NURS 566: Final Exam Study Guide
well rated A+
• Prevention of osteoporosis with hormone replacement therapy
• Selective Estrogen Receptor Modulators (SERMs)
• Tamoxifen (Nolvadex-D), Toremifene (Fareston),
Raloxifene (Evista), and Bazedoxifene (Duavee -
postmenopausal women drug)
• These drugs provide benefits of estrogen
(protection against osteoporosis, maintenance
of the urogenital tract, reduction of LDL
cholesterol) while avoiding its drawbacks
(promotion of breast cancer, uterine cancer,
and thromboembolism)
• Prevention of osteoporosis requires lifelong hormone
replacement
• When stopped, bone loss decreases by 12%.
• LIfelong treatment increases health risks.
• All women (and men) should practice primary prevention of
bone loss by ensuring adequate intake of calcium and
vitamin D, performing regular weight-bearing exercise, and
avoiding smoking and excessive alcohol use.
• When and when not to use progestin for hormone replacement
therapy and why -
• When To Use:
• Menopausal Hormone Therapy
• Counteracts adverse effects of estrogen on
endometrium in women undergoing menopausal
hormone therapy.
• Dysfunctional Uterine Bleeding
• Cessation of bleeding can be achieved with 10-14 day
, treatment.
• Withdrawal bleeding can take place when treatment stops.
• Amenorrhea
• Progestin helps induce menstrual flow in select
women experiencing amenorrhea.
• If endogenous estrogen levels are normal, give
progestin for 5-10 days.
• If estrogen levels are low, need to induce
endometrial proliferation with estrogen before
giving progestin.
• Endometrial Hyperplasia and Carcinoma
• Can provide palliation in women with
metastatic endometrial carcinoma - do not
prolong life.
• Only approved long-term progestin therapy is for
protection against endometrial cancer.
• Progestin can suppress endometrial
hyperplasia - a potentially precancerous
condition
• Help Support early pregnancy with the corpus luteum
deficiency syndrome and in women undergoing IVF.
• Hydroxyprogesterone Acetate (Makena) - helps prevent preterm birth.
• When Not To Use (Contraindications):
• Absolute Contraindications
• Undiagnosed abnormal vaginal bleeding.
• Relative Contraindications
• Active Thrombophlebitis
• Hx of thromboembolic disorders
• Active Liver Disease
• Carcinoma of the breast
• Do Not Use:
• Prepubertal Children
• High-dose therapy in first 4 months of pregnancy (birth defects)
Local vs. systemic estrogen options and why one would be chosen
,over the other -
• Systemic Options
• Oral
• Most active estrogenic compound - ESTRADIOL
• Estradiol is available alone or in
combination with progestins
• Popular because of its convenience.
• Transdermal
• Four Formulations
• Emulsion (Estrasorb), Spray
(Evamist), Gels (EstroGel,
Elestrin, and Divigel)
• Four Advantages Over Oral Formulations:
• 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.
• Intravaginal
• Femring
• Control hot flashes and night sweats as
well as local effects (treatment of vulval
and vagnial atrophy).
• Parental
• IV and IM administrations - use of these routes are rare.
• Used in acute, emergency control of
heavy uterine bleeding.
• Local Options
• Intravaginal
• Primarily treatment for vulvar and vaginal
atrophy associated with menopause.
• Available as inserts, creams, and vaginal rings
• Intravaginal Inserts - Imvexxy, Vagifem, and
, Yuvafem
• Creams - Estrace Vaginal, Premarin Vaginal
• Rings - Estring (other vaginal
ring, Femring, is systemic effects)
Transdermal estrogen therapy has fewer adverse effects.
• Management of oral contraceptives (OCs)
• How to change patients from one combination oral
contraceptive to another.
• Go straight from one type to the other, without taking a gap in
between. Start the new pill the day after taking the last active pill in
the last pill packet. This also applies with 'placebo' pills.
o “No gap method”
• How to initiate treatment (when in the cycle is it best to
start- may vary based on type of contraceptive)
• OCs: The sequence begins on either the first day of the
menstrual cycle or the first Sunday after the onset of menses.
With the first option, protection is conferred immediately;
hence no backup contraception is needed. With a Sunday
start, which is done to have menses occur on weekdays rather
than the weekend, protection may not be immediate; hence
an alternate form of birth control should be used during the
first 7 days of the pill pack.
• What teaching needs to be done
• Educate pts on proper protocol for missed dose
• Women should be informed about the symptoms of
thrombosis and thromboembolism (e.g., leg tenderness or
pain, sudden chest pain, shortness of breath, severe
headache, sudden visual disturbance) and instructed to
consult the prescriber if these occur.
• What baseline data is needed?
• Assess for hx of HTN, diabetes, thromboembolism, cerebrovascular
or cardiovascular disease, breast CA. Urine pregnancy test.
