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2021 Pharm 2 > Reproductive > Flashcards

Reproductive Flashcards

1
Q

types of HRT for women

A
  • estrogen-only
  • progesterone-only
  • combined
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2
Q

If uterus is intact, you must balance ________ with ________.

A
  • estrogen
  • progesterone
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3
Q

first rule of HRT

A

smallest dose for shortest amount of time

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4
Q

estrogen replacement drugs

A
  • conjugated equine estrogens
  • estradiol
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5
Q

Why do we balance estrogen with ______ when the uterus is intact?

A
  • estrogen
  • estrogen → uterine lining growth
    • overgrowth → risk of CA
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6
Q

expected action of estrogens

A
  • block bone resorption
  • reduce LDL
  • improve menopause Sx
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7
Q

estrogen routes

A
  • PO
  • TD
  • intravaginal
  • IM
  • IV
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8
Q

EPT

A

estrogen-progesterone therapy

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9
Q

breast cancer increase with EPT

A

26%

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10
Q

heart attack ↑ with EPT

A

29%

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11
Q

stroke ↑ with EPT

A

41%

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12
Q

VTE ↑ with EPT

A

double

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13
Q

EPT effect on colorectal cancer

A

↓

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14
Q

hip Fx risk with EPT

A

↓

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15
Q

AE of estrogen therapy

A
  • endometrial and ovarian cancers: prolonged postmenopausal estrogen therapy
  • risk for estrogen-dependent breast cancer
  • risk for embolic events (MI, CVA, DVT, PE)
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16
Q

interventions for estrogen therapy

A
  • lowest effective dose for shortest time
  • monitor for breast CA, DVT
  • NO SMOKING
  • monitor lipids, HTN
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17
Q

contraindications for estrogen

A
  • strong Fm or personal Hx of CVD
  • undiagnosed abnormal vaginal bleeding
  • breast or other estrogen-based CA
  • Hx of DVT
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18
Q

estrogen interactions

A
  • ↓ effectiveness of warfarin
  • ↓ effect of estrogen: phenytoin
  • ↑ effect of estrogen: corticosteroids
  • smoking: ↑ risk of thrombophlebitis
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19
Q

estrogen + warfarin =

A
  • ↓ effect of warfarin
  • monitor INR and PT
  • warfarin dose adjustment
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20
Q

estrogens + phenytoin =

A

monitor for ↓ estrogen effects

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21
Q

estrogens + corticosteroids =

A
  • ↑ effects of estrogen
  • monitor for ↑ effects
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22
Q

estrogens + smoking =

A
  • ↑ risk of thrombophelbitis
  • pt education
  • use alternative Tx if smoking persists
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23
Q

pt education for estrogens

A
  • take at same time daily
  • report abnormal bleeding
  • regular breast exams, GYN visits
  • DVT S/Sx
    • redness, warmth, tenderness, swelling in lower leg
  • D/C before surgery/prolonged immobilization
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24
Q

progesterone drugs

A
  • medroxyprogesterone
  • norethindrone
  • megestrol acetate
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25
Q

use

A
  • required combo with estrogen in women with uterus
  • can be given alone for BC or HRT
  • control dysfunctional bleeding
  • Tx of
    • abnormal amenorrhea
    • endometriosis
    • advanced CAs
      • endometrial
      • breast
      • kidney
  • create cycle to treat infertility
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26
Q

routes for progesterone

A
  • PO
  • IM
  • SQ
  • TD
  • intravaginal
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27
Q

HRT with the female hormone __________ has less risks than _________.

