1
Q
types of HRT for women
A
- estrogen-only
- progesterone-only
- combined
2
Q
If uterus is intact, you must balance ________ with ________.
A
- estrogen
- progesterone
3
Q
first rule of HRT
A
smallest dose for shortest amount of time
4
Q
estrogen replacement drugs
A
- conjugated equine estrogens
- estradiol
5
Q
Why do we balance estrogen with ______ when the uterus is intact?
A
- estrogen
- estrogen → uterine lining growth
- overgrowth → risk of CA
6
Q
expected action of estrogens
A
- block bone resorption
- reduce LDL
- improve menopause Sx
7
Q
estrogen routes
A
- PO
- TD
- intravaginal
- IM
- IV
8
Q
EPT
A
estrogen-progesterone therapy
9
Q
breast cancer increase with EPT
A
26%
10
Q
heart attack ↑ with EPT
A
29%
11
Q
stroke ↑ with EPT
A
41%
12
Q
VTE ↑ with EPT
A
double
13
Q
EPT effect on colorectal cancer
A
↓
14
Q
hip Fx risk with EPT
A
↓
15
Q
AE of estrogen therapy
A
- endometrial and ovarian cancers: prolonged postmenopausal estrogen therapy
- risk for estrogen-dependent breast cancer
- risk for embolic events (MI, CVA, DVT, PE)
16
Q
interventions for estrogen therapy
A
- lowest effective dose for shortest time
- monitor for breast CA, DVT
- NO SMOKING
- monitor lipids, HTN
17
Q
contraindications for estrogen
A
- strong Fm or personal Hx of CVD
- undiagnosed abnormal vaginal bleeding
- breast or other estrogen-based CA
- Hx of DVT
18
Q
estrogen interactions
A
- ↓ effectiveness of warfarin
- ↓ effect of estrogen: phenytoin
- ↑ effect of estrogen: corticosteroids
- smoking: ↑ risk of thrombophlebitis
19
Q
estrogen + warfarin =
A
- ↓ effect of warfarin
- monitor INR and PT
- warfarin dose adjustment
20
Q
estrogens + phenytoin =
A
monitor for ↓ estrogen effects
21
Q
estrogens + corticosteroids =
A
- ↑ effects of estrogen
- monitor for ↑ effects
22
Q
estrogens + smoking =
A
- ↑ risk of thrombophelbitis
- pt education
- use alternative Tx if smoking persists
23
Q
pt education for estrogens
A
- take at same time daily
- report abnormal bleeding
- regular breast exams, GYN visits
- DVT S/Sx
- redness, warmth, tenderness, swelling in lower leg
- D/C before surgery/prolonged immobilization
24
Q
progesterone drugs
A
- medroxyprogesterone
- norethindrone
- megestrol acetate
25
use
* required combo with estrogen in women with uterus
* can be given alone for BC or HRT
* control dysfunctional bleeding
* Tx of
* abnormal amenorrhea
* endometriosis
* advanced CAs
* endometrial
* breast
* kidney
* create cycle to treat infertility
26
routes for progesterone
* PO
* IM
* SQ
* TD
* intravaginal
27
HRT with the female hormone __________ has less risks than \_\_\_\_\_\_\_\_\_.
* progesterone
* estrogen
28
AE of progesterone
* Br CA risk
* thromboembolic events (MI, PE, thrombophlebitis, CVA)
* breakthrough bleeding, amenorrhea, breast tenderness
* edema
* jaundice
* migraines
29
interventions for breakthrough bleeding, amenorrhea, and breast tenderness on progesterone therapy
* baseline breast exam and Pap smear
* report abnormal vaginal bleeding
30
progesterone admin/pt teaching
* monitor LFTs
* baseline breast exam and Pap smear
* monitor for DVT, CP, SOB
* monitor BP, I&O, wt
* notify provider of severe HA
31
progesterone interactions
* ↓ contraceptive effectiveness: carbamazepine, phenobarbital, phenytoin, and rifampin
* ↑ risk of thrombophlebitis: smoking
32
progesterone + phenytoin =
* ↓ contraception
* use backup method
33
progesterone + rifampin =
* ↓ contraception
* use backup method
34
progesterone + carbamazepine =
* ↓ contraception
* use backup method
35
progesterone + phenobarbital =
* ↓ contraception
* use backup method
36
pt ed for progesterone
withdrawal bleeding for 3-7 days after D/C
37
BC vs HRT
* hormonal BC will have same effects as HRT
* BC typically in higher doses than HRT
* therapeutic intent and outcome are different
38
routes of BC
* PO
* TD patch
* vaginal ring
* IM
39
combined oral contraceptives (COC)
* ethinyl estradiol/norethindrone
* ethinyl estradiol/drospirenone
* come in various dosages, some with varying dose per day (multiphasic)
40
monophasic COC
hormone amounts the same throughout the month/pack
41
multiphasic COC
* hormone amounts vary throughout pack/month to duplicate a cycle
* come in biphasic, triphasic, quadraphasic
42
mini pill
* progesterone-only BC pill
* norethindrone
43
The ____ \_\_\_\_ is not as reliable as COC.
