NR566 FINAL EXAM
STUDY GUIDE:
WEEK 5
Week 5
- 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.
Most 28-day cycle products are taken in a repeating sequence consisting of 21 days of an active
pill followed by 7 days on which either (1) no pill is taken, (2) an inert pill is taken, or (3) an
iron- containing pill is taken. 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
STUDY GUIDE:
WEEK 5
Week 5
- 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.
Most 28-day cycle products are taken in a repeating sequence consisting of 21 days of an active
pill followed by 7 days on which either (1) no pill is taken, (2) an inert pill is taken, or (3) an
iron- containing pill is taken. 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
