear
15
Q
↑ LH → ↑ production of what hormones?
A
- testosterone
- androstenedione (androgen and testosterone precursor)
16
Q
S/Sx of ↑ androgens
A
- body hair growth
- ↓ breast density
- altered lipid metabolism
- wt gain and retention
17
Q
Can a woman get pregnant during transition to menopause?
A
yes
18
Q
Altered lipid metabolism and weight gain → what risks?
A
- ↑ disease
- doubled risk for CVD
19
Q
Decreasing estrogen → what health issues?
A
- ↓ bone density
- vaso-vagal Sx (hot flashes)
- vaginal atrophy and dryness
- ↑ UTI risk
- dyspareunia
20
Q
HRT
A
hormone replacement therapy
21
Q
types of HRT
A
- estrogen
- progesterone
- combo
22
Q
If uterus is intact, what two hormones must be balanced?
A
- progesterone
- estrogen
23
Q
In HRT, use the smallest ______ for the ______ amount of ______.
A
- dose
- shortest
- time
24
Q
type of estrogens used for HRT
A
- conjugated equine estrogens
- estradiol
25
expected actions of estrogens in HRT
* block bone resorption
* ↓ LDL
* improve menopause Sx
26
Higher doses of estrogen cause growth of ______ \_\_\_\_\_\_.
uterine lining
27
Why must estrogen be balanced with progesterone in a woman with an intact uterus?
to prevent overgrowth or lack of replacement of uterine lining
28
estrogen HRT routes
* **PO**
* **transdermal**
* **intravaginal**
* IM
* IV
**bold** = most common
29
EPT
* estrogen/progesterone therapy
* combo therapy
30
↑ risks r/t EPT
* Br CA
* MI
* CVA
* VTE
31
↓ risks r/t EPT
* colorectal CA
* hip Fx
32
pt teaching for estrogen therapy
* monitor for S/Sx
* Br CA: self-exams, annual provider exams, periodic mammograms
* DVT
* **NO NICOTINE**
* ways to ↓ risk of CVD
* **report persistent vaginal bleeding**
* endometrial biopsy q 2 yrs
* pelvic exam q 1 yr
33
contraindications for estrogen therapy
* strong Fm Hx or personal Hx of CVD
* undiagnosed abnormal vag bleeding
* Br or other estrogen-based CA
* Hx of DVT
34
↑ risks of estrogen therapy
* prolonged, estrogen-only: endometrial and ovarian CAs
* estrogen-dependent Br CA
* embolic events: MI, PE, DVT, CVA
* women \> 60 yrs: MI, CHD
35
nursing implications for estrogen therapy
* lowest dose, shortest time
* monitor for
* Br CA
* DVT
* HTN
* hyperlipidemia
* give progestins with estrogen
36
pt education for estrogens: dosing
* take at same time each day
* D/C before orthopedic surgeries or any surgery that will cause prolonged immobilization
37
pt ed for estrogen: reporting
* Br abnormalities
* abnormal vaginal bleeding
* DVT S/Sx
38
estrogen interactions
* can ↓ effect of warfarin
* monitor PT, INR
* adjust dose if necessary
* phenytoin can ↓ effect
* corticosteroids can ↑ effect
* nicotine ↑ risk of thrombophlebitis
39
types of progesterones
* medroxyprogesterone
* norethindrone
* megestrol acetate
40
progesterone therapy uses
* combo w/ estrogen to ↓ health risks
* can be given alone for BC or HRT
* support for discomforts of menopause w/ ↓ risks than estrogen
* control dysfunctional bleeding
* Tx of abnormal amenorrhea
* endometriosis
* advanced endometrial, breast, or kidney CA
* create cycle for infertility Tx
41
progesterone routes
* PO
* IM
* SQ
* transdermal
* intravaginal
42
health risks of progesterone
* Br CA
* MI, PE, thrombophlebitis, CVA
* breakthrough bleeding, amenorrhea, breast tenderness
* edema
* jaundice
* migraines
43
nursing interventions for progesterone health risks
* Br CA: pt ed, mammograms
* pt ed for thromboembolic event risk
* no smoking
* check for DVT
* notify provider of CP or SOB
* menstrual Sx
* baseline breast exam and Pap
* report abnormal bleeding
* edema: monitor BP, I&O, wt
* jaundice: yellow skin, LFTs
* migraine: notify provider
44
progesterone interactions
* ↓ contraceptive
* carbamazepine
* phenobarbital
* phenytoin
* rifampin
* smoking ↑ risk of clots
45
pt education for progesterone
withdrawal bleeding: 3-7 days
46
BC vs. HRT
* BC usually ↑ doses
* therapeutic intent and outcome differs
47
BC routes with estrogen
* combined OCP
* patch (Ortho Evra)
* ring (Nuvaring)
48
progesterone-only BC routes
* norethindrone (mini pill)
* IM (Depo-Provera)
49
OCP
oral contraceptive pill
50
COC
combined oral contraceptive
51
Multi-phasic pills result in more _____ \_\_\_\_\_.
