NR 568 / NR568 Final Exam Advanced
Pharmacology for the Adult-Gerontology Primary
Care Nurse Practitioner | Questions with Answers
|– Chamberlain
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
Pharmacology for the Adult-Gerontology Primary
Care Nurse Practitioner | Questions with Answers
|– Chamberlain
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
