Pharmacology - Prep U - Chapter 41

A male clent who uses a transdermal testosterone gel for treatment of his oligospermia applies the medication first thing in the morning and washes it off before bed. What client education is necessary?

Leave the gel on until the next application is due. Topical gel produces normal serum testosterone levels within 4 hours of application, and the absorption continues for 24 hours. Steady-state serum concentrations occur by the second or third day of use. When gel use is discontinued, serum testosterone levels remain steady for 24 to 48 hours but decrease to pretreatment levels within about 5 days.

A client has been receiving long-term testosterone therapy. The nurse would expect to monitor:

Liver function studies A potentially life-threatening effect associated with long-term testosterone use is hepatocellular cancer. Clients should have liver function studies monitored regularly, before beginning therapy and every 6 months during therapy.

A young man has received a diagnosis of androgen deficiency and has been prescribed testosterone. At clinic follow-up appointments, the nurse should prioritize which assessment?

weight and measurement of blood pressure For clients who are being treated with androgens, the nurse should regularly assess the client's blood pressure and body weight, as these may be affected by androgens. Urine testing and bladder ultrasound are generally unnecessary. It is prudent to monitor blood glucose levels, but assessment of DTRs is not required.

What aspect of a client's current health status may contraindicate the use of a PDE5 inhibitor?

The client has a history of unstable angina pectoris. Clients who are not sufficiently healthy to engage in sex should not be prescribed PDE5 inhibitors. Unstable angina may preclude the exertion necessary for sexual activity, and it is often treated with nitrates, contraindicating the use of PDE5 inhibitors. Obesity, diabetes, seizures, and the use of antiseizure medications do not contraindicate PDE5 inhibitors.

A male adolescent is prescribed testosterone. In order to help the client deal with the added social stress that the medication may cause, the nurse should discuss which possible adverse effect?

The development of acne Adolescents who are prescribed androgens should be alerted to the potential for increased acne and oily skin. Deepening of the voice may occur but it is not likely to be viewed negatively by a male client. Weight gain is a commonly recognized adverse reaction associated with this medication.

After teaching a client who is prescribed sildenafil about using the drug, the nurse determines that the teaching was successful when the client states:

"I need to take the pill about an hour before any sexual stimulation." Sildenafil should be taken approximately 1 hour before sexual stimulation.

A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him:

"You might find that your face becomes flushed or you get a headache after you take Viagra." Adverse effects associated with sildenafil include facial flushing and headache. The drug is not taken on a daily basis in the morning, but rather 1 hour before anticipated sexual activity. Medication interactions exist, and should be assessed for, but it is not necessary to avoid any and all prescription medications. Heart palpitations and dizziness should be reported to the patient's care provider.

A client has been given a prescription for sildenafil (Viagra) for treatment of erectile dysfunction. The nurse will instruct the client to take this medication at what time prior to the onset of sexual intercourse?

30 minutes The client should take sildenafil approximately 20 to 60 minutes prior to the time of the desired erection.

A client is prescribed testosterone gel. Which would the nurse include in the teaching plan? Select all that apply.

Allowing the application site to dry before getting dressed. Applying the gel once daily in the morning. Washing hands with soap and water after applying. The nurse would instruct the client to apply the gel once daily in the morning to clean, dry, intact skin of the shoulders and upper arms or abdomen. After the packet is opened, the contents are squeezed into the palm of the hand and immediately applied to the sites. The sites are allowed to dry before the client gets dressed. The gel is not applied to the genitals. The client should wash his hands well with soap and water after applying.

A patient with erectile dysfunction is receiving an injection directly into the cavernosum. The nurse identifies this drug as:

Alprostadil Alprostadil is injected directly into the corpus cavernosum. Danazol is not used to treat erectile dysfunction. Sildenafil is administered orally. Vardenafil is administered orally.

A client at the clinic reports amenorrhea and has participated in competitive bodybuilding for years. She tested positive for pregnancy. After obtaining a health history, the nurse finds the client has healthy eating habits, regular exercise, herbal supplement use, and alcohol avoidance. What client education should follow?

Anabolic steroid use is contraindicated in pregnancy. Androgens and anabolic steroids are contraindicated during pregnancy because of possible masculinizing effects on a female fetus.

