NUR 426 Lecture 10: Medications Related to Women

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5 Jan 2018
Department
Course
Professor
Medicatios Related to Woe & Me’s Health
Osteoporosis
Physiology: metabolic bone disorder; bone formation declines resulting in decreased bone mass
Contributors/risk factors: calcium deficiency, hormone imbalance, sedentary lifestyle, alcoholism,
malnutrition, vitamin deficiencies, prolonged steroid use, RA
Clinical findings: loss of height; bone fractures; bone density scan low T score; serum
calcium/phosphorus, alkaline phosphatase
Pharmacologic Treatment: Bisphosphonates, Ca+/Vit D, PTH, others
Non-pharmacologic treatment: Weight-bearing exercise; moderation in alcohol
Category: Bisphosphonates
Action: Act on the serum levels of calcium and not directly on the parathyroid gland or
PTH
Action: Slow or block bone resorption; osteoclasts; by doing this, they help to lower
serum calcium levels, but they do not inhibit normal bone formation and mineralization
Contraindications/Cautions:
o Hypocalcemia, pregnancy and lactation, renal dysfunction, GI disease
o Dysphagia, esophageal disorders
o inability to sit upright (oral med
Interactions: antacids, calcium products, iron, or multiple vitamins and aspirin
Side effects/adverse effects:
o GI: common: nausea; GI upset, diarrhea; serious: esophageal ulcer,
esophagitis, abdominal pain,
o MS: musculoskeletal pain
o HEENT: headache, vision changes (notify provider)
o Osteonecrosis of jaw (rare incidence with IV forms and/or in patients with
cancer or immunocompromised)
o Atypical femur fracture (after 5+ years of use)
o Hypocalcemia (especially in patients with Vit D deficiency)
Agents Used for Osteoporosis
Prototype: Alendronate (Fosamax)
Etidronate (Didronel)
Ibandronate (Boniva)
Pamidronate (Aredia)
Risedronate (Actonel),
Zoledronic acid (Zometa)
Menopause
Physiology: Loss of ability of ovaries to respond to gonadotropins; atrophic changes in
reproductive organs
Clinical findings: dyspareunia, weight gain, facial hair growth, cardiac palpitations, hot flashes,
irritability, anxiety, diaphoresis, long-term: osteoporosis, cardiovascular disease
Pharmacologic agents used: Menopausal Hormone Therapy (MHT); herbal supplements
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Menopausal Hormone Therapy (MHT): effective for hot flashes, vaginal atrophy caused
by low estrogen; not recommended for prevention of CV or bone disease
Hormone therapy
Estrogen and progesterone are used to treat symptoms such as hot flashes and vaginal dryness
Estrogen (unopposed) is used for women who have had a hysterectomy
Combination estrogen/progestin is used in women with a uterus due to increased risk for
endometrial cancer from estrogen alone
Estrogen helps regulate use of calcium in the body and raises HDL cholesterol
HRT can increase risk for: breast cancer, heart disease, blood clots
Estrogen Replacement Agents: Estradiol
Used to treat: menopause, abnormal uterine bleeding, atrophic vaginitis, vulvar/vaginal atrophy
Action: affects pituitary release of gonadotropins
Contraindications: Hypersensitivity, breastfeeding, reproductive cancer, genital bleeding, MI,
angioedema, stroke, anti-thrombin deficiency
Precautions: Cardiac/renal/hepatic/gallbladder/bone disease, hypertension, CHF, history of
angioedema, asthma, blood dyscrasias, diabetes mellitus, seizures, depression, migraine
headache, family history of reproductive cancer, uterine fibroids, vaginal infection, smoking
Pregnancy: fetal abnormalities; not to be used at any time during pregnancy
Nursing Care
Monitor cardiac/renal/hepatic function
Monitor for mental status changes
Monitor for hyperglycemia in diabetic patients
Monitor I&O
Encourage patient to stop smoking
Teach patient to refrain from grapefruit products
Teach patient to report breast lumps/vaginal bleeding
Low Testosterone
Contributors: testicular injury, cancer, infection, hormonal disorders, chronic diseases, obesity
Clinical findings: low sex drive, erectile dysfunction, low semen count, hair loss, muscle mass
loss, fatigue, increased body fat, decreased bone mass, mood changes; testosterone level <
300ng/dL
Treatment: testosterone replacement
Category: Androgens
Prototype: Testosterone
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