Ch. 34, Women's Health Drugs

Question 6 of 12 Which patients does a nurse determine cannot safely receive treatment with the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®)?

A 36 year old with hepatitis A A patient with viral hepatitis cannot safely receive a CHC. A 37 year old with complicated mitral valve prolapseMitral valve prolapse is a valvular heart condition. Because this patient has complicated mitral valve prolapse, she cannot safely receive therapy. A 36 year old who smokes one pack of cigarettes per dayPatients who smoke and are over the age of 35 are at increased cardiovascular risk when receiving CHCs. Therefore this patient cannot safely receive ethinyl estradiol plus etonogestrel.

Question 11 of 12 Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus norelgestromin patch (Ortho Evra®) who is switching from an oral combined hormonal contraception (CHC)?

Before applying, the patient should ensure the skin is dry and free from lotions, creams, or oils.The patch should be applied to clean, dry, nonirritated skin and should not be applied to areas where there lotions, creams, or oils have been applied. Apply the patch on the first day of the menstrual cycle when bleeding occurs. No backup contraception is needed.As this patient is switching from an oral CHC, it should be applied on the first day of the menstrual cycle and no backup contraception is required. If the application occurs on any day other than day 1 of bleeding, backup contraception is needed for 7 days. If the patch comes off and has not been off for more than 24 hours, it should be reattached. Backup contraception is not needed.If the patch comes off and less than 24 hours has lapsed, the patient simply reattaches the patch. Backup contraception is not needed. If the patch comes off and remains off for more than 24 hours, a new cycle should be started with backup contraception needed for 7 days.If the patch has been off for more than 24 hours, a new cycle should be started with backup contraception needed for 7 days.

Question 1 of 3 Which statement accurately describes the pharmacokinetic parameters of the ethinyl estradiol plus norelgestromin patch (Ortho Evra®)?

Both hormones are excreted in the urine and feces. This statement is accurate because both hormones are excreted in the urine and the feces.

Question 3 of 4 A patient who takes carbamazepine for epilepsy has purchased levonorgestrel to use as emergency contraception. Which outcome does a nurse anticipate may occur in a patient taking levonorgestrel with carbamazepine?

Decreased efficacy of levonorgestrel Carbamazepine is a CYP450 inducer and may reduce the efficacy of levonorgestrel, rendering it ineffective in the setting of emergency contraception.

Question 8 of 12 Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®) who has never received hormonal contraception before?

If it is expelled during treatment weeks, it may be washed off with warm water and reinserted.The vaginal ring may inadvertently be expelled. If this occurs during weeks 1 through 3 (i.e., active treatment), the patient can wash off the ring and reinsert it. If it cannot be reused, a new one should be inserted. She should vaginally insert the ring between day 1 and day 5 of the menstrual cycle, even if she is bleeding.The ring should be inserted between days 1 and 5 of the menstrual cycle, regardless if the patient is actively bleeding. The ring should be replaced every 3 weeks, removing for 1 week at the end of this time frame before inserting a new one.The vaginal ring is designed to be inserted for 3 weeks, followed by a treatment free week. The old ring should be removed before inserting the new one. If the ring is expelled for more than 3 hours during week 1 or 2 of use, she should reinsert the ring and use backup contraception for 7 days.If the vaginal ring is expelled, and more than 3 hours has lapsed during weeks 1 and 2 of the treatment, the patient should reinsert the ring and use backup contraception for the next 7 days.

Question 10 of 12 Which statement by the nursing student about the administration of norethindrone tablets (Micronor®) requires correction and further education?

If the postpartum patient is fully breastfeeding, she may begin using norethindrone tablets within 3 weeks of delivery. This statement is incorrect, so the nursing student requires further education. Postpartum women who are fully breastfeeding can begin using norethindrone tablets within 6 weeks, not 3 weeks, of delivery. Patients who are partially breastfeeding can begin treatment within 3 weeks postpartum.

