Week 9 Pharm

Absolute contraindications that clinicians must consider when initiating estrogen therapy include: 1. Undiagnosed dysfunctional uterine bleeding 2. Deep vein or arterial thromboemboli within the prior year 3. Endometriosis 4. 1 and 2

1 and 2

Effects of estrogen include: 1. Regulation of the menstrual cycle 2. Maintenance of bone density by increasing bone reabsorption 3. Maintenance of the normal structure of the skin and blood vessels 4. 1 and 3

1 and 3

Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and chlamydia in: 1. Four weeks 2. 3 to 6 weeks 3. 3 to 6 months 4. One year

3 to 6 months

Dosage changes of conjugated equine estrogen (Premarin) are made at _________ intervals. 1. 1 to 2 week 2. 2 to 4 week 3. 6 to 8 week 4. 12 week

6 to 8 week

Male patients require ______________________ before and during androgen therapy. 1. A digital prostate exam 2. A Doppler exam of testicular blood flow 3. Urine analysis for proteinuria 4. Serial orthostatic blood pressures

A digital prostate exam

A contraindication to the use of combined contraceptives is: 1. Adolescence (not approved for this age) 2. A history of clotting disorder 3. Recent pregnancy 4. Being overweight

A history of clotting disorder

A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: 1. Low-dose oral estrogen 2. A low-dose estrogen/progesterone combination 3. A vaginal estradiol ring 4. Vaginal progesterone cream

A vaginal estradiol ring

Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding the fact that: 1. The most recent partners in the past 60 days should also be treated. 2. Alcohol should not be consumed during and for 72 hours after metronidazole therapy. 3. Condoms should be used during intercourse if intravaginal clindamycin cream is used. 4. Cotreatment for chlamydia is necessary.

Alcohol should not be consumed during and for 72 hours after metronidazole therapy.

In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding: 1. Necessity of treating sexual partner simultaneously 2. Abstaining from intercourse until both partners are treated 3. Need for retesting in three months due to high reinfection rate 4. All of the above

All of the above

Ongoing monitoring for women on ERT includes: 1. Lipid levels, repeated annually if abnormal 2. Annual health history and review of risk profile 3. Annual mammogram 4. All of the above

All of the above

Progesterone-only pills are recommended for women who: 1. Are breastfeeding 2. Have a history of migraine 3. Have a medical history that contradicts the use of estrogen 4. All of the above

All of the above

The goals of treatment when prescribing for sexually transmitted infections include: 1. Treatment of infection 2. Prevention of disease spread 3. Prevention of long-term sequelae from the infection 4. All of the above

All of the above

Your female patient is requesting "Viagra for women" to help with her depressed libido. What can you share with her? 1. This drug does not have the same rapid onset as a phosphodiesterase type 5 (PDE5) for men. 2. The "pink Viagra" is focused on a proposed neurotransmitter dysfunction. 3. It takes about three months for full effect and many patients do not see a major clinical effect. 4. All of the above.

All of the above.

Women who have migraines with an aura should not be prescribed estrogen because of: 1. The interaction between triptans and estrogen, limiting migraine therapy choices 2. An increased incidence of migraines with the use of estrogen 3. An increased risk of stroke occurring with estrogen use 4. Patients with migraines may be prescribed estrogen without any concerns.

An increased risk of stroke occurring with estrogen use

An adult female patient presents to the clinic with vulvovaginal candidiasis. Appropriate treatment for her would be: 1. Over-the-counter (OTC) intravaginal clotrimazole 2. OTC intravaginal miconazole 3. Oral fluconazole one-time dose 4. Any of the above

Any of the above

Treatment for chancroid in a nonpregnant patient would be: 1. Oral azithromycin 2. IM ceftriaxone 3. Oral ciprofloxacin 4. Any of the above

Any of the above

When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with: 1. Azithromycin 1 g PO x 1 2. Amoxicillin 500 mg PO x 1 3. Ciprofloxacin 500 mg PO x 1 4. Penicillin G 2.4 million units IM x 1

Azithromycin 1 g PO x 1

The drug of choice for treatment of primary or secondary syphilis is: 1. Ceftriaxone intramuscular (IM) 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin

Benzathine penicillin G IM

The drug of choice for treatment of tertiary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin

Benzathine penicillin G IM

Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: 1. Nausea 2. Breakthrough bleeding 3. Breast tenderness 4. Pregnancy

Breakthrough bleeding

What medication can be used to help treat hyperprolactinemia? 1. Addyi 2. A PDE-5 3. Bromocriptine 4. Progesterone

