Transcript Drug-Based Methods

NURS 330
November 18, 2010
Announcements
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Final Exam:
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Thurs, December 9, 2010
7:30pm – 10pm
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Last Lecture: Dec 2, 2010
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There is no class on Thurs, 11/25/10
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No essays will be accepted after 11/18/10
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If essay not submitted to Turnitin and hard copy
in class, it will not be graded
Review In-Class Assignments
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10/28/10 – Sexual Response Cycle
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11/4/10 - Contraception
Abortion
Abortion
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Spontaneous abortion
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aka miscarriage
Loss of baby before 20 weeks of pregnancy
Induced abortion
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Surgical
Drug-based
Surgical Method
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Vacuum Aspiration
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First trimester method
Dilation and Extraction (D & X)
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Late surgical method
Drug-Based Methods
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Mifepristone (RU 486) –Injection, 0rally
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An anti-progesterone
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Approved by FDA in September 2000 for abortion
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prevents progesterone from making uterine lining hospitable for
implantation
If fetus is already implanted, causes the uterus to shed its lining
and, along with it, the fertilized fetus
As an alternative to surgical procedure
Effectiveness is increased if used with another drug,
Misoprostol (95-98%)
Most effective within 7 weeks of fertilization
Drug-Based Methods (cont)
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Methotrexate –Injection; orally (rarely)
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Prevents cell division and multiplication
Can be used to induce an abortion
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Effectiveness is increased if used with another drug, Misoprostol (95%)
Approved by FDA for treatment of cancer, arthritis and psoriasis
Most effective within 7 weeks of fertilization
Misoprostol – orally or vaginally
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Legal Drug used in conjunction with above drugs
The second drug used to complete the abortion procedure
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Taken a day or two after administration of the first drug
Causes the uterus to contract and expel its contents
Approved in the US for coating the stomach of people who take
stomach-irritating anti-inflammatory drugs.
Abortifacient
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A method or substance that causes a
fertilized egg that has implanted in the
uterine wall or fetus to be expelled.
Which of the drug-based methods is an
abortifacient?
Incidence of Abortions
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Nearly half of pregnancies among American women are
unintended, and four in 10 of these are terminated by
abortion.
Twenty-two percent of all pregnancies (excluding
miscarriages) end in abortion.
In 2005, 1.21 million abortions were performed, down from
1.31 million in 2000. From 1973 through 2005, more than
45 million legal abortions occurred.
Each year, about two percent of women aged 15-44 have
an abortion; 47% of them have had at least one previous
abortion.
Source: Perspectives on Sexual
and Reproductive Health
When women have abortions
Source: Guttmacher Institute
Cost
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Surgical
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In 2005, the cost of a non-hospital abortion
with local anesthesia at 10 weeks’ gestation
ranged from $90 to $1,800; the average
amount paid was $413
(Source: Perspectives on Sexual and Reproductive Health)
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Drug-based
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most providers do charge more for this method
Abortion and the Law
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Roe v. Wade
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1973 Supreme Court decision stating
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1st trimester abortions cannot be regulated by
states and the decision to abort is between woman
and physician
2nd trimester abortions permitted when mental or
physical health of mother at risk
3rd trimester abortions allowed when life of mother
at risk
California Law
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California does not have any of the major
types of abortion restrictions – such as
waiting period, mandated parental
involvement or limitations on publicly funded
abortions – often found in other states.
Source: Alan Guttmacher Institute
The Pro-Life and Pro-Choice
Controversy
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Anti-abortion (Pro-life) position
Pro-choice position
The following presentation on Cancer is from the
American Cancer Society. It has been authorized
for use in this class by Chrissy Kim,
Manager, Healthcare/Corporate Initiatives
What is Cancer?
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Cancer occurs when cells in a part of the body
begin to grow out of control. Normal cells divide
and grow in an orderly fashion, but cancer cells do
not. They continue to grow and crowd out normal
cells.
Although there are many kinds of cancer, they all
have in common this out-of-control growth of cells.
Cancer (cont)
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Sometimes cancer cells break away from a tumor and spread
to other parts of the body through the blood or lymph system.
They can settle in new places and form new tumors. When
this happens, it is called metastasis. Cancer that has spread
in this way is called metastatic cancer.
Even when cancer has spread to a new place in the body, it is
still named after the part of the body where it started. For
example, if prostate cancer spreads to the bones, it is still
called prostate cancer. If breast cancer spreads to the lungs, it
is still breast cancer. When cancer comes back in a person
who appeared to be free of the disease after treatment, it is
called a recurrence.
Survival Rates
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5-year localized survival rate
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Localized cancer is cancer that, at the time of
diagnosis, had not spread to additional sites
within the body. Typically, the earlier a cancer
is detected and diagnosed, the more
successful the treatment, thus enhancing the
survival rate.
Survival Rates
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5-year overall survival rate
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The 5-year survival rates represent persons who
are living 5 years after diagnosis, whether
disease-free, in remission, or under treatment.
They do not imply that 5-year survivors have
been permanently cured of cancer.
The Breast
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Main function is to produce milk for
breastfeeding
2 main types of tissues:
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glandular tissues
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Lobules – milk production
Ducts – milk passages to the nipples
supporting (stromal) tissues
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Fatty & Fibrous connective tissue
Give breast their size, shape and support
Breast Changes
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Changes in the breasts may be caused either by
benign conditions or cancer
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Benign Breast Conditions
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Never life threatening; very common
Some may increase the risk of developing
breast cancer
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fibrocystic changes
benign breast tumors
breast inflammation
Breast Cancer - Life threatening
Breast Changes
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It is often not possible to tell the difference
between benign and cancerous conditions
based on symptoms alone