A
  • progesterone
  • estrogen
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28
Q

AE of progesterone

A
  • Br CA risk
  • thromboembolic events (MI, PE, thrombophlebitis, CVA)
  • breakthrough bleeding, amenorrhea, breast tenderness
  • edema
  • jaundice
  • migraines
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29
Q

interventions for breakthrough bleeding, amenorrhea, and breast tenderness on progesterone therapy

A
  • baseline breast exam and Pap smear
  • report abnormal vaginal bleeding
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30
Q

progesterone admin/pt teaching

A
  • monitor LFTs
  • baseline breast exam and Pap smear
  • monitor for DVT, CP, SOB
  • monitor BP, I&O, wt
  • notify provider of severe HA
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31
Q

progesterone interactions

A
  • ↓ contraceptive effectiveness: carbamazepine, phenobarbital, phenytoin, and rifampin
  • ↑ risk of thrombophlebitis: smoking
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32
Q

progesterone + phenytoin =

A
  • ↓ contraception
  • use backup method
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33
Q

progesterone + rifampin =

A
  • ↓ contraception
  • use backup method
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34
Q

progesterone + carbamazepine =

A
  • ↓ contraception
  • use backup method
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35
Q

progesterone + phenobarbital =

A
  • ↓ contraception
  • use backup method
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36
Q

pt ed for progesterone

A

withdrawal bleeding for 3-7 days after D/C

37
Q

BC vs HRT

A
  • hormonal BC will have same effects as HRT
  • BC typically in higher doses than HRT
  • therapeutic intent and outcome are different
38
Q

routes of BC

A
  • PO
  • TD patch
  • vaginal ring
  • IM
39
Q

combined oral contraceptives (COC)

A
  • ethinyl estradiol/norethindrone
  • ethinyl estradiol/drospirenone
  • come in various dosages, some with varying dose per day (multiphasic)
40
Q

monophasic COC

A

hormone amounts the same throughout the month/pack

41
Q

multiphasic COC

A
  • hormone amounts vary throughout pack/month to duplicate a cycle
  • come in biphasic, triphasic, quadraphasic
42
Q

mini pill

A
  • progesterone-only BC pill
  • norethindrone
43
Q

The ____ ____ is not as reliable as COC.

A

mini pill

44
Q

first rule of taking BC pills

A

take at the same time every day, especially mini pill

45
Q

TD BC patch

A
  • drug: ethinyl estradiol/norelgestromin
  • schedule: weekly, with 4th wk skipped for period
  • not good for obese pts
  • skin irritant
46
Q

vaginal contraceptive ring

A
  • estrogen-based
  • schedule: monthly; in for 3 wks, out for a week
  • have to be comfortable with inserting it
47
Q

depot medroxyprogesterone acetate

A
  • DMPA
  • route: IM
  • schedule: q 3 months
  • not good for long-term use
  • ideal for adolescents
48
Q

Nuvaring

A

estrogen-based BC vaginal ring

49
Q

Depo-Provera

A

IM progesterone-only BC

50
Q

expected action of hormonal BC

A
  • prevent ovulation
  • thicken cervical mucus
  • alter endometrial lining
51
Q

AE of hormonal BC

A
  • thromboembolic events (unlikely with progestin-only)
  • HTN
  • breakthrough or abnormal uterine bleeding
  • Br CA
52
Q

breast CA risk with hormonal BC

A
  • may ↑ growth of pre-existing breast CA
  • contraindicated for those with breast CA
  • breast exam before giving
53
Q

interventions/pt teaching for breakthrough or abnormal bleeding

A
  • pt: record duration and frequency of bleeding
  • evaluate for PG if 2 or more periods missed
54
Q

nursing actions for hormonal BC

A
  • r/o PG before starting BC
  • take pills at same time each day
  • missed pills
    • 1 missed: take 2 at next dose
    • 2 missed: take 2 for next 2 doses
    • 3 missed
      • use backup
      • stop pack
      • restart in 7 days
    • progesterone-only, 1 missed: use backup
55
Q

