pharm module 13/14 womens and mens drugs ulitmate
Adverse effects of men's health drugs
-Androgens cause fluid retention -Anabolic steroids - liver dysfunction (e.g., peliosis) and many others Peliosis of the liver Hepatic neoplasms (liver cancer) Cholestatic hepatitis Jaundice Abnormal liver function
When should patients take Viagra?
1 hour before sexual activity
Which daily dose of finasteride is prescribed for an adult patient who is being treated for androgenetic alopecia? 1. 1 mg by mouth 2. 5 mg by mouth 3. 25 to 100 mg 1 hour before intercourse 4. 50 to 400 mg by intramuscular injection
1. 1 mg by mouth
A patient receiving finasteride has increased hair growth. Which nursing action is correct? 1. Continue to assess. 2. Hold the medication. 3. Measure testosterone levels. 4. Call the health care provider.
1. Continue to assess.
A patient has been taking sildenafil for erectile dysfunction. The patient reports episodes of dizziness and fainting spells after using this drug. For which other drug would the nurse assess while taking the drug history of the patient? 1. Nitrates 2. Antibiotics 3. Alpha agonists 4. Anticoagulants
1. Nitrates
Contraindications for erectile dysfunction drugs
1. Sildenafil, vardenafil, tadalafil, and avanafil --> cardiovascular disorders, use of nitrates 2. finasteride --> Pregnancy and children using it
A patient who has been taking sildenafil has developed angina. The health care provider has prescribed isosorbide mononitrate. Which instruction will the nurse give the patient? 1. "Take your blood pressure before either medication." 2. "Do not take the sildenafil." 3. "Take the medications on opposite days." 4. "Take the isosorbide mononitrate before the sildenafil."
2. "Do not take the sildenafil."
Testosterone has which functions in the body? Select all that apply. 1. Fat metabolism 2. Bone development 3. Production of red blood cells 4. Excretion of sodium and potassium 5. Development of secondary sexual characteristics
2. Bone development 3. Production of red blood cells 5. Development of secondary sexual characteristics
The nurse is providing care for a patient receiving androgen therapy for weight gain. Which adverse effect of the medication can be mistaken as weight gain? 1. Hirsutism 2. Fluid retention 3. Roundness of face 4. Peliosis of the liver
2. Fluid retention
The nurse would inform a male patient about which potential type of cancer associated with testosterone therapy? 1. Kidney cancer 2. Prostate cancer 3. Bladder cancer 4. Intestine cancer
2. Prostate cancer
Which group of college students does the nurse need to include in a teaching session on the risks of androgen abuse? 1. Those often tardy 2. Team athletes 3. Those who do not socialize well 4. High class performers
2. Team athletes
The nurse is assessing a patient at a follow-up visit after starting treatment with sildenafil for erectile dysfunction. Which assessment finding would indicate that the treatment needs to be revised? 1. The patient's cardiac output is 5.6 L/min. 2. The patient's blood pressure is 90/60 mm Hg. 3. The patient verbalizes the ability to maintain an erection. 4. The patient does not have dry mouth, nausea, or vomiting.
2. The patient's blood pressure is 90/60 mm Hg.
The U.S. Drug Enforcement Administration classifies anabolic steroids as Schedule III medications because they cause which adverse effects? 1. Endometriosis 2. Erectile dysfunction 3. Physical dependence 4. Sedation and hypnosis
3. Physical dependence
A patient who reports difficulty passing urine is prescribed finasteride by the primary health care provider. Which condition would the nurse suspect to have caused difficulty in urination? 1. Renal calculi 2. Neurogenic bladder 3. Urinary tract infection 4. Benign prostatic hyperplasia
4. Benign prostatic hyperplasia
Anabolic steroids have which adverse effect? 1. Chest pain 2. Dermatitis 3. Tachycardia 4. Changes in libido
4. Changes in libido
A male patient is taking sildenafil. Which health problem would the nurse expect in the patient? 1. Gynecomastia 2. Decreased libido 3. Low sperm count 4. Erectile dysfunction
4. Erectile dysfunction
Which method of administration is used for testosterone cypionate? 1. Oral 2. Topical 3. Transdermal 4. Intramuscular
4. Intramuscular
The nurse is providing care for a patient taking oxandrolone. Which test would the nurse evaluate to help prevent complications in the patient? 1. Glucose 2. Hematocrit 3. Hemoglobin 4. Liver function
4. Liver function
Which drug prescription does the nurse report to the primary health care provider if the patient is taking tadalafil? 1. Ibuprofen 2. Famotidine 3. Furosemide 4. Nitroglycerin
4. Nitroglycerin
Finasteride (Propecia)
5 alpha reductase inhibitor (decreases conversion of testosterone to dihydrotestosterone); useful in BPH ; promotes hair growth to treat male pattern baldness * WOMEN, DO NOT USE WHEN PREGNANT and USE GLOVES*
What drugs should pregnant women NOT handle crushed or broken tablets on a regular basis?
5-Alpha-Reductase inhibitors
What are the types of androgen inhibitors?
5-Alpha-reductase inhibitors Alpha1-adrenergic blockers androgen receptor blockers Gn-RH analogs
Finasteride (Proscar)
5-alpha-reductase inhibitors
dutasteride (Avodart)
5-alpha-reductase inhibitors
Danazol (Danocrine)
: treatment of hereditary angioedema, and, in women, endometriosis and fibrocystic breast disease.
10. What is the most common drug used for induction of labor in pregnant women and to promote ejection of milk during lactation? A. Oxytocin (Pitocin) B. Clomiphene (Clomid) C. Misoprostol (Cytotec) D. Mifepristone (Mifeprex)
A
12. Which endogenous estrogen is the primary one and the most active: A. Estradiol B. Estrone C. Estriol D. Hydroxyprogesterone (Hylutin) E. Medroxyprogesterone (Provera) F. Megestrol (Megace) G. Etonogestrel implant (Implanon)
A
13. Androgen Inhibitors can be defined as: A. Drugs that prevent androgens from mediating their biological effects in the body. B. Drugs that cause the synthesis of tissue and increase tissue formation
A
13. Which synthetic exogenous estrogenic drug includes conjugated estrogens, such as estradiol transdermal? A. Steroidal B. Non-Steroidal
A
14. Oxymetholone (Anadrol-50) Stanozolol (Winstrol) Oxandrolone (Oxandrin) Nandrolone (Deca-Durabolin) are examples of: A. Anabolic steroids (Schedule III) B. Androgen Inhibitors
A
18. T/F: α₁-adrenergic blockers are not Androgen Inhibitors but are used for many of the same uses. A. True B. False
A
19. Finasteride (Proscar) Dutasteride (Avodart) are examples of: A. 5-α-reductase inhibitors B. α₁-adrenergic blockers C. Androgen receptor blockers D. Erectile dysfunction drugs
A
19. Post menopausal replacement therapy for a female with a uterus should use: A. CCHRT B. Estrogen alone
A
24. Indications include: - Treatment of functional uterine bleeding caused by hormonal imbalance, fibroids, or uterine cancer - Treatment of amenorrhea - Palliative treatment of some cancers and endometriosis - Prevention of threatened miscarriage - Alleviation of symptoms of PMS A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
A
26. Adverse Effects include: - Liver dysfunction (cholestatic jaundice) - Thrombophlebitis, thromboembolic disorders, such as PE - Nausea, vomiting - Amenorrhea, breakthrough uterine bleeding - Edema, weight gain or loss A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
A
26. Adverse effects include: - cause fluid rentention A. Androgens B. Anabolic steroids C. 5-α-reductase inhibitors D. Erectile dysfunction drugs