A 17-year-old boy has been admitted to the emergency department after suffering a knee sprain during a football practice. The nurse notes that the client has exceptional muscle mass, and the boy quietly admits that this is mostly attributable to the use of steroids, which he obtains from a teammate. What should the nurse teach the boy about anabolic steroid abuse?

Anabolic steroids are universally dangerous but are especially harmful to adolescents. Although steroids have a reputation for being dangerous to adult athletes, such as body builders and football players, they are considered even more dangerous for teens because teens are still growing. These drugs do not necessarily require increasing doses to be effective. They carry numerous health consequences later in life, but reduced weight bearing is not among the most common consequences.

The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil?

Antidysrhythmics Vardenafil is the only PDE5 inhibitor that prolongs the QT interval and should not be used with other drugs with similar effect, particularly class I and II antidysrhythmics.

The health care provider has prescribed testosterone for a 77-year-old client with a low testosterone level. The nurse will evaluate this client for what condition that may develop in this client in response to this medication?

Benign prostatic hypertrophy Older adults who receive testosterone should be evaluated for the development of benign prostatic hypertrophy.

A young male patient, age 14, has been prescribed testosterone for delayed onset of puberty. Follow-up care includes a visit to the clinic at least every 6 months for ongoing assessment. It will be most important for the nurse to monitor:

Bone growth When testosterone is used in prepubescent boys to treat hypogonadism or delayed onset of puberty, the premature closure of the long bones may lead to stunted growth. To monitor the action of testosterone on the patient, radiographs should be taken every 6 months to assess bone age. Radiographs help document bone maturation and the effect of testosterone on the epiphyseal centers. Although it is important to assess a patient's fluid intake and output, hemoglobin and hematocrit levels, and sodium and potassium levels, in this situation assessing bone growth would be the most important.

The nurse is reviewing the history of a client who is to receive testosterone. Which of the following would alert the nurse to the need for close monitoring of the client?

Cardiovascular disease Clients with a history of cardiovascular disease need to be monitored closely when receiving testosterone because the disorder could be exacerbated by the hormone's effect. None of the other options have that concern.

A client is taking androgens and warfarin (Coumadin). What effect will these two medications have on the client's coagulation?

Coagulation will be decreased. Clients taking androgens and warfarin will increase the concentration of warfarin in the blood; thus, the coagulation will be decreased, placing the client at risk for hemorrhage. The medications will not decrease coagulation or cause it to be unaffected. The red blood cell count will not be decreased unless bleeding results.

The nurse receives a call from a male client who takes finasteride (Proscar) for treatment of BPH, and tells the nurse that his wife may be pregnant. What does the nurse expect the health care provider to do?

Discontinue the medication. A client who takes an androgen hormone inhibitor will need to have the drug discontinued if a sexual partner is (or may become) pregnant, because pregnant women should not handle this medication. The provider would not increase or decrease the dose, nor would the provider change the drug to dutasteride.

The nurse is instructing the parents of an 11-year-old male who has testosterone deficiency. Which symptom, if found in this child, would cause the discontinuation of this medication?

Enlarged penis Testosterone therapy would be discontinued if the child demonstrated signs of precocious sexual puberty such as enlargement of the penis. It would also be discontinued if the epiphyseal plate showed signs of early closure.

When teaching a group of high school students about using anabolic steroids, the nurse would include information that these drugs are classified as which class of controlled substances?

III Anabolic steroids are classified as a class III controlled substance.

A 9 year old child has been prescribed testosterone. What information should the nurse provide the client's parents regarding the continuation of the therapy?

If signs of early puberty are identified the therapy should be stopped If precocious puberty occurs the drug should be stopped. None of the remaining options present accurate statements concerning the continuation of testosterone therapy.

A teenage client who is using testosterone to treat a hormone deficiency calls the clinic to report acne-like skin eruptions on the face. How should the nurse counsel this client?

Practice frequent and thorough skin cleansing. Teenage clients who use testosterone often report acne. The best practice is for clients to practice frequent and thorough skin cleansing. It is not necessary to see the dermatologist again but the client should not stop or decrease the dosage of the medication without first having a discussion with the dermatologist.

