Ch. 35, Men's Health Drugs

Question 3 of 4 Match the testosterone formulation with its appropriate administration technique

Inserted by health care provider - Testosterone pellets Take by mouth with or without food -Methyltestosterone Inject deeply into gluteal muscle -Testosterone enanthate Apply to underarms -Testosterone topical solution

Question 12 of 24 Which statement regarding the pharmacodynamics and pharmacokinetics of mirabegron is accurate?

Mirabegron undergoes extensive metabolism that involves CYP2D6 and CYP3A4. Mirabegron undergoes extensive hepatic metabolism, including dealkylation, oxidation, glucuronidation, hydrolysis, and CYP2D6 and CYP3A4 involvement.

Question 2 of 3 Which patient parameters would a nurse ensure are assessed before a patient receives therapy with sildenafil?

Sexual history Sexual history is important to assess, particularly focusing on presence of morning erections, ability to achieve and maintain erection, ability to penetrate partner, libido, and overall satisfaction to document effects associated with therapy. Cardiovascular history The patient's cardiovascular history is critical to assess because sildenafil can worsen some cardiovascular conditions such as angina, arrhythmias, stroke, and myocardial infarction. Blood pressure and heart rate Blood pressure and heart rate should be assessed due to the ability of sildenafil to impact these parameters.

Question 8 of 24 Which statement by the nursing student about benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) therapy requires further intervention?

Sildenafil is a 5-alpha-reductase inhibitor that causes smooth muscle constriction, allowing increased blood flow into the penis. Sildenafil is a type 4 phosphodiesterase inhibitor, not 5-alpha-reductase inhibitor, that causes smooth muscle relaxation, not constriction, allowing increased blood flow into the penis.

Question 1 of 5 Which type of urinary incontinence is treated with a β3-adrenergic agonist?

Urge β3-adrenergic agonists like mirabegron are considered second-line drugs to treat urge urinary incontinence. Antimuscarinics may also be used.

Question 2 of 5 Which statements accurately describe the pharmacokinetic parameters of conjugated equine estrogens (CEE) vaginal cream?

Topical CEE cream is well-absorbed through mucosal membranes in the vagina. The vaginal administration of topical CEE allows for good absorption to occur through the vaginal mucosal membranes. Topical CEE is highly protein bound. The drug is highly protein bound and widely distributes into tissues. The drug undergoes hepatic metabolism. CEE undergoes metabolism in the liver.

Question 3 of 5 In which time frame can a patient expect to experience duloxetine's onset of action?

2 to 6 weeks The onset of action for duloxetine is about 2 to 6 weeks. Patients will not instantly see beneficial effects but must continue to take the drug as prescribed.

Question 7 of 24 In which time frame can a patient expect sildenafil to begin working?

30 to 60 minutes Sildenafil's onset of action is 30 to 60 minutes after administration. The patient should expect to see benefits with treatment and appropriate sexual stimulation.

Question 3 of 3 Which time frame describes how long sildenafil's effects last?

4 to 6 hours The duration of action for sildenafil is 4 to 6 hours. Therefore a patient can expect to experience effects for this time frame.

Question 4 of 24 Which time frame describes when oral conjugated equine estrogens (CEE) should reach the peak plasma concentration?

6 to 10 hours The time frame of 6 to 10 hours is when CEE is expected to reach its peak plasma concentration.

Question 3 of 3 Which patient parameters would a nurse identify as potentially requiring a lower dosage of sildenafil?

A 72-year-old patient with dyslipidemia Although dyslipidemia most likely does not impact the dose of sildenafil, the patient's age does. Generally, patients over 65 years of age may require a lower dosage of sildenafil. A 67-year-old patient with alcoholic cirrhosis Hepatic impairment, such as alcoholic cirrhosis, typically requires a lower dosage of sildenafil. Additionally, this patient's age of 67 would also suggest he might require a lower dose. A 64-year-old patient receiving ketoconazole Although the patient's age does not suggest he would need a lower dosage of sildenafil, the fact that he is taking ketoconazole does. This drug is a CYP3A4 inhibitor, which can increase exposure to the drug and thus cause adverse effects. A 61-year-old patient with a creatinine clearance of 20 mL/min The patient's age of 61 does not require a lower dosage of sildenafil. However, his renal function is below 30 mL/min, which requires the dose to be lowered.

