Dipiro diabetes, osteoporosis, contraception
Type 2 diabetes mellitus is NOT characterized by: A Insulin resistance B A major reduction in hepatic glucose output C A decline in β-cell function and/or mass over time D Low postprandial GLP-1 levels E A higher postprandial glucagon
B) a major reduction in hepatic glucose output is NOT a characteristic of T2DM
CC is a 57-year-old woman with osteoarthritis, GERD, migraines, and hypertension who takes omeprazole daily, lisinopril daily, ibuprofen TID as needed for pain, and sumatriptan as needed for migraines. Which condition or medication may increase her risk of osteoporosis? A Ibuprofen B Osteoarthritis C Omeprazole D Sumatriptan E Lisinopril
C Omeprazole
Use of the vaginal contraceptive ring would be most appropriate in which of the following women? A 30-year-old woman with hypothyroidism B 38-year-old woman who smokes one-pack-per-day C 36-year-old woman with migraines D 39-year-old woman with obesity
A 30-year-old woman with hypothyroidism
Type 1 diabetes mellitus is characterized by: A Absolute insulin deficiency, beta cell destruction, most present as adolescents B Primary insulin resistance, most present as adults C Obesity, high postprandial GLP-1 levels D Intrinsic hyperinsulinemia E Antibodies to insulin receptors
A Absolute insulin deficiency, beta cell destruction, most present as adolescents Notes: - type 2 diabetics often present with obesity and low postprandial GLP-1 levels ; diagnosis made when primary insulin resistance + beta cell loss is identified - Type 1 diabetics have absolute insulin deficiency (hence, not "intrinsic hyperinsulinemia")
A 70-year-old man with symptomatic hypogonadism is diagnosed with osteoporosis. He is thought to be at high risk for hip fracture. Which of the following is the best initial treatment? A Alendronate and testosterone B Ibandronate alone C Testosterone alone D Calcitonin and testosterone
A Alendronate and testosterone
A 36-year-old Caucasian woman is concerned about her risks for developing type 2 diabetes because her mother and father have the disease. Currently, she weighs 145 lbs (66 kg; BMI = 22 kg/m2) and has no other medical conditions. All of her children weighed less than 8 lbs (3.6 kg) at birth and she is preparing for her second marathon. The most appropriate recommendation for screening is to begin: A At the age of 45 then every 3 years if normal. B At the age of 45 then every year if normal. C At the age of 40 then every 3 years if normal. D At the age of 40 then every year if normal. E As soon as possible then every year if normal.
A At the age of 45 then every 3 years if normal.
A 36-year-old Caucasian woman is concerned about her risks for developing type 2 diabetes because her mother and father have the disease. Currently, she weighs 145 lbs (66 kg; BMI = 22 kg/m2) and has no other medical conditions. All of her children weighed less than 8 lbs (3.6 kg) at birth and she is preparing for her second marathon. The most appropriate recommendation for screening is to begin: A At the age of 45 then every 3 years if normal. B At the age of 45 then every year if normal. C At the age of 40 then every 3 years if normal. D At the age of 40 then every year if normal. E As soon as possible then every year if normal.
A At the age of 45 then every 3 years if normal.
A 65-year-old woman is taking osteoporosis prescription medication. She has high blood pressure, hypercholesterolemia, and diabetes type 2. After using motivational interviewing, you find she cannot increase her diet to achieve recommended calcium and vitamin D daily allowances. Her current intake of dietary calcium is 700 mg and vitamin D 100 units. Which supplement recommendation is best in light of cardiovascular concerns? A Calcium carbonate 625 mg plus 400 units vitamin D combination tablet twice daily B Calcium carbonate 500 mg daily and vitamin D 800 units daily C Calcium carbonate 1,200 mg daily and vitamin D 400 units daily D Two multivitamins daily
A Calcium carbonate 625 mg plus 400 units vitamin D combination tablet twice daily
A 32-year-old woman comes to the pharmacy to pick up her prescription for norgestimate/ethinyl estradiol (Ortho-Cyclen). She complains of nausea and headaches since starting her oral contraceptive 5 months ago. What do you recommend? A Call her physician to change her prescription to another oral contraceptive with less estrogen B Call her physician to change her prescription to another oral contraceptive with less progestin C Buy a home pregnancy test to rule out pregnancy D Wait another 1 to 2 months to see if symptoms improve
A Call her physician to change her prescription to another oral contraceptive with less estrogen
A patient has difficulty swallowing and is currently confined to bed. Subcutaneous denosumab represents first-line therapy for osteoporosis for this patient. Which of the following should be completed before initiating therapy with denosumab? A Correct any underlying hypocalcemia prior to administration. B Educate the patient on the need to remain upright after administration. C Ensure that the patient is aware the drug cannot be used for more than 2 years. D Determine the patient's thromboembolic risk.
