NR568 Final Exam Study Guide

Week 5 Topics

Prevention of Osteoporosis with Hormone Replacement Therapy

• Alendronate: This medication is the first-choice treatment for preventing osteoporosis. It works by suppressing bone resorption, which is achieved by decreasing both the number and activity of osteoclasts.

When to Use and When Not to Use Progestin for Hormone Replacement Therapy

• Progestin with Estrogen: Women with an intact uterus should receive progestin in combination with low-dose estrogen. This combination helps minimize the risk of estrogen-induced endometrial cancer.
• Progestin Unnecessary: For women without a uterus, progestin is unnecessary.
• Main Use: The primary use of progestin is to counteract the adverse effects of estrogen.

Local vs. Systemic Estrogen Options

• Systemic Estrogen: Systemic estrogen carries significant risks. The FDA recommends that if hormone therapy (HT) is being used solely to manage vulvar and vaginal symptoms, a topical estrogen formulation should be considered.
• Transdermal Estrogen: Transdermal estrogen therapy tends to have fewer adverse effects compared to systemic options.

Management of Oral Contraceptives (OCs)

• Changing from One Combination OC to Another: When substituting one combination OC for another, the change is best made at the beginning of a new cycle.
• Initiating Treatment: With the exception of one product, combination OCs are typically dosed in a cyclic pattern. Most cycles are 28 days long, although some newer products have an extended cycle of 91 days or are continuous (e.g., Amethyst).
• Patient Teaching: Women should be informed about the symptoms of thrombosis and thromboembolism (e.g., leg tenderness or pain, sudden chest pain, shortness of breath, severe headache, sudden visual disturbance) and instructed to consult their prescriber if these occur.
• Baseline Data Needed: Before starting OCs, it’s essential to assess for a history of hypertension, diabetes, thromboembolism, cerebrovascular or cardiovascular disease, and breast cancer. A urine pregnancy test should also be conducted.
• Contraindications for OCs: Major contraindications to mifepristone/misoprostol include ectopic pregnancy, hemorrhagic disorders, or the use of anticoagulant drugs. Additionally, mifepristone should not be used in women with adrenal insufficiency or those on long-term glucocorticoid therapy due to its ability to block glucocorticoid receptors.

Achieving an Extended Cycle with Oral Contraceptives

• Extended Schedule: To achieve an extended schedule, a user can purchase four packets of a 28-day product (each containing 21 active pills) and take the active pills continuously for 84 days.

Factors Affecting the Effectiveness of Birth Control Methods

• Choosing an Appropriate Method: It’s important to evaluate patient scenarios and suggest the most suitable birth control method (e.g., oral contraceptives, long-term methods, IUDs) based on individual behaviors and preferences.