Question 19 of 24 Which patients would a nurse determine cannot safely receive therapy with duloxetine for stress urinary incontinence?

A patient with alcoholism Duloxetine may worsen liver damage in patients with preexisting liver damage. A patient with alcoholism is prone to liver damage and should not receive therapy with duloxetine. A patient with hepatitis B Duloxetine may worsen liver damage in patients with preexisting liver damage. A patient with hepatitis B has experienced liver impairment and should not receive therapy with duloxetine.

Which patients would a nurse determine can safely receive therapy with topical conjugated equine estrogen (CEE) for stress urinary incontinence?

A patient with osteoporosis Osteoporosis is not a concern for treatment with topical CEE. Therefore this patient can safely receive therapy. A patient with hyperkalemia Hyperkalemia is not a concern for treatment with topical CEE. Therefore this patient can safely receive therapy. A patient who had back surgery 6 months ago Back surgery is not a concern for treatment with topical CEE. Therefore this patient can safely receive therapy.

Question 2 of 4 Which patients would a nurse determine can safely receive treatment with oral conjugated equine estrogens (CEE)?

A patient with type 2 diabetes mellitus Patients with type 2 diabetes mellitus may safely receive CEE because there is no concern with therapy in this population of patients. A patient with osteoporosis Osteoporosis is a condition that could benefit from receiving estrogen therapy. Estrogens are involved in bone formation, and with menopause, the risk for osteoporosis increases. This patient could safely receive therapy.

Question 21 of 24 Which patient teaching points would a nurse to share with a female patient prescribed pseudoephedrine for stress urinary incontinence?

Advise the patient to check her blood pressure at home. Patients receiving pseudoephedrine chronically should measure their blood pressure. The drug may cause hypertension, which may warrant further action steps for blood pressure control. The drug should be taken as prescribed, not taking more or less than what was prescribed. Patients should be encouraged to take pseudoephedrine as prescribed, not deviating from the dosage. The patient should avoid taking the drug late in the day or early evening because it may cause jitteriness, anxiety, or restlessness. Because pseudoephedrine is stimulating, it should not be taken late in the day or early evening; it may cause jitteriness, anxiety, and restlessness, which may impair sleep.

Question 10 of 24 Which mechanism of action describes how pseudoephedrine works to treat stress urinary incontinence?

Alpha1-adrenergic agonism Pseudoephedrine is an alpha1-adrenergic agonist that causes vasoconstriction to enhance the closure of the urethra.

Question 2 of 3 Which conditions may lead to organic erectile dysfunction (ED)?

Arteriosclerosis Arteriosclerosis is a potential causative factor for organic ED. Diabetes Diabetes may cause organic ED. Hormonal imbalance Hormonal imbalance such as testosterone deficiency may lead to organic ED. Penile disorders Penile disorders can contribute to organic ED. Vascular insufficiency Vascular insufficiency is a contributor to the development of organic ED.

Question 5 of 24 Which drugs are type 5 phosphodiesterase (PDE5) inhibitors used to treat erectile dysfunction (ED)?

Avanafil Avanafil is a PDE5 inhibitor used to treat ED. Sildenafil Sildenafil is a PDE5 inhibitor used to treat ED. Tadalafil Tadalafil is a PDE5 inhibitor used to treat ED. Vardenafil Vardenafil is a PDE5 inhibitor used to treat ED.

Question 1 of 3 Which phrase accurately describes the mechanism of action and roles of conjugated equine estrogens (CEEs) in hormone replacement therapy?

Binds to nuclear receptors in estrogen-sensitive tissues to replenish low hormone levels in menopause During menopause, there is a decline in estrogen levels. CEE works to replenish these low hormone levels. Estrogens, like CEE, bind to nuclear receptors in estrogen-sensitive tissues.

Question 23 of 24 Which patient parameter would a nurse closely monitor in a patient who is taking mirabegron?

Blood pressure Mirabegron can increase blood pressure. Therefore it is important that a nurse closely monitor this parameter in patients receiving the drug.

Question 1 of 5 Which interventions are important for a nurse to make in a patient with benign prostatic hyperplasia (BPH) who has been prescribed both tamsulosin and finasteride?