A Correct any underlying hypocalcemia prior to administration. Note: - a precaution to denosumab use is hypocalcemia
PW is a 53-year-old woman with a history of esophageal stricture status-post dilatation due to longstanding GERD and vasomotor symptoms associated with menopause. A recent DXA scan showed a T-score of -2.5 in the lumbar spine and -2.6 in the left hip. Which therapy is most appropriate for PW? A Denosumab 60 mg subcutaneously every 6 months B Raloxifene 60 mg orally once daily C Risedronate 35 mg orally once weekly D Ibandronate 150 mg orally once monthly E Calcitonin 200 IU intranasal daily in alternating nostrils
A Denosumab 60 mg subcutaneously every 6 months
MM is an 82-year-old frail woman who is recovering from a vertebral compression fracture. At her follow-up appointment today, her primary care provider has asked the team to make interventions to reduce her fall risk. Which factor would decrease her risk of falls? A Discontinuation of oxybutynin B Changing amitriptyline to diphenhydramine for sleep C Use of lorazepam several nights per week D Initiation of metoprolol E Tapering of nonsteroidal anti-inflammatory agents
A Discontinuation of oxybutynin
The use of oral contraceptives has been linked (either directly or indirectly) to a decrease in the risk for which of the following types of cancer? A Endometrial cancer B Cervical cancer C Hepatocellular cancer D Breast cancer
A Endometrial cancer Note: - CHCs also shown to decrease ovarian cancer
Which statement is true about bone physiology and pathophysiology? A Estrogen is important in women and men to prevent bone resorption. B Bone loss due to aging is predominantly from increased osteoclast apoptosis. C Both osteoprotegerin and denosumab prevent RANKL from binding to the Wnt signaling pathway. D Sclerostin inhibits cathepsin K, thereby decreasing bone resorption.
A Estrogen is important in women and men to prevent bone resorption.
Which of the following statements regarding nonpharmacologic therapy for treatment of diabetes is true? A Individualized meal plans should be developed for people with diabetes based on cultural preferences, comorbidities, and daily schedule as much as possible. B Current clinical evidence supports the use of dietary supplements such as chromium in the management of diabetes. C Weight loss works best for patients with type 1 diabetes since most are overweight. D Long-term goals for physical activity should include at least 30 minutes of aerobic exercise once a week for all patients with diabetes. E Influenza vaccinations are recommended for all patients with diabetes every 5 years.
A Individualized meal plans should be developed for people with diabetes based on cultural preferences, comorbidities, and daily schedule as much as possible
How does zoledronic acid work? A Inhibits osteoblast secretion of RANKL B Inhibits release of bone destroying enzymes C Inhibits osteoclast binding to the bone D Inhibits osteoclast maturation and function E Increases Wnt signaling pathway to increase osteoblasts and bone formation
A Inhibits osteoblast secretion of RANKL MOA of bisphosphonates (alendronate, risendronate, ibandronate, zolendronic acid) Antiresorption agents - first line therapy Block prenylation - farnesyl diphosphate synthase Inhibit GTPase signaling protein Decrease osteoclast maturation, number, and life span Interfere with osteoclast recruitment ----- inhibit secretion of RANKL Impair osteoclast adhesion to bone
KR is a 39-year-old nonsmoking female with a history of migraines with aura. She has two children with no immediate plans for others. She is obese and weighs 115 kg. What contraceptive method would be the best option? A Levonorgestrel IUD (Mirena) B Progestin implant (Implanon) C Combined oral contraceptive D Vaginal ring contraceptive
A Levonorgestrel IUD (Mirena) Notes: - Obesity has not been noted to have an effect on efficacy of DMPA or levonorgestrel IUD - oral agents and transdermal patches should not be used first line in women over 90kg due to sequestration of hormone in adipose tissue (decreased serum concentration) in addition to increased hepatic clearance
Which of the following pairs correctly matches the medication with its //most common adverse effects? A Raloxifene—hot flushes, blood clots B Calcitonin—rhinitis, epistaxis, atypical fractures C Denosumab—increased cholesterol, serious infections, osteonecrosis of the jaw D Bisphosphonates—nausea, abdominal pain, osteonecrosis of the jaw
A Raloxifene—hot flushes, blood clots Notes: - Atypical fractures are adverse effects of bisphosphonates, but NOT a COMMON one - Correct common adverse effects of bisphosphonates are: Upper GI symptoms (Nausea, abdominal pain, Heartburn, esophageal irritation, Ulcer, perforation, bleeding), Muscle, bone, and joint pain (early or late adverse effect; usually reversible), IV administration-Fever, chills, acute-phase reaction - While ONTJ is a potential adverse effect of bisphosphonates and denosumab (RANKL inhibitor), it is NOT a COMMON one - Correct common adverse effects of denosumab: Back, shoulder, leg, and musculoskeletal pain, increased cholesterol, cystitis
Select the agent that can be administered monthly for osteoporosis treatment. A Risedronate B Raloxifene C Zoledronic acid D Alendronate
A Risedronate Notes: - Risedronate is taken orally either daily, weekly, every 2 consecutive days, or monthly. Ibandronate is also available as an oral monthly formulation. - Zoledronic acid is given IV annually - Alendronate is taken PO QD or weekly - raloxifine is taken PO QD
RR is a 26-year-old woman who has just been diagnosed with premenstrual dysphoric disorder (PMDD) and is also seeking contraception. She is otherwise healthy and is not obese or overweight. Which of the following products is best to recommend for RR? A YAZ B Ortho Tri-Cyclen C Estrostep D Mircette E Yasmin
A YAZ
Which drug therapy may mask the signs of hypoglycemia? A Atenolol B Valsartan C Hydrochlorothiazide D Pioglitazone
A Atenolol Notes: - β-Blockers have been known to mask signs or symptoms of hypoglycemia. The one sign that it may not mask is diaphoresis or sweaty palms. - Hydrochlorothiazide is not noted to mask hypoglycemia; however, transiently may worsen glucose control.