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More tests will be needed
Some benign breast conditions may not
cause any symptoms and may be found
during a mammogram or a breast biopsy.
What Is Breast Cancer?
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Breast cancer is a malignant (cancerous)
tumor that develops from cells in the
breast.
Most breast lumps are benign (not
cancerous).
Early detection is very important because
the cancer can spread if not treated at its
earliest stages.
The American Cancer
Society’s Estimates
The American Cancer Society's most recent
estimates for breast cancer in the United States are
for 2010:
About 207,090 new cases of invasive breast
cancer will be diagnosed in women.
About 54,010 new cases of carcinoma in situ (CIS)
will be diagnosed (CIS is non-invasive and is the
earliest form of breast cancer).
About 39,840 women will die from breast cancer
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Who Is At Risk?
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Two factors greatly influence the risk of
developing breast cancer:
1. Being a woman
The disease is over 100 times more common in
women than in men.
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2. Age
Approximately 77% of women with breast cancer
are age 50 or older at the time of diagnosis.
Why Are Older Women
More At Risk?
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Exposure to reproductive hormones, like
estrogen, over a lifetime may increase the
risk. This is influenced by:
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Age
Age of first menstrual period
Number of pregnancies
Age at menopause
History of taking medication
that contains estrogen
Other Risk Factors
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Family history of breast cancer
Having a first-degree relative (mother, sister, or
daughter) with breast cancer approximately doubles
a woman’s risk.
Most women with breast cancer do not have a
first-degree relative with the disease.
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History of noncancerous breast disease
Never having children or having first live birth
after age 30
Other Risk Factors
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Starting monthly periods before age 12
Starting menopause after age 55
More than 5 years of postmenopausal
estrogen replacement therapy
Use of alcohol, especially two or more drinks
daily
Obesity, especially excessive weight gain
Physical inactivity
Reducing Your Risk
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Limit alcohol use.
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Engage in regular physical activity.
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Maintain a healthy weight.
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Eat a healthy, balanced diet that includes at least
five servings of fruits and vegetables every day.
Symptoms
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The most common sign of breast cancer is a
new lump or mass.
Other signs include:
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Generalized swelling of part of a breast (even if
no distinct lump is felt)
Skin irritation or dimpling
Symptoms – other signs (cont)
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Nipple pain or retraction (turning inward)
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Redness or scaliness of the nipple or breast skin
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Discharge other than breast milk
Detection Methods
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Nearly all breast cancers can be successfully
treated if detected early.
A mammogram is the best method for
detecting breast cancer because often it can
identify cancer before physical symptoms
develop.
All women should have regular breast
examinations by a health provider.
The American Cancer Society’s
Screening Recommendations
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Clinical Breast Exam should be part of a periodic health exam, about
every three years for women in their 20s and 30s, and every year for
women 40 and older.
Women should know how their breasts normally feel and report any
breast change promptly to their health care provider. Breast Self
Examination is an option for women starting in their 20s.
The American Cancer Society’s
Screening Recommendations
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Yearly mammograms are recommended starting at age 40 and
continuing for as long as a woman is in good health.
Women at increased risk (e.g., family history, genetic tendency, past
breast cancer) should talk with their doctors about the benefits and
limitations of starting mammography screening earlier, having
additional tests (i.e., breast ultrasound and MRI), or having more
frequent exams.
Breast Self Exam
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Beginning in their 20s, women should be
told about the benefits and limitations of
BSE. Women should be aware of how their
breasts normally feel and report any new
breast changes to a health professional as
soon as they are found. Finding a breast
change does not mean that a cancer is
present.
Treatment
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Treatment is most successful when
breast cancer is detected early.
Often two or more treatment methods
are used.
Patients should thoroughly
discuss treatment options
with their doctors.
Treatment Options
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*
Breast conservation surgery*
Mastectomy*
In both cases, the lymph nodes under the arm may also
be removed.
Treatment Options
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Chemotherapy
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Uses anticancer drugs that attack cancer cells and
normal cells.
These drugs usually are given by injection or by mouth.
Hormone therapy
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Uses hormones (chemicals made in the body that affect
cell activity) or drugs that interfere with hormone
production.
Treatment Options
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Monoclonal antibody therapy
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Uses substances that locate and bind to cancer
cells.
Can be used alone or to deliver drugs, toxins, or
radioactive material directly to tumor cells.
Radiation therapy
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Uses high-energy rays to shrink or kill cancer
cells.
Survival Rates
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5-year localized survival rate is
98%
5-year overall survival rate is 80%
Hope For The Future
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Scientists are continually learning more about
breast cancer, including how lifestyle,
environment, and other factors affect risk.
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Examining the role of physical activity, weight
gain or loss, diet, hormone replacement therapy,
and environment on breast cancer risks.
Determining the best use of genetic testing to
find gene mutations (BRCA1 and BRCA2) that
may increase breast cancer risks.
Hope For The Future
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Scientists are also finding better ways to detect
and treat breast cancer, such as:
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Developing new screening methods and improving existing
ones.
Testing chemotherapy drugs and drug combinations to find
those that attack breast cancer cells but cause less damage
to normal cells.
Testing hormone therapies, such as raloxifene and
tamoxifen, that have been shown to greatly reduce the risks
among women at high risk for this disease.
The Bottom Line
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Nearly all breast cancers can be treated
successfully if found early.
The key is early detection!
Breast cancer risk may be reduced by being
physically active, maintaining a healthy
weight, and reducing alcohol use.
Conditions of the Scrotum
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Epididymitis
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an inflammation or infection of the epididymis
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Caused by bacterial infections
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Sometimes caused by gonorrhea and chlamydia
Incidence is less than 1 in 1,000 males per year
Epididymitis is primarily a disease of adults, most
commonly affecting males aged 19-40 years.
Testicular Cancer
What Is Testicular Cancer?
Testicular cancer can develop in one or both
testicles in men and boys.