Blood pressure assessment Blood pressure should be assessed in men receiving tamsulosin due to a risk for hypotension with therapy. Prostate-specific antigen (PSA) level assessment Prostate-specific antigen levels should be assessed in men with BPH, particularly those receiving finasteride. The drug is expected to reduce the PSA level and should be monitored every 6 to 12 months.

Question 4 of 4 A patient who was newly prescribed oral conjugated equine estrogens (CEE) is also taking levothyroxine and carbamazepine. Which drug interaction would a nurse determine may occur when the patient begins taking CEE?

Concomitant administration of carbamazepine and CEE may lead to decreased levels of CEE, necessitating a dosage increase in CEE. Carbamazepine is a CYP3A4 inducer that can decrease plasma levels of CEE when taken together. As a result, the patient may require a dosage increase in CEE in order to experience therapeutic effects.

Question 4 of 5 A patient who has been prescribed mirabegron also takes aspirin and digoxin. Which potential drug interaction would a nurse suspect may occur with the administration of mirabegron?

Digoxin and mirabegron is associated with an increase in digoxin levels, potentially requiring a dosage reduction. Digoxin levels may increase when given with mirabegron. A dosage reduction may be required. Digoxin levels should be monitored closely.

Question 24 of 24 Which patient education point would a nurse share with a patient who has been newly prescribed tamsulosin for benign prostatic hyperplasia?

Do not crush, chew, or cut open the capsules. Tamsulosin capsules should not be tampered with, including crushing, chewing, or cutting them. They are intended to be swallowed whole.

Question 6 of 24 Which statements accurately describe what occurs normally within the body during an erection?

During the nonerect state, arterial blood flow into the penis is equal to venous outflow into the body. In the flaccid, nonerect state, arterial flow into the penis is equal to venous outflow into the body. Acetylcholine increases the production of nitric oxide from endothelial cells. Acetylcholine enhances nitric oxide's production from endothelial cells. Nitric oxide activates guanine cyclase, which produces cyclic guanosine monophosphate. Nitric oxide activates the enzyme guanine cyclase to form cyclic guanosine monophosphate. Cyclic guanosine monophosphate causes smooth muscle relaxation and increases blood flow into the penis. Cyclic guanosine monophosphate causes the smooth muscle to relax and enhance blood flow into the penis to yield an erection.

Question 4 of 5 Which urogenital drug works through inhibition of the enzyme 5-alpha-reductase?

Finasteride Finasteride is a 5-alpha-reductase inhibitor that reduces the size of the prostate gland through this mechanism.

Question 9 of 24 Which statement about the pharmacokinetic parameters of finasteride is accurate?

Finasteride is excreted in both the urine and the feces. This statement is accurate. The drug's excretion occurs through both the urine and feces.

Question 5 of 5 Which statements accurately describe the pharmacokinetic parameters of tamsulosin?

Following oral administration, absorption is almost complete (>90%). Tamsulosin is almost completely (>90%) absorbed with oral administration. The drug is highly protein bound (94% to 99%) and is widely distributed. Tamsulosin widely distributes into tissues and is highly protein bound (94% to 99%). Tamsulosin is extensively metabolized through the CYP450 system. The drug is extensively metabolized in the liver by the CYP450 system. The drug is predominantly excreted in the urine. Tamsulosin is predominantly excreted in the urine with some excretion occurring in the feces.

Question 1 of 24 Which statements regarding the pharmacokinetic parameters of medroxyprogesterone acetate is accurate?

Food increases the drug's bioavailability. Food increases the bioavailability of medroxyprogesterone acetate from 50% to 70%. Medroxyprogesterone acetate is 90% protein bound. The drug is highly protein (i.e., 90%). The drug undergoes hepatic metabolism involving hydroxylation and conjugation. Medroxyprogesterone acetate undergoes metabolism in the liver through hydroxylation followed by conjugation.

Question 11 of 24 Which statements regarding the pharmacokinetic parameters of oxybutynin are accurate?

Gels and patches allow for passive diffusion of oxybutynin across the skin.Passive diffusion across the skin occurs with gel and patch formulations of oxybutynin. Oxybutynin is widely distributed in tissues.Wide distribution of the drug into body tissues occurs. The drug is hepatically metabolized, with most metabolism occurring through CYP3A4.Oxybutynin is metabolized in the liver, with most metabolism occurring through the CYP3A4 isoenzyme. A small amount of the administered oxybutynin dose is excreted in the urine.Less than 0.1% of the administered dose of oxybutynin is excreted in the urine.