breakthrough bleeding
52
norethindrone
progesterone-only mini pill
53
mini pill disadvantage
* not as reliable
* requires strict compliance
54
types of COC
* drugs
* ethinyl estradiol/norethindrone
* ethinyl estradiol/drospirenone
* dosing
* monophasic: same hormone level throughout pack except during period
* biphasic
* triphasic
* quadraphasic
55
TD patch
* ethinyl estradiol/norelgestromin
* weekly, skip 4th wk
* not good for obesity
* potential skin irritant
56
contraceptive ring (estrogen-based)
* monthly: in for 3 wks, remove for one
* have to be comfy with inserting
57
IM progesterone-only BC
* depot medroxyprogesterone acetate (DMPA)
* q 3 mos
* not good for long-term
* ideal for adolescents
58
DMPA
depot medroxyprogesterone acetate
59
expected action of hormonal contraceptives
* prevent ovulation
* thicken cervical mucus
* alter endometrial lining
60
AE of hormonal contraceptives
* thromboembolic events (unlikely with progestin-only)
* HTN
* breakthrough or abnormal bleeding
* breast CA: growth of existing CA
61
BC interactions
* ↓ effectiveness when taken with
* carbamazepine
* phenytoin
* phenobarbital
* abx
* penicillins
* cephalosporins
* rifampin
* BC ↓ effectiveness of warfarin
62
nursing actions for BC
* r/o
* PG
* BrCA
* teaching
* take pills at same time each day
* miss 1: take 2 at next dose
* miss 2: take 2 at next 2 doses
* miss 3: use backup, stop, start over in 7 days
* consider different type of BC
* to skip period: skip placebo, start new pack
* **miss ANY progesterone-only BC: use backup**
63
IUD
intrauterine device
64
types of IUDs
* copper (no hormone)
* hormonal: contains small amt of progestin that only acts on uterine tissue
* Skyla
* Mirena
65
androgens
* testosterone
* methyltestosterone
66
testosterone routes
* IM
* transdermal
* pellets
* buccal tablets
67
testosterone uses
* hypogonadism in males
* delayed male puberty
* replacement for testicular failure
* anemia
* if not responsive to tradition Tx
* ↑ RBC production
* postmenopausal Br CA
* muscle wasting in male pts with AIDS
* help for females with
* lethargy
* libido
* hair loss
68
testosterone action
* acts on DNA to promote production of proteins to
* develop male sex traits
* develop sperm production
* increase muscle
* increase synthesis of erythropoietin
69
androgenic (virilization) effects of testosterone
* women
* hirsutism
* lowering of voice
* acne
* other
* men
* acne
* priapism
* ↑ hair growth
70
SE/AE of testosterone
* epiphyseal closure
* cholestatic hepatitis, jaundice
* hypercholesterolemia
* ↑ growth of prostate CA
* polycythemia
* edema from salt/water retention
* high abuse potential
71
premature epiphyseal closure
* closure of growth plate before puberty
* = shorter stature
* caused by testosterone therapy before puberty
72
intervention for cholestatic hepatitis
* baseline and ongoing LFTs
* check for jaundice
73
What CA do we check for before giving testosterone?
prostate
74
labs to monitor for testosterone therapy
* LFTs
* CBC (Hgb, Hct)
* lipid panel
* prostate CA labs (PSA?)
75
med interactions with testosterone
* oral anticoagulants
* insulins/antidiabetic agents
* hepatotoxic meds
76
contraindications for testosterone
* PG
* prostate CA
* Br CA
* hypercalcemia
77
precautions for testosterone therapy
* HF
* HTN
* cardiac, renal, liver dz
78
nursing implications for testosterone therapy
* for topical meds
* wear gloves
* wash hands thoroughly after
* IM: use large muscle
* women: monitor for masculinization
79
alpha1-adrenergic antagonists
* **-osin**
* tamsulosin
* alfuzosin
* terazosin
* doxazosin
80
action of alpha1-adrenergic antagonists
* ↓ mechanical obstruction of urethra (relaxes muscles)
* some effect on blood vessels → ↓ BP
81
use for alpha1-adrenergic antagonists
* Tx of urinary retention from
* BPH
* anesthesia
* kidney stones
82
alpha1-adrenergic antagonists route
PO
83
AE/SE of alpha1-adrenergic antagonists
* hypotension
* dizziness
* nasal congestion
* sleepiness
* faintness
* problems with ejaculation
* failure
* ↓ volume
* **usually minimal AEs**
84
PDE5 Inhibitors
phosphodiesterase Type 5 inhibitors
85
phosphodiesterase Type 5 inhibitors
* sildenafil (Viagra)
* tadalafil (Cialis)
* vardenafil (Levitra)
86
PDE5 inhibitors action
* augments effects of nitric oxide (NO) release during sexual stim
* enhances blood flow to corpus cavernosum to support erection
87
use for PDE5 inhibitors
erectile dysfunction
88
AE of PDE5 inhibitors
* MI, sudden death
* priapism
89
PDE5 inhibitors pt teaching
* notify provider of erection lasting \> 4 hrs
* avoid grapefruit (↑ plasma concentration of drug)
90
PDE5 inhibitors contraindications and precautions
* contra: pts taking
* nitrates
* alpha blockers
* caution
* prolonged QT wave
* CVD
* use of certain meds
* ketoconazole
* erythromycin
* cimetidine
* ritonavir
91
nursing implications for PDE5 inhibitors
monitor heart health, risk factors, and Hx
92
PDE5 inhibitor interactions
* ↑ plasma concentration
* **grapefruit juice**
* ketoconazole
* erythromycin
* cimetidine
* ritonavir
* fatal hypotension
* organic nitrates
* alpha blockers
