Chapter 32: Drug Therapy for Female Reproductive

A student taking combination oral contraceptives reports to the nurse that she has not missed a pill but missed a period. Which instruction does the nurse give to the student?

Continue taking pills as prescribed

A patient prescribed to take the oral contraceptive with the brand name Ortho Tri-Cyclen asks whether she should stop taking the pill for the 10 days that her husband is out of town on business. What is your best advice? a.No, this drug's protection against pregnancy requires taking the drug as prescribed. b.No, the hormonal confusion this would cause could result in an increased risk for blood clots. c.Yes, if you would normally have your period any time during the 10 days that your husband is away. d.Yes, it is very important that your body experience drug-free period from time to time to ensure optimal drug effect.

ANS: A Hormonal contraceptives must be taken exactly as prescribed in order to prevent pregnancy. Even a 2 day miss of the drugs increases the risk for pregnancy.

Which side effects are most common among women taking hormone replacement therapy for menopause? a.Breast tenderness and fluid retention b.Increased vaginal dryness and constipation c.Nausea, vomiting, and diarrhea d.Skin itching and dark-colored urine

ANS: A The most common side effects of hormone replacement therapy for perimenopausal symptoms are breast tenderness, breakthrough bleeding, fluid retention, weight gain, and acne. Vaginal dryness is reduced, not increased. Skin itching is reduced, not increased. Dark urine would be a symptom of the adverse effect of liver toxicity. These drugs are not commonly a cause of any gastrointestinal problems

A patient who has just been prescribed estrogen-based hormone replacement therapy (HRT) also has all of the following health problems. For which problem should you check with the prescriber to determine whether the patient should take HRT? a.Asthma b.Hypertension c.Osteoporosis d.Diabetes mellitus

ANS: B Common side effects of menopausal HRT include breast tenderness, breakthrough bleeding, fluid retention weight gain, and acne. These occur with conjugated estrogen alone and when combined with progesterone. Fluid retention can cause or worsen hypertension. If the patient's hypertension is not well controlled, she should not be taking HRT.

Which female hormone supports pregnancy by directly maintaining the thickened uterine lining? a.Estrogen b.Progesterone c.Luteinizing hormone d.Follicle stimulating hormone

ANS: B Estrogen increases the thickness of the uterine lining and then progesterone maintains this lining making the uterus ready for implantation. Luteinizing hormone stimulates ovulation and follicle stimulating hormone causes the ovary to produce estrogen.

What is the most serious adverse effect of hormone replacement therapy for menopause? a.Pregnancy b.Blood clots c.Miscarriage D. Decreased mental concentration

ANS: B Hormone replacement therapy for perimenopausal symptoms uses different types of estrogens and sometimes progesterone. Exogenous use of these drugs increases the risk for forming blood clots where they are not needed, leading to the potential venous thromboembolism complications of deep vein thrombosis, strokes, and heart attacks.

A patient calls to report that her health care provider prescribed Premphase daily and her new bottle of pills says Prempro. What is your best advice? a.Remind her that Prempro is just another brand of Premphase. b.Instruct her to take the new bottle back to the pharmacy for replacement with Premphase. c.Ask her whether she has already taken one of the Prempro and if she has to go to the nearest emergency department. d.Instruct her to call her health care provider and request that the prescription be changed to Prempro 0.3 mg daily.

ANS: B Prempro and Premphase are sound alike drugs both of which are used to treat perimenopausal symptoms. They can be easily confused; however, because the amounts of hormone are different, these drugs cannot be interchanged.

A woman who wants to take hormone replacement therapy (HRT) for perimenopausal discomfort expresses concern because her father died of a heart attack at age 78. What is your best response? a."If you have an electrocardiogram (ECG) performed every 6 months while you are on HRT, your risk for a heart attack will be reduced." b."The risk for a heart attack while taking HRT is slightly higher, which is why the therapy is prescribed for as short a time period as possible." c."Because it was your father who had the heart attack rather than your mother, you do not need to worry." d."You are right to be concerned and are not a good candidate for this form of therapy."