Question 17 of 24 A nurse is providing care to a patient with benign prostatic hyperplasia and erectile dysfunction who is receiving both sildenafil and tamsulosin. Which potential outcome may result from the two drugs being taken together?

Hypotension Both sildenafil and tamsulosin cause hypotension. Therefore there is an additive risk for hypotension when giving these two together. They can be safely coadministered, but the patient should be monitored for the development of hypotension.

Question 20 of 24 A patient with stress urinary incontinence is prescribed duloxetine 40 mg PO BID. The patient also takes paroxetine (for depression), ibuprofen (for osteoarthritis), lisinopril (for hypertension), atorvastatin (for dyslipidemia), and famotidine (for gastroesophageal reflux disease).

Ibuprofen due to an increased risk for bleedingIbuprofen is a nonsteroidal antiinflammatory drug that may increase the risk for bleeding in patients receiving duloxetine. Paroxetine due to an increased risk for serotonin syndromeParoxetine is both a CYP2D6 inhibitor, which can increase duloxetine levels, and is a serotoninergic drug, which can increase the risk for serotonin syndrome in patients receiving duloxetine.

Question 2 of 24 Which formulation of testosterone has the longest elimination half-life?

Intramuscular testosterone cypionate Intramuscular testosterone cypionate has the longest elimination half-life of 8 days.

Question 1 of 3 A nurse is caring for a patient who has been prescribed sildenafil 50 mg orally 1 hour before sexual activities. The patient also takes simvastatin (for dyslipidemia), isosorbide dinitrate (for angina), aspirin (for heart disease prevention), and nicotine replacement patch (for smoking cessation). Which drug poses a significant concern for interacting with sildenafil, resulting in the nurse calling the health care provider?

Isosorbide dinitrate Isosorbide dinitrate is a nitrate that can lead to significant hypotension in a patient who is also taking sildenafil. This combination of drugs should never be used together. A nurse would alert the health care provider.

Question 1 of 4 Which patient parameters would a nurse ensure are assessed before a male patient begins therapy with intramuscular testosterone for testosterone deficiency?

Lipid panel A lipid panel should be assessed before testosterone therapy initiation to monitor any changes that might occur with therapy. Liver function Liver function tests should be evaluated before testosterone therapy because peliosis hepatitis, in which the patient develops blood-filled cysts in the liver, may occur. Complete blood counts Complete blood counts should be evaluated because testosterone impacts erythropoietin synthesis. Total testosterone levels Two total testosterone levels drawn in the morning should be assessed before initiation of testosterone to determine the dosage.

Question 3 of 3 Which statement is accurate regarding the absorption of testosterone?

Oral absorption of testosterone may be reduced when it is taken with food. This is a true statement. When given orally, food may reduce the absorption of testosterone.

Question 3 of 24 Which phrases accurately describe the mechanism of action and roles of medroxyprogesterone acetate in hormone replacement therapy?

Protects against endometrial proliferation, which can cause cancerProgestins are involved in the protection against estrogen-stimulated endometrial proliferation, which can cause cancer. Causes a transition in the endometrium from the proliferative to the secretory phaseMedroxyprogesterone acetate works to cause a transition in the endometrium from the proliferative to the secretory phase.

Question 22 of 24 Which counseling point would a nurse share with a patient who has been newly prescribed oxybutynin 10% gel 1 sachet once daily?

Smoking should not occur when applying topical oxybutynin. As the gel is flammable, smoking should not occur while applying topical oxybutynin.

Question 13 of 24 Which patient parameters would a nurse ensure are assessed before a female patient begins therapy with oral conjugated equine estrogens and medroxyprogesterone acetate for menopausal symptoms?

Smoking status Smoking status is critical to assess in a female who is initiated on hormone replacement therapy. Smoking and estrogen administration increase the risk for stroke. The patient should be encouraged to stop smoking if she currently smokes. Complete gynecologic history, including if she has an intact uterusA complete gynecologic history, including the results from the most recent Pap smear, should be evaluated to ensure hormone replacement therapy can be safely administered. If the patient does not have a uterus, medroxyprogesterone acetate is not needed. However, it should be included if she has a uterus to protect from estrogen-stimulated endometrial proliferation. History of or current thromboembolism The patient's current and history of thromboembolism should be evaluated as hormone replacement therapy may cause thromboembolism. Patient and family history of hormone-sensitive cancers It is important a nurse assesses a patient's family and personal history for hormone-sensitive cancers such as breast cancer due to a risk with hormone replacement therapy.