Bromocriptine

Long-term use of androgens requires specific laboratory monitoring of: 1. Glucose, calcium, testosterone, and thyroid function 2. Calcium, testosterone, prostate-specific antigen (PSA), and liver function 3. Calcium, testosterone, PSA, liver function, glucose, and lipids 4. CBC, testosterone, PSA, and thyroid level

Calcium, testosterone, PSA, liver function, glucose, and lipid

Treatment for suspected gonorrhea is: 1. Ceftriaxone 250 mg IM x 1 2. Ceftriaxone 2 g IM x 1 3. Ciprofloxacin 500 mg PO x 1 4. Doxycycline 100 mg bid x 7 days

Ceftriaxone 250 mg IM x 1

Education when prescribing androgens to male patients includes advising that: 1. Short-term use places the patient at risk for hepatocellular carcinoma. 2. Cholestatic hepatitis and jaundice may occur with low doses of androgens. 3. Gynecomastia is a rare occurrence with the use of androgens. 4. Low sperm levels only occur with long-term use of androgens.

Cholestatic hepatitis and jaundice may occur with low doses of androgens.

Absolute contraindications to estrogen therapy include: 1. History of any type of cancer 2. Clotting disorders 3. History of tension headaches 4. Orthostatic hypotension

Clotting disorders

Obese women may have increased risk of failure with which contraceptive method? 1. Combined oral contraceptives 2. Progestin-only oral contraceptive pill 3. Injectable progestin 4. Combined topical patch

Combined topical patch

A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: 1. Counseling regarding decreasing or not smoking while taking oral contraceptives 2. Advising a monthly pregnancy test for the first three months she is taking the contraceptive 3. Advising that she may miss two pills in a row and not be concerned about pregnancy 4. Recommending that her next follow-up visit is in one year for a refill and annual exam

Counseling regarding decreasing or not smoking while taking oral contraceptives

Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include: 1. Decrease in bone mineral density with longer-term use 2. Increase in migraines 3. Increased risk for venous thromboembolism (VTE) 4. Increased risk of cardiovascular events

Decrease in bone mineral density with longer-term use

The medroxyprogesterone (Depo-Provera) injection has a black box warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson syndrome

Decreased bone density

Shana is receiving her first medroxyprogesterone (Depo-Provera) injection. Shana will need to be monitored for: 1. Depression 2. Hypertension 3. Weight loss 4. Cataracts

Depression

When prescribing medroxyprogesterone (Depo-Provera) injections, essential education would include advising of the following potential adverse drug effects: 1. Hypertension and dysuria 2. Depression and weight gain 3. Abdominal pain and constipation 4. Orthostatic hypotension and dermatitis

Depression and weight gain

Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: 1. Development of chest pain or dizziness 2. Weight gain 3. Priapism 4. Renal function

Development of chest pain or dizziness

Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering HRT includes: 1. Explaining that HRT is totally safe if used short term 2. Telling her to ignore media hype regarding HRT 3. Discussing the advantages and risks of HRT 4. Encouraging her to use phytoestrogens with HRT

Discussing the advantages and risks of HRT

Postmenopausal women with an intact uterus should not be prescribed: 1. An estrogen/progesterone combination 2. Intramuscular (IM) medroxyprogesterone (Depo-Provera) 3. Estrogen alone 4. Androgens

Estrogen alone

The newer dyspareunia drugs are required by the U.S. Food and Drug Administration (FDA) to carry the same risk warnings as: 1. Progestins 2. Estrogens 3. Testosterone 4. Androgen antagonists

Estrogens

Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for: 1. Impotence when combined with antihypertensives 2. Fatal hypotension if combined with nitrates 3. Weight gain if combined with antidepressants 4. All of the above

Fatal hypotension if combined with nitrates

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: 1. Two years 2. Five years 3. 10 years 4. 15 years

Five years

Re-evaluation of the Women's Health Study has resulted in what changes in HRT implementation? 1. A combination of estrogen and progestin is no longer required in patients with an intact uterus. 2. Women with breast cancer survivorship over 10 years are no longer considered "at risk." 3. HRT can be used in the first five years of menopause without major risk increase. 4. Low-dose estrogen can be used again in women over 65.

HRT can be used in the first five years of menopause without major risk increase.

