Nurs204 Healing Modalities Women's Health

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Estrogen

Back 1

for estrogen deficiencies, S&S of menopause, abnormal uterine bleeding, palliative tx for breast ca
ex: Estradiol, conjugated estrogen (premarin)

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Women's health: 4 main drugs

Back 2

estrogen, progestrin, contraceptives, drugs for osteoporosis

Front 3

2 female sex steroid hormones

Back 3

estrogen and progesins

Front 4

Pituitary gonadotropin hormones: in reproduction

Back 4

follicle stimulating hormone (FSH)
luteinizing hormone (LH)

Front 5

Estrogen: Indications

Back 5

for estrogen deficiency
-atrophic vaginitis, hypogonadism, oral contraception (given with progestin), uterine bleeding

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Estrogen:SE

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thrombolytic events, nausea, HTN, vomiting, tender breast, headaches

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Estrogen: Interactions

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decrease activity of oral anticoagulants, antidiabetics, antihypertensives
-smoking deminishes effects increase risk for thrombosis
-additive effects with rifampin, barbiturates

Front 8

Progesterone: Indications

Back 8

tx of functional uterine bleeding caused by: hormonal imbalance, fibroids, uterine cancertx of amenorrhea
prevention of threatened miscarriage
alleviate PMS

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Progesterone: SE

Back 9

liver dysfunction-cholestatic jaundice, thrombosis DVT/PE, edema, weight gain

Front 10

Contraceptives agents

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oral meds: biphasic and triphasic forms; most contain estrogen-progestin combo
long acting injectables form of medroxyprogesterone
transdermal patch
IUD and intravaginal ring

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Contraceptives: mechanism

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prevent ovulation by inhibiting release of gonadotropins and increase uterine viscosity:
-decrease sperm movement and fertilization of ovum
-possible inhibition of implantation of fertilized egg (zygote)

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Contraception: Indications

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improve menstrual regularity
decrease blood loss during menstruation
Improve acne
decrease incidence of functional ovarian cyst
tx of endometriosis and hypermenorrhea
cyclic withdrawal bleeding
emergency contraception

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Contraception: SE

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edema, dizziness, headache, depression, nausea, vomiting, breast changes, HTN, stroke, MI
** SMOKING INCREASES RISKS

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oral contraceptives: interactions

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decrease effectiveness: antibiotics, barbiturates, isoniazide, rifampin

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Estrogen and Progestins: Implications

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take the smallest dose needed
increase risks of sunburn, report weight gain
PAP smear, breast exam

Front 16

Osteoporosis

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affects 1 in 4 postmenopausal women
low bone mass

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osteopenia

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bone mineral density (BMD) T-scores < 1.0- 2.5

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what does T score 2.0 - 2.4 mean?

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means 20-25% below normal relative to young premenopausal women---->increasing risk of spine 7x greater, risk of hip 5x greater

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what does T score lower than 2.5 mean?

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OSTEOPOROSIS!!

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main site for fracture

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wrist, vertebrae, hip

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fact about hip fracture

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increases morbidity- 50% do not return to same functional state
25% will require nursing home care, decreasing overall quality of life
increases mortality- 20% with hip fracture will die within 1 yr.
10% have another osteoporotic fracture within 1 yr

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osteoporosis: risk factors

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asian slender body, smoking, low calcium intake, family hx, bone metastasis, sedentary lifestyle, early estrogen deficiency, drug induced

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Drug induced osteoporosis:

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heparin
medoxyprogesterone
antileptics
glucocorticoids

Front 24

Calcium

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99% ca in bones and teeth
most abundant mineral in the body
low levels signal PARATHYROID GLANDS to secrete PTH, increasing osteoclast activity (resorption of bone)
MUST have adequate Vit. D

Front 25

Calcium function

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transmit nerve impulses
contraction of cardiac, smooth, and skeletal muscles
renal fx, respiration, blood coagulation

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Ca deficiency

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hypocalcemia

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Hypocalcemia results in

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infantile rickets
adult osteomalacia
osteoporosis
hypoparathyroidism

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Ca intake

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19-50 yrs 1000mg/day
>50 yrs 1500mg/day

DO NOT ABSORD > 500mg AT ONE TIME

Front 29

Vit D intake

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19-50 yrs 400iu
>50 yrs 800iu