ANS: B Recent studies indicate that women taking estrogen-based HRT have a slightly higher incidence of myocardial infarction (heart attack). For this reason estrogen-based HRT is not recommended for long-term therapy. If she has no other risk factors for a heart attack, she can be considered for HRT. An ECG does not protect against heart attack. The genetic risks for conditions that increase the risk for a heart attack are not gender-based.

Which statements about perimenopausal hormone replacement therapy (HRT) are true? (select all that apply) a.Insomnia is a common side effect. b.They slightly increase the risk for heart attacks. c.They increase the chances of becoming pregnant. d.Women taking them should avoid caffeine. e.They are prescribed to prevent osteoporosis. f.Weight may increase during therapy. g.They should be used only by women who are sexually active. h.They cannot be used by anyone who took oral contraceptives for more than 5 years.

ANS: B, C, F HRT does slightly increase the risk for heart attacks and increases the risk for clot formation. Although osteoporosis can be delayed by HRT, because of the heart attack and blood clot risk, they are not prescribed to prevent osteoporosis. Insomnia is a menopause problem. The low dose of estrogen helps prevent ovulation and does not increase the chances for becoming pregnant. HRT does cause water and fluid retention, which often causes some degree of weight gain and hypertension. Patients are prescribed HRT to control perimenopausal symptoms regardless of sexual activity. Caffeine restriction is not needed. A woman who took oral contraceptives for more than 5 years and had no clotting problems with them, can take HRT when it is needed.

Which precautions are important to teach a patient who is taking hormone replacement therapy (HRT) to reduce menopausal discomfort? (select all that apply) a.Use oral contraceptives. b.Avoid cigarette smoking. c.Avoid drinking alcoholic beverages. d.Obtain a yearly influenza vaccination. e.Perform monthly breast self-examinations. f.Go to the hospital immediately if chest pains or symptoms of a stroke occur.

ANS: B, E, F HRT with estrogens increases the risk for clot formation that could cause venous thromboembolism, stroke, and heart attack. The risk is higher if the patient also smokes. Patients taking HRT should avoid cigarette smoking and should seek medical help immediately if chest pain or symptoms of a stroke occur. Hormones like estrogen can make breast cancers grow faster. The patient should perform monthly breast self-examinations to determine the presence of any lumps that could be cancerous. Although a yearly influenza vaccination is a good health promotion practice, HRT does not increase the risk for influenza. Oral contraceptives should not be used with HRT. There is no contraindication for drinking alcohol (in moderation) while taking HRT.

Which type of oral contraceptive drug must be taken every day of the month to be effective? a.An estrogen-progestin combination b.An estrogen only "mini" pill c.A progestin-drospirenone combination d.A progestin only "mini" pill

ANS: D Progestin only mini pills contain very low concentrations of only one hormone. Because the hormone levels are low, they must be taken daily, without any time off, to be effective.

A woman who wants to use the oral contraceptive drospirenone ethinyl estradiol (Yasmin) is prescribed to take these other drug types daily. Which drug makes Yasmin a poor choice for her? a.A corticosteroid inhaler b.A nonsteroidal anti-inflammatory drug c.An angiotensin-converting enzyme inhibitor d.A combination opioid receptor agonist/antagonist agent

ANS: C Angiotensin-converting enzyme (ACE) inhibitors increase the reabsorption of potassium. Oral contraceptives that contain drospirenone also increase blood potassium levels. These two drugs should not be taken together

Which brand name oral contraceptive contains drospirenone? a.Camila b.Ovral c.Yasmin d.Zovia

ANS: C The brand of oral contraceptive known as Yasmin is a combination of drospirenone and ethinyl estradiol.

A woman taking oral contraceptives reports the following changes. Which one is an expected side effect and requires no intervention? a.Calf swelling b.Severe constipation c.Increased breast size d.Heavier menstrual periods

ANS: C The hormones in oral contraceptives increase the growth of breast ductal tissue, often resulting in an enlargement of the breasts. This change is not pathologic and does not require intervention. Severe constipation is not related to oral contraceptive use. Calf swelling may indicate a blood clot and is a symptom that must be explored further. Most women have lighter menstrual periods.