A 24-year-old female patient is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be: 1. IM ceftriaxone 2. IM benzathine penicillin G 3. Oral azithromycin 4. Any of the above

IM benzathine penicillin G

Women with an intact uterus should be treated with HRT with both estrogen and progestin due to: 1. Increased risk for endometrial cancer if estrogen alone is used 2. Combination therapy providing the best relief of menopausal vasomotor symptoms 3. Reduced risk for colon cancer with combined therapy 4. Lower risk of developing blood clots with combined therapy

Increased risk for endometrial cancer if estrogen alone is used

Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? 1. Increased migraine headaches 2. Increased risk of developing blood clots 3. Irregular vaginal bleeding for the first few months 4. Increased risk for hypercalcemia

Irregular vaginal bleeding for the first few months

An advantage of using the NuvaRing vaginal ring for contraception is: 1. It does not require fitting and is easy to insert. 2. It is inserted once a week, eliminating the need to remember to take a daily pill. 3. Patients get a level of estrogen and progestin equal to combined oral contraceptives. 4. It also provides protection against vaginal infections.

It does not require fitting and is easy to insert.

Monitoring for a patient who is using androgens includes evaluation of: 1. Complete blood count (CBC) and C-reactive protein levels 2. Lipid levels and liver function tests 3. Serum potassium and magnesium levels 4. Urine protein and potassium levels

Lipid levels and liver function tests

"Fertility drugs" linked with female infertility treatments can also be used for: 1. Male spermatogenesis issues 2. Lactation suppression 3. Pituitary tumor suppression 4. An abortifacient

Male spermatogenesis issues

Oral emergency contraception (Plan B) is contraindicated in women who: 1. Had intercourse within the past 72 hours 2. May be pregnant 3. Are taking combined oral contraceptives 4. Are using a diaphragm

May be pregnant

Patients who are prescribed exogenous androgens need to be warned that decreased libido: 1. Is an unusual side effect of androgens and should be reported to the provider 2. Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems 3. May be a sign of early prostate cancer, so he should make an appointment for a prostate screening exam 4. May occur with androgen therapy

May occur with androgen therapy

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is: 1. Immediate protection against pregnancy the first week of using the pill 2. No back-up method is needed when starting 3. Menses occur during the week 4. They can start the pill on the Sunday after the office visit

Menses occur during the week

An adult female presents with a malodorous vaginal discharge and is confirmed to have a Trichomonas infection. Treatment for her would include: 1. Metronidazole 2 g PO x 1 dose 2. Topical intravaginal metronidazole daily x 7 days 3. Intravaginal clindamycin daily x 7 days 4. Azithromycin 2 g PO x 1 dose

Metronidazole 2 g PO x 1 dose

A female patient presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be: 1. Metronidazole 500 mg PO b.i.d. x 7 days 2. Doxycycline 100 mg PO b.i.d. x 7 days 3. Intravaginal tinidazole daily x 5 days 4. Metronidazole 2 g PO x 1 dose

Metronidazole 500 mg PO b.i.d. x 7 days

Herbals that have proven efficacy for improving vasomotor symptoms include: 1. Black cohosh 2. Red clover 3. Evening primrose 4. None of the above

None of the above

The U.S. Food and Drug Administration warns that androgens may cause: 1. Peliosis hepatis 2. Orthostatic hypotension 3. Menstrual irregularities 4. Acne

Peliosis hepatis

An adult female presents with genital warts on her labia. Patient-applied topical therapy for genital warts includes: 1. Podofilox 0.5% gel 2. Podophyllin 10% resin 3. Trichloroacetic acid 4. Any of the above

Podofilox 0.5% gel

A test of cure is recommended after treating chlamydia in which patient population? 1. Men who have sex with men 2. Adolescent females 3. Pregnant patients 4. All of the above

Pregnant patients

Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: 1. Recommend she return to the clinic at the start of her next menses to get a Depo- Provera shot. 2. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first seven days. 3. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days. 4. Discuss the advantages of using the topical birth control patch and recommend she consider using it.

Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days.

Which of the following is not an indication for starting HRT? 1. Symptomatic hot flashes 2. Treatment or prevention of vaginal atrophy 3. Prevention of osteoporosis 4. Early surgical menopause

Prevention of osteoporosis

The mechanism of action of oral combined contraceptives that prevents pregnancy is: 1. Estrogen prevents the luteinizing hormone surge necessary for ovulation. 2. Progestins thicken cervical mucus and slow tubal motility. 3. Estrogen thins the endometrium making implantation difficult. 4. Progestin suppresses follicle stimulating hormone release.

Progestins thicken cervical mucus and slow tubal motility.

Shana received her first medroxyprogesterone (Depo-Provera) injection six weeks ago and calls the clinic, concerned that she has been having a light period off and on since receiving her Depo shot. What should the provider do? 1. Reassure her that some spotting is normal the first few months of Depo and it should improve. 2. Schedule an appointment for an exam as this is not normal. 3. Prescribe four weeks of estrogen to treat the abnormal vaginal bleeding. 4. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot.