mini pill
44
first rule of taking BC pills
take at the same time every day, especially mini pill
45
TD BC patch
* drug: ethinyl estradiol/norelgestromin
* schedule: weekly, with 4th wk skipped for period
* not good for obese pts
* skin irritant
46
vaginal contraceptive ring
* estrogen-based
* schedule: monthly; in for 3 wks, out for a week
* have to be comfortable with inserting it
47
depot medroxyprogesterone acetate
* DMPA
* route: IM
* schedule: q 3 months
* not good for long-term use
* ideal for adolescents
48
Nuvaring
estrogen-based BC vaginal ring
49
Depo-Provera
IM progesterone-only BC
50
expected action of hormonal BC
* prevent ovulation
* thicken cervical mucus
* alter endometrial lining
51
AE of hormonal BC
* thromboembolic events (unlikely with progestin-only)
* HTN
* breakthrough or abnormal uterine bleeding
* Br CA
52
breast CA risk with hormonal BC
* may ↑ growth of pre-existing breast CA
* contraindicated for those with breast CA
* breast exam before giving
53
interventions/pt teaching for breakthrough or abnormal bleeding
* pt: record duration and frequency of bleeding
* evaluate for PG if 2 or more periods missed
54
nursing actions for hormonal BC
* r/o PG before starting BC
* take pills at same time each day
* missed pills
* 1 missed: take 2 at next dose
* 2 missed: take 2 for next 2 doses
* 3 missed
* use backup
* stop pack
* restart in 7 days
* **progesterone-only, 1 missed: use backup**
55
IUD
intrauterine device
56
copper IUD
non-hormonal
57
hormonal IUDs
* Skyla
* Mirena
* small amt of progestin that acts only on uterine tissue
58
androgens
* testosterone
* methyltestosterone
59
testosterone routes
* IM
* TD
* pellets (subdermal)
* buccal tabs
60
testosterone action
* development of male sex traits
* sperm production
* ↑ muscle
* ↑ synthesis of erythropoietin
61
uses for testosterone therapy
* hypogonadism in males
* delayed male puberty
* replacement for testicular failure
* anemia (if not responsive to tradiational Tx)
* postmenopausal breast CA
* muscle wasting in male pts with AIDs
* help with lethargy, libido, hair loss in females
62
testosterone's androgenic effects on women
* hirsutism
* lowering of voice
* acne
* other undesired effects
63
testosterone's androgenic effects on men
* acne
* priapism
* ↑ hair growth
64
AE of testosterone
* androgenic (virilization) effects
* premature epiphyseal closure
* cholestatic hepatitis
* hypercholesterolemia
* ↑ growth of prostate CA
* polycythemia
* edema from salt and water retention
* high abuse potential
65
premature epiphyseal closure
* epiphyseal plate: growth plate responsible for lengthening long bones
* premature closure → ↓ mature height
* monitor epiphysis with serial X-rays
* do not give testosterone before puberty
66
pt ed for androgenic effects
notify provider
67
cholestatic hepatitis
* S/Sx
* nausea
* fatigue
* pruritis
* dark urine
* jaundice
* baseline/periodic LFTs
68
testosterone contraindications
* pre-pubescence
* pregnancy
* men with prostate or breast CA
* hypercalcemia
69
labs for testosterone therapy
* LFTs
* lipid panel
* CBC (Hgb, Hct)
70
precautions for testosterone
* HF
* HTN
* cardiac, renal, or liver dz
71
testosterone admin
* wear gloves
* wash hands after
* use large muscle for IM injection
* monitor women for masculinization
72
alpha1-adrenergic antagonists
* (-osin)
* tamsulosin
* alfuzosin
* terazosin
* doxazosin
73
alpha1-adrenergic antagonist action
↓ mechanical obstruction of urethra by relaxing smooth muscles of bladder and prostate
74
alpha1-adrenergic antagonist use
* urinary retention from
* BPH
* anesthesia
* kidney stones
75
alpha1-adrenergic antagonist route
PO
76
BPH
benign prostatic hyperplasia
77
AE of alpha1-adrenergic antagonists
* hypotension
* nasal congestion
* dizziness
* sleepiness
* faintness
* ejaculation failure, ↓ volume
78
nursing actions for alpha1-adrenergic antagonists
* monitor BP
* pt teaching
* rise slowly
* don't drive or operate machinery at first or when changing dose
79
PDE5 inhibitor
phosphodiesterase type 5 inhibitor
80
PDE5 inhibitors
* -afil
* sildenafil (Viagra)
* tadalafil (Cialis)
* vardenafil (Levitra)
81
PDE5 inhibitor action
* augments effect of nitric oxide release during sexual stim
* enhances blood flow to corpus cavernosum to support erection
82
PDE5 inhibitor use
Tx of erectile dysfunction
83
AE of PDE5 inhibitors
* MI, sudden death: monitor risk factors, Hx of CV health
* priapism
84
priapism
* prolonged erection of the penis
* notify provider if erection lasts \> 4 hrs
85
contraindications for PDE5 inhibitors
nitrate use
86
precautions for PDE5 inhibitors
* CVD
* prolonged QT wave
87
interactions with PDE5 inhibitors
* ↑ PDE5 plasma concentration
* grapefruit
* ketoconazole
* erythromycin
* cimetidine
* ritonavir
* fatal hypotension
* nitrates
* alpha blockers
88
PDE5 inhibitor route
PO
2021 Pharm 2
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