A
31. Osteoporosis drug therapy: Bisphosphonates A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. - Teriparatide (Forteo) - Calcitonin
A
34. Work by inhibiting osteoclast-mediated bone resorption, thus preventing bone loss: A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
A
39. Adverse effects include: Headache, GI upset, joint pain; Risk of esophageal burns if medication lodges in esophagus before reaching the stomach A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
A
4. During a postpartum patient assessment, the nurse notes a boggy uterus and increased vaginal bleeding. Based on this assessment data, the nurse prepares to administer which medication? A. Oxytocin (Pitocin) B. Clomiphene (Clomid) C. Terbutaline (Brethine) D. Dinoprostone (Prostin E₂)
A
40. Nonsteroidal ovulation stimulant; Blocks estrogen receptors in the uterus and brain, resulting in a false signal of low estrogen levels; Increases production of Gn-RH, FSH, and LH; As a result, maturation of ovarian follicles is stimulated, leading to ovulation and increased chance of conception: A. Clomiphene (Clomid) B. Menotropins (Pergonal) C. Chorionic gonadotropin alfa (Ovidrel)
A
43. Oxytocin (hormonal drug) Prostaglandins Ergot derivatives Progesterone antagonist A. Uterine Stimulants (Oxytocics) B. Uterine Relaxants (Tocolytics)
A
45. Used to promote labor: A. Uterine Stimulants (Oxytocics) B. Uterine Relaxants (Tocolytics)
A
47. Used to induce labor at or near full-term gestation, and to enhance labor when contractions are weak and ineffective; Prevent or control postpartum uterine bleeding; Complete an incomplete abortion (after miscarriage); Promote milk ejection during lactation A. Oxytocin (hormonal drug) B. Prostaglandins - Dinoprostone (Prostin E2) - Misoprostol (Cytotec) C. Ergot derivatives - Methylergonovine (Methergine) D. Progesterone antagonist - Mifepristone (Mifeprex)
A
51. Beta-adrenergic drug; Stimulation of beta2-adrenergic receptors on the uterine smooth muscle; Results in relaxation of the uterus, thus stopping premature contractions; "Off-label" use A. Terbutaline (Brethine) B. Magnesium sulfate IV
A
9. Androgens are defined as: A. Male sex hormones responsible for mediating the development and maintenance of male sex characteristics. Chief among these are testosterone B. The main androgenic hormone C. Non-malignant enlargement of the prostate gland
A
A woman who lives in Seattle is preparing to take a plane trip to London. She has been taking the SERM raloxifene (Evista) for 6 months. The nurse will provide which instructions to this patient? a. She needs to stop taking the drug at least 72 hours before the trip. b. She must remember to take this drug with a full glass of water each morning. c. She will not take the drug while traveling on the plane. d. No change in how the drug is taken will be needed.
A A patient taking a SERM must be informed to discontinue the drug 72 hours before and during prolonged immobility so as to prevent the development of a thrombosis.
The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? a. Headache b. Drowsiness c. Dysmenorrhea d. Hypertension
A Headache is one of the possible adverse effects of the fertility drugs. They may also cause vomiting, restlessness, and urticaria. Drowsiness, dysmenorrhea, and hypertension are not potential adverse effects. See Table 34-5 for other adverse effects.
A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for which potential drug interaction? a. Thyroid replacement therapy b. Oral anticoagulant therapy c. Nonsteroidal anti-inflammatory drugs d. Beta blockers
A Orally administered soy may interfere with thyroid hormone absorption, so concurrent use must be avoided. The other options are incorrect.
The nurse recognizes that the risk of osteoporosis is higher in an individual with which risk factor? a. White or Asian race b. African-American race c. History of participation in active sports d. Obesity
A Risk factors for postmenopausal osteoporosis include white or Asian descent, slender body build, early estrogen deficiency, smoking, alcohol consumption, low-calcium diet, sedentary lifestyle, and family history of osteoporosis.
A nurse is caring for 4 clients who have peptic ulcer disease. The nurse should identify misoprostol is contraindicated for which of the following clients?
A client who is pregnant
A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? A) Transdermal nitroglycerin\ B) Hydrochlorothiazide C)Potassium D) Multivitamin with iron
A) transdermal nitroglycerin -Taking drugs such as sildenafil with nitrates may lead to dangerous hypotensive episodes.
20. The MOA for these drugs is: - Block the effects of endogenous androgens A. Finasteride B. Dutasteride C. Flutamide D. Nilutamide E. Bicalutamide
A, B
21. Indications for these drugs include: - Used to treat benign prostatic hyperplasia (BPH) (easier passage of urine) - Used for treatment of male-pattern baldness (also minoxidil) A. Finasteride B. Dutasteride C. Flutamide D. Nilutamide E. Bicalutamide
A, B
11. The major endogenous estrogens, which are synthesized from cholesterol in ovarian follicles: A. Estradiol B. Estrone C. Estriol D. Hydroxyprogesterone (Hylutin) E. Medroxyprogesterone (Provera) F. Megestrol (Megace) G. Etonogestrel implant (Implanon)
A, B, C
15. The MOA for these drugs are: -Stimulation of normal growth and development of the male sex organs -Development and maintenance of male secondary sex characteristics -Stimulate increased synthesis of body proteins, aiding in the formation of muscular and skeletal proteins A. Oxymetholone (Anadrol-50) B. Stanozolol (Winstrol) C. Oxandrolone (Oxandrin) D. Nandrolone (Deca-Durabolin) E. Doxazosin (Cardura) F. Tamsulosin (Flomax) G. Terazosin (Hytrin) H. Alfuzosin (Uroxatral)
A, B, C, D
16. The indications for these drugs include: - Used to treat a hypogonadal male - Used to treat oligospermia - Used to treat HIV wasting A. Oxymetholone (Anadrol-50) B. Stanozolol (Winstrol) C. Oxandrolone (Oxandrin) D. Nandrolone (Deca-Durabolin) E. Doxazosin (Cardura) F. Tamsulosin (Flomax) G. Terazosin (Hytrin) H. Alfuzosin (Uroxatral)
A, B, C, D
17. Androgen inhibitors include: A. 5-α-reductase inhibitors B. α₁-adrenergic blockers C. Androgen receptor blockers D. Erectile dysfunction drugs
A, C
18. Continuous-combined hormone replacement therapy (CCHRT) reduces complications that occur from using estrogen alone, such as: A. Endometrial hyperplasia B. Infertility C. Endometrial cancer D. Vulvodynia
A, C
The nurse is providing patient education for a patient taking an oral contraceptive. Which drugs may cause interactions with oral contraceptives? (Select all that apply.) a. Cephalexin (Keflex) b. Guaifenesin (Robitussin) c. Warfarin (Coumadin) d. Ibuprofen (Motrin) e. Theophylline (Uniphyl)
A, C, E Patients must be educated about the need to use alternative birth control methods for at least 1 month during and after taking any of these drugs: antibiotics (especially penicillins and cephalosporins); barbiturates; isoniazid; and rifampin. The effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral contraceptives.
8. The nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medications have the longest therapeutic effect when taken orally? (Select all that apply.) A. Tadalafil (Cialis) B. Sildenafil (Viagra) C. Avanafil (Stendra) D. Vardenafil (Levitra) E. Alprostadil (Caverject)
A, D
A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? A. transdermal nitroglycerin B. hydrochlorothiazide C. potassium D. multivitamin with iron
