NR566 Final Exam Study Guide – Latest Solutions To Score A+

NR566 Final Exam Study Guide – Latest Solutions To Score A+ Prevention of osteoporosis with hormone replacement therapy Tara (p.433) Hormone therapy reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. Therapy is lifelong and the risk for harm is increased. Hormone therapy should only be considered for women with significant risk for osteoporosis, and only when that risk outweighs the risks of hormone therapy. Meds are: raloxifene (Evista), bisphosphonates (e.g., alendronate {Fosamax}), calcitonin (Miacalin), and teriparatide (Forteo). Encourage patients to prevent bone loss by ensuring adequate intake of calcium and Vit D, performing regular weight-bearing exercises, and avoiding smoking and excessive alcohol use. - When and when not to use progestin for hormone replacement therapy and why Tara (p.430-432) When: Menopausal hormone therapy Why: The primary noncontraceptive use of progestins is to counteract the adverse effects of estrogen on the endometrium in women undergoing menopausal HT. When: Dysfunctional uterine bleeding Why: Heavy irregular bleeding that occurs when progesterone levels are insufficient to balance the stimulatory influence of estrogen on the endometrium. Treatment goals with administration of progestins are to stop the bleeding and establish a regular monthly cycle. When: Amenorrhea Why: Progestins can induce menstrual flow in selected women who are experiencing amenorrhea. When: Endometrial hyperplasia and carcinoma Why: Progestins can provide palliation in women with metastatic endometrial carcinoma, but they do not prolong life. Endometrial hyperplasia, a potentially precancerous condition, can be suppressed with progestins. Benefits derive from counteracting the proliferative effects of estrogen. When: Other uses - Supports early pregnancies, prevention of preterm birth (Makena) Why: Progestins can be used to support early pregnancy in women with corpus luteum deficiency syndrome and in women undergoing in vitro fertilization (IVF). One progestin (hydroxyprogesterone acetate (Makena) is approved for preventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. When not to: Women with no uterus Why: Do not prescribe progestins to women who have undergone a hysterectomy. - Local vs. systemic estrogen options and why one would be chosen over the other Tara Intravaginal: Estrogens for intravaginal administration are available as inserts, creams, and vaginal rings. The intravaginal inserts (Imvexxy, Vagifem, Yuvafem), creams (Estrace Vaginal, Premarin Vaginal), and one of the two available vaginal rings (Estring) are used only for local effects, primarily treatment of vulval and vaginal atrophy associated with menopause. The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot flashes and night sweats) as well as local effects (e.g., treatment of vulval and vaginal atrophy). Parenteral: Although estrogens are formulated for intravenous (IV) and intramuscular (IM) administration, use of these routes is rare. IV administration is generally limited to acute, emergency control of heavy uterine bleeding. - Transdermal estrogen therapy has fewer adverse effects Tara Compared with oral formulations, the transdermal formulations have four advantages: • The total dose of estrogen is greatly reduced (because the liver is bypassed). • There is less nausea and vomiting. • Blood levels of estrogen fluctuate less. • There is a lower risk for DVT, pulmonary embolism, and stroke. - Management of oral contraceptives (OCs) Jennifer Jacques o How to change patients from one combination of oral contraceptives to another. When one combination OC is being substituted for another, the change is best made at the beginning of a new cycle. Pg 440 o How to initiate treatment (when in the cycle is it best to start- may vary based on type of contraceptive) The 28-day regimens are subdivided into four groups: monophasic, biphasic, triphasic, and quadriphasic (four-phasic) (see Table 51.5). In a monophasic regimen, the daily doses of estrogen and progestin remain constant throughout the cycle of use. In the other regimens, the estrogen, progestin, or both change as the cycle progresses. The biphasic, triphasic, and quadriphasic schedules reflect efforts to more closely simulate ovarian production of estrogens and progestins. However, these preparations appear to offer little or no advantage over monophasic OCs.