IUD

A

intrauterine device

56
Q

copper IUD

A

non-hormonal

57
Q

hormonal IUDs

A
  • Skyla
  • Mirena
  • small amt of progestin that acts only on uterine tissue
58
Q

androgens

A
  • testosterone
  • methyltestosterone
59
Q

testosterone routes

A
  • IM
  • TD
  • pellets (subdermal)
  • buccal tabs
60
Q

testosterone action

A
  • development of male sex traits
  • sperm production
  • ↑ muscle
  • ↑ synthesis of erythropoietin
61
Q

uses for testosterone therapy

A
  • hypogonadism in males
  • delayed male puberty
  • replacement for testicular failure
  • anemia (if not responsive to tradiational Tx)
  • postmenopausal breast CA
  • muscle wasting in male pts with AIDs
  • help with lethargy, libido, hair loss in females
62
Q

testosterone’s androgenic effects on women

A
  • hirsutism
  • lowering of voice
  • acne
  • other undesired effects
63
Q

testosterone’s androgenic effects on men

A
  • acne
  • priapism
  • ↑ hair growth
64
Q

AE of testosterone

A
  • androgenic (virilization) effects
  • premature epiphyseal closure
  • cholestatic hepatitis
  • hypercholesterolemia
  • ↑ growth of prostate CA
  • polycythemia
  • edema from salt and water retention
  • high abuse potential
65
Q

premature epiphyseal closure

A
  • epiphyseal plate: growth plate responsible for lengthening long bones
  • premature closure → ↓ mature height
  • monitor epiphysis with serial X-rays
  • do not give testosterone before puberty
66
Q

pt ed for androgenic effects

A

notify provider

67
Q

cholestatic hepatitis

A
  • S/Sx
    • nausea
    • fatigue
    • pruritis
    • dark urine
    • jaundice
  • baseline/periodic LFTs
68
Q

testosterone contraindications

A
  • pre-pubescence
  • pregnancy
  • men with prostate or breast CA
  • hypercalcemia
69
Q

labs for testosterone therapy

A
  • LFTs
  • lipid panel
  • CBC (Hgb, Hct)
70
Q

precautions for testosterone

A
  • HF
  • HTN
  • cardiac, renal, or liver dz
71
Q

testosterone admin

A
  • wear gloves
  • wash hands after
  • use large muscle for IM injection
  • monitor women for masculinization
72
Q

alpha1-adrenergic antagonists

A
  • (-osin)
  • tamsulosin
  • alfuzosin
  • terazosin
  • doxazosin
73
Q

alpha1-adrenergic antagonist action

A

↓ mechanical obstruction of urethra by relaxing smooth muscles of bladder and prostate

74
Q

alpha1-adrenergic antagonist use

A
  • urinary retention from
    • BPH
    • anesthesia
    • kidney stones
75
Q

alpha1-adrenergic antagonist route

A

PO

76
Q

BPH

A

benign prostatic hyperplasia

77
Q

AE of alpha1-adrenergic antagonists

A
  • hypotension
  • nasal congestion
  • dizziness
  • sleepiness
  • faintness
  • ejaculation failure, ↓ volume
78
Q

nursing actions for alpha1-adrenergic antagonists

A
  • monitor BP
  • pt teaching
    • rise slowly
    • don’t drive or operate machinery at first or when changing dose
79
Q

PDE5 inhibitor

A

phosphodiesterase type 5 inhibitor

80
Q

PDE5 inhibitors

A
  • -afil
  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
81
Q

PDE5 inhibitor action

A
  • augments effect of nitric oxide release during sexual stim
  • enhances blood flow to corpus cavernosum to support erection
82
Q

PDE5 inhibitor use

A

Tx of erectile dysfunction

83
Q

AE of PDE5 inhibitors

A
  • MI, sudden death: monitor risk factors, Hx of CV health
  • priapism
84
Q

priapism

A
  • prolonged erection of the penis
  • notify provider if erection lasts > 4 hrs
85
Q

contraindications for PDE5 inhibitors

A

nitrate use

86
Q

precautions for PDE5 inhibitors

A
  • CVD
  • prolonged QT wave
87
Q

interactions with PDE5 inhibitors

A
  • ↑ PDE5 plasma concentration
    • grapefruit
    • ketoconazole
    • erythromycin
    • cimetidine
    • ritonavir
  • fatal hypotension
    • nitrates
    • alpha blockers
88
Q

PDE5 inhibitor route

A

PO

2021 Pharm 2 (18 decks)

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