DL is a 19-year-old woman who calls you and states that she forgot to take her Desogen (EE 30-μg/0.15 mg desogestrel) tablets for the last 2 days. She says she is in her second week of the cycle. Select the following statement that is most appropriate for missed tablets. A DL should take two tablets the next day and use a backup method for 7 days. B DL should continue taking her tablets as scheduled, one per day, no backup method is necessary. C DL should discard her pill pack and start a new one, use a backup method for 7 days. D DL should take two tablets for 2 days, no backup method is necessary.
A DL should take two tablets the next day and use a backup method for 7 days. Notes: - If two tablets of a COC are missed, the most recent missed dose should be taken and a backup method should be used for 7 days, and EC may also be used if unprotected intercourse occurred within the last 5 days. - DL does not need to start a new pack because she is in her second week of the cycle meaning she will have at least 7 days of active tablets remaining.
K is a 32-year-old woman who weighs 75 kg and is 5 " 1 in. Which of the following is best to avoid in overweight/obese patients because of the side effects of weight gain? A Depo-Provera B NuvaRing C Ortho Evra D Yasmin
A Depo-Provera Notes: - Depo-Provera is not the best agent to use in women who are overweight or obese because it may cause more weight gain. - Ortho Evra has not been shown to cause a significant weight gain but should be avoided due to decreased effectiveness in women weighing more than 198 lb
TB is a 78-year-old man with a history of vertebral compression fractures, hypertension, osteoarthritis, and depression. Spinal kyphosis is noted on physical examination. Laboratory results show normal testosterone and vitamin D levels. DXA results include aT-score of -2.2 in the left hip and -2.9 in the lumbar spine. His physician would like to initiate treatment for osteoporosis. Which initial therapy is recommended for this patient? A Testosterone 200 mg intramuscularly every 4 weeks B Alendronate 70 mg orally once weekly 30 minutes before breakfast C Calcitonin salmon nasal spray one spray daily in alternating nostrils D Teriparatide 20 mcg subcutaneously daily E Ibandronate 150 mg by mouth every month
B Alendronate 70 mg orally once weekly 30 minutes before breakfast
A 72-year-old woman with a history of hypertension, gastroesophageal reflux disease, and breast cancer status-post completion of anastrozole therapy 7 years ago presents to a primary care physician for a new patient work-up. Her current medications include lisinopril 5 mg daily and omeprazole 20 mg daily. The physician would like to evaluate the patient for the presence of osteoporosis. Which evaluation or tests would aid in the decision to recommend drug therapy for osteoporosis in this patient? A Calcium and vitamin D laboratory tests B Bone densitometry; thoracic and lumbar spine x-ray C Evaluation of exercise and exercise tolerance D Basic metabolic panel and biochemical markers of bone turnover E Fall risk assessment
B Bone densitometry; thoracic and lumbar spine x-ray
A 23-year-old frantic woman comes to the pharmacy asking for advice. She had sexual intercourse last night and her partner's condom broke. She states she has a past medical history of type 2 diabetes and hypothyroidism. What do you recommend? A Purchase a home pregnancy test B Buy levonorgestrel-containing emergency contraception at the pharmacy C Make an appointment with her physician to discuss emergency contraception D Do nothing and reassure her that she is not likely to get pregnant
B Buy levonorgestrel-containing emergency contraception at the pharmacy
Mr. Jones, a 60-year-old man who just started treatment for prostate cancer, wants to know why his doctor wants to start an osteoporosis medication. Which of the following is the best response? A Osteoporosis medications destroy cancer cells. B Cancer and some chemotherapy cause bone loss and fractures that can be prevented with these medications. C Because of his age, Mr. Jones should take these medications to prevent osteoporosis. D The osteoporosis medication is not needed.
B Cancer and some chemotherapy cause bone loss and fractures that can be prevented with these medications.
Contraceptives that can prevent both pregnancy and STIs include: A Diaphragms B Condoms C Intrauterine devices D Both A and B
B Condoms
Rapid return of fertility would be least likely to occur upon discontinuation of which of the following contraceptives: A NuvaRing B Depo-Provera C Yasmin D Ortho Evra
B Depo-Provera
An 18-year-old woman with a seizure disorder seeks contraception today. She is taking carbamazepine. Which of the following contraceptive methods would be most appropriate? A Combined oral contraceptive (with 35 mcg of ethinyl estradiol) B Depo-medroxyprogesterone acetate C Transdermal contraceptive D Progestin-only oral contraceptive
B Depo-medroxyprogesterone acetate Note: - DMPA is recommended in women with seizure disorders as it may decrease seizure rate and provide effective contraception
In which of the following situations would it be inappropriate to recommend combined oral contraceptives? A Sickle-cell disease B Hypertension treated with a diuretic and an average blood pressure of 172/92 mm Hg C History of migraines without aura in women less than 35 year of age D Dyslipidemia without coronary artery disease treated to goal LDL with a statin
B Hypertension treated with a diuretic and an average blood pressure of 172/92 mm Hg Notes: - the preferred agent for sickle-cell disease is DMPA, however CHCs are likely safe and benefit > risk in most patients - CHCs are contraindicated if history of stroke, CAD, or MI. Risk factors that magnify risk for CVD when given CHC are HTN, smoking, advancing age, and diabetes. - CHCs are CI when Migraine + aura due to increased risk of stroke - Women with Uncontrolled lipids and other CV risk factors should use another method. Progestins decrease HDL and increase LDL but estrogens do the opposite with possible increase to TG, however most low dose CHCs have no significant lipid effect.
