Week One Flashcards
1
Q
Nuva Ring
A
- 2 inch diameter ring inserted into upper 1/3 of vagina
- placed for three weeks out for one week
- placed during first five days of menstruation
- use back up contraception for 5 days
2
Q
Nexplanon
A
- implanted under skin for 3 years
- may not be effective in women with a BMI over 30, or on medications that induce liver enzymes
- contains barium to be located
3
Q
Medeoxyprogesterone acetate
A
Long acting injectable progestin
- injection every 3 months
4
Q
Ortho-evra transdermal patch
A
- patch is placed on skin of buttocks, upper putter arm, stomach, upper torso
- does not work well in women above 198 lbs
- do not place near breast because of estrogen
- does not go through first pass effect
- patch placed once a week for three weeks one week off for withdrawal bleeding
5
Q
Period cycle
A
- a woman get her period every 28 days
- if fertilization doesn’t occur estrogen and progestin drop causing shedding of uterine wall(bleeding)
6
Q
Nonpharmacologic treatment of PMS
A
- expression of empathy
- family support
- exercise
- dietary changes(limit salty foods, alcohol, caffeine, and concentrated sweets
7
Q
Herbal botanical and vitamin/mineral therapy for PMS
A
- some experience symptom relief with vitamin B6
- increase calcium “food” intake(lowers risk of PMS)
8
Q
Antidepressants and anti anxiety medication for PMS
A
- Prozac and Zoloft are most common Selective Saratonin Reuptake Inhibitors
- Xanax, Valium, Ativan most common for anti anxiety
9
Q
Increased progestin
A
Causes thickening of endometrious mucous
“Hostile environment”
10
Q
Increased estrogen
A
- prevention of dominant follicle
- no estrogen or LH surges
11
Q
Monophonic contraception
A
Set amount of estrogen and progestin throughout cycle
12
Q
Biphasic contraceptive
A
Estrogen is same throughout cycle, progestin varies
13
Q
Triphasic contraceptive
A
Varying levels of estrogen and progestin throughout cycle
14
Q
First day start method
A
- contraception is initiated on the 1st day of bleeding
- no backup method is needed when started on the 1st-5th day of menstruation
15
Q
Sunday start
A
- patient starts tab/patch on 1st Sunday after the 1st day of menstruation(if bleeding starts on Sunday start then)
- if pt. starts her contraceptive later than 5 days after her menstruation, backup contraception should be used for 7 days
16
Q
Quick start method
A
Patient starts the contraceptive the day she receives the prescription regardless of where she may be in here menstrual cycle
-back up contraceptive for 7 days
17
Q
Extended cycle dosing
A
- 24 days of active hormone, 4 days placebo
- more effective less withdrawal bleeding
18
Q
Continuous dosing
A
- 84 days of active hormone, seven days of placebo
- 4 periods a year
- seasonale(jolessa) seasonique
19
Q
Lybrel (cont.dosing)
A
No interruption for withdrawal menses
-Sunday start
20
Q
Antibiotics and birth control
A
- may effect birth control especially tetracyclines
- use backup method of contraception during treatment and 7 days after treatment
21
Q
ACHES
A
Abdominal pain Chest pain Headaches Eye disorders Severe leg pain/swelling(DVT)
22
Q
Patient teaching
A
- remind patient these drugs should only be used under watch of qualified practitioner
- advise pt. certain drugs and herbs can decreases effectiveness and backup method should be used while being used
23
Q
Patient safety
A
- teach pt. smoking has many cardiovascular risks
- teach how to manage missed pills
24
Q
One tablet missed
A
-take one tablet as soon as realized missed, then take next dose as scheduled
25
Two tablets missed
- take two tablets as soon as realized, and two tablets the next day
- use backup contraception the rest of cycle
26
Three tablets missed
- discontinue present pack and allow for withdrawal bleeding
- start new package 7 days after last tablet taken
- use backup contraception until tablets have been taken 7 days consecutively
27
Progestin only tablet missed
- take tablet as soon as realized and follow with next tablet at regular time
- backup method for 48 hours
28
Spermicides
- chemical agents that inactivate sperm before they can travel to the cervix and into the upper genital tract
- the sponge(nonoxynol-9)
29
Combined hormone contraception pills
| Emergency contraception
- raises both estrogen and progestin to delay or prevent ovulation
- yuzpe is the original type
- 75% effective
- should be taken within 72 hours
30
Plan B pill
- progestin only pill that can be taken by anyone of childbearing age
- must be over 17 Y/O to get OTC
- should be taken by 72 hours after but can be effective up to 120 hours after
- if taken within 24 hours it's 95% effective
31
Paragaurd copper IUD
- may be inserted within 5 days of unprotected sex
| - may stay in place up to 10 years as method of backup contraception
32
Menopause
- documented after permanent cessation of menstruation after a full year
- should use backup contraception for full year after cessation
- women who experience menopause before age 40 are said to have premature ovarian failure
33
S/S of menopause
```
Hot flashes
Mood changes
Decreased libido
Vaginal dryness
Insomnia
Irregular the cessation of bleeding
```
34
Side effects of estrogen being depleted
Vaginal bleeding
Oligomenorrhea
Nervousness
Dyspareunia(painful intercourse)
35
Dude effects of progesterone being depleted
Dysmenorrhea
- bleeding late in cycle
- heavy flow with clots
36
Hormone replacement therapy
- used only to treat menopausal symptoms, at lowest dose, for shortest time possible(usually no more than 5 years)
- without uterus women can do estrogen only pills
37
Contraindications of HRT
- DVT,CAD, liver disease
- HX of endometrious or breast cancer
- people with diabetes use HRT with caution
38
Osteoporosis
Amy disease process that results in reduction in the mass of bone
39
HT to prevent osteoporosis
- showed 35% decrease in hip and vertebral FX, but had too many adverse reactions
- no longer recommended for osteoporosis treatment
40
Estrogen receptor modulator
Raloxifene(Evista)
| -stimulates estrogen receptors without estrogen being around
41
Osteoporosis prevention
- 1200 mg of calcium+Vitamin D daily
- regular weight bearing exercise
- no smoking
42
The Deontae's for osteoporosis
Alendronate(Fosamax)
| -must be taken with 6oz. Of water 30 min before meals, and patient must remain upright for 30 min
43
Teriparatide for osteoporosis
- stimulates parathyroid hormone to increase Ca levels
- subcut injection
- for men and women with multiple risk factors for FX especially osteoporosis
44
Androgens
Male sex hormones that control the development and maintenance of sexual processes, accessory sexual organs, cellular metabolism, and bone and muscle growth
45
Testosterone
Class: androgen
AR: masculinization, urinary urgency,gynecomastia, priapism(prolonged erection), allergic reaction
-drug interactions: increases effects of anticoagulants, decreases effects of barbiturates,phenytoin, and corticosteroids
-lab interactions: lowers blood glucose in diabetics, increases serum cholesterol, thyroid, liver function hematocrit
-inserted: IM
-excreted in urine and bile
- pregnancy category X
46
Anabolic steroids
- increases protein synthesis within cells, which results in a build up of cellist tissue, especially in muscle.
