Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Womens health, pharm
Chapter 34 womens health
| Question | Answer |
|---|---|
| Female Hormones: Estrogens | function in development of female reproductive organs, secondary sex characteristics, and menstrual cycle. Also helps conserve calcium. |
| Female Hormones: Progesterone (progestin) | functions in menstrual cycle, also necessary for maintenance of pregnancy |
| What are some Medical Uses for Estrogen & Progesterone? | ERT hormone replacement after menopause (not recommended) menstrual irregularities or severe acne/birth control In Men: palliative treatment of cancers of male reproductive organs—not common |
| What is the Significant controversy with ERT? | does not offer cardiac prevention as once thought.2005 WHI research on HRT shows increased risk of breast & uterine cancer as well as MI & stroke. Essential that women get mammograms & pelvic exams. 😉 |
| BLACK BOX WARNING OF ERT? | uterine & breast cancer, CV risk for stroke, MI, DVT/PE |
| Conjugated estrogens (Premarin®) | used primarily to counteract effects of menopause (HRT: hormone replacement therapy) |
| estradiol (Variety of trade names) | used to prevent menopausal symptoms; used to treat prostate cancer. /Available PO, creme, patch, spray. Topical seem less likely to cause thrombosis. /Topical & sunscreen should not be applied at same time as can increase med. absorption. 😉 |
| Herbal option to estrogen HRT: Black Cohosh | Plant-based Phytoestrogen. Used for over 200 years by Native Americans, widely used by Europeans. The root is medicinal part. |
| What are the advantages of using black cohosh? | Evidence that it does provide some relief. No evidence of risk for breast Cancer. Many combo products but single ingredient gets best results/Recommend USP certified |
| What is one disadvantage of using black cohosh? | possible hepatotoxicity in high doses. Watch liver enzymes |
| Birth Control: Oral Contraceptives: Mechanism: | (both estrogen and progestin) inhibit ovulation through feedback to hypothalamus which in turn affects pituitary release of FSH, LH. Also thins endometrial lining to limit implantation of ovum. |
| What is the black box warning with OCP? | BLACK BOX WARNING: cigarette smoking increases CV risk for women esp. >35 y/o (contraindicated)😉 |
| Patient teaching: Drug-drug interactions with OCP | Most important is antibiotic (abx) use which inhibit activation of oral contraceptives in the gut; need to use others means of birth control x 30 days after finishing abx (a full ovulation cycle) Don’t prevent STDs, still need a condom |
| progesterone micronized (Prometrium®): | PO qd, for post-menopausal endometrial health (HRT- intact uterus). |
| medroyxprogesterone (Provera® & Depo-Provera®): | IM q3mo, for birth control |
| Arm Implants: (Implanon® or Nexplanon®) | subdermal implant into upper arm for slow diffusion of etonogestrel (progestin). Effective for 3 yrs. |
| Vaginal spermicides: | Available OTC as cremes, foams, suppositories. Active ingredient is chemical nonoxynol 9. For effectiveness requires insertion before intercourse and reapplied before each ejaculation. No douche for 6-8 hrs after use. |
| What is the mechanism for drugs with progesterone? | regulating endometrial density/thickening the cervical mucus, thereby reducing sperm viability and penetration |
| Uterine Implants | Uterine Implants (IUD): slowly releases levonorgestrel (progestin) to prevent endometrial proliferation and ovum implantation. |
| FDA approved uterine implants. | FDA Approved IUDs: Skyla – 3 years Kyleena – 5 years Mirena, Liletta – 7 years Paragard – No hormone, copper wrapped – 12 years |
| Who Should Consider IUD? | GREAT for women taking teratogenic meds/Women at risk for thrombosis...smokers, migraine with aura/Women who have dysmenorrhea, heavy menstrual bleeding, or endometriosis. |
| Emergency Contraception “Morning After Pill” | Active ingredient: levonorgestrel/Can take up to 5 days after unprotected intercourse |
| What is some patient teaching and side effects of levonorgestrel? | ADR: dizziness, upset stomach, breast tenderness, mood swings. Teaching: the next menstrual cycle may be earlier, later, heavier, or feel different |
| Medical Abortion abortifacients: mifepristone (Mifeprex®) + misoprostol (Cytotec®) | out-patient combo therapy with progesterone receptor antagonists + prostaglandins. Used on formed fetus up to 60 days post-conception. |
| megestrol (Megace®) | Synthetic progestin that is very similar to progesterone. Used for Palliative management of inoperable or metastatic endometrial or breast cancer/increased risk of blood clots |
