Osteo, meno, testosterone

Question 1

Which risk factors for osteoporosis? (Select ALL that apply.)

A
Postmenopausal
B
Low body mass weight
C
Advanced age
D
Prednisone use
E
Rheumatoid arthritis

Answer 1

All the above

Question 2

Which of the following statements regarding SC’s calcium supplementation is correct?

Calcium carbonate 1250 mg PO BID

A
SC is receiving 1000 mg of elemental calcium daily.
B
SC is receiving 550 mg of elemental calcium daily.
C
SC should take her calcium supplement on an empty stomach to increase absorption.
D
SC should switch to a more expensive formulation that has a higher percentage of elemental calcium.
E
SC should switch from calcium carbonate to Calcitrate.

Answer 2

A
SC is receiving 1000 mg of elemental calcium daily.

Incorrect
Calcium carbonate contains 40% elemental calcium. It should be taken with food since absorption is acid dependant. There is no advantage to switching to a different formulation in this patient but based on her age, she should increase her intake to 1,200 mg of elemental calcium daily.

Question 3

Which of the following treatments for osteoporosis causes hypercalcemia?
Answer

A
Risedronate
B
Ibandronate
C
Calcitonin
D
Denosumab
E
Teriparatide

Answer 3

E
Teriparatide
Incorrect
Teraparitide causes hypercalcemia. All other options presented cause hypocalcemia.

Question 4

What is the most common application site for the Vivelle-Dot and most estrogen patches?
Answer

A
Hip
B
Lower abdomen
C
Buttocks
D
Upper thigh
E
Back

Answer 4

B

Lower abdomen

Question 5

HB is a 76 year old female with osteoporosis. She is 5’ 2’’ and 110 lbs. Her serum creatinine is 1.3 mg/dL. Which of the following statements is correct?
Answer

A
It is safe for HB to take alendronate and zoledronic acid but not ibandronate or risedronate.
B
It is not safe for HB to use any bisphosphonates.
C
It is safe for HB to use injectable bisphosphonates but not oral bisphosphonates.
D
It is safe for HB to use oral bisphosphonates but not injectable bisphosphonates.
E
If HB has not had any fractures, she does not need therapy with a bisphosphonate; she can use raloxifene for prevention.

Answer 5

B
It is not safe for HB to use any bisphosphonates.

Correct
HB has a calculated CrCl of 29 mL/min. All bisphosphonates should be avoided in patients with severe renal impairment. Since HB has osteoporosis, she needs treatment (not prevention).

Question 6

AP is an 82 year-old female patient with very low bone density. Which of the following represent options for improving bone density and reducing the risks of fracture? (Select ALL that apply.)
Answer

A
Loop diuretics such as furosemide
B
Weight bearing exercise, such as walking
C
Ensuring adequate calcium and vitamin D intake
D
Bisphosphonates
E
Teriparatide

Answer 6

B
Weight bearing exercise, such as walking
C
Ensuring adequate calcium and vitamin D intake
D
Bisphosphonates
E
Teriparatide
Incorrect
Osteoporosis is usually treated with medications, weight-resistant exercise (such as walking) and adequate calcium and vitamin D. Furosemide and other loop diuretics causes hypocalcemia; they are a class of medications that increase the risk of osteoporosis.

Question 7

Which of the following drugs or conditions can lower testosterone? (Select ALL that apply.)
Answer

A
Cimetidine
B
Methadone
C
Coreg
D
Normal aging process
E
Effexor

Answer 7

Cimetidine, methadone, normal aging

Question 8

Which of the following are common side effects of the bisphosphonates? (Select ALL that apply.)
Answer

A
Bone and joint pain
B
Hypercalcemia
C
Nausea and heartburn
D
Dizziness
E
Pancreatitis

Answer 8

A
Bone and joint pain
C
Nausea and heartburn

Incorrect
All the bisphosphonates can cause GI upset and burning. Patients can experience bone pain with these agents, and joint aches.

Question 9

Counseling on the use of Forteo should include the following points except:
Answer

A
There may be a small risk of bone cancer with the use of this medication.
B
You will need to take this medication for 3-5 years.
C
Keep the pens refrigerated while in use.
D
You may feel dizzy or lightheaded after the first few doses.
E
Inject the medication once daily into your abdomen.

Answer 9

B
You will need to take this medication for 3-5 years.

Incorrect
Teriparatide (Forteo) comes in a prefilled SC injection pen that lasts 28 days. Each injection provides the 20 mcg dose and it should be injected into the abdomen or thigh. The pens need to be refrigerated. Forteo has a boxed warning for bone cancer (osteosarcoma) that is dose and duration dependent; it should not be used for > 2 years. For the first few doses, patients should sit or lie down due to the risk of dizziness/orthostasis.