Contained in a sac of skin called the scrotum, the
testicles are the part of the male reproductive
system that produces sperm and male hormones
(like testosterone).
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Very rare cancer but is the most common cancer
found in men ages 15 - 35
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The American Cancer Society’s
Estimates
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In the United States during 2008:
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8,090 new cases of testicular cancer
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Deaths per year: 380 men
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Testicular cancer is not common; about 1 in 300 men will
develop testicular cancer in their lifetime.
Risk Factors
The main risk factors for testicular cancer
include:
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Race
 Family history
 Being born with an undescended testicle
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Cryptorchidism
Because these risks cannot be avoided, it is
not currently known how to prevent most
cases of testicular cancer.
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Risk Factors (cont)
Although testicular cancers usually occur in patients
between the ages of 15 and 40, they can affect males
of any age, including infants and elderly men.
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The risk among White men is about five
times higher than among African American men.
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Men who have had cancer in one testicle are at
increased risk for developing cancer in the other
testicle.
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What Are Other Risk Factors?
If a man’s close family members have had
testicular cancer, he is at greater risk.
Men who had an undescended testicle as a
baby are at increased risk (3 out of every 100
male infants).
Men who have had cancer in one testicle are
at increased risk for developing cancer in the
other testicle.
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Other Risk Factors
Some jobs may put men at increased risk for testicular
cancer. Examples include being one of the following:
 Miner
 Oil or gas worker
 Janitor
 Leather worker
Recent studies found no
evidence that having a
vasectomy increases a
man’s risk of developing
the disease.
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Reducing Your Risk
The main risk factors for testicular
cancer include:
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Race
 Family history
 Being born with an undescended testicle
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Because these risks cannot be
avoided, it is not currently known
how to prevent most cases of
testicular cancer.
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Risk Factors (cont)
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Since none of these risks can be prevented,
the best protection is awareness of risks
and symptoms, early detection, and prompt
treatment.
Men at risk may want to perform a monthly
self-exam
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Testicular Self Exam (TSE)
Testicular Self Exam (TSE)
The best time to perform the self-exam is during or after a
bath or shower, when the skin of the scrotum is relaxed. To
perform a testicular self exam:
 Hold the penis out of the way and examine each testicle
separately.