A 33-year-old nonobese woman wants to discuss her contraceptive options. She is married with two children and does not desire to have additional children. Her medical history includes hypertension and migraines with aura. Which one of the following is the best approach to hormonal contraception for this patient? A Ortho Cyclen (combined oral contraceptive) B Implanon (implantable contraceptive) C Ortho Evra (transdermal patch) D Nuvaring (vaginal contraceptive)
B Implanon (implantable contraceptive) Notes: CHCs are contraindicated in women who have migraines + aura due to increased risk of stroke. - Ortho Cyclen is a CHC (EE/norgestimate) - Ortho Evra is a transdermal patch CHC (ethinyl estradiol/norelgestromin) - Nuvaring is a vaginal ring CHC (ethinyl estradiol/etonogestrel) - Implanon is an implantable (subdermal) rod - synthetic progestin
The most clinically useful indicator of approaching ovulation is: A Estrogen surge B LH surge C Progesterone drop D Corpus luteum degeneration
B LH surge
COCs work by inhibiting ovulation. The progestin component of COCs works mainly by suppressing which of the following hormones: A Gonadotropin-releasing hormone (GnRH) B Luteinizing hormone (LH) C Follicle-stimulating hormone (FSH) D Growth hormone (GH)
B Luteinizing hormone (LH) Note: - FSH is NOT greatly suppressed by progestins as it is by estrogens - progestins mainly cause atrophy to the endometrium, thickening of cervical mucous, prevention of LH surge (blocks ovulation), and reduced ovum motility in the fallopian tube
PM is a 68-year-old woman with a past medical history of hypertension and osteoarthritis who has been told by her primary care physician that she should start risedronate treatment of osteoporosis (T-score of -2.6 at femoral neck). Her other medications include chlorthalidone 25 mg daily and ibuprofen 600 mg TID. She recently read in a women's magazine that medications like alendronate and risedronate can cause "jaw problems," especially in patients who have dental procedures. She is concerned about starting the medication because she needs to have some dental work done. What factor could increase her risk for osteonecrosis of the jaw (ONJ)? A Concomitant thiazide diuretic use B Preexisting dental disease C Use of oral instead of IV bisphosphonate D Use of concomitant gastrointestinal toxic drugs E There are no risk factors that could increase her risk of ONJ
B Preexisting dental disease
PM is a 68-year-old woman with a past medical history of hypertension and osteoarthritis who has been told by her primary care physician that she should start risedronate treatment of osteoporosis (T-score of -2.6 at femoral neck). Her other medications include chlorthalidone 25 mg daily and ibuprofen 600 mg TID. She recently read in a women's magazine that medications like alendronate and risedronate can cause "jaw problems," especially in patients who have dental procedures. She is concerned about starting the medication because she needs to have some dental work done. What factor could increase her risk for osteonecrosis of the jaw (ONJ)? A Concomitant thiazide diuretic use B Preexisting dental disease C Use of oral instead of IV bisphosphonate D Use of concomitant gastrointestinal toxic drugs E There are no risk factors that could increase her risk of ONJ
B Preexisting dental disease
A 25-year-old single, nulliparous, nonsmoking female with no significant medical history wants an easy, highly effective, and quickly reversible contraceptive method. What would you recommend? A Combined oral contraceptive B Progestin implant (Implanon) C Depo-medroxyprogesterone acetate D Progestin-only oral contraceptive
B Progestin implant (Implanon)
A healthy woman who is 3 weeks postpartum and breast-feeding seeks contraception. She would like to have another child in 1 year. Which of the following is the preferred method of contraception? A Combined oral contraceptive B Progestin-only oral contraceptive C Depo-medroxyprogesterone acetate D Transdermal contraceptive
B Progestin-only oral contraceptive Notes: - CHCs may be used after breastfeeding is well established (6wks postpartum) - DMPA should not be used in her case because she desires a quick return to fertility
SP is a 60-year-old postmenopausal obese woman with a history of DVTs. She has a family history of osteoporosis and breast cancer and inquires about the use of raloxifene, because she heard that it might prevent osteoporosis and protect against breast cancer. Which one of the following is a correct statement? A She does not have an indication for raloxifene due to her menopausal status. B She has a contraindication due to her history of DVT. C Her family history of breast cancer precludes use of raloxifene. D Raloxifene is not indicated for her age group. E Raloxifene is an appropriate agent for MW.
B She has a contraindication due to her history of DVT.
Which of the following is true regarding the action of insulin? A Enhances ketone production B Stimulates glucose uptake in the periphery C Activates peroxisome proliferator-activated receptor-γ (PPAR-γ) D Increases amylin production
B Stimulates glucose uptake in the periphery Notes: - Insulin stimulates glucose uptake into muscles and adipose tissue. Stimulates hepatic glucose uptake. Stimulates amino acid uptake and protein synthesis. Inhibits hepatic glucose production. Inhibits breakdown of triglycerides in adipose tissue. Inhibits protein degradation.
