NR566 -Week 5 Study Guide- DUE 23 OCTOBER 2023

NR566 -Week 5 Study Guide- DUE 23 OCTOBER 2023 Regarding osteoporosis, what are the two SERM drugs? - CORRECT ANSWER-- Tamoxifen -Raloxifene Tamoxifen is a good drug because it protects against osteoporosis, but what is it's downside? - CORRECT ANSWER--Higher risk for cancer -Higher risk for blood clots What is the the awesome benefit of Tamoxifen other than bone health? - CORRECT ANSWER--Promotes good blood lipid levels What is one thing that makes Raloxifene better than Tamoxifen? - CORRECT ANSWER--Lower risk for cancer What is the only drug approved for prevention and treatment of osteoporosis? - CORRECT ANSWER--Duavee (conjugated estrogens/bazedoxifene) What drug prevents osteoporosis and vasomotor symptoms in postmenopausal women with a uterus? - CORRECT ANSWER--Duavee (conjugated estrogens/bazedoxifene) What are the 3 main benefits of hormone therapy? - CORRECT ANSWER--suppression of vasomotor symptoms -prevention of urogenital atrophy -prevention of osteoporosis and related fractures Does urogenital atrophy and osteoporosis prevention sustain after withdrawal of HT? - CORRECT ANSWER---No, benefits will decline after HT withdrawal Although HT therapy is great for bone loss prevention, what will happen when HT is stopped? - CORRECT ANSWER--bone mass rapidly decreases by approximately 12% ---Therapy must be life long-- Examples of progestins - CORRECT ANSWER--Medroxyprogesterone acetate -Norethindrone A patient has undiagnosed vaginal bleeding, should she be prescribed HT? - CORRECT ANSWER--No, don't give HT with undiagnosed vaginal bleeding Julie has some blood clotting issues in his body. He has active thrombophlebitis & thromboembolic disorders Should she use HT? - CORRECT ANSWER--No, better not use HT with blood and clotting issues. Amy has active liver disease, would HT be okay? - CORRECT ANSWER-No, better not use HT with active liver problems Yolanda has active breast cancer. Should she receive HT? - CORRECT ANSWER-No, those with active breast cancer should not receive HT! The nurse practitioner is considering adding progestin plus estrogen to his patient's med regimen. The patient has HX of blood clotting disorders. What considerations must be dicussed? - CORRECT ANSWER--Increased risk for --DVT --Stroke --MI --PE Susie just had her 65th birthday. She also has dementia and cardiovascular disease. Regarding combination of estrogen/progestin, what is she at higher risk for ? - CORRECT ANSWER--With these things, she's at a higher risk for dementia Tina has a mild risk of breast cancer. Is it a good idea for her to have estrogen/progestin combo? - CORRECT ANSWER--No, this combo of progestin/estrogen increases risk for breast cancer The new doctor wants to prescribe progestins for a prepubertal child, his attendee says what? - CORRECT ANSWER--He screams "NO", those are not for prepubertal children. A patient asks her doctor if progestin is okay while breast feeding. What does he say? - CORRECT ANSWER--Progestins while breastfeeding may cause neonatal jaundice. What are the guidelines for tapering a patient off HT? - CORRECT ANSWER--There are no firm guidelines! What kind of symptoms may occur while tapering off HT? - CORRECT ANSWER-- Tapering of HT may cause vasomotor symptoms. For women on EPT, the progestin dosage should remain... - CORRECT ANSWER-- unchanged because lowering the progestin dosage might permit estrogen to stimulate endometrial growth, thereby posing a risk for endometrial hyperplasia. What are some names of intravaginal inserts? - CORRECT ANSWER--Imvexxy -Vagifem -Yuvafem What are some names of intravaginal creams? - CORRECT ANSWER--Estrace vaginal -Premarin Vaginal What is the name of a vaginal ring used for local effects? - CORRECT ANSWER-- Estring --treatment of vulval and vaginal atrophy associated with menopause What is the name of a vaginal ring used for systemic effects? - CORRECT ANSWER-- Femring --(control of hot flashes and night sweats) as well as local effects (e.g., treatment of vulval and vaginal atrophy) What is the best treatment for genitourinary symptoms of menopause? - CORRECT ANSWER--Estrogen is the best treatment for these symptoms. What are some symptoms of genitourinary symptoms of menopause? - CORRECT ANSWER--dryness -irritation -uncomfortable intercourse Because systemic estrogen carries