Reassure her that some spotting is normal the first few months of Depo and it should improve.

The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is: 1. Ability to deliver higher doses of estrogen in a nonoral form 2. The vaginal cream formula provides moisture to the vaginal area. 3. Relief of symptoms without increasing cardiovascular risk 4. All of the above

Relief of symptoms without increasing cardiovascular risk

Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: 1. Hemoglobin 2. Serum calcium 3. White blood count 4. Serum potassium

Serum potassium

A 19-year-old female is a nasal Staph aureus carrier and is placed on five days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness. 4. If she gets nauseated with the medications she should call the office for an antiemetic prescription.

She should use a back-up method of birth control such as condoms for the rest of the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness

Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: 1. Washing their hands after applying the gel 2. Wearing occlusive clothing while using the gel 3. Exposure to estrogens while using the gel 4. Skin-to-skin contact with pregnant women while using the gel

Skin-to-skin contact with pregnant women while using the gel

The topical patch combined contraceptive (Ortho Evra) is: 1. Started on the first day of the menstrual cycle 2. Recommended for women over 200 pounds 3. Not as effective as oral combined contraceptives 4. Known to have more adverse effects, such as nausea, than the oral combined contraceptives

Started on the first day of the menstrual cycle

Reexamination of the women's health study has modified guidelines for the use of estrogen in menopause. Which of the following is true? 1. Supplementation for the first five years is considered to have a reasonable risk/benefit profile for selected groups of women. 2. Estrogen can once again be given solely for its bone health benefits. 3. The risk of deep vein thrombosis (DVT) is not as high as previously thought. 4. Supplementation has a great CV benefit if started after the first five years of menopause.

Supplementation for the first five years is considered to have a reasonable risk/benefit profile for selected groups of women.

Androgens are indicated for: 1. Symptomatic treatment for male deficiency 2. Female libido, endometriosis, and postmenopausal symptoms treatment 3. Increased muscle mass in frail women 4. Symptomatic treatment in both sexes for cancer and human immunodeficiency virus (HIV)

Symptomatic treatment for male deficiency

Follow-up testing after treatment of chancroid would be: 1. Syphilis and human immunodeficiency virus (HIV) testing at three-month intervals 2. Chancroid-specific antigen test every three months 3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure 4. Annual HIV testing if the patient engages in high-risk sexual behavior

Syphilis and human immunodeficiency virus (HIV) testing at three-month intervals

What is the duration of selective estrogen receptor modifier (SERM) use for menopausal issues? 1. It matches the five year duration for estrogen products. 2. The bone health impact allows long-term use. 3. The increased risk of breast cancer encourages tapering as soon as possible. 4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur.

The bone health impact allows long-term use.

"Menopause" is diagnosed when: 1. The patient has no menses for 12 months. 2. The patient has onset of vasomotor symptoms with irregular menses. 3. The patient has no bleeding cycle for six months. 4. Precise laboratory values are documented.

The patient has no menses for 12 months.

Why are SERMs generally not ordered for women early into menopause? 1. The rapid onset of severe hot flashes can be unbearable. 2. The bone remodeling effect results in osteoporosis. 3. They tend to induce intermittent spotting. 4. The increased risk of breast cancer isn't worth the benefits of a SERM.

The rapid onset of severe hot flashes can be unbearable.

William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for ________________ before receiving a prescription for sildenafil. 1. Renal dysfunction 2. Unstable coronary artery disease 3. Benign prostatic hypertrophy 4. History of priapism

Unstable coronary artery disease

To improve actual effectiveness of oral contraceptives women should be educated regarding: 1. Use of a back-up method if they have vomiting or diarrhea during a pill packet 2. Doubling pills if they have diarrhea during the middle of a pill pack 3. The fact that they will have a normal menstrual cycle if they miss two pills 4. The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

Use of a back-up method if they have vomiting or diarrhea during a pill packet

All of the following are risks of exogenous hormones except: 1. Breast cancer 2. Uterine cancer 3. Increased cardiovascular problems 4. Vaginal atrophy

Vaginal atrophy

The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: 1. Cardiovascular risk 2. Risk of stroke or other thromboembolic event 3. Risk of breast cancer 4. Vasomotor symptoms

Vasomotor symptoms

A woman with recurrent vulvovaginal candidiasis may be treated with: 1. Weekly intravaginal butoconazole for three months 2. Fluconazole 150 mg PO daily x 7 doses then monthly for six months 3. Weekly fluconazole 150 mg PO x six months 4. Intravaginal tioconazole x 14 days

Weekly fluconazole 150 mg PO x six months