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Vit D

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fat soluble, "sunshine vit", converts to provitamin D, stored in liver, activated in kidneys
it is needed in Ca and phosphorus metabolization

Front 31

Vit D3 (cholecalciferol)

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produced in skin by UVrays
fish oils, salmon, sardines, herring, fortified milk, animal livers, tuna fish, egg yolks

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Vit D2

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plant vit in mushrooms

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Vit D functions

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neuromuscular fx, role in muscle mass and stregnth, balance
-hormone regulating cell growth, prevent Cancer progression

Front 34

Drugs for osteoporosis

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Biphosphonates
SERMs (selective estrogen receptor modifiers- raloxifene, tamoxifen)
hormone calcitonin
hormone therapy: for prevention

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Biphosphonates ex:

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fosamax, etidronate

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Fosamax: mechanism

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inhibits osteoclast activity, reverse bone loss
for prevention and tx of osteoporosis
tx for Paget's Disease

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Fosamax: considerations

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must remain upright for 30 min after dose to prevent esophagitis
take with full glass of H2O, no food after for 1-2 hrs
no ca, fe, vit d , caffeine or antacids for 2 hrs
best taken in mornings

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SERMs (selective Estrogen receptor modulators)
ex

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raloxifene (evista)
for prevention of post menopausal osteoporosis
stimulates estrogen receptors on bone
increase bone density
SE: hot flashes, leg cramps, teratogenics, increase thromboembolic disorders
Interactions: decreases INR and effects on warfarin

Front 39

Calcitonin

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naturally occuring peptide hormone, inhibits osteoclast activity
prevents vertebral fractures, reduce pain
**nasal spray must alternate nostrils, kept in fridge

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Hormone therapy: findings

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decrease risk of hip and vertebral fractures and colon ca
Increases risk of breast ca, CAD, CVA, DVT/PE
***RISK of HT seems to outweigh benefits
increases general cognitive decline almost 2x as much as in placebo group

Front 41

Hormone therapy recommendations

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not for prevention of osteoporosis
for vasomotor S&s, vulvoginal atrophy caused by menopause, surgical or premature menopause
low dose for shorter duration

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Common SE in combination hormone therapy

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estrogen/prempo
38% breast pain
36% headache
21% abd pain
14% back pain
13% joint pain
11% nausea

Front 43

Mens health Agents: only one kind

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androgens

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Androgens

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testosterone derivatives, large first pass effect
primarily for replacement therapy
for BPH, male baldness, erectile dysfunction

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Alpha1-adrenergic blockers

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for relief in BOH obstruction
ex: terazosin (non-uroselective)
flomax (uroselective)
for relaxation of prostate and improve flow
SE: postural hypotension, dizziness, erectile dysfuntion

Front 46

5 alpha reductase inhibitor

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blocks conversion of testosterone to dihydrotestosterone-alleviate BPH, easier passage of urine, higher doses of prostate cancer, also for male pattern baldness

Front 47

Adrogen inhibitor: 5 alpha reductase inhibitor Implication

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prenant women should not handle finastride tablets!!!
can cause erectile dysfunction

Front 48

Saw Palmetto

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herbal, extract from american dwarf palm tree
mild mod improvement in flow rates, decrease in voiding symptoms, DOES NOT decrease prostate size
well tolerated, no quality, large scale trials

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drugs for erectile dysfunction

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viagra( sildenafil)
first PO drug for ED
** warn men with preexisting cardiovascular disease- esp. those taking nitrates---lowers BP and serious adverse effects

Front 50

Antineoplastic agents: chemotherapy

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to kill every neoplastic cell and produce a cure
can only kill portion of the cells in a tumor (dividing part of tumor)

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2 groups of chemotherapy drugs

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CCNS cell cycle nonspecific
CCS cell cycle specific

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Tor F chemo drugs have narrow therapeutic index

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True

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Combo chemo drugs are usually more effective T or F

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True

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chemo drugs are not cancer cell specific also destroys

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hair follicles
bone marrow
GI tract
Oral mucosa
sperm-forming cells

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Chemo SE

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severe and cytotoxic
alopecia
N&V, diarrhea
bone marrow suppression, increased infection
sterility