significant risks, the FDA recommends... - CORRECT ANSWER--If HT is being used solely to manage vulvar and vaginal symptoms, a topical estrogen formulation should be considered. All intravaginal estrogens are used to treat what? - CORRECT ANSWER--urogenital atrophy Imvexxy has specific indications for what? - CORRECT ANSWER--Dyspareunia With one product—Femring—estradiol is absorbed in amounts... - CORRECT ANSWER-sufficient to cause systemic effects, both beneficial Every woman undergoing systemic HT receives a... - CORRECT ANSWER-Estrogen! Every women with a uterus receives a what? - CORRECT ANSWER--Progestin, to counteract the stimulant effects of estrogen in the endometrium What are some need to knows regarding the continuous administration of progestin & estrogen? - CORRECT ANSWER-An alternative is to give estrogen continuously but give the progestin cyclically (e.g., on calendar days 15 through 28). However, cyclic progestin has the disadvantage of promoting monthly bleeding, which may explain why most women prefer continuous dosing. Estring remains in the vagina for how many months? - CORRECT ANSWER--For 3 months. It is then removed and replaced with a new ring. Cindy wants to know whether topical or oral estrogen is safer. How does her doctor answer this? - CORRECT ANSWER--Although long-term data are lacking, it seems likely that topical estrogen is safer than oral estrogen because, with nearly all topical formulations, blood levels of estrogen remain low. -The notable exception is the Femring, which releases enough estrogen to cause significant systemic effects. Which form of estrogen therapy has fewer adverse effects? - CORRECT ANSWER-- Transdermal estrogen therapy has fewer adverse effects. Example of combo OC? - CORRECT ANSWER--Ethinyl estradiol/norethindrone When changing one combination oral contraceptive for another, the change is best made at - CORRECT ANSWER-the beginning of a new cycle. This doesn't mean it's the only time that can be done. It is just noted as the best time Lilly wants to know the best time to initiate her OC treatment. What counsel does the doctor tell her? - CORRECT ANSWER--Right at the beginning of the cycle -The patient begins taking the pills on the first day of menstrual bleeding. -The patient begins taking the pills on the first Sunday after menstrual bleeding begins. -The patient begins taking the pills immediately if she is definitely not pregnant and has not had unprotected sex since her last menstrual period. What individuals need to be caution when on OCs? - CORRECT ANSWER--Those with HTN -Those with heart disease -Those with DM When prescribing OCs, the doctor should assess what kind of patient history? - CORRECT ANSWER-HTN, DM, CLOTS, BRAIN STROKE STUFF, HEART DZ, BREAST CX, PREGO TEST A doctor tells the patient she can't have OC's. What are the contraindications for OCs? - CORRECT ANSWER--Pregnancy -Blood clots -Strokes -Acute coronary syndrome -Liver problems -Breast cancer -Unknown vaginal bleeding -Smoking (35yrs ) What are some relative contraindications for OCs" - CORRECT ANSWER--HTN, HEART, DM, CHOLESTATIC DZ OF PREG, GALLBL, UTERINE LEIOMYOMA, EPILEPSY, MIGRAINE How to achieve an extended cycle with oral contraceptives - CORRECT ANSWER--To achieve an extended schedule, the user would simply purchase four packets of a 28- day product (each of which contains 21 active pills) and then take the active pills for 84 days straight. What behaviors would make one birth control method more effective over another? - CORRECT ANSWER--able to evaluate a patient scenario and suggest an appropriate birth control method (type of prescribed contraception: OC, long-term methods, IUD, etc. If one takes oral contraceptives, they are INHIBITING CYP1A2-- Thus INCREASING drug levels of - CORRECT ANSWER--Amiptriptline, clomipramine, clozapine, despramine, duloxetine, fluvoxamine, haldol, imipramine, methadone, ramelteon, resagiline, roprinirole, tacrine, theophyline, tizanidine, warfarin These drugs Inhibit metabolism of Ocs..thus increasing their effectiveness - CORRECT ANSWER--Amiodarone, Amprenavir, Aprepitant, Atazanavir, Azole antifungals Chloramphenicol, Cimetidine, Clarithromycin, Cobicistat, Conivaptan, Cyclosporine Darunavir/ritonavir, Delavirdine, Diltiazem, Dronedarone, erythromycin, Fluvoxamine, Fosamprenavir Grapefruit