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FNP Pharmacology part 1
My study guide for part of my comprehensive finals for pharmacology in my FNP school. Contraceptives are included in this set.
82
Medical
Graduate
04/19/2009

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Term
ÿþHow many half-lifes are needed, generally, to reach steady state?
Definition
3-5
Term
What metabolic pathway can be used to predict drug-drug interactions?
Definition
Cytochrome P450
Term
What percentage of all births to women, aged 15-40 are unplanned?
Definition
30%
Term
No decision about birth control is a decision to accept what?
Definition
Pregnancy
Term
What are the 2 biggest teaching issues with diaphragms?
Definition
1 insert up to 2 hours before, 2- do not remove for 6 hours after
Term
What percentage of pregnancies are miscarried?
Definition
50%
Term
How many birth control patches are on the market?
Definition
One
Term
If a pt is only having intercourse a few times a year over several years, then starting oral contraceptives how many months beforehand is acceptable?
Definition
one to two
Term
What are the four hormone phases in a woman's cycle?
Definition
Follicular, Ovulatory, Luteal and Menstrual
Term
What 3 primary functions do oral contraceptives fulfill?
Definition
1- Suppresses the ovulatory phase, 2- Thickens the vaginal mucosa, 3- Affects the endometrial lining so the egg has a hard time implanting
Term
Oral contracetives do or do not regulate a woman's feminine cycle?
Definition
They do regulate a woman's cycle
Term
Suppressing estrogen does what to a woman's skeletal system?
Definition
It provides greater opportunity for bone demineralization
Term
Estrogen increases or decreases women's HDLs?
Definition
Increases
Term
Estrogen increases or decreases women's triglycerides?
Definition
Increases
Term
What does Depo-provera "wipe out"?
Definition
estrogen
Term
What affect does Depo-Provera have on the skeletal system?
Definition
Affects bone mass negatively (though not directly)
Term
What does estrogen do to cervical mucous?
Definition
Makes it watery - easier for sperm transportation
Term
What does estrogen do to the fallopiann tube?
Definition
It dilates it
Term
What does Depo-Provera do to a woman's cycle?
Definition
It inhibits a woman's cycle
Term
What 2 major risk factors increase the likelihood of blood clot development in a woman on oral contraceptives?
Definition
smoking and obesity
Term
What type of OC should you not prescribe a woman over 35 that smokes?
Definition
Anything that decreases estrogen
Term
What is a major contraindication to oral contraceptives?
Definition
A history of coagulapathies
Term
Is a family hx of stroke a contraindication to OC's?
Definition
No
Term
What does progesterone do to insulin levels?
Definition
increases tem
Term
Depo-provera increases or decreases appetite?
Definition
Increases, leading to weight gain.
Term
How much does pregnancy increase a woman's chance of developing a clot?
Definition
60%
Term
Progesterone does what to the body's ligaments?
Definition
it relaxes them
Term
What 2 types of estrogen is used in contraception?
Definition
Ethinyl estradiol and Mestranol
Term
Which is a "weaker" OC, Ethinyl estradiol or Mestranol?
Definition
Mestranol
Term
What type of estrogen is used most often in OC's?
Definition
Ethinyl estradiol
Term
What type of oral contraceptive is most effective?
Definition
Progesterones
Term
What has more side effects, estrogen or progesterone OCs?
Definition
Progesterone
Term
Name at least 2 progesterone OC's.
Definition
Norethindrone, Ethynodiol diacetate, Norgestrel, Norgestimate
Term
What surge does progestins suppress?
Definition
LH surge
Term
What affect do progestins have on tubal motility?
Definition
It slows tubal motility
Term
What hormone release is suppressed with estrogen OC therapy?
Definition
FSH
Term
What thickens cervical mucous, progestins or estrogens?
Definition
Progestins
Term
After initiating OC therapy, what should pts return to have checked?
Definition
BP
Term
Describe a pt who would be on the "caution list" for OC therapy.
Definition
Over 35 y.o., smoker, vericose veins, colitis, compromised liver (it can cause liver tumors).
Term
What are the absolute contraindications to OC therapy?
Definition
Hx of DVT, stroke, CAD, jaundice, benign liver tumors, factor V mutation, breast or endometrial cancer, pregnancy.
Term
If the pt on OC therapy states, "these pills make me feel pregnant," then what action should be done to improve her symptoms?
Definition
Lower the dose.
Term
What skin condition can hormonal birth control improve?
Definition
Acne
Term
What is this biggest difficulty with contraceptive use and patients?
Definition
Efficacy
Term
What's the minimum number of pills that can be missed that can result in ovulation?
Definition
One.
Term
Is it abnormal for women to spot for the first few months of OC use?