A. transdermal nitroglycerin Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes.
A nurse is assessing a client who is experiencing prostatic hypertrophy. Which of the following findings associated with urinary retention should the nurse expect? (select all that apply) 1. Report of feeling pressure 2. Tenderness over the symphysis pubis 3. Distended bladder 4. Voiding 30 mL frequently 4. Dysuria
ANS: Report of feeling pressure Tenderness over the symphysis pubis Distended bladder Voiding 30 mL frequently is correct RATIONALE: voiding of 25-60mL of urine Dysuria is painful burning with urination; not expected finding
A nurse is caring for a client who is 1 day postop following TURP and has a continuous bladder irrigation in place. Which of the following actions should the nurse take? (Select all that apply) 1. Add the amount of bladder irrigation to the total amount 2. Use sterile technique when preparing the irrigation solution 3. Ensure the drainage tubing is patent and without obstruction 4. Contact the surgeon if the client reports a continual need to void 5. Notify the surgeon if the urine is bright red in appearance or has large clots
ANS: Use sterile technique when preparing the irrigation solution; ~decreases risk of contamination and infection- fever & elevated WBC Ensure the drainage tubing is patent and without obstruction or kinks; ~prevents accumulation of solution in bladder which can cause bladder distention Notify the surgeon if the urine is bright red in appearance or has large clots; ~normal to see small clots and pink tinged drainage Subtract irrigation amount from total output Catheter balloon provides traction against the internal sphincter causing continual need to void
The patient is to receive medroxyprogesterone (Depo-Provera) 500 mg, weekly, intramuscularly, on Mondays for 4 weeks as part of palliative therapy for cancer. The medication is available in vials of 400 mg/mL. How many milliliters will the nurse draw up and administer with each injection? Round to the nearest tenth
ANS: 1.3 mL
A female patient who lives in New York City is preparing to take a plane trip to Australia. She has been taking the SERM raloxifene (Evista). The nurse will provide which instructions to this patient? A. She should stop taking the drug at least 72 hours before the trip. B. She must remember to take this drug with a full glass of water each morning. C. She should increase the calcium supplements that she takes with the drug. D. No change in interventions is needed.
ANS: A
A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for potential drug interactions, including A. thyroid replacement therapy. B. oral anticoagulant therapy. C. nonsteroidal antiinflammatory drugs. D. beta blockers.
ANS: A
The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? A. Dizziness B. Drowsiness C. Dysmenorrhea D. Increased appetite
ANS: A
When reviewing the risk factors for osteoporosis, the nurse recognizes that which of the following is considered a risk factor? A. White or Asian race B. African American race C. History of participation in active sports D. Obesity
ANS: A
A patient taking an oral contraceptive should be aware of potential drug interactions with which medications? Select all that apply. A. cephalexin (Keflex) B. guaifenesin (Robitussin) C. warfarin (Coumadin) D. isoniazid (INH) E. ibuprofen (Motrin) F. theophylline (Uniphyl)
ANS: A, C, D, F
A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP). The nurse should plan to administer the clients PRN bethanechol when the client reports which of the following manifestations? 1. Bladders spams 2. Severe pain 3. An inability to void 4. Frequent episodes of painful urination
ANS: An inability to void RATIONALE: cholinergic medication that stimulates the parasympathetic nervous system; improves tone and motility of smooth muscle to initiate urination Bladder spasms; Antispasmodic Sever pain: Analgesic Painful urination: Analgesic OR Antibiotic r/t infection
A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having plastic surgery. Which intervention is appropriate at this time? A. She should continue to take the alendronate with water. B. She should not take the alendronate until she can sit up for 30 minutes. C. She can take the medication with breakfast. D. She should stop taking the medication 72 hours before her surgery.
ANS: B
The nurse notes in the patient's medication orders that the patient is taking the tocolytic drugs terbutaline (Brethine). Based on this finding, the nurse interprets that the drug has been ordered for which problem? A. Prevention of preterm labor in the 15th week of pregnancy B. Prevention of preterm labor in the 22nd week of pregnancy C. Stimulation of contractions in prolonged labor D. Stimulation of ovulation as part of infertility treatments
ANS: B
The nurse should instruct a patient who will be taking bisphosphonate alendronate (Fosamax) to take this medication at which time? A. In the evening just before bedtime B. In the morning with an 8-ounce glass of water C. With the first bite of the morning meal D. Between meals on an empty stomach
ANS: B
A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? A. Giving magnesium sulfate along with the oxytocin B. Administering the medication in an intravenous bolus C. Administering the medication with an IV infusion pump D. Monitoring fetal heart rate and maternal vital signs every 6 hours
ANS: C
The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? The patient should A. double-up on the medication if a dose is missed. B. not be concerned about breast lumps or bumps that occur. C. report any weight gain of more than 5 pounds per week. D. take the medication on an empty stomach to enhance absorption.
ANS: C
When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? A. Monophasic B. Biphasic C. Triphasic D. Long-acting
ANS: C
When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of A. severe weight gain. B. irregular menses. C. multiple births. D. alopecia.
ANS: C
While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse's best response? A. "Estrogen patches are still the first choice for osteoporosis prevention." B. "Estrogen patches are often used as long-term therapy for osteoporosis prevention." C. "Estrogen patches are associated with a high risk for cardiovascular problems and are not the first choice for osteoporosis prevention." D. "Estrogen patches will be prescribed if the patient prefers patches to oral medications."
ANS: C
A nurse is caring for a client who is 5 hr postop following a TURP. The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first? 1. Notify the provider 2. Check the tubing for kinks 3. Adjust the rate of the bladder irrigant 4. Irrigate the catheter
ANS: Check the tubing for kinks RATIONALE: Use the least invasive intervention, to prevent clotting which would occlude the catheter lumen Notify the provider; if unable to induce fluid flow, if output is bright red and thick Adjust the rate; to stimulate removal of urine and clots irrigate the catheter; to check for internal obstruction
A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of the treatment for postmenopausal osteoporosis. The nurse reviews potential adverse effects with this patient, including the possible occurrence of A. pregnancy. B. breast cancer. C. stress fractures. D. venous thromboembolism.
ANS: D
A patient is being treated for primary amenorrhea. The nurse expects which drug to be used to treat this problem? A. oxytocin (Pitocin) B. estradiol transdermal (Estraderm) C. raloxifene (Evista) D. medroxyprogesterone (Provera)
ANS: D
A woman visits a health center requesting oral contraception. Which lab test is most important for the nurse to assess before the patient begins oral contraception therapy? A. Complete blood count B. Urinalysis C. Vaginal cultures D. Pregnancy test
ANS: D
During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased A. incidence of nausea. B. tendency to bleed during menstruation. C. levels of triglycerides. D. risk for thrombosis.
