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NRP507 Advanced Pharmacology

Week 4 Quiz

Question 1

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.

Question 2

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

Question 3

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

Question 4

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

Question 5

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

Question 6

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.

Question 7

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

Question 8

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.

Question 9

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

Question 10

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

Question 11

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

Question 12

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.

Question 13

“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.

Question 14

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

Question 15

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

Question 16

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

Question 17

All of the following are risks of exogenous hormones except:

1. Breast cancer

2. Uterine cancer

3. Increased cardiovascular problems

4.Vaginal atrophy

Question 18

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.

Question 19

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

Question 20

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

Question 21

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

Question 22

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

Question 23

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

Question 24

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

Question 25

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

Question 26

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

Question 27

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

Question 28

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

Question 29

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.

Question 30

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

Question 31

Monitoring for a healthy, nonpregnant adult patient being treated for a UTI is:

1. Symptom resolution in 48 hours

2. Follow-up urine culture at completion of therapy

3. Test of cure urinary analysis at completion of therapy

4.Follow-up urine culture two months after completion of therapy

Question 32

The treatment goals when treating urinary tract infection (UTI) include:

1. Eradication of the infecting organism

2. Relief of symptoms

3.Prevention of recurrence of the UTI

4.All of the above

Question 33

Lisa is a healthy nonpregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The  to give her would be:

1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.

2.Cranberry juice will decrease UTIs.

3.There is no clear evidence that cranberry juice helps prevent UTIs.

4.Cranberry juice only works to prevent UTIs in children.

Question 34

Which of the following patients may be treated with a five day course of therapy for their UTI?

1. A 28-year-old pregnant woman

2. A six-year-old healthy female

3.A 24-year-old female

4.A 26-year-old female diabetic

Question 35

Maternal-to-child transmission of HIV infection during pregnancy may be prevented by:

1. Use of antiviral drugs such as zidovudine

2. Use of condoms during intercourse

3.Both 1 and 2

4.Neither 1 nor 2

Question 36

Which of the following holds true for the pharmacokinetics of women?

1. Gastric emptying is faster than that of men.

2.Organ blood flow is the same as that of men.

3.Evidence is strong concerning renal differences in elimination.

4.Medications that involve binding globulins are impacted by estrogen levels.

Question 37

Gender differences between men and women in pharmacokinetics include:

1.Women have more rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

2. Women have a higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

3. Women have increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

4.Women have slower organ blood flow rates so drugs tend to take longer to be excreted

Question 38

Which of the following drug classes is associated with significant differences in metabolism based on gender?

1. Beta blockers

2. Antibiotics

3.Serotonin reuptake inhibitors

4.Angiotensin-converting-enzyme (ACE) inhibitors

Question 39

The best way to use nonsteroidal anti-inflammatory drug (NSAIDs) for severe menstrual cramps is:

1. Take them for 2 to 3 days prior to the start of bleeding.

2.Take them 2 to 3 times a day during the first two days.

3. Take them every 2 to 3 hours.

4. They have not been found to be helpful at all.

Question 40

Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is:

1. Oral contraceptive pills

2. Caffeine

3.Nonsteroidal anti-inflammatory drug (NSAIDs)

4.Aspirin

Question 41

The metabolism of drugs in women is primarily impacted by:

1. Hepatic blow flow

2.Enzymes of the CYP450 system

3.The amount of gastric secretions

4. Whether they are pre- or postmenopausal

Question 42

Since 40% of bone accrual occurs during adolescence, building bone during this time is critical. Ways to improve bone accrual in adolescents include:

1. Use of bisphosphonates early if dual energy x-ray absorptiometry (DEXA) scans show limited bone accrual

2. Encouraging a daily dietary intake of 1,300 mg of calcium and 400 IU of vitamin D

3.Avoiding all birth control methods that include progesterone

4.Fostering the intake of iron mainly in green and leafy vegetables

Question 43

Treatment of PMDD that affects all or most of the symptoms includes:

1. Tryptophan up to 6 g/day

2. Vitamin E 200 to 400 mg/day

3. Evening primrose oil 500 mg/day

4.Fluoxetine 20 mg/day

Question 44

Hot flashes are often a concern during menopause. Which of the following may help in reducing them?

1. Drink one caffeinated liquid per day.

2.Take progesterone supplementation.

3.Exercise 20 to 40 minutes/day.

4. Increase intake of carrots, yams, and soy products.

Question 45

The goal of testosterone replacement therapy is:

1. Absence of all hypogonadism symptoms

2.Testosterone levels in the mid-normal range one week after an injection

3. Testosterone levels in the mid-normal range just prior to the next injection

4. Avoidance of high serum testosterone levels during therapy

Question 46

While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:

1.Hemoglobin 14 g/dL or hematocrit 39%

2. Hemoglobin 11.5 g/dL or hematocrit 31%

3. Hemoglobin 13 g/dL or hematocrit 38%

4.Hemoglobin 17.5 g/dL or hematocrit 54%

Question 47

Male patients who should not be prescribed PDE-5 inhibitors include:

1.Diabetics

2.Those who have had an acute myocardial infarction in the past six months

3.Those who are deaf

4.Those who are under age 60 years of age

Question 48

When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn:

1.Without regard to time of day

2.First thing in the morning

3.Late afternoon

4.In the evening

Question 49

Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?

1.Age-related decrease in cognitive functioning

2.Metabolic syndrome

3.Decreased muscle mass in aging men

4.All of the above

Question 50

When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of:

1. Statins

2. Nitrates

3.Insulin

4. Opioids

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