| Fertility Drugs | Given to stimulate ovulation/If effective, often results in multiple births. |
| What are some ADR'S of fertility drugs? | tachycardia, DVT, dizziness, HA, flushing, mood changes, N/V, constipation, breast tenderness |
| Examples of fertility drugs .......... | human chorionic gonadotropin (HCG), human menopausal gonadotropin (HMG); humegon (Pergonal®); clomiphene (Clomid®), leuprolide (Lupron®) |
| Selective Estrogen Receptor Modulator (SERM) “anti-estrogen” | not estrogen but estrogen receptor modulator (SERMs). Can be estrogen (+/-) agonist or antagonist depending on medication |
| Black box warning for SERM'S? | thromboembolism, depending on estrogen agonist effects has been linked to breast and uterine cancer risk |
| tamoxifen: 😉 | Drug of choice for ERP breast CA/blocks estrogen from connecting to the cancer cells and telling them to grow and divide. Anti-estrogen in breast cells acts like an estrogen in other tissues, like the uterus and the bones |
| raloxifene: | for post-menopausal osteoporosis and adjuvant to ERP breast cancer |
| toremifene: | for ERP breast cancer with metastases |
| ospemifene: | for post-menopausal vaginal atrophy. ADR- uterine CA |
| Placenta transfer of drugs: | Most drugs will cross placenta into fetal circulation and immature liver and kidneys make drug toxic to fetus. |
| Prenatal Vitamins Folic acid😉 | Folic acid - RDA doubles during pregnancy Recommended because it prevents the risk of Nural tube defect 4000mg if they have had a previous pregnancy with this. |
| What are the iron recommendations during pregnancy? | Iron – ferrous sulfate 325 mg PO 1 – 3 times a day |
| Hyperemesis Gravidarum | Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and continues throughout the pregnancy. |
| Hyperemesis Gravidarum: Treatment options: | diphenhydramine – H1 blocker/famotidine – H2 blocker “prazole” family – PPI (esomeprazole, omeprazole) pyridoxine/doxylamine (Diclegis) – B6 + anticholinergic ondansetron – 5HT3 blocker |
| Hypertensive Disorders of Pregnancy | Gestational HTN – develops after 20 weeks BUT does not have proteinuria Preeclampsia-eclampsia - develops after 20 weeks with proteinuria. |
| Hypertensive Disorders of Pregnancy: Treatment😉 Antihypertensive medications: > 160 mmHG systolic and/or 110 mmHG diastolic | labetalol – less maternal tachycardia and fewer adverse reactions/hydralazine – higher doses are associated with HA and fetal distress/nifedipine – may be associated with reflex tachycardia and HA |
| Magnesium Sulfate HIGH ALERT MED😉 (deep tendon reflexes) | Severe preeclampsia prophylactically for neurological symptoms and/or seizures. Given IV loading dose followed by maintenance infusion. kidneys↓ output can lead to toxicity – monitor levels frequently CNS depression /can decrease fetal heart rate |
| Chronic Hypertension | antihypertensive can reduce blood flow to the placenta Methyldopa is drug of choice because of documented safety record and effectiveness during pregnancy Beta blockers or CCB can be use |
| Are ACE'S and ARB'S recommended during pregnancy? | ACEI and ARBs are NOT recommended in pregnancy due to risk of fetal abnormalities (kidneys) |
| MEDICATIONS USED DURING LABOR Preterm Labor | Indomethacin – NSAID inhibits prostaglandin activity Nifedipine – CCB inhibits myometrial activity by blocking calcium influx |
| Medications that Suppress Uterine Contractions | Tocolytics: drugs to suppress uterine contractions in pre-term labor. Mechanism: uterine smooth muscle relaxation. Require signed consent form. |
| terbutaline (Brethine®): | FDA position not recommended for long-term use due to maternal and fetal safety risks Is still used short term in hospital setting, usually IM in triage ANTIDOTE: propranolol, a beta blocker. Magnesium sulfate—MgSO4 ANTIDOTE: calcium gluconate |
| Medications to Stimulate Uterine Contractions | Oxytocics: drugs that stimulate uterine contractions to initiate labor or control post-partum hemorrhage. |
| Medications to Stimulate Uterine Contractions Drugs include: | oxytocin (Pitocin®): “pit drip”. Requires close monitoring of contractions and maternal & fetal VS and response to contractions. ANTIDOTE: terbutaline ) |
| Ergot alkaloids—methylergonovine (Methergine®) | for control of post-partum hemorrhage only, not for labor induction |
| Prostaglandin PGF28: carboprost (Hemabate®): | used to control post-partum hemorrhage; also used to promote uterine contractions to abort |
Created by:
Akrombach
Popular Nursing sets