ANS: D
The nurse recognizes that use of estrogen drugs is contraindicated in which of the following patients? A. A patient who has atrophic vaginitis B. A patient who has inoperable prostate cancer C. A woman who has just given birth and wants to prevent postpartum lactation D. A woman with a history of thrombophlebitis
ANS: D
A nurse is caring for a client who has benign prostatic hyperplasia/hypertrophy (BPH). The nurse should expect which of the following findings? 1. Urge incontinence 2. Critically elevated prostate-specific antigen (PSA) level 3. Difficulty starting the flow of urine 4. Painful urination
ANS: Difficulty starting the flow of urine RATIONALE: Hesitancy is an expected finding Overflow incontinence Critically elevated prostate-specific antigen (PSA) level IS PROSTATE CANCER It is a complication not expected finding = UTI
A nurse is teaching a client following a cystoscopy about his new prescription for tamsulosin. Which of the following adverse effects should the nurse include in the teaching? 1. Temporary loss of libido 2. Dizziness 3. Bradycardia 4. Burning with urination
ANS: Dizziness RATIONALE: Or lightheadedness occurs with first several doses. Teach client to rise, lye or sit slowly Libido occurs with Finasteride Tachycardia occurs with orthostatic (postural) hypotension Burning is NOT an expected finding
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer? 1. Danazol 2. Finasteride 3. Fluoxymesterone 4. Methyltestosterone
ANS: Finasteride RATIONALE: 5-alpha-reductase inhibitor, prevents the ocnversion of testosterone and to decrease prostate size Danazol; anabolic steriod to treat endometriosis Fluoxymesterone; anabolic steriod Methyltestosterone; anabolic steriod anabolic steroids are CONTRAINDICATED in BPH
A nurse is caring for a client who is postoperative following a transurethral resection (TURP) of the prostate. Which of the following complications is the priority for the nurse to monitor? 1. Hemorrhage 2. Infection 3. Urinary retention 4. Pain
ANS: Hemorrhage RATIONALE: use ABC. monitor for urinary output for blood clots and bright red blood tinged urine following surgery Infection: important complication Urinary Retention: monitor in postop period Pain: important complication
A nurse is providing an education program about dietary interventions to reduce the risk for prostate cancer. Which of the following information should the nurse include? 1. Increase animal fat in the diet 2. Increase fatty fish in the diet 3. Reduce dietary fiber intake 4. Increase complex carbohydrates in the diet
ANS: Increase fatty fish in the diet - Omega 3 fatty acid RATIONALE: to reduce the risk for prostate cancer Reduce animal fats; red meats Reduce complex carbs Increase fruits & veggies Increase fiber intake
The nurse is planning an education program on SILDENAFIL to a group of older male clinets. Which of the following information should the nurse include in the education program? 1. Swallow the medication with grapefruit juice to improve the action 2. Ingestion of the medication with nitrates causes hypotension 3. Take the medication 2 hr prior to sexual activity. 4. Consume a high-fat meal to increase the medication absorption
ANS: Ingestion of the medication with nitrates causes hypotension. RATIONALE: due to the vasodilation effect of each medication and is not recommended. Take medication one 1hr prior to activity. High-fat meal will delay absorption
A nurse is caring for a client who is 2hr postop following a transurethral resection of the prostate (TURP) gland. Which of the following ASSESSMENTS should the nurse view to be an indication of a postop complication? 1. Output of burgundy colored urine 2. Pulse rate of 88/min 3. Oral temperature of 38.2C (100.76F) 4. An urge to void despite having an indwelling urinary catheter
ANS: Output of burgundy colored urine RATIONALE: Indicates venous bleeding, inform the provider and anticipate an order for increased CBI rate or manual irrigation Pulse rate of 88/min: is within expected range Oral temp of 100.7: indicated mild postop dehydration An urge to void despite having an indwelling catheter; traction is applied to the catheter causing pressure on the bladder neck causing a sensation to urinate
A nurse is caring for a client who has undergone a transurethral prostatectomy. Following catheter removal, the nurse should inform the client that he should expect which of the following variations in the color of his urine? 1. Pale pink 2. bright yellow 3. Bright red 4. Dark amber
ANS: Pale pink RATIONALE: patient should expect to pass some small clots and tissue for a few days. 2 to 3 days AFTER surgery, discharge the urine should be clear yellow. Bright yellow: increase fluid intake, 2000 to 2500 ml daily Bright red: call the provider immediately, indicates active bleeding Darm amber: increase his fluid intake, 2000 to 2500 ml daily
The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route should be planned? A. Oral B. Intramuscular C. Vaginal D. Transdermal
ANSl B
A nurse is teaching a client who takes phenytoin and has a new prescription for sucralfate tablets. Which of the following instructions should the nurse include?
Allow a 2hr interval between these medications
1. What is a pharmacodynamic effect of exogenous androgens? A. Decreased erythropoiesis B. Increased protein synthesis C. Increased nitrogen excretion D. Decreased sperm production
B
10. Testosterone is defined as: A. Male sex hormones responsible for mediating the development and maintenance of male sex characteristics. Chief among these are testosterone B. The main androgenic hormone C. Non-malignant enlargement of the prostate gland
B
12. Anabolic steroids can be defined as: A. Drugs that prevent androgens from mediating their biological effects in the body. B. Drugs that cause the synthesis of tissue and increasing tissue formation
B
14. Which synthetic exogenous estrogenic drug includes diethylstilbestrol (DES) and is no longer available in the United States due to its ability to cause cervical cancer? A. Steroidal B. Non-Steroidal
B
15. Responsible for the development and maintenance of the female reproductive system and the development of female secondary sex characteristics: A. Hormones B. Estrogens C. Steroids
B
16. Indications include: -Atrophic vaginitis -Hypogonadism -Oral contraception (given with a progestin) -Dysmenorrhea -"Hot flashes" of menopause -Uterine bleeding -Palliative treatment of advanced breast and prostate cancer -Osteoporosis treatment and prophylaxis A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
B
20. Post menopausal replacement therapy for a female who has undergone a hysterectomy can use: A. CCHRT B. Estrogen alone
B
21. Contraindictions include: - Any estrogen dependent cancer - Undiagnosed abnormal vaginal bleeding - Pregnancy - Active thromboembolic disorder or history (*estrogens increase clotting) A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
B
22. Doxazosin (Cardura) Tamsulosin (Flomax) Terazosin (Hytrin) Alfuzosin (Uroxatral) are examples of: A. 5-α-reductase inhibitors B. α₁-adrenergic blockers C. Androgen receptor blockers D. Erectile dysfunction drugs
B
22. Adverse Effects include: - Thrombotic events (most serious) - Nausea (most common) - Hypertension, thrombophlebitis, edema - Vomiting, diarrhea, constipation, abdominal pain - Photosensitivity - Chloasma (dark skin discolorations on face) - Amenorrhea, breakthrough uterine bleeding - Tender breasts, fluid retention, headaches A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
B
27. MOA includes: Prevent ovulation by inhibiting the release of gonadotropins and increasing uterine mucous viscosity, resulting in decreased sperm movement and fertilization of the ovum and possible inhibition of implantation of a fertilized egg (zygote) A. Hydroxyprogesterone (Hylutin) B. Medroxyprogesterone (Provera, Depo Provera) C. Megestrol (Megace) D. Etonogestrel implant (Implanon)
B
28. Adverse effects include: - Hepatotoxicity - Liver cancer A. Androgens B. Anabolic steroids C. 5-α-reductase inhibitors D. Erectile dysfunction drugs
B
32. Osteoporosis drug therapy: Selective estrogen receptor modifiers (SERM) A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. - Calcitonin - Teriparatide (Forteo)
B
35. Stimulate estrogen receptors on bone and increase bone density A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
B
38. Adverse effects include: Hot flashes, leg cramps, Increased risk of venous thromboembolism, Contraindicated if patient is near age of menopause because of possible hot flashes, Leukopenia A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
B
4. Patients prescribed sildenafil (Viagra) should be instructed regarding the potential life-threatening drug interaction with which medication? A. Warfarin (Coumadin) B. Nitroglycerin (Nitrostat) C. Acetaminophen (Tylenol) D. Aspirin (Acetylsalicylic acid)
B
41. Standardized mixture of FSH and LH; Stimulates development of ovarian follicles, leading to ovulation; May also be given to men to stimulate spermatogenesis: A. Clomiphene (Clomid) B. Menotropins (Pergonal) C. Chorionic gonadotropin alfa (Ovidrel)
B
44. Terbutaline (Brethine) Magnesium sulfate IV A. Uterine Stimulants (Oxytocics) B. Uterine Relaxants (Tocolytics)
B
46. Used to stop labor that begins before term to prevent premature birth: A. Uterine Stimulants (Oxytocics) B. Uterine Relaxants (Tocolytics)
B
48. Natural hormones; Cause potent contraction of myometrium, smooth muscle fibers of the uterus; Used to induce labor by softening the cervix and enhancing uterine muscle tone A. Oxytocin (hormonal drug) B. Prostaglandins - Dinoprostone (Prostin E2) - Misoprostol (Cytotec) C. Ergot derivatives - Methylergonovine (Methergine) D. Progesterone antagonist - Mifepristone (Mifeprex)
B
5. Which laboratory test would the nurse expect the health care provider to prescribe to monitor a patient for adverse effects related to progestin medications? A. Cardiac enzymes B. Liver function tests C. Complete blood count D. Serum creatinine level
B
The nurse is providing patient teaching about the oral bisphosphonate alendronate (Fosamax). Which statement by the patient indicates a good understanding of when this drug should be taken? a. "I will take it in the evening just before bedtime." b. "I will take it in the morning with an 8-ounce glass of water." c. "I will take it with the first bite of the morning meal." d. "I will take it between meals on an empty stomach."
B Bisphosphonates must be taken in the morning, with 6 to 8 ounces of plain water, to prevent esophageal erosion. In addition, the patient must sit upright for 30 minutes after taking them.
