Chapter 56 Drugs for Women’s Reproductive Health and Menopause 3 – Flashcards
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amenorrhea
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absence or suppression of normal menstrual flow
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breakthrough bleeding (BTB)
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bleeding at abnormal times during the menstrual cycle
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dysmenorrhea
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painful menstruation
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dyspareunia
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painful sexual intercourse
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ethinyl estradiol (EE)
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Synthetic estrogen: used in many hormonal contraceptives; mestranol is similar
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hormone therapy (HT)
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use of supplemental hormones (estrogen, progesterone, and/or testosterone) during and after menopause or following surgical removal of the ovaries
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menarche
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the first occurrence of menstruation in a woman
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menopause
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the time of natural cessation of menstruation; also refers to the biological changes a woman experiences as her ability to reproduce declines
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mestranol
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a synthetic form of estrogen used in combination with a progestin in oral contraceptives
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mittelschmerz
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Pain in the area of the ovary that is felt at the time of ovulation (usually midway through the menstrual cycle)
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osteopenia
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thinner than average bone density in a young person
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osteoporosis
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abnormal loss of bony tissue resulting in fragile porous bones attributable to a lack of calcium
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pelvic inflammatory disease (PID)
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inflammation of organs in the pelvic cavity; usually includes the fallopian tubes, ovaries, and endometrium; most often caused by bacteria
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progestin
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female hormone that stimulates the uterine lining during pregnancy and is also used in treatment of abnormal uterine bleeding and for hormone replacement therapy
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withdrawal bleeding
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results from drop in hormones which causes weakening of the uterine lining
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Types of estrogen-progestin combination drugs
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Monophasic Biphasic Triphasic Seasonale
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Monophasic
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Most common. Provides fixed ratio of estr/prog throughout the cycle
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Biphasic
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Estrogen fixed throughout Progesterone varies
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Triphasic
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Both hormones decreased
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Seasonale (quasene) is generic Seasonique another extended cycle
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Extended cycle - 91 day regimen - 84 day active pill /7 day inert -endometriosis -dysmenorrhea -PMS -ovarian cyst
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Excess estrogen causes side effects
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GI, dizziness, fluid retention, bloating. breast enlargement, leg cramps, decreased tearing, visual changes, headache, hypertension - plus blood clotting -DVTs (especially with hypertension
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Low estrogen causes side effects
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vaginal bleeding, oligomenorrhea, nervousness, dyspareunia - Also possible osteoporosis
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Excess progestin causes side effects
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Incr. appetite, weight gain, oily skin/scalp, acne, depression, vaginitis from yeast, excess hair growth (hirsutism), amenorrhea after cessation, incr. breast size
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Low progestin causes side effects
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dysmenorrhea, bleeding late in cycle, heavy flow with clots
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Alternate contraception
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- IUDs -Norplants -Depo-Provera
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Emergency birth control
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Yuzpe regimen - Estrogen - use within 5 days - expect pregnancy 65-70% of cases - 50% report nausea -20% vomiting Plan B - use within 72 hours (3 days post-intercourse - can be up to 5 days - under age 17 needs a script - causes less nausea - need to use a non-denominational facility Copper IUD Medical Abortion -
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Premenstrual syndrome (PMS) precautions
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- NO salty foods - NO alcohol - NO caffiene - NO chocolate
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Drugs for Hormone Dysfunction
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Non pharmacological - Stress reduction recommended Pharmacologic - many varieties Nursing process - Assessment - Planning - Nursing Interventions - Evaluation
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Endometriosis
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DEFINED: Abnormal location of endometriotic tissue outside of the uterus - Drugs for treatment - Danazol - Leupride acetate - Nafarelin acetate - Nursing process - Assessment - Planning - Nursing interventions - Evaluation
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Menopause - "Change of Life"
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- natural cessation of menstruation Hormone Replacment Therapy (HRT) - pills, rings, creams CONTRAINDICATIONS to HRT: -- NO breast cancer for > 5 years -- not in acute liver disease -- no for poorly controlled hypertension -- NO endometriosis for >5 years Estrogen Replacement Therapy (ERT) Dosage - Oral, Transdermal patch Nursing process - assessment - Planning - Nursing interventions - Evaluation
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Hormone Replacement Therapy (HRT)
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- Guidelines from Women's Health Intitiative (WHI) - Page 881 - HRT - ONLY for menopausal symptoms - Lowest dose - Shortest duration - < than 5 years TYPES - Estraderm Transdermal System - Climara Pro - Vaginal Cream - Estring, Femring - Estragel, Estrasorb
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Osteoporosis
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abnormal loss of bony tissue resulting in fragile porous bones attributable to a lack of calcium - Nursing Intervention - SAFETY - prevent fractures Medications - Menostar - Fosamax - Boniva - Actonel - Evista - Forteo
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HERBAL ALERT 56-1
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St. John's wort - May reduce effect of contraceptive steroids - breakthrough bleeding Chasteberry extract - cuation with CHC or hormone therapy
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Missed Dose of oral contraceptives Box 56-2
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One Tablet - take as soon as realized - take next as scheduled Two tabs - Take two tabs for two days - take next as scheduled Three tabs - DC the present pack and allow withdrawal bleeding - Start a new pack 7 days after the last tab - Use alternate method until tabs are taken for 7 days Progestin only Products One or two tabs - Take as soon as realized - Next tab as scheduled - PLUS use backup contraceptives for 48 hours
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Q: When preparing a teaching plan for oral contraceptive use, a nurse should include:
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A: 1. Report dangerous side effects via ACHES system - - Abdominal pain - Chest pain or SOB - Headaches (severe) - Eye disorders - blurred or lost vision - Severe leg pain in calf or thigh 2. COC will not protect from STIs 3. Pills should be taken at the same time every day
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Q: What is an indication for hormone therapy
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A: Relief of hot flashes
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Q: What are the routes of adminsitration for HT products?
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A: - Oral tablets - Vaginal rings - Transdermal products
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Q: What are contraindications to estrogen therapy?
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A: - Estrogen - dependent cancer - Thromboembolitic disorder
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Q: Oral contraceptives prevent conception by doing what?
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A: - Thickening the cervical mucus, slowing sperm passage - Altering endometrium to prevent implantation - Inhibiting ovulation
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Q: Nurse teaching for a female client taking testosterone. Client should report what?
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A: - Deepening voice - Male pattern baldness - Facial hair
