Final Exam-Adv Pharm NR568
How does hormone therapy aid osteoporosis?
Estrogen slows down bone resorption.
When should progestin be used for hormone replacement therapy?
For menopausal women with INTACT UTERUS.
Required to prevent estrogen-associated endometrial hyperplasia.
When should progestin NOT be used for hormone replacement therapy?
Women with HYSTERECTOMY
When should local estrogen be used?
Intravaginal—vaginal and vulvar atrophy (LESS ADR)
Vaginal ring (Estring)—vaginal and vulvar atroph
When should systemic estrogen be used?
IV—acute emergency control of heavy uterine bleeding Vaginal ring (Femring)—
systemic hot flashes/night sweats
What is the purpose of peri-menopausal estrogen therapy?
Most effective treatment option for menopausal symptoms and structural
changes. ET (estrogen alone); EPT (estrogen-progestin)
Which form of estrogen therapy has fewer ADR?
Transdermal—bypasses liver. Causes less n/v. Less fluctuation in estrogen levels.
Lower risk for stroke, PE/DVT. Examples: Estrasorb (Emulsion), Evamist (Spray),
Gels-EstroGel, Elestrin, Divigel; Patches-Alora, Climara, Estraderm, Menostar,
Vivelle-Dot, Oesclim
What medication is used for osteoporosis, osteopenia, and HRT?
,SERM—Bazedoxifene
How to change pt from one OC to another?
Start new brand and either Skip placebo week of old OC OR use condoms until 7
pills taken of new brand
When is the best time in cycle to start new OC?
On day ONE of period. Use condoms for 7 days.
Patient teaching with new OC?
a. Take at same time daily
b. Higher weight = less effective
c. Report: leg tenderness/redness, SOB, headache, chest pain, visual changes
What to do if you mess up OC?
a. More than 3 hr late—take 1 ASAP and condom x 2 days
b. 1+ pills missed in FIRST WEEK—take 1 ASAP continue pack condoms x 7 days
c. 1-2 pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week
d. 3+ pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week AND condoms x 7 days
What baseline info is needed for OC?
Assess for HTN, DM, Thromboembolism, CV disease, Breast CA and obtain urine
Pregnancy test
What are absolute CI for OC?
i. Thrombophlebitis / thrombotic disorders ii. Cerebrovascular disease iii. Coronary
occlusion iv. Liver dysfunction v. Breast CA vi. Abnormal vaginal bleedingvii.
Pregnant viii. Smoker 35+
What are relative CI for OC?
, i. HTN ii. CV disease iii. DM iv. Cholestatic jaundice (pregnancy) v. Gallbladder
disease vi. Uterine leiomyoma vii. Epilepsy viii. Migraine
How do you achieve an extended cycle with OC?
Skip placebo pills (safe)
What effect do CYP450 INHIBITORS have on OC?
Can accelerate OC metabolism and thereby reduce OC effects. Indications of
reduced OC blood levels-breakthrough bleeding or spotting.
Some CYP450 Inhibitors
Grapefruit b. Amio c. Fluconazole d. Fluoxetine e. Flagyl f. Ritonavir g. Bactrim
What should be done if a woman is showing signs of reduced OC blood levels?
(1) increase the estrogen dosage of the OC, (2) combine the OC with a second
form of birth control (e.g., condom), or (3) switch to an alternative form of birth
control.
What are the benefits of PROGESTIN-ONLY OC?
NO thromboembolic ADR
What are the drawbacks of PROGESTIN-ONLY OC?
Less effective , Irregular bleeding
What are the most effective forms of contraception?
EXTREMELY EFFECTIVE: i. Etonogestrel subdermal implant (Nexplanon) ii. Surgical
sterilization (tubal ligation / vasectomy) iii. Intrauterine devices iv. Copper T 380A
(Paraguard) v. Levonorgestrel T (Mirena)
VERY EFFECTIVE: i. OC ii. Combination pills iii. Progestin-only pills iv. IM
contraception (Depo-Provera) v. Vaginal ring (NuvaRing) vi. Contraception patch
(OrthoEvra)
How is the administration of testosterone replacement?
Patch once DAILY—upper arm, back, thigh, or abdomen, or Gel; IM injection; nasal
gel; buccal tablet, implantable SQ pellets
How does hormone therapy aid osteoporosis?