The nurse is preparing to administer the contraceptive form of medroxyprogesterone (DepoProvera). What route is appropriate? a. Subcutaneous b. Intramuscular c. Vaginal d. Transdermal
B Depo-Provera is a progestin-only injectable contraceptive that is given by the intramuscular route. The other options are incorrect.
The nurse is administering oxytocin (Pitocin). Which situation is an indication for the use of oxytocin? a. Decreased fetal heart rate and movements b. Stimulation of contractions during labor c. Cervical ripening near term in pregnant patients d. To reverse premature onset of labor
B Oxytocin is used to induce labor at or near full-term gestation and to enhance labor when uterine contractions are weak and ineffective.
During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased: a. incidence of nausea. b. risk for thrombosis. c. levels of triglycerides. d. tendency to bleed during menstruation.
B Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. The other options are incorrect.
A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having ophthalmic surgery. Which intervention is appropriate at this time? a. She will continue to take the alendronate with water. b. She cannot take the alendronate until she can sit up for 30 minutes. c. She can take the medication with breakfast. d. She will stop taking the medication 72 hours before her surgery.
B The nurse must emphasize that the patient should remain upright in either a standing or sitting position for approximately 30 minutes after taking a bisphosphonate so as to help prevent esophageal erosion or irritation. Because this patient will be required to lie flat in bed for 2 days after the surgery, the prescriber will need to be notified that the patient cannot take the medication during this time.
The nurse is reviewing the use of uterine tocolytics, such as indomethacin (Indocin). Which statement best describes the indication for these drugs? a. Prevention of preterm labor in the 15th week of pregnancy b. Prevention of preterm labor in the 22nd week of pregnancy c. Stimulation of contractions in prolonged labor d. Stimulation of ovulation as part of infertility treatments
B Tocolytics relax uterine smooth muscles and stop the uterus from contracting and are used along with nonpharmacologic measures to prevent preterm labor between 20 and 37 weeks of pregnancy.
7. A nurse is providing education to a group of athletes on the topic of anabolic steroids. What serious adverse effects would the nurse include in the discussion with the group of athletes? (Select all that apply.) A. Stroke B. Sterility C. Impotence D. Liver cancer E. Cardiovascular disease
B, D, E
A patient has been prescribed Testoderm transdermal patches for hypogonadism. The nurse should teach the patient to A. apply the patch to the upper arm B. apply the patch to clean, dry scrotal skin that has been shaved for optimal skin contact C. shave the skin of the calf and apply the patch D. discontinue use of the patch if the skin is uncomfortable
B. apply the patch to clean, dry scrotal skin that has been shaved for optimal skin contact
What is saw palmetto used for?
BPH alopecia Diruretic Urinary antiseptic
BPH
Benign prostatic hyperplasia - nonmalignant enlargement of prostate gland
What are the indications of Adrenogen Receptor Blockers?
Block activity of androgen hormones at target tissue receptors
Androgen Receptor Blockers
Block the activity of androgen hormones at target tissue (prostate) receptors * Help treat prostate cancer** Flutamide (Eulexin) Nilutamide (Nilandron) Bicalutamide (Casodex
11. Benign prostatic hyperplasa (BPH) is defined as: A. Male sex hormones responsible for mediating the development and maintenance of male sex characteristics. Chief among these are testosterone B. The main endogenous androgenic hormone, that plays a role in the development of bone and muscle tissue. C. Non-malignant enlargement of the prostate gland
C
17. Continuous-combined hormone replacement therapy (CCHRT) includes using: A. Estrogen B. Progestin C. Fixed estrogen/progestin combination products
C
24. Flutamide Nilutamide Bicalutamide are examples of: A. 5-α-reductase inhibitors B. α₁-adrenergic blockers C. Androgen receptor blockers D. Erectile dysfunction drugs
C
25. Indications for this progestin drug include: - Adjunct therapy for treatment of breast and endometrial cancers - Also used for management of anorexia, cachexia, or unexplained weight loss in AIDS patients - Used to stimulate appetite and promote weight gain in patients with cancer A. Hydroxyprogesterone (Hylutin) B. Medroxyprogesterone (Provera, Depo Provera) C. Megestrol (Megace) D. Etonogestrel implant (Implanon)
C
29. Adverse effects include: - Loss of libido - Loss of erection - Ejaculatory dysfunction A. Androgens B. Anabolic steroids C. 5-α-reductase inhibitors D. Erectile dysfunction drugs
C
33. Osteoporosis drug therapy: Hormones A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. - Teriparatide (Forteo) - Calcitonin
C
37. Only drug that stimulates bone formation; Derivative of parathyroid hormone; Action similar to natural parathyroid hormone A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
C
42. Recombinant form of human chorionic gonadotropin; Causes rupture and ovulation of mature ovarian follicles, and maintenance of corpus luteum; Used to stimulate ovulation: A. Clomiphene (Clomid) B. Menotropins (Pergonal) C. Chorionic gonadotropin alfa (Ovidrel)
C
49. Increases force and frequency of uterine contractions; Used after delivery of the infant and placenta to prevent postpartum uterine atony and hemorrhage; A. Oxytocin (hormonal drug) B. Prostaglandins - Dinoprostone (Prostin E2) - Misoprostol (Cytotec) C. Ergot derivatives - Methylergonovine (Methergine) D. Progesterone antagonist - Mifepristone (Mifeprex)
C
5. When teaching a patient regarding proper application of a testosterone (Testoderm) transdermal patch, the nurse will provide which information about this medication? A. Advise to replace the patch every 36 hours. B. Remind to remove the patch every 72 hours. C. Instruct to place the patch on clean, dry, shaved scrotal skin. D. Explain to apply the patch on the back, abdomen, or upper arms.
C
6. A female patient arrives to the clinic for counseling on potential hormone replacement therapy. When taking the patient's history, which condition would the nurse consider as a contraindication to use of hormone replacement therapy for the patient? A. Osteoporosis B. Hyperlipidemia C. Thromboembolic events D. Early onset of menarche
C
7. When educating a patient about the use of oral contraceptives, the nurse provides what explanation for the pills having different colors each week? A. "They help you remember which week you are taking." B. "There isn't a reason for the color; it's just the choice of the drug company." C. "The different color pills are because of different amounts of hormones in each week." D. "They are color coded for the weeks of the month."
C
8. A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives? A. "Report any abdominal pain, blood in the urine, or changes in vision." B. "There is no drug interaction between oral contraceptives and antibiotics." C. "Use an alternative method of birth control for up to 1 month during and after antibiotic use." D. "Your sexual partner should use a nonprescription test kit that will detect a urinary tract infection."
C
9. An elderly female patient being treated for osteoporosis with a selective estrogen receptor modulator (SERM) should alert the nurse for an increased risk of which condition? A. Hypertension B. Hypercalcemia C. Deep vein thrombosis D. Coronary heart disease
C
A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? a. Giving magnesium sulfate along with the oxytocin b. Administering the medication in an intravenous (IV) bolus c. Administering the medication with an IV infusion pump d. Monitoring fetal heart rate and maternal vital signs every 6 hours
C Oxytocin is infused via an infusion pump, not via an IV bolus. Magnesium sulfate is not administered with oxytocin. Fetal heart rate and maternal vital signs should be monitored continuously.
An older adult female patient is receiving the progestin drug megestrol (Megace). Which is the most likely reason megestrol is ordered for this patient? a. Migraine headaches b. Osteoporosis c. Appetite stimulant d. Reduction of hot flashes
C Megestrol can cause appetite stimulation and weight gain, and therefore is used in the management of anorexia, cachexia, or unexplained substantial weight loss in patients with acquired immunodeficiency syndrome (AIDS) and in patients with cancer. The other options are incorrect.
The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? a. "If you miss a dose, double-up on the next dose." b. "There's no need to be concerned about breast lumps or bumps that occur." c. "Be sure to report any weight gain of 5 pounds or more per week." d. "Take the medication on an empty stomach to enhance absorption."
C Patients taking oral estrogen therapy should report weight gain of 5 pounds or more per week to a physician. The other statements are not true for estrogen replacement therapy.
