22: Drugs affecting the Reproductive system

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

4. May occur with androgen therapy

Question 4

4. The U.S. Food and Drug Administration warns that androgens may cause:
5. Peliosis hepatis
6. Orthostatic hypotension
7. Menstrual irregularities
8. Acne

Answer 4

1. Peliosis hepatis

Question 5

5. Monitoring for a patient who is using androgens includes evaluation of:
6. Complete blood count and C-reactive protein levels
7. Lipid levels and liver function tests
8. Serum potassium and magnesium levels
9. Urine protein and potassium levels

Answer 5

2. Lipid levels and liver function tests

Question 6

6. Male patients require ______________________ before and during androgen therapy.
7. A digital prostate exam
8. A Doppler exam of testicular blood flow
9. Urine analysis for proteinuria
10. Serial orthostatic blood pressures

Answer 6

1. A digital prostate exam

Question 7

7. Absolute contraindications to estrogen therapy include:
8. History of any type of cancer
9. Clotting disorders
10. History of tension headaches
11. Orthostatic hypotension

Answer 7

2. Clotting disorders

Question 8

8. Postmenopausal women with an intact uterus should not be prescribed:
9. Estrogen/progesterone combination
10. IM medroxyprogesterone (Depo Provera)
11. Estrogen alone
12. Androgens

Answer 8

3. Estrogen alone

Question 9

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

Answer 9

3. An increased risk of stroke occurring with estrogen use

Question 10

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

Answer 10

1. Counseling regarding decreasing or not smoking while taking oral contraceptives

Question 11

11. A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?
12. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour.
13. Both medications are best tolerated if taken on an empty stomach.
14. She should use a back-up method of birth control such as condoms for the rest of the current pill pack.
15. If she gets nauseated with the medications she should call the office for an antiemetic prescription.

Answer 11

3. She should use a back-up method of birth control such as condoms for the

Question 12

12. 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:
13. Low-dose oral estrogen
14. A low-dose estrogen/progesterone combination
15. A vaginal estradiol ring
16. Vaginal progesterone cream

Answer 12

3. A vaginal estradiol ring

Question 13

13. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:
14. Depression
15. Hypertension
16. Weight loss
17. Cataracts

Answer 13

1. Depression

Question 14

14. When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects:
15. Hypertension and dysuria
16. Depression and weight gain
17. Abdominal pain and constipation
18. Orthostatic hypotension and dermatitis

Answer 14

2. Depression and weight gain

Question 15

15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to:
16. The potential development of significant hypertension
17. Increased risk of strokes
18. Decreased bone density
19. The risk of a life-threatening rash such as Stevens-Johnson

Answer 15

3. Decreased bone density

Question 16

16. Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light “period” off and on since receiving her Depo shot. What would be the management of Shana?
17. Reassurance that some spotting is normal the first few months of Depo and it should improve.
18. Schedule an appointment for an exam as this is not normal.
19. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding.
20. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot.

Answer 16

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

Question 17

17. William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for ________________ before prescribing sildenafil.
18. Renal dysfunction
19. Unstable coronary artery disease
20. Benign prostatic hypertrophy
21. History of priapism

Answer 17

2. Unstable coronary artery disease

Question 18

18. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:
19. Development of chest pain or dizziness
20. Weight gain
21. Priapism
22. Renal function

Answer 18

1. Development of chest pain or dizziness

Question 19

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

Answer 19

2. Fatal hypotension if combined with nitrates

Question 20

20. Androgens are indicated for:
21. Symptomatic treatment for male deficiency
22. Female libido, endometriosis, and postmenopausal symptoms
23. Increased muscle mass
24. Symptomatic treatment in both sexes for cancer and HIV
25. 1, 2, and 4
26. All of the above

Answer 20

5. 1, 2, and 4

Question 21

21. Long-term use of androgens requires specific laboratory monitoring of:
22. Glucose, calcium, testosterone, and thyroid function
23. Calcium, testosterone, PSA, and liver function
24. Calcium, testosterone, PSA, liver function, glucose, and lipids
25. CBC, testosterone, PSA, and thyroid level

Answer 21

3. Calcium, testosterone, PSA, liver function, glucose, and lipids

Question 22

22. Effects of estrogen include:
23. Regulation of the menstrual cycle
24. Maintenance of bone density by increasing bone reabsorption
25. Maintenance of the normal structure of the skin and blood vessels
26. A and C
27. All of the above

Answer 22

4. A and C

Question 23

23. Absolute contraindications that clinicians must consider when initiating estrogen therapy include:
24. Undiagnosed dysfunctional uterine bleeding
25. Deep vein or arterial thromboemboli within the prior year
26. Endometriosis
27. 1 and 2
28. All of the above

Answer 23

4. 1 and 2

Question 24

24. Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent:
25. Nausea
26. Breakthrough bleeding
27. Breast tenderness
28. Pregnancy

Answer 24

2. Breakthrough bleeding