juice, Indinavir, Isoniazid, Methylprednisolone, Nefazodone, Nelfinavir, Nicardipine, Nifedipine, Norfloxacin, Pazopanib, Prednisone, Protease inhibitors, Quinine, Quinupristin/dalfopristin, Ritonavir, Saquinavir. Telithromycin, Tipranavir/ritonavir, Verapamil These drugs induce metabolism of Ocs..thus decreasing their effectiveness - CORRECT ANSWER--Amprenavir, aprepitant, bosentan, carbamezapine, dexamethazone, efavirenz, ethosuxmide, etravirine, garlic supplements, garlic supplements, nevirapine, oxcarbazepne, phenobarbitol, phenyroin, primidone, rifabutin, rifampin, rifapentine, ritonavir, St. Johns Wort. A doctor tells his patient that there are two scary progestin-only drugs that have HIGH risk for blood clots. What are these? - CORRECT ANSWER--Drospirenone & Desogestrel Too much progestin does what? - CORRECT ANSWER-Increased appetite Weight gain Depression Tiredness Fatigue Hypomenorrhea Breast regression Monilial vaginitis Acne, oily scalpa Hair lossa Hirsutisma Too little progestin does what? - CORRECT ANSWER-Late breakthrough bleeding Amenorrhea Hypermenorrhea Why should a diabetic be afraid of progestins? - CORRECT ANSWER-Progestins can increase blood sugar Progestin only "mini pills" do not cause blood clots, HAs, or NZA. Why? - CORRECT ANSWER--Because they lack estrogen A patient wants to know if progestin-only "mini pills" are effective too? How should the doctor reply? - CORRECT ANSWER--They are not as productive, but they are considered more safe. Progestin-only pills are more likely to cause what? - CORRECT ANSWER-Irregular bleeding Extremely effective contraceptive - CORRECT ANSWER--Estonogestral subdermal implant (Nexplanon) -Surgical sterilization -Tubal ligation -Vasectomy -Intrauterine devices -Copper T 380A -Levonogestrel T(Mirena) Very effective contraceptive - CORRECT ANSWER--Oral contraceptive -Combination pills -Progestin-only pills -Intramuscular medroxyprogesterone acetate -Vaginal contraceptive -Contraceptive patch Effective - CORRECT ANSWER--Condoms -Diaphram with spermicide Least effective - CORRECT ANSWER--contraceptive sponge -Parous -Nulliparous -Spermicide alone -Periodic abstinence -Withdrawal Regarding testosterone replacement, oral androgens are indicated for what? - CORRECT ANSWER-Hypogonadism Regarding tesosterone replacement, transdermal patches are indicated for hypogonadism. How does administration work? - CORRECT ANSWER--One would give 2 or 4mgs over 24hrs. Applied to arm, thigh, or back. Regarding testosterone replacement, gels have the following BLACKBOX warning of? - CORRECT ANSWER--Secondary exposure has caused virilization in kiddoz. What are some names to testosterone replacement gels? - CORRECT ANSWER-- Androgel -Testim -Fortesta -Vogelxo In regards to testosterone replacement, gels may be better compared to patches because? - CORRECT ANSWER-Less local irritation, can't fall off, more consistent teste levels In kiddos, those who accidentally get secondary exposure to testosterone gel may experience? - CORRECT ANSWER-Large genitals, preme pubic hair, adv bone age, increased libido, agressiveness testosterone gel users should do the following... - CORRECT ANSWER-Wash hands, cover apl site, wash site prior to skin to skin, avoid women and kidz, if accidental contact victim should wash. Testosterone topical application goes under the forearm. What should users do after application? - CORRECT ANSWER--They should avoid swimming or bathing for 2 hours post application Billy bob took some nasal testosterone, he wants to know possible side effects. What should you tell him? - CORRECT ANSWER-Sir, you may experience: -runny nose -nose bleeds -or nasopharyngitis John asks his NP for instructions on his testosterone nasal pump. How should his NP reply? - CORRECT ANSWER-Prime pump, remove excess gel, blow nose prior, tip toward lateral nose, avoid blowing/sniffing 1hr post Jack implants his testosterone pellets into his hip (because he's cool like that), what are the doses? - CORRECT ANSWER-Dose is 150-450 every 3-6 months What should a NP know before prescribing testosterone buccal tablets? - CORRECT ANSWER-These are not effected by eating or drinking. Apply in the gum area above incisor tooth, and Kissing could cause transfer..maybe Does IM testosterone have varying blood levels? - CORRECT ANSWER-Yep, sure does. Patient teaching for topical testosterone: - CORRECT ANSWER-To minimize the risk for accidental skin-to-skin transfer, advise users of testosterone gel or testosterone topical solution to (1) wash their hands after every application, (2) cover the application site with clothing after the gel has dried, and (3) wash the application site before anticipated contact with another person. Also, warn women and children to avoid contact with the user's skin where testosterone was applied and advise them to wash contaminated skin if accidental contact with an application site should occur. Patient teachings for androgens - CORRECT ANSWER-Tell female patients about signs of virilization (deepening of the voice, acne, changes in body and facial hair, menstrual irregularities). Instruct them to report these if they occur. Apprise patients of the signs of liver dysfunction (yellow tint to skin and eyes, fatigue, loss of appetite, nausea, dark-colored urine, light-colored stools). Advise them to report the occurrence of these changes. Inform patients that swelling of the extremities or unusual weight gain may be evidence of salt and water retention. Counsel them to report these events. Remind patients of child-bearing age that this drug can cause fetal malformations. If the patient is capable of becoming pregnant, emphasize the need for consistent use of reliable contraception. When is it appropriate to prescribe and initiate androgen therapy for delayed puberty? - CORRECT ANSWER-In some, puberty fails at the usual age (i.e., before age 15 years). Often, failure reflects familial pattern of delayed puberty and does not indicate pathology. Puberty can be expected to occur spontaneously but later than usual. Hence treatment aint absolute necessity. Why might a NP prescribe androgen therapy off label? - CORRECT ANSWER-the psychologic pressures of delayed sexual maturation are causing a boy significant distress. In these cases, a limited course of androgen therapy is indicated. Both fluoxymesterone (Androxy, Halotestin) and methyltestosterone (Methitest) are approved for this purpose. If delayed puberty is the result of true hypogonadism... - CORRECT ANSWER-longterm replacement therapy is indicated (see later section titled Androgen Preparations for Male Hypogonadism). Androgen replacement therapy is indicated for when testicle failure occurs. What are the benefits? - CORRECT ANSWER-Restores libido Increases ejaculatory volume Secondary sex characteristics WILL NOT RESTORE FERTILITY Two main drugs for androgen replacement therapy are... - CORRECT ANSWERtestosterone enanthate and testosterone cypionate Regarding androgen therapy, two drugs are approved for delayed puberty. What are they? - CORRECT ANSWER-fluoxymesterone (Androxy, Halotestin) and methyltestosterone (Methitest) Testosterone therapy in menopausal women (NOT IN THE U.S/BUT IS APPROVEDIN U.K) Helps to alleviate... - CORRECT ANSWER-Fatigue Reduce libido Reduced genital sensitivity In women, testosterone therapy should mimic premenopause testosterone at what strength? - CORRECT ANSWER-300ug/day Regarding andreogen therapy & Cachexia (wasting of the body/failure to thrive) Oxandrolone (Oxandrin) is... - CORRECT ANSWER-FDA-approved for this purpose. Oxandrolone is an anabolic steroid that is a synthetic derivative of testosterone. OXANDROLONE has BLACKBOX WARNING OF... - CORRECT ANSWEROxandrolone can cause peliosis hepatitis, a condition in which blood-filled cysts form in the liver, leading to liver failure or intra-abdominal hemorrhage. It can also contribute to the development of highly vascular liver tumors. An increased risk for atherosclerosis can occur secondary to marked elevations in lowdensity lipoprotein (LDL) and decreases in high-density lipoprotein (HDL). Regarding androgen therapy, this therapy can help with anemia. What types of anemia does this therapy help? - CORRECT ANSWER-Aplastic anemia, renal failure, fanconi anemia, cancer assocaited Androgen therapy helps with anemia by doing what? - CORRECT ANSWER-Promote synth of erythropoetin With the emergence of other therapies such as erythropoietin-stimulating agents, however, androgens have fallen out of favor for off-label treatment of anemia. Drug therapy for transgender men - CORRECT ANSWER-although not approved by the FDA for this purpose, testosterone is prescribed off label as part of gender-affirmation drug therapy.