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NR 566 Final Study Guide
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NR 566 Final Study Guide
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NR 566 Final Study GuideWeek 1
Ch 50 estrogen and progestins - answers
Menopause
1. is the associated loss of estrogen which typically begins
2. During the initial phase, the menstrual cycle becomes
3. Eventually, ovulation and menstruation - answers 1. at approximately age 51 to 52 years, with 95% of
women entering menopause between the ages of 45 and 55 years.
2. irregular, anovulatory cycles may occur, and periods of amenorrhea may alternate with menses
3. cease entirely
Physiologic Alterations Accompanying Menopause
1. Vasomotor Symptoms; hot flashes and night sweats) develop in approximately
2. Genitourinary Syndrome of Menopause; the urethra and vagina have the highest
3. Mental Changes; Many women report
4. Bone Loss; In the absence of estrogen, bone resorption accelerates, leading
5. Altered Lipid Metabolism; studies have shown increases in
6. Female Sexual Interest-Arousal Disorder - answers 1. 70% of postmenopausal women. Episodes are
characterized by sudden skin flushing, sweating, and a sensation of uncomfortable warmth. These
episodes can occur at night, resulting in drenching sweats
2. concentrations of ERs; when estrogen levels decline during menopause, these structures begin to
atrophy resulting in urge incontinence and urinary frequency; Urethritis and UTIs can also occur
3. cognitive changes such as difficulty in problem solving and short-term memory loss. Others
experience depression or an increase in anxiety
,NR 566 Final Study Guide
4. to a 12% loss of bone density leading to Osteoporosis which can cause compression fractures of the
vertebrae causing a decrease in height and produce a hump. In osteoporotic women, fractures of the hip
and wrist can result from minimal trauma
5. LDL cholesterol & decreases in HDL cholesterol. which play a role in the increase in CV disease after
menopause.
6. more common during this stage of life
Estrogen
Therapeutic Uses:
1. Menopausal hormone therapy- When estrogen is used for this purpose,
2. Female hypogonadism-In the absence of ovarian estrogens,
3. Acne-Estrogens, in the form of
4. Cancer palliation-sometimes used for palliative therapy
5. Gender-affirmation therapy-for - answers 1. it is usually accompanied by the use of progestins
2. pubertal transformation will not take place. (variety of causes see pg 428) This treatment promotes
breast development, maturation of the reproductive organs, and pubic and axillary hair. This tx regimen
consists of continuous low-dose therapy (for approx a year) followed by cyclic administration of
estrogen in higher doses
3. oral contraceptives, can help control acne. Tx is limited to patients at least 14-15 years old who want
contraception
4. in management of advanced prostate CA in men and in a select type of metastatic breast CA in men&
women
5. transgender women; not approved by the FDA) but prescribed off-label
Forms of Estrogen
,NR 566 Final Study Guide
1. Estrogen is available in conjugated and esterified forms. Esterified estrogens
2. Until mid-2016, synthetic conjugated estrogens A (Cenestin) and B (Enjuvia) were available; however,
3. Phytoestrogens (plant-based compounds)-commonly used by women as a
4. Phytoestrogens are not as potent as estradiol, but they carry some of the same risks.
5. Selective estrogen receptor modulators (SERMs) are drugs that activate ERs in some tissues and block
them in others. These drugs were developed in an effort - answers 1. are plant based; conjugated
estrogens are natural preparations derived from the urine of pregnant horses.
2. the manufacturer has withdrawn them from the market
3. "natural" way to manage symptoms associated with menopause
4. Women should not use phytoestrogens if they have a history of thromboembolic events or a personal
or family history of breast, uterine, or ovarian cancer.
5. to provide the benefits of estrogen (e.g., protection against osteoporosis, maintenance of the
urogenital tract, reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast
cancer, uterine cancer, and thromboembolism)
Estrogen-Adverse Effects
1. principal concerns with estrogen therapy are the potential for
2. endometrial hyperplasia and endometrial cancer can be resolved
3. Estrogens have been associated with what common SE
4. menopause may produce or uncover
5. Nausea is the most
6. (blank) a patchy brown facial discoloration, though not dangerous, may cause significant distress -
answers 1. endometrial hyperplasia, endometrial cancer, breast cancer, and cardiovascular
thromboembolic events
2. by prescribing a progestin
, NR 566 Final Study Guide
3. Fluid retention with edema, gallbladder disease, jaundice, and headache; especially migraine
headache
4. gallbladder disease. Jaundice may develop in women with preexisting liver dysfunction, especially
those who experienced cholestatic jaundice of pregnancy
5. frequent undesired response to the estrogens
6. Chloasma,
Contraindications of Estrogen
1. Estrogens should not be taken by patients with a history of
2. They should not be prescribed to women who
3. Patients with a hx of - answers 1. DVT, pulmonary embolus, or conditions such as stroke or MI that
occurred secondary to a thromboembolic event.
2. are pregnant or who have vaginal bleeding without a known cause.
3. liver disease, estrogen-dependent tumors, or breast cancer (except when indicated for management)
also should not take estrogens.
Estrogen-Interactions
1. Estrogens are major substrates of
2. In addition, they may decrease the effectiveness of some
3. Estrogens can also interact with - answers 1. CYP1A2 and CYP3A4; inducers/inhibitors of these
isoenzymes may raise/lower estrogen levels
2. antidiabetic drugs and thyroid preparations.
3. anticoagulants and other drugs that affect clotting.
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