- developed to maximize anabolic effects of androgens
- athlete abuse can result in 30X TD
- older teens heaviest users
47
Anti-androgens
- block synthesis/actions of androgens
- used in treatment of BPH, advanced prostatic cancer, and HT
- SE: hypotension
48
Drugs for BPH
- tamulosin(Flomax)
| - doxazosin(coders)
49
5-Alpha refuctase inhibitors
Finasteride(Proscar)
Dustaride(avodart)
50
Hypogonadism
-given male androgens for TX
51
Constitutional growth delay
- Given androgens to boost long bone growth
- not given before age 14
- typically given between 15 and 17 before growth plates shut
52
Finasteride(Proscar)
- women should prepare with gloves on
- cannot be taken by pregnant women
- women who are/may be pregnant should not handle broken or crushed tabs d/t risk for fetal abnormalities
53
Drugs that cause ED
```
Anticholinergics
Antidepressants
Antihistamines
Anti hypertensives
Antipsychotics
Sedatives/recreational drugs
Antiulcer drugs
```
54
Causes of ED
- blood flow(atherosclerosis)
- nerve impairment(neuropathy)
- pharmacological agents
- low testosterone
55
The afils ED meds
Phosphodieaterase inhibitors end in afil
56
Sildenafil citrate(viagra)
Onset:30-60 min
| -lasts 4 hours
57
Vardenafil(levitra)
Onset:25-30 min
| -lasts 4-5 hours
58
Tadalafil(Cialis)
Onset:15 minutes
| Lasts 36 hours
59
Chest pain: the afils and nitroglycerin
- cannot use Sidenafil citrate(viagra) within 24 hours of recieving NTG, Cialis must wait 36 hours or longer depending on age
- SE of afils: blue vision, headaches, GERD
60
Endometriosis
Abnormal location of endometrial tissue outside of uterus, that tissue is known as ectopic endometrial implants
-it's a common cause of dysmenorrhea, pelvic pain associated with menstrual cycle, and infertility
61
Pharmacological management of endometriosis
| CHC products
-suppress Gn-RH release,prevent ovulation, and cause atrophy of uterine lining(actions thought to relieve pelvic pain by causing a regression of the endometrial implants
62
Pharmacological management of endometriosis
| Progestinal products
- suppress ovulation and cause long term endometrial atrophy
- suppress Gn-RH release
- overtime progestins can shrink or eliminate endometrial implants
-Provera: 70-90% feel relief, causes bone density loss
Injection given every 11-13 weeks
63
Pharmacological management of endometriosis
Gn-RH Agonists
- pregnancy category C
- gives negative feedback to have body no longer make LH or FSH
- given 4-6 months at a time and puts woman in hypoestrogen state, at risk for osteoporosis
- leupride acetate:IM injection monthly for up to 6 months
- should be initiated in the first 3 days of menstrual cycle
- nafarlin(nasal spray) one spray in one nostril in morning and one spray in other nostril at night for up to 6 months
64
Primary infertility
Woman has never conceived
65
Secondary infertility
Woman has conceived at some point
66
Clomiphene Citrate( Clomid)
Class: Ovulation stimulant
SE: hot flashes,cyst formation, ovarian enlargement, weight gain,GI disturbances, multiple gestation
TE: stimulates the release of pituitary gonadotropins:FSH,LH
- readily absorbed in the GI TRACT
-half life is 5 days
67
Nursing process for infertility
- be aware of social/psychological issues it can cause on a couple
- can be uncomfortable, expensive, with no garuntee of pregnancy
68
PID SHUFFLE
Pelvic inflammatory disease
69
Metronidazole(Flagyl)
Used for trichomoniasis
-do not use alcohol
70
Ceftriaxone(Rocephin)
Used for ghonorrhea
71
Penicillin G
Used for cyphilis
72
Azithromycin (Zithromax)
Used for chlamydia
73
Acyclovir(Valtrex)
Used for herpes
