Quiz

72 y/o woman with a history of vertebral compression fracture and a DEXA T score of -2.7 in the left hip. What is the best initial therapy for this patient? A. Fosamax 70 mg weekly B. Calcitonin [1] spray to alternating nares qd C. Prempro 0.625/2.5 mg [1] qd D. Prolia 60 mg SQ every 6 months

A. Fosamax 70 mg weekly

75 y/o woman with newly diagnosed osteoporosis, being discharged after total hip replacement due to right hip fracture. She has never been medication for osteoporosis. PMH is significant for severe GERD, DVT [20 years ago], atrial fibrillation and family history of breast cancer. Which therapy may offer the MOST benefit in this patient? A. Prolia 60 mg SQ every 12 months B. Calcitonin [1] spray to alternative nares qd C. Evista 60 mg daily D. Forteo 20 mcg SC daily E. Reclast 5 mg IV every 12 months

A. Prolia 60 mg SQ every 12 months

53 y/o woman with history of esophageal stricture—recently treated successfully with dilatation—from longstanding GERD, and vasomotor symptoms of menopause. A recent DEXA showed a T score of -2.5 of the LS spine and -2.6 in the left hip. Which therapy is MOST appropriate? A. Prolia 60 mg SQ every 6 months B. Evista 60 mg po daily C. Actonel 35 mg po weekly D. Boniva 150 mg po monthly E. Calcitonin 200 units alternate nares qd

A. Prolia 60 mg SQ every 6 months

Which of the following is NOT a desired characteristic of a therapy for ED? A.leads to a prolonged erection [>4 hours] B.Minimal side effects C.Convenient administration D.Quick onset of action E.Few drug interactions

A.leads to a prolonged erection [>4 hours]

Which of the following is TRUE regarding Finasteride [Proscar]? A. Associated with significant HTN B. Associated with birth defects C. Effective within 2 weeks of initiation D. Renally eliminated

B. Associated with birth defects

68 y/o post menopausal woman with a history of T2DM, CAD, dyslipidemia, GERD, OA of knees, stage 3 CKD. Recent EGD was unremarkable. DEXA scan showed t score of -3 of the left hip. Which of the following precludes the used of a bisphosphonate? A. Age B. Renal disease C. GERD D. OA E. DM

B. Renal disease (Prolia would be ok)

What is the MOA of the PFE-5 inhibitors? A.Increase prostaglandin production B.Enhance effect of nitric oxide C.Cause vasoconstriction of the erection chamber D.Antagonize cyclic GMP

B.Enhance effect of nitric oxide

What is the most appropriate next step? A. Change the vaginal estrogen to oral B. Refer to urologist for biofeedback to assist with Kegel exercises C. Start Sudafed 30 mg BID D. Start Ditropan XL 5 mg daily

B.Refer to urologist for biofeedback to assist with Kegel exercises

Your patient is a 62 y/o female with UI, 6 weeks ago she began estrogen vaginal cream at bedtime and Kegel exercises—she says she is no better. She states she leaks whenever she is doing any activity—none when seated or recumbent. She has a history of HTN and she takes HCTZ to control her BP. What kind of UI are you treating? A.Urge incontinence B.Stress incontinence C.Mixed incontinence D.None of the above

B.Stress incontinence

What is the most important third step? A.Change the vaginal estrogen to oral B.Refer to urologist for biofeedback to assist with Kegel exercises C.Refer to urologist for consideration of periurethral bulking agents D.Start Sudafed 30 mg BID E.Start Ditropan XL 5 mg daily

C. Refer to urologist for consideration of periurethral bulking agents

Your patient is concerned about starting Terazosin because he is very sensitive to side effects of medications. Which of the following adverse effects would be most expected in this patient? A.ED B.Gynecomastia C.Dizziness D.Vomiting

C.Dizziness

Which of the following distinguishes the phosphodiesterase type 5 [PDE-5] inhibitor Tadalafil[Cialis] from the other inhibitors Sildenafil [Viagra] and Vardenafil[Levitra]? A.Efficacy B.Safety C.Duration of Action D.All of the above

