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INTRODUCTION

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estrogens, conjugated (equine) (es-troe-jenz)

Image not available.C.E.S, Image not available.Congest, Premarin

estrogens, conjugated (synthetic, A)

Cenestin

estrogens, conjugated (synthetic, B)

Enjuvia

Classification

Therapeutic: hormones

Pharmacologic: estrogens

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Indications
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PO: Treatment of moderate to severe vasomotor symptoms of menopause. Estrogen deficiency states, including Female hypogonadism, Ovariectomy, Primary ovarian failure. Prevention of postmenopausal osteoporosis. Advanced inoperable metastatic breast and prostatic carcinoma. IM, IV: Uterine bleeding resulting from hormonal imbalance. Vaginal: Management of atrophic vaginitis. Concurrent use of progestin is recommended during cyclical therapy to decrease the risk of endometrial carcinoma in patients with an intact uterus.

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Action
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Estrogens promote the growth and development of female sex organs and the maintenance of secondary sex characteristics in women. Therapeutic Effects: Restoration of hormonal balance in various deficiency states and treatment of hormone-sensitive tumors.

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Adverse Reactions/Side Effects
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(systemic use)

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CNS: headache, dizziness, insomnia, lethargy, mental depression. CV: MI, THROMBOEMBOLISM, edema, hypertension. GI: nausea, weight changes, anorexia, increased appetite, jaundice, vomiting. GU: womenamenorrhea, breakthrough bleeding, dysmenorrhea, cervical erosion, loss of libido, vaginal candidiasis; menerectile dysfunction, testicular atrophy. Derm: acne, oily skin, pigmentation, urticaria. Endo: gynecomastia (men), hyperglycemia. F and E: hypercalcemia, sodium and water retention. MS: leg cramps. Misc: breast tenderness.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of myocardial infarction, especially during exercise. Seek immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

  • Monitor signs of venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) to the physician.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of high calcium levels (hypercalcemia), including muscle pain, cramps, weakness, joint pain, confusion, and lethargy. Notify physician because severe cases can lead to stupor and coma.

  • Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

  • If treating menopausal symptoms, monitor severity and frequency of vasomotor symptoms (hot flashes) and other symptoms (vaginal/vulvular itching and irritation) to help document drug efficacy.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and ...

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