Question 3 of 3 Which statement about the pharmacodynamic parameters of medroxyprogesterone acetate is accurate?

Intramuscular injection provides higher peak levels due to reabsorption of crystalline deposits. Medroxyprogesterone acetate is administered as an intramuscular injection. It is a crystalline suspension and is not lipid or water soluble. The crystalline deposits in body tissues and then is reabsorbed. This drug provides higher peak levels of progestin compared to other progestin-only contraception products (POPs)

Question 1 of 12 Which statement accurately describes the pharmacokinetic parameters for levonorgestrel used as emergency contraception?

Levonorgestrel is excreted in both urine and feces. The drug is excreted in both the urine and the feces.

Question 2 of 12 Which hormonal contraceptive has the longest elimination half-life?

Medroxyprogesterone acetate injection (Depo Provera®) Medroxyprogesterone acetate injection (Depo Provera®) has the longest elimination half-life of 50 days.

Question 1 of 4 Which potential side effects and adverse effects would a nurse share with Ms. Wilson regarding treatment with intramuscular medroxyprogesterone acetate (Depo Provera®)?

Osteoporosis Osteoporosis as manifested by a reduction in bone mineral density may occur with prolonged use of medroxyprogesterone acetate. This is a black box warning for the drug. Injection-site reactions Injection-site reactions may occur when giving medroxyprogesterone acetate as an intramuscular injection. Delay of conception upon discontinuation of therapy Ms. Wilson should be counseled about the potential delay to conception upon discontinuation of therapy. Although she does not desire pregnancy currently, she expresses interest upon marriage. A potential delay in pregnancy should be factored in to her decision of when to stop treatment.

Question 2 of 3 Which mechanisms of action describe how levonorgestrel works as emergency contraception?

Prevention of ovulation Levonorgestrel as emergency contraception works through the prevention of ovulation. Prevention of fertilization Levonorgestrel as emergency contraception works through the prevention of fertilization. Inhibition of implantation through alteration of the endometrium Levonorgestrel as emergency contraception works through changing the endometrium to inhibit implantation.

Question 3 of 12 Which effects are advantages to the use of nonoral combined hormonal contraceptives (CHCs) over oral CHC?

Reduced drug interaction potentialBecause nonoral CHCs bypass first-pass metabolism in the liver, there is a potential for fewer drug interactions. Rapidly achieved serum hormone levelsBecause nonoral CHCs bypass first-pass metabolism in the liver, serum hormone levels are achieved rapidly. Decreased fluctuations of hormone levels in blood Because nonoral CHCs bypass first-pass metabolism in the liver, there are decreased fluctuations in hormone levels.

Question 4 of 12 Which advantages are associated with the use of progestin-only products (POPs) compared with combined hormonal contraceptives (CHCs)?

Relative safety of contraception POPs offer relative safety as compared to CHCs. Specifically, they may serve as an alternate option for women who cannot safely receive estrogen therapy that is in CHCs. Reversibility of contraception, except the depot POP POPs offer the advantage of reversible contraception that is rather quick. However, the injectable depot POP can result in a delayed return to fertility.

Question 12 of 12 Which teaching points would a nurse share with a patient who is taking levonorgestrel 0.75 mg PO BID for two doses for emergency contraception?

Remember to take the second dose within 12 hours of the first dose.It is important for the patient who is taking the two-dosage regimen of emergency contraception to remember to take the second dose. The dose should be taken 12 hours after the first dose. Once implantation occurs, emergency contraception is not effective. Emergency contraception is not effective if implantation has occurred. Emergency contraception does not protect against sexually transmitted infections. Levonorgestrel and other combined hormonal contraceptions (CHCs) do not protect against sexually transmitted infections (STIs). If the patient does not know the STI status of her partner, she should be evaluated. Nausea, vomiting, and heavier menstruation may occur with emergency contraception. Emergency contraception may cause nausea, vomiting, and heavier menstruation. However, these regimens are associated with less nausea and vomiting compared with using CHC for emergency contraception.