Definition
No. It's normal, but after 2 or 3 months it should go away - important to teach patients this.
Term
What's the efficacy for hormone contraceptive therapy?
Definition
99%
Term
What are the 2 most common somatic complaints after initiating OC therapy?
Definition
Breast tenderness and nausea. Take pills with food, take at night, take with ibuprofen.
Term
About when should a pt who's just started oral contraceptives return to the clinic?
Definition
In a couple of months
Term
What's the name of the IUD product that does not have hormones?
Definition
Paragard
Term
How long can Paragard be in place for contraceptive use?
Definition
10 years
Term
What can be done if women continue to ovulate while on OCs?
Definition
Decrease the number of placebo days, i.e. from 7 to 3; or just stop the period alltogether
Term
What are some of the benefits for using hormonal contraceptive preparations?
Definition
Pregnancy prevention, decreased dysmenorrhea, decreased menstrual irregularities and blood flow, improvement of acne and hirsuitism, fewer ovarian cysts, significantly reduced endometrial/ovarian cancer risk, lower incidence of benign breast conditions, reduced risk of hospitalizations for PID, suppression of endometriosis.
Term
What antibiotoc can greatly increase the risk of pregnancy while a pt is using OC's?
Definition
Tetracycline
Term
What are 4 risk factors for venous thromboembolism in pts using OC's?
Definition
1- Inherited bleeding disorders, 2- >35 years old, 3- Smoking > 10 cigarettes per day 4- Obesity (BMI>30)
Term
In regards to OC's, what does monophasic mean?
Definition
Same dose, everyday
Term
In regards to OC's, what does triphasic mean & give one brand example?
Definition
Tries to mimic what the body does & Ortho-tricyclin
Term
When are the 3 common times of initiating OC's?
Definition
1- First day of cycle (this way you know she's not pregnant), 2- Sunday-start (first Sunday after period), 3- Quick start (start in your office, that day. Can be good because it gets them started, they can re-adjust the dose after their next cycle).
Term
Give one example of a hormone-releasing vaginal ring & how long is it effective for?
Definition
NuVa Ring; effective for at least 5 week (35 days), then the pt has 1 week for a menstrual cycle.
Term
Does the NuVa Ring suppress ovulation?
Definition
Yes
Term
What kind of drug-drug interactions are there between the NuVa Ring and antibiotics?
Definition
There are non.
Term
What does EE stand for?
Definition
Ethinylestradiol
Term
What hormones are released by NuVa Ring & in what quantity?
Definition
15mcg EE and 120mcg etonogestrel daily.
Term
What's the name of the contraceptive patch?
Definition
Ortho Evra
Term
What drugs/hormones are released by Ortho Evra and in what quantity?
Definition
20mcg EE and 150mcg norelgestromin
Term
Over time, how much estrogen are pts exposed to when placed on the patch vs. OC's?
Definition
60% more
Term
How often is Ortho Evra administered/applied?
Definition
weekly
Term
What's one of the most important lifestyle factor to assess pts for before starting them on Ortho Evra?
Definition
Tobacco use - increases risk of VTE.
Term
Name 3 brands of progestin-only pills.
Definition
1-Micronor, 2- Nor-QD, Ovrette
Term
Progestin-only OC's should be used when what is contraindicated?
Definition
estrogen use
Term
What is the primary contraceptive effect of progestin-only OC's?
Definition
thickens cervical mucus, making penetration of sperm more difficult
Term
What are 2 common side effects of progestin-only OC's?
Definition
1- changes in bleeding patterns, 2- breast tenderness
Term
What is the injectable progestin used for contraception & how long is it effective for?
Definition
Depot medroxyprogesterone acetate (DMPA - formerly depo-provera) & 12-13 weeks for IM & 12-14 weeks for SubQ
Term
What's the name of the implantable IUD with progesterone & how long is it effective?
Definition
Mirena, 5 years.
Term
How well does Mirena stop ovulation?
Definition
It doesn't stop ovulation, so it will not help with ovarian cysts.
Term
What's one important assessment women should perform monthly while using an IUD?
Definition
String placement.
Term
Is Implanon estrogen-based, or progestin-based?
Definition
Progestin
Term
Where is Implanon usually implanted?
Definition
In the upper arm, subdermally.
Term
How long is Implanon effective for?
Definition
3 years.
Term
What does Implanon removal usually involve?
Definition
It needs to be cut out & often requires a suture or two.
Term
Within how many hours should emergency contraception be used?
Definition
ASAP, within 72 hours.
Term
Is Plan B estrogen or progesterone based?
Definition
Progesterone.
Term
What "surge" does Plan B affect?
Definition
the LH surge
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