How does estrogen-based hormone replacement therapy (HRT) reduce perimenopausal symptoms? a.By inhibiting ovulation and implantation. b.By making periods more regular and predictable. c.By inhibiting excessive secretion of follicle stimulating hormone. d.By increasing the rate of normal involution and menopausal cessation.

ANS: C When the glandular cells of the ovary shrink, they no longer produce normal levels of estrogen. The decreased blood levels of estrogen trigger the brain to secrete GnRH, which then triggers the pituitary gland to secrete follicle stimulating hormone (FSH). Before menopause the FSH acts on the ovary and causes ovarian cells to secrete estrogen, which then inhibits the pathway through negative feedback. With nonfunctional ovarian cells unable to respond to FSH by increasing estrogen secretion, this pathway is disrupted for a time. The continued low blood levels of estrogen constantly stimulate the brain to secrete gonadotropin releasing hormone (GnRH) in large amounts, resulting in the secretion of very large amounts of FSH. This extra FSH is useless because the ovary cannot respond to it and it has effects on other body tissues. The estrogen taken at this time suppressed GnRH and prevents excessive secretion of FSH, thereby reducing unpleasant symptoms.

Which laboratory finding in a perimenopausal woman who takes Premarin should be reported to the prescriber? a.Random blood glucose 116 mg/dL b.Potassium 4.8 mEq/L c.Sodium 146 mEq/L d.Hematocrit 27%

ANS: D Premarin taken long-term can thicken the uterine lining and lead to severe dysfunctional uterine bleeding. A hematocrit of 27% is way below normal.

Which hormone levels in the blood are reduced as a result of taking hormone replacement therapy for menopause? a.Estrogen and progesterone b.Estrogen and follicle stimulating hormone c.Gonadotropin releasing hormone and progesterone d.Follicle stimulating hormone and gonadotropin releasing hormone

ANS: D The blood levels of estrogen are increased during hormone replacement therapy, which reduces the release of gonadotropin releasing hormone from the brain. With low levels of gonadotropin releasing hormone, the anterior pituitary gland greatly reduces secretion of follicle stimulating hormone.

A woman who is hospitalized overnight after surgery usually takes Premarin 2.5 mg daily for control of perimenopausal symptoms. Her prescriber orders a one-time dose of Premarin 2.5 mg orally as soon as possible. The drug on hand is Premarin 0.625 mg/tablet. How many tablets should you administer?

ANS:4 Want 2.5 mg, Have 0.625 mg/tablet.2.5 mg/0.625 mg/tablet = 4 tablets.

A patient is prescribed dutasteride (Avodart) for the treatment of benign prostatic hypertrophy. The nurse questions the order after finding that the patient is also taking which medication?

Diltiazem ( Cardizem) a calcium channel blocker

The nurse is teaching a patient about the use of the transdermal contraceptive patch. Which statement by the patient indicates a correct understanding about the use of this medication?

I need to use a back-up contraceptive for the first 7 days of the first cycle I use the patch.

The nurse is teaching a patient about the use of tamsulosin (Flomax). Which statement by the patient indicates a need for further teaching?

I will stop taking this medication if I develop a headache

Which instruction does the nurse give to a patient with angina who has just received a prescription for sildenafil (Viagra)?

If anginal attack occurs, lies down and rest; do not take nitroglycerin.

In which situation does the nurse instruct a patient taking the oral contraceptive Tri Levlen to use an additional form of birth control?

If pt is taking penicillin

How does the nurse instruct a patient to use the NuvaRing for birth control when she has not used a hormonal contraceptive within the past month?

Insert the contraceptive rind on or prior to day 5 of the cycle

Which premedication assessment is essential before initiating finasteride (Proscar) therapy?

Prostrate Specific Antigen (PSA) level

Which herbal supplement may reduce the effectiveness of oral contraceptives?

St .John's wort

The nurse instructs a patient taking a transdermal contraceptive to avoid placing the patch in which location?

breasts