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2021 Pharm 2 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

estrogen’s role in the menstrual cycle

A

builds uterine lining

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2
Q

FSH’s role in the menstrual cycle

A

stimulates follicle growth

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3
Q

LH’s role in the menstrual cycle

A

egg release

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4
Q

progesterone’s role in the menstrual cycle

A

maintains lining incase of pregnancy

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5
Q

FSH

A

follicle-stimulating hormone

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6
Q

LH

A

luteinizing hormone

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7
Q

menopause

A

cessation of menses for 12 mos following loss of ovarian activity

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8
Q

biologic menopause

A
  • natural failure of ovaries
  • average age: 51.5 yrs
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9
Q

artificial menopause

A

surgical removal of ovaries

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10
Q

oophorectomy

A

surgery to remove ovaries

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11
Q

climactic period

A
  • transition to menopause
  • Sx of estrogen deficiency begin
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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
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13
Q

weaker form of estrogen that becomes primary during menopause

A

estrone

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14
Q

What happens when estrone becomes the primary form of circulating estrogen?

A

S/Sx of estrogen deficiency appear

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15
Q

↑ LH → ↑ production of what hormones?

A
  • testosterone
  • androstenedione (androgen and testosterone precursor)
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16
Q

S/Sx of ↑ androgens

A
  • body hair growth
  • ↓ breast density
  • altered lipid metabolism
  • wt gain and retention
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17
Q

Can a woman get pregnant during transition to menopause?

A

yes

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18
Q

Altered lipid metabolism and weight gain → what risks?

A
  • ↑ disease
  • doubled risk for CVD
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19
Q

Decreasing estrogen → what health issues?

A
  • ↓ bone density
  • vaso-vagal Sx (hot flashes)
  • vaginal atrophy and dryness
  • ↑ UTI risk
  • dyspareunia
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20
Q

HRT

A

hormone replacement therapy

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21
Q

types of HRT

A
  • estrogen
  • progesterone
  • combo
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22
Q

If uterus is intact, what two hormones must be balanced?

A
  • progesterone
  • estrogen
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23
Q

In HRT, use the smallest ______ for the ______ amount of ______.

A
  • dose
  • shortest
  • time
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24
Q

type of estrogens used for HRT

A
  • conjugated equine estrogens
  • estradiol
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25
Q

expected actions of estrogens in HRT

A
  • block bone resorption
  • ↓ LDL
  • improve menopause Sx
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26
Q

Higher doses of estrogen cause growth of ______ ______.

A

uterine lining

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27
Q

Why must estrogen be balanced with progesterone in a woman with an intact uterus?

A

to prevent overgrowth or lack of replacement of uterine lining

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28
Q

estrogen HRT routes

A
  • PO
  • transdermal
  • intravaginal
  • IM
  • IV

bold = most common

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29
Q

EPT

A
  • estrogen/progesterone therapy
  • combo therapy
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30
Q

↑ risks r/t EPT

A
  • Br CA
  • MI
  • CVA
  • VTE
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31
Q

↓ risks r/t EPT

A
  • colorectal CA
  • hip Fx
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32
Q

pt teaching for estrogen therapy

A
  • 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
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33
Q

contraindications for estrogen therapy

A
  • strong Fm Hx or personal Hx of CVD
  • undiagnosed abnormal vag bleeding
  • Br or other estrogen-based CA
  • Hx of DVT
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34
Q