C.Duration of Action

Which of the following drugs in most appropriate for managing incontinence related to bladder overactivity? A. Imipramine B. Estrogens C. Phenylpropanolamine D. Oxybutynin E. Bethanechol

D. Oxybutynin

Which agent [s] has/have a low likelihood of causing CV adverse effects in a patient with BPH who is also taken meds for HTN? 1. Alfuzosin [Uroxatrol] 2. Tamulosin [Flomax] 3. Finasteride [Proscar] A.1 only B.2 only C.3 only D.1 and 3 E.2 and 3 F.1, 2 and 3

E. 2 and 3

68 y/o man with several risk factors for osteoporosis— cigarette smoking, drinking 3-5 alcoholic drinks/day, low body weight and sedentary lifestyle. Labs reveal a 25 Vitamin D level of 18 mcg. Of the following, what will you recommend? A. Increase dietary intake of milk, eggs and catfish B. Increase sun exposure C. Calcium citrate with Vitamin D [200/200 IU] BID D. Vitamin D2 50,000 IU daily for 6-12 months E. Vit D3 [Calcitriol] 0.5 mcg daily for 8 wks, then 5,000 IU thereafter

E. Vit D3 [Calcitriol] 0.5 mcg daily for 8 wks, then 5,000 IU thereafter

Stimulation of muscarinic cholinergic receptors in the bladder muscle may be responsible for: A.Functional incontinence B.Urge incontinence C.Bladder overactivity D.Bladder underactivity E.Both B and C are correct

E.Both B and C are correct

Your patient is taking a PGE-5 inhibitor for ED—he is diagnosed with angina. Which of the following medications would be of particular concern in this man? A.Toprol XL B.CatapressTTS-2 patch C.Norvasc D.Lisinopril E.Isosorbide

E.Isosorbide

38 y/o woman who is at a health fair. She asks what she can do to maintain her bone health. Her mum had sever osteoporosis with vertebral fractures, spinal kyphosis, hip fracture and limited mobility. Your patient is 64 inches tall and weighs 115 pounds. She is postmenopausal. Her meds include OCP and a multivitamin daily; her DEXA scan shows a T score of -1.3 and a Z score of -.8. which exercise regimen is going to be most helpful to improve her bone health? A. Stair climbing B. Cycling C. Water aerobics D. Yoga E. Spin class F. Running G. A, D and F H. A and F

H. A and F

A pregnant patient is prescribed a medication that y produce toxicity if it is prolonged in the body. What physiological change in the pregnant woman would be most likely to cause an increased risk in toxicity? a. Increased glomerular filtration rate (GFR) b. Decreased renal blood flow c. Prolonged transit through the gut d. Increased hepatic metabolism

c. Prolonged transit through the gut

Response to medication in the infant and young child is influenced by factors that include the following concept: a. Infants under 6 months of age absorb orally administered drugs rapidly b. All nutrients and vitamins are well absorbed by young infants c. The absorption of topically applied drugs is enhanced in children as compared to adults d. Drugs are well absorbed form intramuscular sites in infants

c. The absorption of topically applied drugs is enhanced in children as compared to adults

45 year old African American woman who was a previous smoker has a BMI of 32 kg/m2. She is currently on a 1 week taper of Prednisone for an asthma flair. She is also taking Lisinopril 20 mg for HTN. Which of the following is associated with the most INCREASED risk for her developing osteoporosis in this patient? a. AA ethnicity b. Past smoker c. Present use of steroids d. Female gender e. BMI > 30 kg/m2

d. Female gender

In a frail elderly patient with a rapid and sever weight loss, poor oral intake, and taking multiple medications, which of the following pharmacokinetic principles is MOST relevant? a. Drug half-life b. Bioavailability of the drug c. First-pass effect d. Plasma protein binding

d. Plasma protein binding (ELDERLY DECREASED BODY WATER, INCREASED FAT, REDUCED PLASMA ALBUMIN ALLOWS MORE FREE DRUG TO CIRCULATE)