Pharmacology: Chapter 56: Drugs for Womens Reproductive Health and Menopause

A woman is taking a combination oral contraceptive and asks the nurse why progestin is necessary. The nurse will explain that progestin helps prevent pregnancy by which method? a. Altering the quantity and viscosity of cervical mucus b. Inhibiting proliferative and secretory changes in the endometrium c. Increasing motility of muscles and cilia in the fallopian tubes d. Stimulating a surge in luteinizing hormone

a. Altering the quantity and viscosity of cervical mucus Progestin alters the quantity and viscosity of cervical mucus, making it thick and hostile to sperm penetration. Estrogen inhibits proliferative and secretory changes in the endometrium. Progestin decreases muscle and ciliary motility and decreases the LH surge.

A woman will begin taking a combination oral contraceptive (COC) that has a higher estrogenic activity than her previous COC. When teaching this woman about the new product, the nurse will explain that she may experience which effect(s)? a. Cyclic breast changes and chloasma b. Decreased dysmenorrhea and menorrhagia c. Decreased libido d. Weight gain and fatigue

a. Cyclic breast changes and chloasma Increased estrogenic activity may include side effects such as cyclic breast changes and chloasma as well as increased dysmenorrhea and menorrhagia. Increased progestin causes decreased libido, weight gain, and fatigue.

A 35-year-old woman asks the nurse about oral contraceptives. The nurse learns that the patient smokes and has a family history of venous thromboembolism (VTE). The nurse will suggest that the patient a. discuss a progestin-only oral contraceptive with her provider. b. may want to consider having a tubal ligation. c. use a transdermal contraceptive product. d. will not be a candidate for oral contraceptive products.

a. discuss a progestin-only oral contraceptive with her provider. Patients who smoke or who have an increased risk of VTE may be candidates for progestin-only products. A 35-year-old woman may still want children in the future, so recommending a tubal ligation is not indicated. Transdermal products contain estrogen and carry the same risks as COCs.

The nurse is caring for a woman who will begin taking ibuprofen to treat arthritis. The woman tells the nurse that she takes Yasmin for contraception. The nurse will perform which action? a. Counsel the patient to use a backup method of contraception while taking ibuprofen. b. Notify the provider to discuss an alternate combination oral contraceptive. c. Suggest a COX-2 inhibitor instead of ibuprofen for arthritis pain. d. Tell the patient to use a lower dose of ibuprofen to prevent adverse effects.

b. Notify the provider to discuss an alternate combination oral contraceptive. Yasmin contains drospirenone, which is derived from spironolactone. Drospirenone can alter water and electrolyte balances in women, and women taking this product should avoid NSAIDs to avoid compounding this effect. The provider may want to consider another COC product. It does not alter fertility.

A woman who has recently begun taking a combination oral contraceptive calls the clinic to report breakthrough bleeding. The nurse will a. advise her to use a backup method of contraception. b. counsel her to continue taking the contraceptive as prescribed. c. recommend discussing an alternative contraceptive with her provider. d. suggest that she perform a home pregnancy test to rule out pregnancy.

b. counsel her to continue taking the contraceptive as prescribed. Breakthrough bleeding is more common at the start of COC use, and there is no evidence that an episode of bleeding is associated with a decrease in the COCs effectiveness as long as the patient continues to take the pill as prescribed. She does not need to use backup contraception. Unless the bleeding continues and is problematic, there is no need to change products. A pregnancy test is not indicated.

A young woman who is taking Ortho-Tri-Cyclen for contraception tells the nurse that her provider has told her it will help to treat her acne. The nurse explains that this is because this product is a. high in progestin. b. low in androgenic activity. c. low in estrogen. d. triphasic.

b. low in androgenic activity. Products with low androgenic activity help to reduce acne.

A woman comes to the clinic for a Depo-Provera injection. The nurse reviews her medical record and notes that it has been 100 days since her last injection. What action will the nurse perform? a. Administer Depo-Provera 150 mg IM. b. Give Depo-Provera 300 mg IM. c. Perform a pregnancy test. d. Suggest she wait until she has had a period.

c. Perform a pregnancy test. Women should receive Depo-Provera injections every 13 weeks. Patients who are late for injections (13 weeks plus 1 day) will need to rule out pregnancy before receiving the next

A 45-year-old woman who has not had a period for 15 months reports severe hot flashes and poor sleep. The nurse reviews information about hormone replacement therapy and tells this woman that hormone therapy a. is very safe and may be used freely to treat menopausal symptoms. b. may be used indefinitely to treat menopausal symptoms. c. should be used at the lowest dose possible for less than 5 years. d. will be necessary to prevent osteoporosis caused by estrogen depletion.

c. should be used at the lowest dose possible for less than 5 years. Women should use hormone therapy at the lowest dose possible for a period of less than 5 years. It carries risks for breast cancer and cardiovascular disease and cannot be used indefinitely. Hormone therapy can help slow osteoporosis, but it does not prevent osteoporosis and is not recommended for this use.

A woman who is taking a combined oral contraceptive (COC) that contains 21 days of active pills and 7 days of inert pills reports having headaches accompanying withdrawal bleeding every month. The nurse will a. counsel her to take ibuprofen to counter these side effects. b. notify her provider to discuss these adverse effects. c. recommend a Loestrin Fe product. d. suggest she ask her provider about Mircette.

d. suggest she ask her provider about Mircette. Mircette provides 2 inert pills and 5 pills with 10 mcg of ethinyl estradiol during the counter phase, which helps to decrease withdrawal bleeding and headaches. Loestrin counters withdrawal bleeding but does not help with headaches.

A 45-year-old woman reports cessation of menses for the past 6 months and asks the nurse if she needs to continue using contraception. The nurse will tell her a. that she may discontinue using contraception. b. that she most likely has premature ovarian failure. c. to begin hormone therapy to prevent menopausal symptoms. d. to continue using contraception for at least 6 more months.

d. to continue using contraception for at least 6 more months. Women should use contraception until menstruation has ceased for 1 year if they do not wish to become pregnant. Premature ovarian failure occurs when menstruation stops before age 40 years. It is not necessary to treat menopausal symptoms until they occur.

A woman who is using a NuvaRing transvaginal contraceptive product calls to report that the ring has slipped out while sleeping. The nurse will instruct the patient to rinse the ring with lukewarm water, reinsert the ring, and a. abstain from sexual intercourse for 24 hours. b. replace it with a new ring as soon as possible. c. take an oral contraceptive product for 2 weeks. d. use a backup method of contraception for 7 days.

d. use a backup method of contraception for 7 days. If the NuvaRing slips out, it should be rinsed off and reinserted. If it has been out longer than 3 hours, the woman should be counseled to use a backup method of contraception.