A patient has difficulty swallowing and is currently confined to bed. Which agent represents first-line therapy for osteoporosis in this patient? A Subcutaneous teriparatide B Subcutaneous denosumab C Intranasal calcitonin D Effervescent alendronate
B Subcutaneous denosumab
LR is a 27-year-old woman who started on a low dose combined oral contraceptive containing 20 mcg ethinyl estradiol (EE) 2 months ago. She went out of town for the weekend and missed two doses of her medication. It is the third week of her cycle. She is now asking for your opinion on how she should handle the situation. What would be the most appropriate response? A Take an active tablet as soon as possible (two tablets on that day) and then continue taking tablets daily, 1 each day. No additional contraceptive protection is recommended B Take an active tablet as soon as possible (two tablets on that day) and then continue taking tablets daily, 1 each day. Use condoms or abstain from sex until tablets have been taken for 7 days in a row. Finish the active tablets in the current pack and start a new pack the next day (i.e., do not take the seven inactive tablets). C Discard the current pack, allow bleeding to occur and then restart a new pack, taking 1 tablet each day. Use condoms or abstain from sex until the new pill pack has been taken for 7 days in a row D Take an active tablet as soon as possible (two tablets on that day) and then continue taking tablets daily, 1 each day. Use condoms or abstain from sex until tablets have been taken for 7 days in a row
B Take an active tablet as soon as possible (two tablets on that day) and then continue taking tablets daily, 1 each day. Use condoms or abstain from sex until tablets have been taken for 7 days in a row. Finish the active tablets in the current pack and start a new pack the next day (i.e., do not take the seven inactive tablets).
Unlike COCs, which of the following risks has not been associated with progestin-only pills? A Hypertension B Venous thromboembolism C Headaches D Acne
B Venous thromboembolism
RS just started a new combined oral contraceptive 2 weeks ago and has had some mild nausea when she takes the pill. What is the best recommendation for RS with respect to changing products? A Change the oral combined contraceptive to another agent this week. B Wait for 3 months to see if side effects improve, if not change products. C Wait for 2 months to see if side effects improve, if not change products. D Wait for 6 months to see if side effects improve, if not change products
B Wait for 3 months to see if side effects improve, if not change products Notes: - It is recommended to try a COC for at least 3 months before changing products. For counseling, patients may be instructed to take COCs at bedtime to help decrease nausea.
BW is a 28-year-old obese woman who delivered a baby 1 week ago via C-section. She does not plan to breast-feed and would like to start a combined oral contraceptive as soon as possible. When is the earliest she can start taking combined oral contraceptives without an increased risk of blood clots? A Immediately B 2 weeks postpartum C 6 weeks postpartum D 6 months postpartum
C 6 weeks postpartum Notes: - Higher risk for blood clots if CHCs are taken <6 wks postpartum - could start at 3 wks if no risk factors for VTE and is NOT breastfeeding - BW recently had a C-section & is obese putting her at risk for a VTE, therefore starting CHC @6 wks is the best recommendation
Which osteoporosis drug is correctly matched with its contraindication? A Zoledronic acid—previous thromboembolism B Calcitonin—bone pain C Denosumab—uncorrected hypocalcemia D Raloxifene—osteosarcoma E Teriparatide—uncorrected hypocalcemia
C Denosumab—uncorrected hypocalcemia
All of the following are the functional phases of the menstrual cycle except: A Follicular B Ovulatory C Implantation D Menstrual
C Implantation
If a woman has breakthrough bleeding or spotting that continues the first 10 days beyond her normal menses, what would be the most appropriate suggestion to decrease this side effect? A Increase progestin dose B Decrease progestin dose C Increase estrogen dose D Decrease estrogen dose
C Increase estrogen dose
A 36-year-old patient who is fairly nonadherent to medications and has never been on hormonal contraception in the past is requesting contraception. She is a smoker. What would be the most appropriate recommendation? A Nuvaring (vaginal contraceptive) B Ortho-Cyclen (combined oral contraceptive) C Injectable depo-medroxyprogesterone D Micronor (progestin-only pill)
C Injectable depo-medroxyprogesterone
CC is a 57-year-old woman with osteoarthritis, GERD, migraines, and hypertension who takes omeprazole daily, lisinopril daily, ibuprofen TID as needed for pain, and sumatriptan as needed for migraines. Which condition or medication may increase her risk of osteoporosis? A Ibuprofen B Osteoarthritis C Omeprazole D Sumatriptan E Lisinopril
C Omeprazole
Which of the following is considered to be an absolute contraindication to the use of COCs? A Smoking 10 cigarettes per day B History of migraine headache disorder without aura C Postpartum 2 weeks following delivery D Uterine fibroids
C Postpartum 2 weeks following delivery Notes: Absolute contraindications to CHCs - smoking >15 cigarettes daily and >35 years old - migraine + aura - <21 days postpartum (DVT risk) - SLE (aggravate symptoms and increase risk of VTE but CI if + for antiphospholipid Ab) - history of stroke, CAD, MI - personal history of VTE - personal history of breast cancer - diabetic & vascular disease - uncontrolled lipids & other CV risk factors - avoid in stage II HTN
Which instruction for administration should be relayed to a patient on ibandronate? A Take 30 minutes after breakfast. B Remain upright for 15 minutes after taking. C Take with at least 6 ounces (180 mL) of water. D Take with calcium and vitamin D tablet
C Take with at least 6 ounces (180 mL) of water.