• Contraindications for OCs
• Pregnancy, history of thromboembolism, breast cancer, and
well rated A+
• Prevention of osteoporosis with hormone replacement therapy
• Selective Estrogen Receptor Modulators (SERMs)
• Tamoxifen (Nolvadex-D), Toremifene (Fareston),
Raloxifene (Evista), and Bazedoxifene (Duavee -
postmenopausal women drug)
• These drugs provide benefits of estrogen
(protection against osteoporosis, maintenance
of the urogenital tract, reduction of LDL
cholesterol) while avoiding its drawbacks
(promotion of breast cancer, uterine cancer,
and thromboembolism)
• Prevention of osteoporosis requires lifelong hormone
replacement
• When stopped, bone loss decreases by 12%.
• LIfelong treatment increases health risks.
• All women (and men) should practice primary prevention of
bone loss by ensuring adequate intake of calcium and
vitamin D, performing regular weight-bearing exercise, and
avoiding smoking and excessive alcohol use.
• When and when not to use progestin for hormone replacement
therapy and why -
• When To Use:
• Menopausal Hormone Therapy
• Counteracts adverse effects of estrogen on
endometrium in women undergoing menopausal
hormone therapy.
• Dysfunctional Uterine Bleeding
• Cessation of bleeding can be achieved with 10-14 day
, treatment.
• Withdrawal bleeding can take place when treatment stops.
• Amenorrhea
• Progestin helps induce menstrual flow in select
women experiencing amenorrhea.
• If endogenous estrogen levels are normal, give
progestin for 5-10 days.
• If estrogen levels are low, need to induce
endometrial proliferation with estrogen before
giving progestin.
• Endometrial Hyperplasia and Carcinoma
• Can provide palliation in women with
metastatic endometrial carcinoma - do not
prolong life.
• Only approved long-term progestin therapy is for
protection against endometrial cancer.
• Progestin can suppress endometrial
hyperplasia - a potentially precancerous
condition
• Help Support early pregnancy with the corpus luteum
deficiency syndrome and in women undergoing IVF.
• Hydroxyprogesterone Acetate (Makena) - helps prevent preterm birth.
• When Not To Use (Contraindications):
• Absolute Contraindications
• Undiagnosed abnormal vaginal bleeding.
• Relative Contraindications
• Active Thrombophlebitis
• Hx of thromboembolic disorders
• Active Liver Disease
• Carcinoma of the breast
• Do Not Use:
• Prepubertal Children
• High-dose therapy in first 4 months of pregnancy (birth defects)
Local vs. systemic estrogen options and why one would be chosen
,over the other -
• Systemic Options
• Oral
• Most active estrogenic compound - ESTRADIOL
• Estradiol is available alone or in
combination with progestins
• Popular because of its convenience.
• Transdermal
• Four Formulations
• Emulsion (Estrasorb), Spray
(Evamist), Gels (EstroGel,
Elestrin, and Divigel)
• Four Advantages Over Oral Formulations:
• 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.
• Intravaginal
• Femring
• Control hot flashes and night sweats as
well as local effects (treatment of vulval
and vagnial atrophy).
• Parental
• IV and IM administrations - use of these routes are rare.
• Used in acute, emergency control of
heavy uterine bleeding.
• Local Options
• Intravaginal
• Primarily treatment for vulvar and vaginal
atrophy associated with menopause.
• Available as inserts, creams, and vaginal rings
• Intravaginal Inserts - Imvexxy, Vagifem, and
, Yuvafem
• Creams - Estrace Vaginal, Premarin Vaginal
• Rings - Estring (other vaginal
ring, Femring, is systemic effects)
Transdermal estrogen therapy has fewer adverse effects.
• Management of oral contraceptives (OCs)
• How to change patients from one combination oral
contraceptive to another.
• Go straight from one type to the other, without taking a gap in
between. Start the new pill the day after taking the last active pill in
the last pill packet. This also applies with 'placebo' pills.
o “No gap method”
• How to initiate treatment (when in the cycle is it best to
start- may vary based on type of contraceptive)
• OCs: The sequence begins on either the first day of the
menstrual cycle or the first Sunday after the onset of menses.
With the first option, protection is conferred immediately;
hence no backup contraception is needed. With a Sunday
start, which is done to have menses occur on weekdays rather
than the weekend, protection may not be immediate; hence
an alternate form of birth control should be used during the
first 7 days of the pill pack.
• What teaching needs to be done
• Educate pts on proper protocol for missed dose
• Women should be informed about the symptoms of
thrombosis and thromboembolism (e.g., leg tenderness or
pain, sudden chest pain, shortness of breath, severe
headache, sudden visual disturbance) and instructed to
consult the prescriber if these occur.
• What baseline data is needed?
• Assess for hx of HTN, diabetes, thromboembolism, cerebrovascular
or cardiovascular disease, breast CA. Urine pregnancy test.
• Contraindications for OCs
• Pregnancy, history of thromboembolism, breast cancer, and