A woman is diagnosed with pulmonary hypertension. The nurse explains the drug prescribed and the patient states, "That's a drug that used to treat erectile dysfunction." Which drug would this most likely be?

Sildenafil Sildenafil is used to treat pulmonary hypertension in females.

A nurse is preparing a class on the various drugs used to treat erectile dysfunction. Which would the nurse include?

Tadalafil Tadalafil is a PDE 5 inhibitor used to treat erectile dysfunction. Testosterone is an androgen used as replacement therapy in hypogonadism. Danazol is an androgen used to prevent ovulation in women. Oxandrolone is an anabolic steroid.

What would danazol (Danocrine) be administered to women for?

Decrease symptoms of endometriosis Danazol may be used in women to prevent or treat endometriosis or fibrocystic breast disease. Danazol is not prescribed for increased hair growth, to reverse folic acid deficiencies, or to prevent toxic shock syndrome.

The nurse is educating an adult male client diagnosed with erectile dysfunction about the prescribed sildenafil. Which statement made by the client establishes the need for further clarification?

"If I eat a fatty meal I will need to take two pills instead of one, so the drug will take effect faster." The nurse needs to clarify the statement that the client made regarding doubling the dosage after eating a fatty meal. Fatty foods delay the action of the drug. Taking two tablets could lead to excessive dosing and the adverse effect, priapism. The other statements are correct. If the client develops priapism for longer than 4 hours, medical attention is needed to prevent permanent damage to the penis. A rare event, nonarteritic ischemic optic neuropathy (NAION) is an adverse effect of the drug, which leads to the obstruction of circulation to the optic nerve resulting in irreversible loss of vision in one or both eyes. Also, a rare adverse effect, permanent loss of hearing with ringing in the ears, or tinnitus may occur. A client taking sildenafil should not take nitrates because it can cause a serious drop in blood pressure, dizziness, syncope, heart attack, or stroke.

A male clent has been diagnosed with impotence and is started on a regimen of androgens. Which statement by the client indicates that he has understood the teaching?

"If my skin appears yellow or my urine turns dark, I will contact my health care provider." Clients taking anabolic steroids can experience jaundice. It is important for the client to notify his health care provider of this condition. The normal effect of the medication is an increase in hair growth, which indicates he would need additional teaching. The clotting factor will increase as a result of anabolic steroids. The client is at risk for cerebrovascular accident related to anabolic steroids and increased clotting factor.

A male client has been prescribed testosterone for cryptorchidism. Which statement indicates that the client teaching was effective?

"My body hair will increase." The administration of testosterone will cause an increase in body hair. It will not decrease sexual desire, but increase it. The client's voice will deepen and skin will likely have acne-related reactions.

A 72-year-old client has been diagnosed with benign prostatic hypertrophy (BPH) and will begin treatment with tamsulosin. The client admits that he is skeptical about the drug's ability to relieve his distressing symptoms. The nurse should respond in what way?

"Tamsulosin can relax your prostate and your bladder neck, making it easier to pass urine." Tamsulosin works by relaxing the muscles in the prostate and bladder neck, enhancing the ability to urinate. Blockage of alpha1-adrenergic receptors decreases vascular smooth muscle contraction, influencing the activity of genitourinary smooth muscle. The drug does not change the pH of urine, strengthen the bladder muscle, or increase urine production.

Mark, age 42, is prescribed sildenafil for the treatment of pulmonary hypertension. The nurse caring for Mark would explain that sildenafil works by what mechanism?

Causing vasodilation in the pulmonary vascular bed When sildenafil is used to treat pulmonary arterial hypertension, it stabilizes patients clinically as well as improves their exercise capacity and the function of the right ventricle. The drug causes vasodilation of the pulmonary vascular bed and, to a lesser degree, vasodilation in the systemic circulation.

A client is receiving androgen therapy. Which would cause the nurse the greatest concern?

Elevated liver enzyme levels Elevated liver enzyme levels indicate impaired hepatic function that could be related to the development of hepatocellular cancer—a potential and life-threatening effect associated with androgen therapy. Decreased thyroid function and increased creatinine and creatinine clearance levels are not associated with disease states and can last for up to 2 weeks after discontinuing therapy.