↑ risks of estrogen therapy

A
  • prolonged, estrogen-only: endometrial and ovarian CAs
  • estrogen-dependent Br CA
  • embolic events: MI, PE, DVT, CVA
  • women > 60 yrs: MI, CHD
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35
Q

nursing implications for estrogen therapy

A
  • lowest dose, shortest time
  • monitor for
    • Br CA
    • DVT
    • HTN
    • hyperlipidemia
  • give progestins with estrogen
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36
Q

pt education for estrogens: dosing

A
  • take at same time each day
  • D/C before orthopedic surgeries or any surgery that will cause prolonged immobilization
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37
Q

pt ed for estrogen: reporting

A
  • Br abnormalities
  • abnormal vaginal bleeding
  • DVT S/Sx
38
Q

estrogen interactions

A
  • can ↓ effect of warfarin
    • monitor PT, INR
    • adjust dose if necessary
  • phenytoin can ↓ effect
  • corticosteroids can ↑ effect
  • nicotine ↑ risk of thrombophlebitis
39
Q

types of progesterones

A
  • medroxyprogesterone
  • norethindrone
  • megestrol acetate
40
Q

progesterone therapy uses

A
  • 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
Q

progesterone routes

A
  • PO
  • IM
  • SQ
  • transdermal
  • intravaginal
42
Q

health risks of progesterone

A
  • Br CA
  • MI, PE, thrombophlebitis, CVA
  • breakthrough bleeding, amenorrhea, breast tenderness
  • edema
  • jaundice
  • migraines
43
Q

nursing interventions for progesterone health risks

A
  • 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
Q

progesterone interactions

A
  • ↓ contraceptive
    • carbamazepine
    • phenobarbital
    • phenytoin
    • rifampin
  • smoking ↑ risk of clots
45
Q

pt education for progesterone

A

withdrawal bleeding: 3-7 days

46
Q

BC vs. HRT

A
  • BC usually ↑ doses
  • therapeutic intent and outcome differs
47
Q

BC routes with estrogen

A
  • combined OCP
  • patch (Ortho Evra)
  • ring (Nuvaring)
48
Q

progesterone-only BC routes

A
  • norethindrone (mini pill)
  • IM (Depo-Provera)
49
Q

OCP

A

oral contraceptive pill

50
Q

COC

A

combined oral contraceptive

51
Q

Multi-phasic pills result in more _____ _____.

A

breakthrough bleeding

52
Q

norethindrone

A

progesterone-only mini pill

53
Q

mini pill disadvantage

A
  • not as reliable
  • requires strict compliance
54
Q

types of COC

A
  • drugs
    • ethinyl estradiol/norethindrone
    • ethinyl estradiol/drospirenone
  • dosing
    • monophasic: same hormone level throughout pack except during period
    • biphasic
    • triphasic
    • quadraphasic
55
Q

TD patch

A
  • ethinyl estradiol/norelgestromin
  • weekly, skip 4th wk
  • not good for obesity
  • potential skin irritant
56
Q

contraceptive ring (estrogen-based)

A
  • monthly: in for 3 wks, remove for one
  • have to be comfy with inserting
57
Q

IM progesterone-only BC

A
  • depot medroxyprogesterone acetate (DMPA)
  • q 3 mos
  • not good for long-term
  • ideal for adolescents
58
Q

DMPA

A

depot medroxyprogesterone acetate

59
Q

expected action of hormonal contraceptives

A
  • prevent ovulation
  • thicken cervical mucus
  • alter endometrial lining
60
Q

AE of hormonal contraceptives

A
  • thromboembolic events (unlikely with progestin-only)
  • HTN
  • breakthrough or abnormal bleeding
  • breast CA: growth of existing CA
61
Q

BC interactions

A
  • ↓ effectiveness when taken with
    • carbamazepine
    • phenytoin
    • phenobarbital
    • abx
      • penicillins
      • cephalosporins
      • rifampin
  • BC ↓ effectiveness of warfarin
62
Q

nursing actions for BC

A
  • 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
Q

IUD

A

intrauterine device

64
Q

types of IUDs

A
  • copper (no hormone)
  • hormonal: contains small amt of progestin that only acts on uterine tissue
    • Skyla
    • Mirena
65
Q

androgens

A
  • testosterone
  • methyltestosterone
66
Q

testosterone routes

A
  • IM
  • transdermal
  • pellets
  • buccal tablets
67
Q

testosterone uses

A
  • 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
Q

testosterone action

A
  • acts on DNA to promote production of proteins to
    • develop male sex traits
    • develop sperm production
    • increase muscle
    • increase synthesis of erythropoietin
69
Q

androgenic (virilization) effects of testosterone

A
  • women
    • hirsutism
    • lowering of voice
    • acne
    • other
  • men
    • acne
    • priapism
    • ↑ hair growth
70
Q