Hold the testicle between the thumbs and fingers with both
hands and roll it gently between the fingers.
Look and feel for any hard lumps or nodules (smooth
rounded masses) or any change in the size, shape, or
consistency of the testes.
American Cancer Society. 2006
Symptoms
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Lump or swelling in either testicle
90% of cases
 Often painless or slightly uncomfortable

Enlargement of a testicle
Feeling of heaviness in the scrotum
Dull ache in the lower abdomen or groin
Sudden collection of fluid in the scrotum
Enlargement or tenderness of the breasts
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Detection Methods
In 90% of cases, men have a lump or
swelling in a testicle.
Any swelling or aching in
the testicles should be
examined by a doctor
without delay.
Men at risk may want to
perform a monthly
self-exam.
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Diagnosis
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Medical History and Physical Exam
Ultrasound
Blood Tests
Treatment
Testicular cancer is highly treatable,
usually curable, and relatively rare.
Treatment is most successful when cancer is
detected early.
Often two or more treatment methods are
used.
Patients should thoroughly discuss
treatment options with their doctors.
Treatment Options
There are three main treatment options:

Surgery
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Radiation therapy
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An operation to remove cancer cells.
Uses high-energy rays to shrink or kill cancer cells.
Chemotherapy

Uses anticancer drugs that attack cancer cells and
normal cells. The drugs are usually given by
injection or by mouth.
Survival Rates

5-year localized survival rate is 99%

5-year overall survival rate is 95%
Survival rates drop to 76% when cancer
has spread to distant organs, which underlines
the need for early action.

Prostate Cancer
What Is Prostate Cancer?
In American men, prostate cancer is the most common
cancer and the second leading cause of cancer death.

The prostate gland is walnut-sized and is located in
front of the rectum, behind the penis, and under the
bladder.

Most prostate cancers grow very slowly, but when they
spread, they can do so quickly.

The American Cancer
Society’s Estimates

In the United States during 2008:

186,320 new cases of prostate cancer

Deaths per year: 28,660
Three Greatest Risk Factors
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Being a man
Only men develop prostate cancer, typically those ages 50
and older.
Age
More than 70% of prostate cancers are diagnosed in men
over 65.
Race:
African American men have the highest prostate
cancer incidence rates in the world. The rates of prostate
cancer death for African American men are more than twice
the rates for White men.

Other Risk Factors
About 5 to 10% of prostate cancers may be
inherited.
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Eating a high-fat diet
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especially a diet high in saturated fat, found
primarily in animal sources, such as red meat and
dairy products—may play a part in
causing prostate cancer.
Symptoms
Most early cases of prostate cancer cause no
symptoms, but some early signs may be:
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Frequent urination, especially at night.
Difficulty starting urination
or inability to urinate.
Weak or painful urination.
Diagnosis
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Prostate-Specific Antigen (PSA)

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Digital Rectal Exam (DRE)
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blood test
rectal exam
All men 50 years of age and older should ask
their physicians about having the PSA test and a
DRE every year.

At a younger age if at high risk
Treatment
Treatment is most successful when prostate
cancer is detected early.

Often two or more treatment methods are
used.

Patients should thoroughly discuss
treatment options with their doctors.

Treatment
If prostate cancer is detected early, is slow
growing, and is not causing symptoms,
“watchful waiting” may be chosen initially,
especially for older men.

Active treatment is started if the cancer
begins to grow more quickly or symptoms
appear.

Treatment (active) Options

Surgery

Removal of the prostate, called prostatectomy, is
the most commonly chosen surgical treatment.

Radiation therapy
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Uses high-energy rays to shrink or kill cancer cells.
Treatment Options (cont)

Chemotherapy


Uses anticancer drugs that attack cancer cells and normal cells. The
drugs are usually given by injection or by mouth.
Hormone therapy

Treatment with hormones or drugs that interfere with hormone
production or action, or the surgical removal of hormone producing
glands.
Survival Rates

5-year localized survival rate is 100%

5-year overall survival rate is 99%
Prevention
All men 50 and older should talk to their doctors
about having annual DRE and PSA tests to help find
prostate cancer early.

Men who are at high risk for prostate cancer
(African Americans or men with a first-degree
relative diagnosed with prostate cancer at a young
age) should begin testing at age 45.

Prostate cancer is less likely to be curable once it
has spread; however, with annual screening,
prostate cancer can be detected before this occurs.
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December 9, 2010
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Final Exam
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7:30PM – 10:00PM
100 Questions
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Cumulative
Study guide will be posted on course website by
12/2/10.