Estrogen slows down bone resorption.
When should progestin be used for hormone replacement therapy?
For menopausal women with INTACT UTERUS.
Required to prevent estrogen-associated endometrial hyperplasia.
When should progestin NOT be used for hormone replacement therapy?
Women with HYSTERECTOMY
When should local estrogen be used?
Intravaginal—vaginal and vulvar atrophy (LESS ADR)
Vaginal ring (Estring)—vaginal and vulvar atroph
When should systemic estrogen be used?
IV—acute emergency control of heavy uterine bleeding Vaginal ring (Femring)—
systemic hot flashes/night sweats
What is the purpose of peri-menopausal estrogen therapy?
Most effective treatment option for menopausal symptoms and structural
changes. ET (estrogen alone); EPT (estrogen-progestin)
Which form of estrogen therapy has fewer ADR?
Transdermal—bypasses liver. Causes less n/v. Less fluctuation in estrogen levels.
Lower risk for stroke, PE/DVT. Examples: Estrasorb (Emulsion), Evamist (Spray),
Gels-EstroGel, Elestrin, Divigel; Patches-Alora, Climara, Estraderm, Menostar,
Vivelle-Dot, Oesclim
What medication is used for osteoporosis, osteopenia, and HRT?
,SERM—Bazedoxifene
How to change pt from one OC to another?
Start new brand and either Skip placebo week of old OC OR use condoms until 7
pills taken of new brand
When is the best time in cycle to start new OC?
On day ONE of period. Use condoms for 7 days.
Patient teaching with new OC?
a. Take at same time daily
b. Higher weight = less effective
c. Report: leg tenderness/redness, SOB, headache, chest pain, visual changes
What to do if you mess up OC?
a. More than 3 hr late—take 1 ASAP and condom x 2 days
b. 1+ pills missed in FIRST WEEK—take 1 ASAP continue pack condoms x 7 days
c. 1-2 pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week
d. 3+ pills missed in WEEKS 2 OR 3—take 1 ASAP continue pack and SKIP placebo
week AND condoms x 7 days
What baseline info is needed for OC?
Assess for HTN, DM, Thromboembolism, CV disease, Breast CA and obtain urine
Pregnancy test
What are absolute CI for OC?
i. Thrombophlebitis / thrombotic disorders ii. Cerebrovascular disease iii. Coronary
occlusion iv. Liver dysfunction v. Breast CA vi. Abnormal vaginal bleedingvii.
Pregnant viii. Smoker 35+
What are relative CI for OC?
, i. HTN ii. CV disease iii. DM iv. Cholestatic jaundice (pregnancy) v. Gallbladder
disease vi. Uterine leiomyoma vii. Epilepsy viii. Migraine
How do you achieve an extended cycle with OC?
Skip placebo pills (safe)
What effect do CYP450 INHIBITORS have on OC?
Can accelerate OC metabolism and thereby reduce OC effects. Indications of
reduced OC blood levels-breakthrough bleeding or spotting.
Some CYP450 Inhibitors
Grapefruit b. Amio c. Fluconazole d. Fluoxetine e. Flagyl f. Ritonavir g. Bactrim
What should be done if a woman is showing signs of reduced OC blood levels?
(1) increase the estrogen dosage of the OC, (2) combine the OC with a second
form of birth control (e.g., condom), or (3) switch to an alternative form of birth
control.
What are the benefits of PROGESTIN-ONLY OC?
NO thromboembolic ADR
What are the drawbacks of PROGESTIN-ONLY OC?
Less effective , Irregular bleeding
What are the most effective forms of contraception?
EXTREMELY EFFECTIVE: i. Etonogestrel subdermal implant (Nexplanon) ii. Surgical
sterilization (tubal ligation / vasectomy) iii. Intrauterine devices iv. Copper T 380A
(Paraguard) v. Levonorgestrel T (Mirena)
VERY EFFECTIVE: i. OC ii. Combination pills iii. Progestin-only pills iv. IM
contraception (Depo-Provera) v. Vaginal ring (NuvaRing) vi. Contraception patch
(OrthoEvra)
How is the administration of testosterone replacement?
Patch once DAILY—upper arm, back, thigh, or abdomen, or Gel; IM injection; nasal
gel; buccal tablet, implantable SQ pellets
