Women's Health

Question 1

Conjugated Estrogens (Premarin)

Answer 1

MENOPAUSAL HORMONE THERAPY
Action:
-women without a uterus
-only estrogen
-made from pregnant mares urine

Uses:
-flushing
-vaginal atrophy (thinning, drying)
-osteoporosis
-take for one year then come off
-patches and creams = local effects

ADRs:
-CV: cancer, dementia, HA, breast tenderness, waking
-increased clotting

Question 2

Estrogen-progestin combinations

Answer 2

CONTRACEPTIVE
Action:
-estrogen-progestin combination
-suppress ovulation (blocks LH, FSH)
-thickens cervical mucus (“sperm plug”)
-endometrial changes, inhibits zygote from planting

ADRs:
-thromboembolic disorders (increased clotting)
-does NOT cause cancer
-protect effect on ovarian and endometrial
-no impact on cervical
-promotes breast cancer growth ONLY IF it is already present
-nausea
-bloating
-breast tenderness
-weight gain
-hirsutism
-depression

Uses:
-ance
-endometriosis
-irregular painful periods

CI:
-thromboembolic disorders and associated risk factors
-known or suspected breast cancer
-abnormal liver function (dysfunction = accumulation)
-severe depression
-undiagnosed abnormal vaginal bleeding
-known or suspected pregnancy (does not cause direct harm, category X)
-migraine headaches

Implications:
-education pt. on side effects
-monitor vital signs
-takes 1 week to be effective
-counsel smoking and decrease fat intake
-drug interactions (consider gastric situations/increased enzymes)
-12h window for missed pill

Question 3

Norgestrel

Answer 3

CONTRACEPTIVE
Action
-only progestin
-thickens mucus and alters endometrial lining
-avoids many ADRs of COCP (does not have thromboembolic effects)
-less potent
-irregular, breakthrough bleeding
-can be used during breastfeeding
-3h window for missed pill

Question 4

Depot Injections - Medroxyprogesterone

Answer 4

CONTRACEPTIVE
Action:
-IM or SC injection of progestin
-oily vehicle (does not mix = slow release)
-cover for 3 months

Question 5

IUDs - Intrauterine Device

Answer 5

CONTRACEPTIVE
Action:
-release a progestin
-cover for 5 years
-risk for pelvic inflammatory disease

Question 6

High dose progestin (Plan B)

Answer 6

EMERGENCY CONTRACEPTIVE
Action:
-high dose progestin
-Levonorgestrel
-CARE: NV-> give antiemetic 1 hour before dose to keep from vomiting up

Question 7

Mifepristone (RU-486) (2 days later = misoprostol)

Answer 7

MEDICAL ABORTION
Action:
-medical abortion without surgery
-progesterone antagonist (blocks development)
-terminate up to 49 days of gestation w/o surgery

Protocol:
1. Mifepristone (oral): terminates fetus in uterus
2. Misoprostol (2 days after): prostaglandin = stimulates uterine contractions = expulsion of uterine contents (embryo)

Question 8

Oxytocin

Answer 8

INCREASE UTERINE MOTILITY
Action:
-stimulates uterine contractions in childbirth (myometrium) and lactation
-IV (intranasal if breastfeeding)
-dose is gradually increased until contractions are every 3-5 mins, lasting 60-90s

Uses:
-induce or augment labor
-control postpartum bleeding
-assist breastfeeding

Implications:
-constant monitoring (pulse, BP, LOC, uterine contractility, I/O, serum electrolytes)
-do not leave patient unattended
-monitor fetus HR and rhythm

ADRs:
-uterine rupture

Question 9

Methylergonovine

Answer 9

INCREASE UTERINE MOTILITY
Action:
-increase force and rate of myocardial contractions (very intense, do not use when baby is still in)
-control postpartum bleeding
-for migraines

ADRs:
-nausea
-uterine cramping

Toxicity:
-peripheral vasoconstriction (heavy arms, chest)