Which of the following is not an example of an extended-cycle contraceptive? A Loestrin 24 Fe B Seasonique C Yasmin D Lybrel
C Yasmin
Which of the following oral contraceptives is available by prescription only? A Plan B One Step B My Way C ella D Next Choice One Dose
C ella
RS is a 67-year-old Asian woman with a T-score of −2.7. She is 5 " 6 in and 127 lb. She was admitted to the hospital with leg swelling that was diagnosed as deep vein thrombosis (DVT) and was ultimately referred to your clinic upon resolution and discharge. Her medical history includes hypertension, osteoarthritis, and diabetes. She currently takes furosemide, Accupril, celecoxib, metformin, and aspirin. Which of the following is the best answer? Select all that apply. A RS should begin taking calcium 1000 mg qd and vitamin D 400 IU qd. B RS is a candidate for estrogen 0.625 mg po qd. C RS is a candidate for ibandronate 3 mg IV every 3 months. D RS is a candidate for raloxifene 60 mg po qd.
C RS is a candidate for ibandronate 3 mg IV every 3 months. Notes: - RS is a candidate for osteoporosis treatment, including ibandronate IV. She should also begin taking calcium 1200 mg qd and vitamin D 800 to 1000 IU qd. - Patients at age 50+ require calcium 1200 mg qd and vitamin D 800 to 1000 IU qd.
Which patient is a candidate for screening BMD measurement? A 55-year-old woman with osteoarthritis B 48-year-old woman with wrist fracture secondary to motor vehicle crash C 69-year-old man with 40 pack-year history of smoking, quit 5 years ago D 68-year-old woman with 2-cm height loss from adulthood E 25-year-old woman who received a 10-day course of steroids for asthma
D 68-year-old woman with 2-cm height loss from adulthood
FRAX should be used to calculate fracture risk in which patient to determine whether there is a need for therapy? A A 70-year-old woman currently on alendronate therapy B A postmenopausal woman with a T-score of the femoral neck of -3.0 C A postmenopausal woman currently completing teriparatide D A 66-year-old woman with a T-score of the femoral neck of -2.0 E A 70-year-old man with a T-score of the spine of -3.0 and a low-trauma vertebral fracture
D A 66-year-old woman with a T-score of the femoral neck of -2.0
Which of the following is true regarding bisphosphonates? A Ibandronate oral should be taken with food to minimize any GI side effects. B Risedronate should be taken at bedtime to minimize central nervous system side effects, including dizziness. C A patient receiving zoledronic acid should avoid drinking high-mineral water (eg, well water). D A patient taking alendronate should also routinely be taking calcium and vitamin D.
D A patient taking alendronate should also routinely be taking calcium and vitamin D. Notes: - All oral bisphosphonates, including ibandronate, should be taken on an empty stomach, as food greatly diminishes absorption. - All oral bisphosphonates, including risedronate, should be taken first thing in the morning, with a full glass of water while the patient remains upright to avoid esophageal/GI irritation. - Zoledronic acid is given IV and will not be affected by water intake. Patients should avoid high-mineral water when taking oral bisphosphonates due to the decreased bioavailability. - A patient taking alendronate, or any bisphosphonate, should routinely take calcium and vitamin D per WHO guidelines. One caveat for oral bisphosphonates, however, is to avoid taking supplements within 60 minutes of the BP to avoid effecting bioavailability.
Potential risks associated with the use of oral contraceptives include all of the following except: A Venous thromboembolism B Hypertension C Gallbladder disease D Breast cancer
D Breast cancer
A 66-year-old woman with a femoral neck T-score of -0.5 and a spine T-score of -0.9 asks for recommendations for calcium and vitamin D. According to the National Osteoporosis Foundation, which daily intake do you recommend that she achieve? A Calcium 600 mg and vitamin D 600 units B Calcium 600 mg and vitamin D 800 units C Calcium 1,200 mg and vitamin D 600 units D Calcium 1,200 mg and vitamin D 1,000 units E Calcium 1,500 mg and vitamin D 2,000 units
D Calcium 1,200 mg and vitamin D 1,000 units
AT is a 26-year-old female with a history significant for depression, dysmenorrhea, and smoking. She is not currently using hormonal contraception. She and her boyfriend were on a cruise and did not use a condom and had unprotected sexual intercourse 5 days ago. What is the best recommendation? A Buy levonorgestrel-containing emergency contraception at the pharmacy B Buy a home pregnancy test C Inform her there is no emergency contraception option for her particular situation D Call her clinician with a recommendation for a verbal order for ulipristal emergency contraception
D Call her clinician with a recommendation for a verbal order for ulipristal emergency contraception. Notes: - If vomiting occurs within 3 hours, dose should be repeated. Menstrual bleeding typically occurs within 3 days after administration. Advise her to perform pregnancy test and contact PCP if menstrual period is delayed by >1wk beyond the expected date. - Would not recommend levonorgestrel (PlanB) because Ella (ulipristal) is more effective at 120 hours. - Can take ella up to 5 days after unprotected intercourse; 85% effective. - Can also use copper IUD emergency contraception within 5 days for >99% effectiveness but this requires MD insertion and is more expensive.
