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NURS 572 - 60

Ch. 60 Est/Progest non-contraceptive

QuestionAnswer
General fx of estrogen/progesterone *sexual organs/menstruation *bone/prevent resorption, maint density, *cholesterol favorable effects
Estrogen given without progesterone can cause what adverse effects (first four) *endometrial hyperplasia *ovarian ca *breast ca *stimulates existing ca using estrogen receptors
Estrogen/progestin adverse effects (second four) *CV increase MI, DVT, CVA, VTE *GI A, N, V *GB cholelithiasis
Minor s/e of both est/progest jaundice, HA, depr, Na/H20 retent
Major non-contraceptive uses *HRT *female hypogonadism *acne *prostate ca
Routes of est/progest po, transdermal, vag, parenteral
SERMs definition selective estrogen receptor modulator
MOA of SERMs mixed action - agonist and antagonist
2 SERM drugs *tamoxifen *raloxifene
positive effects of both SERMs *tx breast ca *prevent osteoporosis *positive lipid effects
negative effects SERMs tamoxifen *hot flashes *endometrial ca *VTE
negative effect of SERM raloxifene *hot flashes *VTE *DOES NOT cause endometrial hyperplasia
General fx of endogenous progesterone *prepare/maintain uterine lining (secretory changes in leutal phase) *cervical secretions - inc. visc, dec amt *maint pg, inhibit uterine contractions *some estrogenic, adrogenic, anabolic effects
What might be given to prevent pre-term labor progestins to inhibit uterine contractions
first 4 ADRs of progestins *teratogenic fetus masculinization *menstrual irreg (BTB, amenorr) *cervical secretions dec amt, inc visc *if used with estrogen-->breast ca
second 3 ADRS of progestins *breast tenderness *depression *same misc as estrogen (and phto sens, wt gain, dec app)
Noncontraceptive tx uses of progestin *HRT *uterine dx (bleed, amenorr, endometriosis, endometrial ca) *PMS
how does progest effect uterine lining? it makes endometrium thinner to prevent ca
benefits of HRT *dec vasomotor menop effects *dec uroginital dysfx, atrophy *dec bone loss *dec colon cancer *maybe QOL
Is HRT established to provide a CV benefit? No, HRT has NOT been established to provide a CV benefit
Risks of HRT *CV events *if ET only, not EPT: ovarian, uterine ca *breast ca *cholecystitis, lithiasis
What do we give for HRT with in tact uterus pempro given for this uterine status
What do we give for HRT s/p hysterectomy? premarin given for this uterine status
Example of EPT drug pempro representative of this class
Example of ET drug premarin representative of this class
WHI, HERs study concenus *HRT NOT advised >4 yrs (long term) *IS advised < 4 years
WHI, HERs study short term uses *vasomotor menop sxs *osteoporosis *vulvar/vaginal menop atrophy
Created by: lorrelaws