Question 9 of 12 Which potential symptoms resulting from treatment with a combined hormonal contraception (CHC) would a nurse teach a patient to report immediately to the health care provider?

Severe abdominal pain Severe abdominal pain is the "A" of "ACHES". This should be reported immediately. Chest pain or shortness of breathChest pain or shortness of breath is the "C" of "ACHES" and should be immediately reported. Severe leg pain or swelling in the calf or thighSevere leg pain or swelling in the calf or thigh represents the "S" of "ACHES," which could signify deep vein thrombosis, requiring immediate attention. Severe headaches, dizziness, speech difficultiesSevere headaches, dizziness, speech difficulties represents the "H" of "ACHES" and could indicate stroke. These should be reported. Eye disorders such as blurry vision or loss of visionEye disorders such as blurry vision or loss of vision represent the "E" of "ACHES" and should be reported.

Question 5 of 12 A 29-year-old woman with hypertension had unprotected sexual intercourse about 36 hours ago. Which statement accurately explains whether this patient is a candidate for emergency contraception?

She is a candidate for emergency contraception because it may be taken within 72 hours of unprotected sexual intercourse. This patient is a candidate for emergency contraception. It should ideally be taken within 72 hours of unprotected intercourse, which this patient's situation fits. The American College of Obstetricians and Gynecologists suggest that it should be offered to women within 5 days of unprotected sexual activities because there is modest efficacy through this time frame.

Question 2 of 4 Which patient parameters will a nurse ensure are assessed before the initiation of ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®)?

Smoking status Smoking status is critical because smoking with CHCs is associated with significant cardiovascular risks. The number of cigarettes should also be quantified. Patients greater than 35 who smoke should not receive therapy with a CHC. Reproductive history Reproductive history including age of menarche, menstrual pattern, cycle length, duration, amount of bleeding, and first day of last menstrual period should be determined. Current pregnancy status Current pregnancy status is important to note because contraceptives should not be taken while pregnant. Complete medical, gynecologic, and obstetric history Complete medical, gynecologic, and obstetric history should be determined, including assessing for risk for vascular/cardiovascular disorders, thromboembolic disease, hormone-sensitive cancers, liver disease, and gallbladder disease. The most recent Pap smear results should also be reviewed, noting any gynecologic abnormalities.

Question 7 of 12 A female patient has been taking ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®) for contraception. She was recently prescribed rifampin for the prevention of tuberculosis because her husband was recently diagnosed with the infection. Which nursing interventions would be appropriate to address the reduction in contraception efficacy?

Switch to another form of contraception.Switching to an alternate form of contraception is a possibility. It would be prudent to know how long this patient will continue with prophylactic rifampin. Increase the estrogen dosage in the combined hormonal contraception (CHC).Increasing the dosage of estrogen could help to prevent against reduced efficacy of the CHC from rifampin's induction of CYP450. Advise her to monitor for breakthrough bleeding, which might indicate lack of CHC effect.Although this step should be combined with others, it is important to have the patient monitor for breakthrough bleeding because this could be an indicator of reduced CHC efficacy. Advise the patient to use a second form of contraception like a condom while receiving rifampin.When receiving rifampin, the patient should be encouraged to use a second form of contraception such as a condom.

Question 4 of 4 A patient who has been taking ethinyl estradiol and norgestimate (Ortho Tri-Cyclen®) tablets calls a nurse to determine what she needs to do because she has missed two doses of her daily regimen. She is in week 2 of the contraceptive cycle and is a "Sunday starter." Which instructions would the nurse give the patient?

Take the 2 missed tablets as soon as she remembers and the next 2 active tablets the next day. Continue taking daily until package is finished. Backup contraception should be used for 7 days. Because this patient has missed 2 active doses during week 2, she will take the 2 tablets as soon as she remembers and then 2 active tablets the next day. She will continue taking 1 tablet daily until the package in finished and will need backup contraception for the next 7 days.