When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? a. Monophasic b. Biphasic c. Triphasic d. Short acting
C The triphasic drugs most closely duplicate the normal hormonal levels of the female menstrual cycle. The other options are incorrect.
25. The MOA for these drugs is: - Block the activity of androgen hormones at target tissue (prostate) receptor A. Finasteride B. Dutasteride C. Flutamide D. Nilutamide E. Bicalutamide
C, D, E
1. Which statement by the patient indicates an understanding of discharge teaching for the medication alendronate (Fosamax)? A. "I need to decrease my intake of dairy products to prevent hypercalcemia." B. "This medication will help relieve the bone pain I have from my osteoporosis." C. "I need to take this medication with food to prevent damage to my esophagus caused by reflux of stomach acid." D. "I will take the medication in the morning before I eat with 8 oz of water and remain upright for 30 minutes."
D
2. The combined continuous administration of progestin and estrogen reduces the risk of which cancer? A. Breast B. Vaginal C. Ovarian D. Endometrial
D
2. The nurse would question the administration of testosterone (Androderm) to a patient with which condition? A. Hypovolemia B. Hypocalcemia C. Hyponatremia D. Hyperkalemia
D
26. Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) are examples of A. 5-α-reductase inhibitors B. α₁-adrenergic blockers C. Androgen receptor blockers D. Erectile dysfunction drugs
D
28. Indications include: Primarily used to prevent pregnancy *Other uses: - Treatment of endometriosis and hypermenorrhea - To produce cyclic withdrawal bleeding - Postcoital emergency contraception A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
D
29. Adverse effects include: - Hypertension, thromboembolism, possible PE, MI, stroke - Edema, dizziness, headache, depression, nausea, vomiting, diarrhea, increased appetite, increased weight A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
D
3. The nurse would question a prescription for estrogen replacement therapy in a patient with a history of which condition? A. Weight loss B. Dysmenorrhea C. Vaginal bleeding D. Deep vein thrombosis
D
3. What possible common adverse effect would the nurse include in the discharge teaching for a patient prescribed finasteride (Proscar)? A. Hair loss B. Increased libido C. Muscle weakness D. Ejaculatory dysfunction
D
30. Adverse effects include: - Headache, flushing, dyspepsia, chest pain, hypotension - Priapism (Painful erection of the penis) - Unexplained visual loss - Lower BP substantially (In men with pre-existing cardiovascular disease, especially those taking nitrates) A. Androgens B. Anabolic steroids C. 5-α-reductase inhibitors D. Erectile dysfunction drugs
D
30. Interactions include: Antibiotics, barbiturates, isoniazid, rifampin A. Progestins B. Estrogens C. Steroids D. Contraceptive drugs
D
36. Directly inhibits osteoclastic bone resorption A. - Risedronate (Actonel) - Alendronate (Fosamax) - Ibandronate (Boniva) - Zoledronic acid (Reclast) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Calcitonin
D
50. Stimulates uterine contractions to induce abortion; Given with a prostaglandin drug for elective abortions A. Oxytocin (hormonal drug) B. Prostaglandins - Dinoprostone (Prostin E2) - Misoprostol (Cytotec) C. Ergot derivatives - Methylergonovine (Methergine) D. Progesterone antagonist - Mifepristone (Mifeprex)
D
6. The nurse is providing education to a patient and the patient's caregiver, who is pregnant, on the medication dutasteride (Avodart) for treatment of benign prostatic hyperplasia (BPH). What important teaching would the nurse provide to the patient and the patient's caregiver about this medication? A. Instruct to put the drug into a container with other medications. B. Notify your health care provider for an erection that lasts 2 hours. C. Take the medication with dairy containing products such as milk or yogurt. D. Emphasize it must not be touched or handled by pregnant women because of teratogenic effects.
D
The nurse recognizes that use of estrogen drugs is contraindicated in which patient? a. A patient who has atrophic vaginitis b. A patient who has inoperable prostate cancer c. A woman who has just given birth and wants to prevent postpartum lactation d. A woman with a history of thrombophlebitis
D Estrogenic drugs are contraindicated in people who have active thromboembolic disorders and in those with histories of thromboembolic disease. Atrophic vaginitis and inoperable prostate cancer are potential indications for estrogen therapy. Estrogen is not used to prevent lactation.
A patient is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem? a. Methylergonovine (Methergine) b. Estradiol transdermal (Estraderm) c. Raloxifene (Evista) d. Medroxyprogesterone (Provera)
D Medroxyprogesterone, a progestin, is one of the drugs most commonly used for secondary amenorrhea. Secondary amenorrhea is not an indication for the other drugs listed.
A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? a. Complete blood count b. Serum potassium level c. Vaginal cultures d. Pregnancy test
D Pregnancy should be ruled out before beginning oral contraceptive therapy because the medications can be harmful to the fetus; they are classified as pregnancy category X.
A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of treatment for postmenopausal osteoporosis. The nurse reviews potential contraindications, including which condition? a. Hypocalcemia b. Breast cancer c. Stress fractures d. Venous thromboembolism
D SERMs such as raloxifene are contraindicated in women with a venous thromboembolic disorder, including deep vein thrombosis, pulmonary embolism, or a history of such disorders. The other options are incorrect.
23. Synthetic derivatives of progesterone include: A. Estradiol B. Estrone C. Estriol D. Hydroxyprogesterone (Hylutin) E. Medroxyprogesterone (Provera) F. Megestrol (Megace) G. Etonogestrel implant (Implanon)
D, E, F, G
When assessing a patient taking testosterone, which laboratory value is most important for the nurse to review? A. hemoglobin A1C B. triglycerides C. potassium D. lactate dehydrogenase (LDH)
D. Lactate dehydrogenase (LDH) Rationale: Assess the patient for liver disease because formation of blood-filled cavities may occur. This condition, also called peliosis, is associated with long-term therapy and may be life-threatening. Perform liver function studies (e.g., LDH, CPK, and bilirubin levels) as ordered to monitor for the possible adverse effect of abnormal liver function and jaundice.
A patient tells the nurse that he takes saw palmetto because he thinks his prostate gland is enlarged. The patient informs the nurse of the medications he takes on a regular basis. Which medication will be of most concern to the nurse? A. calcium with vitamin D B. acetaminophen (Tylenol) C. St. John's wort D. ibuprofen (Motrin)
D. ibuprofen (Motrin) Rationale: The nurse should be most concerned about concurrent use of saw palmetto with the NSAID ibuprofen (Motrin) because of the potential for drug interactions.
A patient has been prescribed AndroGel. When providing patient teaching, the nurse will instruct the patient that the gel may be applied to all of the following areas EXCEPT the A. abdomen B. shoulders C. arms D. thighs
D. thighs
A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast cancer. The nurse should tell the client that which of the following are adverse effects of this medication?
Deepening voice Weight gain Facial hair
A nurse is caring for a client who recieved prochlorperazine 4hr ago. The client reports spasms of the face. The nurse should expect a prescription for which of the following medications?
Diphenhydramine
23. The indication for these drugs is: - Used for symptomatic relief of obstruction caused by BPH A. Doxazosin (Cardura) B. Tamsulosin (Flomax) C. Terazosin (Hytrin) D. Alfuzosin (Uroxatral) E. All of the above
E
What possible common adverse events with the nurse include in the discharge teaching for a patient prescribe finasteride (Proscar)?
Ejaculatory dysfunction
The nurse is providing education to a patient and the patient's caregiver, who is pregnant, on the medication dutasteride (Avodart) for treatment of benign prostate hyperplasia BPH . What important teaching what the nurse provided to the patient and the patient's caregiver about this medication?
Emphasize it must not be touched or handle by pregnant women because of teratogenic effects
A nurse is teaching a client about cimetidine. Which of the following are adverse effects of cimetidine?
Enlargement of breast tissue Confusion Decreased sperm count
Prostate Problems are no... FUN
F- Frequency U- Urgency N- Nocturia
What are AE of androgens?