AK is a 66-year-old woman who was recently prescribed teriparatide. Which is an important counseling point for this medication? A Injection pens should be kept frozen until they are ready to be used. B Each injection pen should last 90 days. C This medication should be administered once a month. D Contact your doctor right away if you have bone pain. E This medication can only be used for a maximum of 5 years.
D Contact your doctor right away if you have bone pain.
AC is a 26-year-old woman who presents to the pharmacy asking to buy emergency contraceptive (Plan B One-Step) and says she had unprotected intercourse 3 days ago. Based on the information, select the best statement as it relates to EC. A EC will not be effective for AC because it has been more than 24 hours since she has had unprotected sex. B EC will not be effective for AC because it has been more than 48 hours since she has had unprotected sex. C EC cannot be provided to AC without a prescription from her doctor. D EC may still work for AC because it is still within 72 hours since she has had unprotected sex. E EC may still work for AC because it is still within 120 hours since she has had unprotected sex, but she will require a prescription.
D EC may still work for AC because it is still within 72 hours since she has had unprotected sex. Notes: - there is moderate efficacy up to 120 hours after intercourse, however efficacy starts to decline after the first 72 hours
TD is a 68-year-old man with several risk factors for osteoporosis, including current cigarette smoking, alcohol consumption of three to five drinks per day, low body weight, and physical inactivity. Laboratory test results showed 25-hydroxyvitamin D level of 18 ng/mL (45 nmol/L). What recommendation can be made for TD to decrease his osteoporosis risk? A Increase dietary intake of fortified milk, egg yolks, and salt-water fish B Increase sun exposure + vitamin D3 800 IU daily C Calcium citrate + D3 200 IU twice daily + multivitamin (vitamin D3 400 IU) daily D Ergocalciferol 50,000 IU once weekly for 8 weeks; then cholecalciferol 2000 IU daily E Ergocalciferol 50,000 IU once weekly indefinitely
D Ergocalciferol 50,000 IU once weekly for 8 weeks; then cholecalciferol 2000 IU daily
RW is a 45-year-old African-American woman with an 18 pack-year smoking history who quit 10 years ago and has a BMI of 32 kg/m2. She is currently on a 1-week prednisone taper for an asthma exacerbation and takes lisinopril 20 mg daily for hypertension. Which characteristic is associated with an increased risk of developing osteoporosis? A African American ethnicity B Presence of hypertension C Present systemic oral glucocorticoid therapy D Female sex E BMI greater than 30 kg/m2
D Female sex
Ms. Martinez, a 40-year-old woman with a long-standing history of inflammatory bowel disease for which she takes glucocorticoids on and off, is discussing the results of her DXA examination—Z-score lumbar spine -2.8 and femoral neck (right) -2.5. Besides a bone-healthy lifestyle, what should she begin today? A All medications are contraindicated, so she should try running every day. B Data support bisphosphonates in premenopausal women, but concerns exist about the effects on a fetus. C Phytoestrogens can prevent osteoporosis and decrease fracture risk. D If she uses birth control, she could use a bisphosphonate, although few data exist about their long-term safety.
D If she uses birth control, she could use a bisphosphonate, although few data exist about their long-term safety.
Select the agent most likely to have its metabolism increased by a COC. A Theophylline B St. John's wort C Rifampin D Lamotrigine
D Lamotrigine
You identify a woman who has not refilled her alendronate prescription for the last 3 months. She tells you she is concerned about getting osteonecrosis of the jaw (ONJ). Your response is? A There is no risk of ONJ with oral osteoporosis medications. B ONJ only happens in patients with cancer. C Because of the risk of ONJ, you call her doctor to get it switched to raloxifene. D ONJ is very rare and she is more likely to get a hip fracture.
D ONJ is very rare and she is more likely to get a hip fracture.
A 22-year-old woman has been using Depo-Provera for the past year. She comes to the office for her quarterly injection (her last injection was 13 weeks ago). The nurse asks you about the administration of Depo-Provera, and you recommend that she: A Have the patient wait until her next menses before receiving the injection B Return to the office next week for her injection C Give the injection today but use a second method of contraception for the next cycle D Obtain a pregnancy test and if negative give the injection today
D Obtain a pregnancy test and if negative give the injection today Notes: - if given up to 14 days late, get injection asap and no backup/emergency contraception needed - if given 14 or more days late, give injection if woman tests negatively for pregnancy and use back up contraception for 7 days and consider emergency contraception. Repeat pregnancy test in 3 weeks
SD is a 45-year-old woman. She does not have any significant past medical history and currently smokes one- half pack a day and drinks alcohol socially. She attends a health fair and learns her T-score is −1.5. Which is the best course of action? A SD has osteopenia and should be started on alendronate 70 mg po every week. B SD has no physical signs or symptoms of osteoporosis and should be advised to quit smoking and to have her BMD checked again in 6 months. C SD is young and should be started on teriparatide 20 μg SQ qd to rebuild her bone mass to more normal levels. D SD should be started on calcium 1000 mg and vitamin D 800 IU qd.