Question 18 of 24 A patient with hyperthyroidism, prostate cancer, type 2 diabetes mellitus, and status post myocardial infarction 9 months ago is in clinic to see if he is able to receive sildenafil for erectile dysfunction. Which of the patient's medical conditions would a nurse alert the health care provider about before sildenafil is prescribed?

Status post myocardial infarction Patients who have had a prior myocardial infarction should be carefully evaluated before initiation of sildenafil. Given the cardiovascular effects sildenafil may cause, it is important to ensure the patient can safely receive therapy.

Question 1 of 3 Which statement is accurate regarding the pharmacokinetic profile of sildenafil?

The drug is metabolized by CYP3A4 and CYP2C9. Sildenafil is metabolized by CYP3A4 and CYP2C9, producing a metabolite that has similar PDE selectivity to sildenafil.

Question 2 of 3 Which statements accurately describe the pharmacokinetic parameters of oral conjugated equine estrogens (CEEs)?

The drug is well absorbed with oral administration. CEE is well absorbed following oral administration. CEE undergoes hepatic metabolism. CEE is metabolized in the liver. The drug is subject to enterohepatic recirculation when given orally. CEE is subject to enterohepatic recirculation when given via the oral route.

Question 16 of 24 Which patient education points would the nurse share with a patient who has been prescribed sildenafil for erectile dysfunction?

The drug will not work without adequate sexual stimulation.Sildenafil will work when the patient is adequately stimulated sexually. The drug does not produce an erection in the absence of sexual stimulation. The drug should be administered about an hour before sexual activities.For best effects, sildenafil should be taken about an hour before sexual activities. The patient should report any dizziness, chest pain, or blood pressure changes to the health care provider.Dizziness, chest pain, and/or blood pressure changes should be reported to the health care provider.

Question 14 of 24 Which patient education points are important for a nurse to share with a patient who has been prescribed buccal testosterone 30 mg twice daily?

The old tablet should be removed before applying a new one.Before a new dose is applied, the old tablet should be removed. It may take the drug about 30 seconds for the drug to be applied.When applying the drug, it may take about 30 seconds before the tablet has adhered above the incisor tooth to the gum. The tablet should be placed above the incisor tooth, adhering to the gum.To appropriately apply, the tablet should be placed above the incisor tooth, adhering to the gum.

Question 2 of 5 A nurse is providing care to a patient who has been prescribed the oxybutynin transdermal patch. Which administration steps should be shared with the patient to ensure the drug is used correctly?

The patch should be applied to clean, dry skin on the abdomen, hips, or buttocks. The patch should be placed on clean, dry skin that is not on body folds. The areas of application can include the abdomen, hips, or buttocks. To discard the patch, fold the sticky sides of the patch together and throw it away. When changing out the patch, the old patch should be folded on the sticky sides together and thrown away. The patch should not be placed on skin where lotions, oils, or powders have been applied. The patch should not be used on areas of skin that have lotion, oil, or powder applied.

Question 15 of 24 Which teaching points would the nurse share with a patient who had a hysterectomy and is newly prescribed conjugated equine estrogen (CEE)?

The patient may experience depressive symptoms or mood changes with CEE therapy. Depressive symptoms and mood disturbances are possible with estrogen therapy. CEE increases the risk for deep vein thrombosis and stroke and should be used for the shortest amount of time. The Women's Health Initiative demonstrated a risk for stroke and deep vein thrombosis in women receiving estrogens. Therefore cardiovascular risk factors should be assessed before initiating estrogen-containing therapies.

Question 5 of 5 Place the steps in the order a patient would follow to appropriately administer topical CEE therapy.

To appropriately administer topical CEE therapy the patient would first remove the cap from the tube of cream. Next, they would screw the nozzle of the application tube. They would then gently squeeze the cream from the bottom of the tube into the applicator to the indicated line. After unscrewing the applicator from the tube, they would lie on their back and with their knees drawn up. They would insert the applicator deep into the vagina. Lastly, they would press down on the plunger until it stops and then remove it from the vagina.