Test 4 part 1 Flashcards
onset of puberty occurs between ages
8-13
puberty is stimulated by
Gonasotropin releasing hormone from the hypothalamus
Is stimulated to secrete gonadotropins
anterior pituitary
gonadotropin stimulate the secretion of
estrogen form ovaries
when does menarche occur
2 years after the onset of secondary sex characteristics
Cycles are usually ______ the first few years after menarche
annovulatory
Hormones stimulating hormones (FSH) and luteinizing hormone (LH) mature the follicles Dominant follicle (Graafian) mature and produces estrogen
Follicular phase
Estrogen levels peak and begin to fall, progesterone levels increase
This is followed by surge in KH stimulating release of the oocyte from the dominate follicle
Ovulatory phase
Day 14 in the cycle
Empty follicle forms the corpus luteum
Corpus leuteum produces progesterone and will continue to produce progesterone and estrogen if pregnancy occurs
If no pregnancy occurs, the corpus leteum degenerates and progesterone levels decrease
This triggers the onset of menstruation
Luteal phase
Labs and test to test for menstruration abnormalities
hormone levels and thyroid panel
Ultrasound
Is moving from concrete thinking to more abstract thinking and problem solving
Consider moral and social issues
(Piagets formal operations stage)
developmental stage
Role identity, sense of self-esteem and worth, sexual identity
(Erikson)
psychosocial stage
Health problems specific to female adolescents may include
Eating disorders
STIs and pregnancy
Menstrual disorders
Acne
menopausal transition period
perimenopause
age range for perimenopause
35-58
when does the perimenopause transition end
cessation of menses for one full year
physical symptoms of hot flashes, sweating, and irregular periods
Mechanism is unknown
Vasomotor symptoms
when do perimenopause symptoms occur
2-8 years prior to menopause
what happens to labs during perimenopause
FSH levels increase
Estradiol decrease
TSH to rule out thyroid disease
Test form perimenopause women
DXA
Mammography
administration of hormones to alleviate menopausal symptoms
hormone replacement therapy
Estrogen only hormone replacement therapy can be used only in women who have had a
hysterectomy
combined therapy is used for women with
a uterus
plant absorbed products with estrogen properties such as yams, soy, carrots, and red clover
phytoestrogen
supplement that breaks down in the body as estrogen and testosterone
Suggested anti-aging effects, increase in sexual desire, better mood, cognition and bone density (RCTs and observational studies)
DHEA
is the permanent cessation of menses from loss of ovarian function
Defined as absence of menstruation for one full year
Menopause
Causes menopause
Spontaneous
Surgical
Chemical
Pelvic irradiation
Lipoprotein profile changes
Increase in triglycerides
increase in total and LDL cholesterol
Decrease in HDL
how often should lipid screening be done
every 5 years
Soon for women at risk for CAD
risks for breast cancer
Age Family History BMI Prolonged HRT (after 5 years)
anxiety and irritability of menopause
climacteric syndrome
are signs that vertebrae are being compresses because of reduced bone mass
Loss of height
Nontraumatic fractures
Loss of bone mass (osteopenia) that compromises bone strength causing a predisposition to risk of bone fractures
Osteoporosis
is characterized by loss of trabecular bone and thinning or cortical bone shell
osteoporotic bone
Races at higher risk for osteoporosis
Non-hispanic caucasian
Asian
Maximum level of bone density (peak of bone mass) is reached by age ____ and is genetically influenced
25 to 30
medical conditions that can cause osteoporosis
Hyperthyroidism Cushing's syndrome Kidney disease RA Organ transplant
osteoporosis testing is done via
dual x-ray absorptiometry (DEXA)
Common fracture sites
Vertebrae
Hip fracture
Wrist fracture
Fractures may be followed by
Full recovery
Chronic pain
Disability
Death
Daily calcium intake for ages 9-18
1300mg
Daily calcium intake for ages 19-50
1000mg
Daily calcium intake for ages >50 (and taking HRT)
12000mg
DAily calcium intake for ages > 50 (not taking HRT)
1500mg
when should calcium supplements be considered
if daily calcium intake is less than 600 mg
Daily vitamin D intake for ages 9-70
400-600 IU
Daily vitamin D intake for > 70
800 IU
Know Vitamin D deficiency or autoimmune disease associated with deficiency should take
1000-2000 IU
Food hight in vitamin D
Fatty fish
Cheese
Egg yolk
Beef liver
Are found naturally in some plants and may bind to calcium and inhibit absorption
Phytic and oxalic acid
Phytic and oxalic acids are found in
Spinach Collard greens Sweet potatoes Rhubarb Beans
when should you take calcium when palnning to eat foods contain phytic or oxalic acid
1 hour before or 2 hours after
What DXA score indicated need for treatment
BMD testing (DXA) should occur
2 years after starting drug therapy and every 2 years after that
(antiresorptive) PO nitrogen containing bisohosphonates- calcium regulators that act by inhibiting bone resorption and increase bone mass are
Alendronate (Fosomax)
Risedronate (Actonel)
Ibandronate (Boniva) PO and IV
Zoledronic Acid (Zometa) IV
Side effects of of anriresorptive drugs
GI disturbance
Abdominal pain
Dyspepsia
Esophageal ulceration (rare)
Patients taking Alendronate and risedronate need to remain upright and take nothing else for how long after taking medication
30 min
take with water
Patients taking PO Ibandronate need to remain upright and take nothing else for how long
60 min
Raloxifene (Evista) will not help with vasomotor S and S
Will not stimulate uterine/ breast tissue
Preserves estrogen
selective estrogen-receptro modulators
Reserved for patients who do not respond to other treatments or those with severe disease
teriparatide (parathyroid hormone)
Slows bone loss
Given intranasally
Used when non-responsive to other meds or uses in combo with other meds
Salmon calcintonin- calcium regulator
Surgery used to stabilize vertebral fractures (does not reduce bone resorption)
Cement mixture is injected into fractured bone
Outcome is better in those with
Percutaneous vertebroplasty