SE/AE of testosterone

A
  • epiphyseal closure
  • cholestatic hepatitis, jaundice
  • hypercholesterolemia
  • ↑ growth of prostate CA
  • polycythemia
  • edema from salt/water retention
  • high abuse potential
71
Q

premature epiphyseal closure

A
  • closure of growth plate before puberty
  • = shorter stature
  • caused by testosterone therapy before puberty
72
Q

intervention for cholestatic hepatitis

A
  • baseline and ongoing LFTs
  • check for jaundice
73
Q

What CA do we check for before giving testosterone?

A

prostate

74
Q

labs to monitor for testosterone therapy

A
  • LFTs
  • CBC (Hgb, Hct)
  • lipid panel
  • prostate CA labs (PSA?)
75
Q

med interactions with testosterone

A
  • oral anticoagulants
  • insulins/antidiabetic agents
  • hepatotoxic meds
76
Q

contraindications for testosterone

A
  • PG
  • prostate CA
  • Br CA
  • hypercalcemia
77
Q

precautions for testosterone therapy

A
  • HF
  • HTN
  • cardiac, renal, liver dz
78
Q

nursing implications for testosterone therapy

A
  • for topical meds
    • wear gloves
    • wash hands thoroughly after
  • IM: use large muscle
  • women: monitor for masculinization
79
Q

alpha1-adrenergic antagonists

A
  • -osin
  • tamsulosin
  • alfuzosin
  • terazosin
  • doxazosin
80
Q

action of alpha1-adrenergic antagonists

A
  • ↓ mechanical obstruction of urethra (relaxes muscles)
  • some effect on blood vessels → ↓ BP
81
Q

use for alpha1-adrenergic antagonists

A
  • Tx of urinary retention from
    • BPH
    • anesthesia
    • kidney stones
82
Q

alpha1-adrenergic antagonists route

A

PO

83
Q

AE/SE of alpha1-adrenergic antagonists

A
  • hypotension
  • dizziness
  • nasal congestion
  • sleepiness
  • faintness
  • problems with ejaculation
    • failure
    • ↓ volume
  • usually minimal AEs
84
Q

PDE5 Inhibitors

A

phosphodiesterase Type 5 inhibitors

85
Q

phosphodiesterase Type 5 inhibitors

A
  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
86
Q

PDE5 inhibitors action

A
  • augments effects of nitric oxide (NO) release during sexual stim
  • enhances blood flow to corpus cavernosum to support erection
87
Q

use for PDE5 inhibitors

A

erectile dysfunction

88
Q

AE of PDE5 inhibitors

A
  • MI, sudden death
  • priapism
89
Q

PDE5 inhibitors pt teaching

A
  • notify provider of erection lasting > 4 hrs
  • avoid grapefruit (↑ plasma concentration of drug)
90
Q

PDE5 inhibitors contraindications and precautions

A
  • contra: pts taking
    • nitrates
    • alpha blockers
  • caution
    • prolonged QT wave
    • CVD
    • use of certain meds
      • ketoconazole
      • erythromycin
      • cimetidine
      • ritonavir
91
Q

nursing implications for PDE5 inhibitors

A

monitor heart health, risk factors, and Hx

92
Q

PDE5 inhibitor interactions

A
  • ↑ plasma concentration
    • grapefruit juice
    • ketoconazole
    • erythromycin
    • cimetidine
    • ritonavir
  • fatal hypotension
    • organic nitrates
    • alpha blockers

2021 Pharm 2 (18 decks)

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