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NR566 Final Exam Study Guide-week Week 5-to week 8

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- Prevention of osteoporosis with hormone replacement therapy Tara (p.433) Hormone therapy reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. Therapy is lifelong and t ...

- Prevention of osteoporosis with hormone replacement therapy Tara (p.433) Hormone therapy reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. Therapy is lifelong and the risk for harm is increased. Hormone therapy should only be considered for women with significant risk for osteoporosis, and only when that risk outweighs the risks of hormone therapy. Meds are: raloxifene (Evista), bisphosphonates (e.g., alendronate {Fosamax}), calcitonin (Miacalin), and teriparatide (Forteo). Encourage patients to prevent bone loss by ensuring adequate intake of calcium and Vit D, performing regular weight-bearing exercises, and avoiding smoking and excessive alcohol use. - When and when not to use progestin for hormone replacement therapy and why Tara (p.430-432) When: Menopausal hormone therapy Why: The primary noncontraceptive use of progestins is to counteract the adverse effects of estrogen on the endometrium in women undergoing menopausal HT. When: Dysfunctional uterine bleeding Why: Heavy irregular bleeding that occurs when progesterone levels are insufficient to balance the stimulatory influence of estrogen on the endometrium. Treatment goals with administration of progestins are to stop the bleeding and establish a regular monthly cycle. When: Amenorrhea Why: Progestins can induce menstrual flow in selected women who are experiencing amenorrhea. When: Endometrial hyperplasia and carcinoma Why: Progestins can provide palliation in women with metastatic endometrial carcinoma, but they do not prolong life. Endometrial hyperplasia, a potentially precancerous condition, can be suppressed with progestins. Benefits derive from counteracting the proliferative effects of estrogen. When: Other uses - Supports early pregnancies, prevention of preterm birth (Makena) Why: Progestins can be used to support early pregnancy in women with corpus luteum deficiency syndrome and in women undergoing in vitro fertilization (IVF). One progestin (hydroxyprogesterone acetate (Makena) is approved for preventing preterm birth in women with a singleton pregnancy and a history of preterm delivery. When not to: Women with no uterus Why: Do not prescribe progestins to women who have undergone a hysterectomy. CONTINUED....................

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