Which would be most important to assess in a client receiving testosterone for a prolonged period of time?

Liver function studies Clients on long-term therapy with androgens should have hepatic function tests monitored regularly because of the increased risk for hepatocellular cancer.

On the advice of his brother, a 53-year-old man has made an appointment to request a prescription for sildenafil. The nurse who works at the clinic is reviewing the man's medical history and would recognize what health problem as being prohibitive to this treatment?

angina, treated with nitroglycerin Prescribers should not order sildenafil for men who also take organic nitrates, commonly used to treat angina, because the sildenafil-nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. Metformin, metoprolol, and simvastatin are not likely to cause adverse effects.

An older adult client's current medication regimen includes tamsulosin and sildenafil. The combination of these two medications should prompt what action by the nurse?

assessing the client regularly for signs of orthostatic hypotension Combining an alpha1-adrenergic blocker with a phosphodiesterase type 5 inhibitor creates a risk for orthostatic hypotension. There is no particular need for tests of hemostasis, cystoscopy, or the insertion of a urinary catheter.

Sildenafil has been prescribed to a client in his 60s, and the nurse is providing health education about the safe and effective use of the drug. The nurse should teach the client to:

avoid taking the drug more than once in any 24-hour period. It is important not to take sildenafil more than once in a 24-hour period. A recent high-fat meal may delay drug action, but it is not essential to take it on an empty stomach. Heartburn is not a common adverse effect and would not necessarily require discontinuing treatment.

An adult client is suspected of having an androgen deficiency and has spoken with his primary care provider about the possibility of treatment with testosterone. The use of testosterone would be most complicated by the presence of what preexisting health problem?

benign prostatic hypertrophy Disorders of the prostate contraindicate testosterone use because men with an enlarged prostate may have additional enlargement. Incontinence, diabetes, and kidney disease are not absolute contraindications to the use of testosterone.

Anabolic steroid use causes an increase in muscular work capacity, which is what makes these agents popular as performance-enhancing drugs. They are dangerous specifically to teens because they:

can damage the heart, liver, and kidneys. Anabolic steroids are considered even more dangerous for teens because teens are still growing. Anabolic steroids can stop bone growth and damage the heart, kidneys, and liver of adolescents.

A 70-year-old man has enjoyed good overall health for all of his adult life, but he has been experiencing urinary frequency and dribbling that has culminated in a diagnosis of benign prostatic hypertrophy (BPH). As a result, the client has been prescribed finasteride. When teaching the client about the potential adverse effects of the drug, the nurse should ensure that he knows about the possibility of:

sexual dysfunction. Adverse effects of finasteride include various sexual dysfunctions, such as impotence, gynecomastia, reduced libido, and ejaculatory disorders. Urethral burning, kidney stones, and visual disturbances are not common adverse effects of finasteride.

A nurse is caring for a 28-year-old patient who is taking exogenous testosterone for treatment of cryptorchidism. What statement by this patient would lead the nurse to believe that patient teaching has been ineffective?

"My sperm count should increase." The effects of testosterone include increased body hair, thickening of the skin, deepening of the voice, and increased sexual desire. The medication isn't expected to increase sperm count.

A client has been prescribed vardenafil. Which medication in the client's history would the nurse be most concerned about?

nitroglycerin Drugs for ED, including vardenafil, should not be taken by men who use nitrates because these drugs affect smooth muscle. Clients with preexisting cardiac problems, especially those using drugs to lower blood pressure, should discuss use with their primary health care provider before using the drug. Insulin is not contraindicated or used with caution with vardenafil. Amoxicillin is an antibiotic and can be used with vardenafil. Tamoxifen is used by women for breast cancer treatment, osteoporosis prevention, and menopause symptoms.

The nurse is educating a young adult client diagnosed with androgen deficiency about the prescribed testosterone transdermal system, apply two systems (dose of 5 mg) nightly. Which statement made by the client establishes the need for further clarification?