Fluid retention pelisses of liver/hepatic effects
What are examples of Androgen Receptor Blockers
Flutamide (Eulexin) nilutamide (Nilandron) bicalutamide (Casodex)
What are the AE of saw palmetto?
GI upset HA backpain dysuria
What are AE of drugs that treat erectile dysfunction?
HA, flushing, dspepsia, chest pain, hypotension, priapism, visual loss, heartburn
A nurse is planning to administer ondansetron to a client. For which of the following adverse effects of ondansetron should the nurse monitor?
Headache Diarrhea Prolonged QT interval
A nurse is providing teaching to a client who will start alfuzosin for treatment of benign prostatic hyperplasia. The nurse should instruct the client that which of the following is an adverse effect of this medication?
Hypotension
What is a pharmacodynamic effect of exogenous androgens ?
Increased protein synthesis
Adverse effects of erectile dysfunction drugs
Increased pulse hypo tension priapism (prolonged erection) headache flushing * NO NITRATE, THIS WILL BOTTOM BP*
How do Gn-RH analogs work?
Inhibits the secretion of pituitary gonadotropins that leads to decrease testosterone
When teaching a patient regarding proper application of a testosterone (Testoderm) Transdermal patch, the nurse will provide which information about this medication?
Instruct to place the patch on clean, dry, shaved scrotal skin.
A nurse is caring for a client who has angina and asks about obtaining a prescription for slidenafil to treat erectile dysfunction. Which of the following medication is contraindicated with slidenafil?
Isosorbide
A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should expect a prescription for which of the following medications?
Metoclopramide
What drugs interact with Saw Palmetto
NSAIDs Estogen/oral contaceptives Immunostimulants
What should not be taken with viagra?
Nitrates
Patients prescribed sildenafil (Viagra) should be instructed regarding the potential life-threatening drug interactions with which medication?
Nitroglycerin (Nitrostat)
Can treatment for ED work without sexual stimulation?
No
What is oxandrolone used for?
Non-FDA approved HIV associated wasting syndrome to stimulate weight gain
Methyltestosterone (Android)
Oral Testosterone Therapy
Why are transdermal forms better absorbed than oral forms of androgens?
Oral forms have a high first-pass effect
What must be assessed before beginning any drugs for treating prostate disease?
PSA level Digital rectal examination (DRE) renal and liver function
A nurse is teaching a client about probiotic supplements. Which of the following information should the nurse include?
Probiotics are micro-organisms that are normally found in the GI tract Probiotics are used to treat benign prostatic hyperplasia You can experience bloating while taking probiotic supplements
Alprostadil (Caverject)
Prostaglandin; Administered by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra
What are the approved indications for androgens?
Replacement hormone therapy Anemia herebditary angioedema metastatic breast cancer
What schedule are anabolic steroids? Why?
Schedule III - great potential for misuse by athletes
Where do you place transdermal testoderm?
Scrotal skin - changed everyday
What are patient teaching tips about Finasteride?
Should not be taken by women Women should wear gloves while handling Protect the drug from light and heat Must not be handled at all by pregnant women
Vardenafil (Levitra) Tadalafil (Cialis) Avanafil (Stendra)
Similar use to viagra but longer duration
A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client to avoid which of the following laxatives.
Sodium phosphate
A nurse is providing education to a group of athletes on the topic of anabolic steroids. What serious adverse event with the nurse include in the discussion with the group of athletes? Select all that apply
Sterility Liver cancer Cardiovascular disease
What are serious consequences of using anabolic steroids?
Sterility Cardiovascular disease liver cancer
The nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medication have the longest therapeutic effect when taking orally? Select all that apply
Tadalafil (Cialis) Vardenafil(Levitra)
A nurse is teaching a client who will begin taking aluminum hydroxide. Which of the following information should the nurse include in the teaching?
Take this medication two hours before or after other medications
A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives?
Thickening of the cervical mucus Altering the endometrial lining Inhibiting ovulation
A nurse is teaching a client who has a new prescription for omeprazole. Which of the following information should the nurse include in the teaching?
This medication decreases the production of gastric acid
A nurse is reviewing the health care record of a client who is asking about conjugated equine estrogens. The nurse should inform the client this medication is contraindicated in which of the following conditions?
Thrombophlebitis
Alpha1-Adrenergic Blockers
Used for symptomatic relief of obstruction caused by BPH: -Doxazosin (Cardura) -Tamsulosin (Flomax) - Terazosin (Hytrin) -Alfuzosin (Uroxatral) - Silodosin (Rapaflo)
What is the first oral drug that treats ED?
Viagra
A male patient wants to known if there are any drugs that can be used for baldness. The nurse knows that which drug, in low dosages, is used for androgenetic alopecia in men? a. finasteride (Propecia) b. vardenafil (Levitra) c. danazol (Danocrine) d. oxandrolone (Oxandrin)
a
A patient will be receiving testosterone therapy for male hypogonadism and has a new prescription for transdermal testosterone (Testoderm). The nurse needs to include which teaching about the use of this medication? a. apply the patch only on the scrotum b. apply the patch to the chest, back, or shoulders c. if the adverse effects become bothersome, the patient should stop using the patch d. the patch should be applied to a different area of the upper body each day
a
A patient has a new prescription for finasteride. The nurse will instruct the patient about which potential adverse effects? (select all that apply) a. loss of erection b. gynecomastia c. headaches d. increased libido e. ejaculatory dysfunction
a, b, e
anabolic steroids: approved indications
adjunctive therapy to promote weight gain after extensive surgery, trauma, chronic diseases, anemia, hereditary angioedema, and metastatic breast cancer
Fluoxymesterone (Halotestin)
anabolic steroid
A 19 year old college football player asks a nurse about taking steroids to help him "beef up" his muscles. Which statement is true? a. there should be no problems as long as he does not exceed the recommended dosage. b. long term use may cause a life-threatening liver condition. c. he would need to be careful to watch for excessive weight loss. d. these drugs also tend to increase the male's sperm count
b
In addition to their many other effects on body systems, the nurse would be correct in identifying which of the following as an outcome of androgen therapy? a. increased sperm production and enhanced fertility b. increased red blood cell production c. weight loss d. bone resorption
b
In which situations would androgens be prescribes for a women? (select all that apply) a. development of secondary sex characteristics b. fibrocystic breast disease c. ovarian cancer d. treatment of endometriosis e. postmenopausal osteoporosis prevention f. inoperable breast cancer
b, d, f
What are the indications of 5 alpha reductase inhibitors?
block effects of endogenous androgens treat BPH Male-pattern baldness
A male patient tells the nurse he has been taking finasteride (Proscar) for 3 months and has seen little relief of symptoms. Which response by the nurse is most accurate? a. "you will need surgical intervention" b. "tell me how you're taking your medication" c. "it may take up to 6 months for full effect" d. "a second drug will need to be added to your medications"
c
A patient is taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia. His wife, who effects that may occur with this drug. Which statement by the nurse is the most important at this time? a. "gastric upset may be reduced if he takes this drug on an empty stomach" b. "he should notice therapeutic effects of increased libido and erection within 1 month" c. "this medication should not even handled by pregnant women because it may harm the fetus" d. "he may experience transient hair loss while taking this medication"
c
men's health drugs: adverse effects - PDE inhibitors
can cause unexplained visual loss
A patient has asked for a new prescription for sildenafil (Viagra), an erectile dysfunction drug. As the nurse reviews his current medications, which drug, if taken by the patient, would cause a significant interaction? a. coumadin, an oral anticoagulant b. amoxil, an antibiotic c. nexus, a proton pump inhibitor d. isordil, a nitrate
d
Before a patient begins therapy with finasteride (Proscar), the nurse should make sure that which laboratory test has been performed? a. blood glucose level b. complete blood count c. urinalysis d. prostate-specific antigen (PSA) level
d
What are examples of Alpha1-adrenergic blockers?