D SD should be started on calcium 1000 mg and vitamin D 800 IU qd. Notes: - SD is not currently taking calcium or vitamin D per WHO guidelines. Though this may or may not fully explain her low BMD score, it is the most logical starting point to minimize the risk of developing osteoporosis. - While SD does have osteopenia based on the WHO guidelines, it would be prudent to do a more thorough assessment before initiating a bisphosphonate at this point. Furthermore, if a bisphosphonate is ultimately deemed appropriate, the "prevention" dose of alendronate is 5 mg po qd or 35 mg po every week.
The most effective fertility awareness-based contraceptive method is thought to be the: A Calendar (rhythm) method B Temperature method C Cervical mucous method D Symptothermal method
D Symptothermal method
In a woman with which of the following scores should bisphosphonate therapy be recommended? A T-score lumbar spine of 0.2 B T-score lumbar spine of -0.9 C T-score lumbar spine of -2.0, T-score femoral neck of -2.0 and 10-year probability of hip fracture of 2% D T-score femoral neck of -2.2 and 10-year probability of hip fracture of 5% E T-score femoral neck of -2.4 and 10-year probability of major osteoporotic fracture of 15%
D T-score femoral neck of -2.2 and 10-year probability of hip fracture of 5%
A patient with poorly controlled type 2 diabetes mellitus with extreme insulin resistance is currently on a total daily dose of 300 units of U-100 insulin. They are being transitioned to a concentrated insulin preparation. Which of the following would be appropriate? A U-200 insulin degludec: inject 300 units subcutaneously daily (Given as 2 injections of 150 units each) B U-500 regular insulin: inject 100 units (20 units as measured by the unit markings of a U-100 syringe) subcutaneously three times daily before meals C U-300 insulin glargine: inject 300 units subcutaneously daily (given as 4 injections of 75 units each) D All are correct
D) all are correct
You are a pharmacist involved in bone density screening during a health fair in your community. Several patients present to your booth for a peripheral bone density measurement. Based on the following descriptions and recommendations from the National Osteoporosis Foundation, who should be referred to a health care provider for follow-up and evaluation of bone mineral density by central DXA? A 71-year-old man with low bone mineral density B 66-year-old woman with low calcium intake and nicotine dependence C 53-year-old active African-American man receiving chronic glucocorticoid therapy D 58-year-old woman with a FRAX 10-year probability of hip fracture of 3.2% E All of these patients meet criteria for screening by central DXA.
E All of these patients meet criteria for screening by central DXA. Notes: A is a male 70+ B is a woman 65+ and smoker C is on chronic glucocorticoids (drug induced osteoporosis) D has a hip fracture FRAX greater than 3%
CM is a 62-year-old woman who recently started bisphosphonate therapy for osteoporosis. Due to a history of dry mouth, the patient is experiencing difficulty swallowing her ibandronate tablets. What the best recommendation for CM? A Take ibandronate with the first meal of the day. B Take ibandronate with a full glass of milk. C Crush the ibandronate tablet and mix it with a small amount of pudding or applesauce and take it. D Dissolve ibandronate in a full glass of water and drink it. E Consider switching to an IV bisphosphonate.
E Consider switching to an IV bisphosphonate.
A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than normal and has lost approximately 20 pounds (9.1 kg) in the past 6 months without trying. His random glucose today is 252 mg/dL (14.0 mmol/L). Which of the following is most appropriate to confirm diagnosis of type 2 diabetes? A Obtain a fasting glucose level in the morning. B Have patient perform a 2-hour oral glucose tolerance test. C Obtain patient's hemoglobin A1c. D Obtain a repeat random glucose level. E Nothing; there is enough information available to diagnose patient with type 2 diabetes.
E Nothing; there is enough information available to diagnose patient with type 2 diabetes.
RS is a 75-year-old woman with newly diagnosed osteoporosis who is being discharged from the hospital after total hip replacement due to hip fracture. She has never taken any medication for osteoporosis. Her history is significant for GERD, DVT associated with oral contraceptive use 20 years ago, and family history of breast cancer. Which therapy may offer the most benefit in this patient? A Denosumab 60 mg subcutaneously every 6 months B Calcitonin one spray daily in alternating nostrils C Raloxifene 60 mg orally daily D Teriparatide 20 mcg subcutaneously daily E Zoledronic acid 5 mg IV every 12 months
E Zoledronic acid 5 mg IV every 12 months
Please choose the correct statement. A Diabetes mellitus associated with cystic fibrosis involves severe insulin resistance. B Diabetes mellitus is most often due to autoimmune destruction of pancreatic β-cells. C The incidence of MODY diabetes increases with age. D Type 1 diabetes accounts for about 20% of cases of diabetes. E All of the above are incorrect.
E) all of the above are incorrect
Question 23: Incorrect CS is a 36-year-old woman who admits to smoking one pack of cigarettes per day. She is getting married and would like to start hormonal contraception. Which of the following products is most appropriate for CS? A NuvaRing B Ortho Evra C Mircette D Tri-Levlen E Nor-QD
E. Nor-QD Notes: - Nor-QD is a POP and is not contraindicated in women older than 35 who smoke - NuvaRing, Ortho Evra, Mircette, and Tri-Levlen are CHCs containing ethinyl estradiol. EE is contraindicated in women over 35 years and who smoke more than 15 cigarettes per day (stroke and blood clot risk)