"One transdermal patch is applied to my back, upper arm, or abdomen to dry, clean skin, and the other to my groin." The nurse needs to clarify the statement that the client made regarding applying the transdermal patch to the groin. The client should not apply the patch to the groin. The client needs to rotate sites, so there is 7 days before another patch is paced on the area of skin. The thigh was not mentioned, which may be used as a site. The other statements are correct. Common adverse effects of the drug include acne, headache, bitter taste or mouth irritation, hair loss, and increase in libido. The client may weigh self once or twice a week, and should report if there is an increase in weight, which reflects fluid retention. Keeping appointments for follow-up is essential because hypercalcemia can occur leading to renal calculi, polyuria, nausea and vomiting, and abdominal pain.

What is most important to tell the client who will be taking adrenergic blocking drugs for benign prostatic hypertrophy?

Take the medication at the same time each day. The client should take the medication at bedtime every day because it can cause dizziness. The important issue, however, is to take the medication at about the same time each day. The drug should not be stopped and started because after the first dose, orthostatic hypotension may occur if the drug is stopped and started a week or more later. The client is at risk for constipation if the client reduces the amount of liquid he drinks.

A student asks the pharmacology instructor what effect the administration of androgens can have on a fetus if administered during pregnancy. What should the instructor respond?

Female child may have masculinized features Androgens and anabolic steroids are contraindicated during pregnancy because of possible masculinizing effects on a female fetus.

A client diagnosed with benign prostatic hypertrophy (BPH) is prescribe tamsulosin. The client communicates with the nurse about a friend that was prescribed sildenafil for his BPH. Which is the nurse's best response regarding the difference in the use of the two drugs for BPH?

Tamsulosin relaxes muscles in the prostate and bladder and increases ability to urinate. The alpha-1 adrenergic blockers (tamsulosin) are recommended over PDE5 inhibitors (sildenafil) for initial monotherapy for the treatment of BPH. Alpha-1 adrenergic blockers (tamsulosin) provide immediate therapeutic benefits, while PDE5 inhibitors (sildenafil) require long-term treatment (6-12 months) before symptom improvement. Tamsulosin relaxes muscles in the prostate and bladder and increases the client's ability to urinate. Sildenafil improves ED by a vasodilatory effect in the smooth muscle of the corpus cavernosum.

A nurse is teaching a class at the local high school on the abuse of anabolic steroids. Which potential adverse reaction should the nurse cite regarding the long-term use of these hormones?

liver tumors. Abuse of anabolic steroids may cause a wide range of potentially serious adverse effects, including hepatic neoplasms (liver tumors), hypertension, diminished testicular size and function, and aggression.

When fluoxymesterone is administered to a 14-year-old male, what is the expected result?

Development of sexual organs In prepubertal boys, administration of androgens will stimulate development of masculine characteristics. These include development of sex organs, deepened voice, and development of body musculature. Virilization is an adverse effect associated with the use of anabolic steroids in females. There is no expected impact on acne or depression.

A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child?

Hand and wrist epiphyseal growth plates Arrange for radiographs of the long bones of children every 3 to 6 months, so that the drug can be discontinued if bone growth reaches the norm for the child's age. It would not be necessary to measure LFTs, cholesterol levels, or the child's vision.

A female patient receiving fluoxymesterone, an androgenic drug, for metastatic breast cancer is disturbed by the physical changes seen in her body. Which feature of virilization may be seen in the patient receiving this therapy?

Deepening of the voice Deepening of the voice may be seen as a feature of virilization following male hormone therapy in a female patient. Virilization is the acquisition of male characteristics in the female. Other features of virilization include pigmentation, and not hypopigmentation, of the skin, and increase, not decrease, in the size of the clitoris. Increase in body weight is not a sign of virilization. It may occur due to impaired nutrition of the body.

A client is prescribed androgen therapy to be given by IM injection. The nurse would select which site for administration?

gluteal muscle When androgens are administered IM, the injection is administered by deep IM injection into the gluteal muscle. The other muscles are not as large.

An 8-year-old boy has been diagnosed with a sex hormone deficiency and has begun a course of treatment with testosterone. What change in the boy's health status would necessitate a stop to the course of treatment?

signs of puberty If premature puberty occurs in a boy being treated with androgens (e.g., precocious sexual development, enlarged penis), it is necessary to stop the drug. Changes in blood pressure, increased growth, and urinary tract infections are unlikely causes for the cessation in treatment.