doxazosin (Cardura) tamsulosin (Flomax) terazosin (Hytrin) alfuzosin (Uroxatral) silodosin (Repaflo)
men's health drugs: adverse effects - androgens
fluid retention
What are examples of Gn-RH analogs?
goserelin (Zoladex) leuprolide (Lupron) triptorelin (Trelstar)
The nurse would question the administration of testosterone (Androderm) to a patient with which condition?
hyperkalemia
What are the AE of 5 alpha reductase inhibitors?
loss of libido loss of erection ejaculatory dysfunction
men's health drugs: adverse effects - finasteride
loss of libido, loss of erection, ejaculatory dysfunction, hypersensitivity reactions, gynecomastia, severe myopathy, and a 50% decrease in prostate-specific antigen (PSA) concentrations
Androgens
male sex hormones secreted by the testes
What are the functions of testosterone?
normal development and maintenance of male sex characteristics Bone and muscle tissue Inhibition of protein catabolism Retention of various electrolytes Stimulates the production of blood cells
What drugs interact with androgens?
oral anticoagulants cyclosporine alpha blockers "Azole" antifungals
What are examples of the anabolic steroids?
oxymetholone (Anadrol-50) oxandrolone (Oxandrin) Nandrolone (Deca-Durabolin)
What do Gn-RH analogs treat?
prostate cancer
Where do you place transdermal androderm?
skin on the body, never the scrotal skin
danazol (Danocrine)
synthetic androgen indicated for treatment of hereditary angioedema, endometriosis, and fibrocystic breast disease
What are the AE of Alpha1-Adrenergic blockers?
tachycardia, hypotension, syncope, depression, drowsiness, rash, impotence, urinary frequency
What is the main androgenic hormone?
testosterone
Testosterone
the most important of the male sex hormones. Both males and females have it, but the additional testosterone in males stimulates the growth of the male sex organs in the fetus and the development of the male sex characteristics during puberty
Phosphodiesterase (PDE) inhibitors
treatment of erectile dysfunction (ED). Sildenafil (Viagra) First oral drug for treatment of ED Causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis and permits the inflow of blood
Gonadotropin-Releasing Hormone Analogues
• Luteinizing hormone-releasing hormone (LH-RH) agonists • Leuprolide (Lupron), goserelin (Zoladex) • Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. • Reduction in the production of androgens and estrogens
herbal products: saw palmetto
•Serenoa repens, Sabal serrulata •used for treatment of BPH and alopecia •adverse effects: GI upset, headache, back pain, dysuria
priapism
•abnormally prolonged penile erection •relatively uncommon •possible adverse effect of both the ED drugs and the androgens •medical emergency that warrants urgent medical •caused by an excessive therapeutic drug response
anabolic steroids
•anabolic activity: synthesis of tissue and increasing tissue formation •schedule III, great potential for misuse by athletes •oxymetholone (Anadrol-50) •oxandrolone (Oxandrin) •nandrolone (Deca-Durabolin)
interactions
•androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity •androgens with cyclosporine increases the risk of cyclosporine toxicity •sildenafil, vardenafil, tadalafil, and avanafil may cause severe hypotension when given together with nitrates such as nitroglycerin, isosorbide mononitrate, or isosorbide dinitrate •alpha blockers: additive hypotension when given with other drugs that lower blood pressure •effects of tamsulosin may be increased when it is taken with azalea antifungal drugs, erythromycin and clarithromycin, cardiac drugs such as propranolol and verapamil, and protease inhibitors
nursing implications
•assessment should include complete history, including medication history, urinary elimination problems, and potential contraindications •obtain baseline vital signs, weight, height, and serum electrolyte levels •assess renal and liver function •assess PSA level and perform digital rectal examination before beginning any drugs for treatment of prostate disease •assess current medications for potential interactions •follow exact instructions for sublingual, buccal, and oral forms •transdermal Testoderm patches are applied to the scrotal skin •transdermal Androderm patches are applied to the skin on the body, never to scrotal skin •pregnant women should not touch crushed or broken hormone drugs •educate patients on proper administration techniques for each drug •monitor for therapeutic responses •monitor for adverse effects
androgen receptor blockers
•block the activity of androgen hormones at target tissue (prostate) cancer •used in the treatment of prostate cancer •flutamide (Eulexin) •nilutamide (Nilandron) •bicalutamide (Casodex)
androgen inhibitors
•block the effects of naturally occurring (endogenous) androgens •5-Alpha reductase inhibitors •benign prostatic hyperplasia (BPH) treatment •finasteride •dutasteride
anabolic steroids: great potential for misuse
•bodybuilders and weightlifters •muscle-building properties •serious consequences: sterility, cardiovascular diseases, and liver cancer •schedule III controlled substances by the US Drug Enforcement Administration •misuse of these drugs can lead to psychological or physical dependence or both
androgens: mechanism of action
•effects are similar to the body's endogenous androgens •stimulate normal growth and development of the male sex organs •development and maintenance of male secondary sex characteristics •stimulate increase synthesis of body proteins, aiding in the formation of muscular and skeletal proteins •enhanced erythropoiesis
sildenafil (Viagra)
•first oral drug for treatment of ED •causes relaxation of the smooth muscle in the corpora cavernosa (erectile tubes) of the penis and permits the inflow of blood
finasteride (Propicia)
•inhibition of 5-alpha reductase prevents the thinning of hair caused by increased levels of DHT •male pattern baldness •women - not for treatment of female baldness - teratogenic in pregnant women - use in women of any age (pregnant or not) is not recommended - women need to wear gloves when handling
men's health drugs: contraindications
•known androgen-responsive tumors •sildenafil, vardenafil, tadalafil, and avanafil: contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications such as nitroglycerin •use of finasteride is contraindicated in women (especially pregnant women) and in children
men's health drugs: adverse effects - anabolic steroids
•peliosis of the liver •hepatic neoplasms (liver cancer) •cholestatic hepatitis •jaundice •abnormal liver function
drugs to treat erectile dysfunction
•phosphodiesterase (PDE) inhibitors are used in the treatment of erectile dysfunction (ED) •sildenafil (Viagra) •vardenafil (Levitra) •tadalafil (Cialis): similar to sildenafil (Viagra) but longer duration of action •sildenafil and tadalafil are also used to treat pulmonary hypertension •avanagil (Stendra): newest PDE inhibitor approved for ED •alprostadil (Caverject) •prostaglandin •administered by injecting it directly into the erectile tissue of the penis or pushing a suppository form of the drug into the urethra
men's health drugs: indications
•primary use: replacement therapy •other uses vary with the specific drug
testosterone
•responsible for norm development and maintenance of primary and secondary male sex characteristics •development of bone and muscle tissue •inhibition of protein catabolism (metabolic breakdown) •retention of various electrolytes •stimulates the production of blood cells
danazol (Danocrine)
•synthetic androgen is danazol (Danocrine) •use: treatment of hereditary angioedema, and, in women, endometriosis and fibrocystic breast disease
androgens
•testosterone •several synthetic derivatives of testosterone are available •long-term dosage forms can last from 2 to 3 days to 2 to 4 weeks •oral forms have a high first-pass effect - methyltestosterone (Android) - fluoxymesterone (Halotestin) •transdermal forms available - patches and gel •anabolic steroids •danazol (Danocrine)
alpha1-adrenergic blockers
•used for symptomatic relief of obstruction cause by BPH •doxazosin (Cardura) •tamsulosin (Flomax) •terazosin (Hytrin) •alfuzosin (Uroxatral) •silodosin (Rapaflo) •these drugs have clinical effects of prostate shrinkage immediately •5-Alpha reductase inhibitors may take up to 6 months of continual therapy for clinical effects of prostate shrinkage
gonadotropin-releasing hormone analogs
•used to treat prostate cancer •action: inhibit the secretion of pituitary gonadotropin, which eventually leads to a decrease in testosterone production •goserelin (Zoladex) •Leuprolide (Lupron) •triptorelin (Trelstar)