Question 10

A patient is going to begin alendronate for osteoporosis. Which of the following are possible side effects, or adverse drug reactions, from bisphosphonate therapy? (Select ALL that apply.)
Answer

A
Diarrhea
B
Alopecia
C
Necrosis of the jaw
D
Esophagitis
E
Hypocalcemia

Answer 10

C
Necrosis of the jaw
D
Esophagitis
E
Hypocalcemia

Question 11

A 73 year-old woman has a T-score of -4.3 in her right hip, -4.7 in her left hip and has had several vertebral fractures in her lumbar spine. Her only known medical conditions are osteoporosis and hypertension. She has never had any surgeries. This woman may be a candidate for the following therapy:
Answer

A
Prolia
B
Premarin
C
Actonel
D
Boniva
E
Duavee
Correct

Answer 11

A
Prolia

Denosumab (Prolia) and teriparatide (Forteo) may both be useful in this very high-risk patient.

Question 12

Select the correct statements concerning Brisdelle:
Answer

A
It contains sertraline.
B
It is indicated for depression associated with menopause.
C
It can cause hypernatremia.
D
It can be used safely with warfarin.
E
It cannot be used with tamoxifen.

Answer 12

E

It cannot be used with tamoxifen.

Question 13

What is the definition of menopause?
Answer

A
No menstrual period for 60 consecutive days.
B
No menstrual period for 120 consecutive days.
C
No menstrual period for 6 consecutive months.
D
No menstrual period for 12 consecutive months.
E
No menstrual period for 24 consecutive months.

Answer 13

D

No menstrual period for 12 consecutive months.

Question 14

Which of the following natural products can be used to help vasomotor symptoms? (Select ALL that apply.)
Answer

A
Black cohosh
B
Evening primrose oil
C
Red clover
D
Saw palmetto
E
Soy

Answer 14

A
Black cohosh
B
Evening primrose oil
C
Red clover

E
Soy

Question 15

Which of the following statements concerning denosumab are correct?
Answer

A
It is used for hypercalcemia of malignancy in the formulation called Zometa.
B
It comes in an injectable and oral formulation.
C
Denosumab can raise serum calcium levels; calcium should be checked prior to initiation of therapy.
D
Denosumab is administered every six months, in a medical office.
E
Denosumab is a recombinant form of endogenous parathyroid hormone; it increases bone formation.

Answer 15

D

Denosumab is administered every six months, in a medical office.

Question 16

A patient gave the pharmacist a prescription for Prempro. Which of the following is an appropriate generic substitution for Prempro?
Answer

A
Conjugated equine estrogens
B
Ethinyl estradiol, conjugated
C
Medroxyprogesterone acetate
D
Estradiol and drospirenone
E
Conjugated equine estrogens and medroxyprogesterone

Answer 16

E
Conjugated equine estrogens and medroxyprogesterone
Incorrect
The generic name for Prempro is conjugated equine estrogens and medroxyprogesterone (MPA).

Question 17

MT is a 54 year-old female who suffers from dry, painful intercourse. This started about a year ago after she underwent a total hysterectomy. The following drug may provide benefit and would reduce her exposure to systemic estrogen:
Answer

A
Prempro
B
Premphase
C
Vivelle-Dot
D
Climara
E
Estring

Answer 17

E
Estring
Correct
Vaginal products are most useful for patients who have vaginal symptoms (dryness, painful intercourse) only, since the risks may be less compared to systemic estrogen exposure. Estring, a vaginal ring that releases estradiol would provide local benefit.

Question 18

he Risk Fracture Assessment Tool (FRAX) is used to assess the need for prescription drug therapy in patients with low bone density. Which of the following statements apply to this tool?
Answer

A
The tool should only be used in patients with a history of fragility fracture.
B
The tool is not well-validated and not recommended by the National Osteoporosis Foundation.
C
The tool is intended for any patient > 40 years of age.
D
It is not necessary to use this type of tool in most patients since it is well-established that drugs such as alendronate are safe and useful.
E
The tool predicts the risk of osteoporosis-related fracture in the next 10 years.

Answer 18

E

The tool predicts the risk of osteoporosis-related fracture in the next 10 years.

Question 19

MK is a 65 year-old male with NYHA Class I heart failure, prostate enlargement, mild cognitive decline and erectile dysfunction. His medications include valsartan, metoprolol extended-release, hydrochlorothiazide, tamsulosin, finasteride and donepezil. MK’s testosterone level is within the normal range. He wishes to use sildenafil, but it is not covered by his Medicare plan and he finds the cost per tablet prohibitive. He asks his physician for another option, and the physician suggests testosterone. Which of the following statements is not correct:
Answer

A
Testosterone can cause acne, male pattern baldness and gynecomastia.
B
Testosterone products have the potential for abuse.
C
The FDA recommends testosterone for sexual dysfunction even if levels are normal.
D
Testosterone will worsen the prostate symptoms.
E
A popular form of testosterone is called Androderm.

Answer 19

C
The FDA recommends testosterone for sexual dysfunction even if levels are normal.
Incorrect
Refer to page 665-666 of the 2018 RxPrep Course Book. The FDA only recommends testosterone therapy if the patient has low testosterone with a related condition, such as muscle wasting.

Question 20

A patient will be counseled on the AndroGel Pump. He is using it for the first time. Which of the following are correct counseling statements? (Select ALL that apply.)
Answer

A
Do not wash your hands after applying the gel so that the maximum amount of drug can be absorbed.
B
AndroGel can catch fire when wet on the skin; it is flammable until dry.
C
Do not let pregnant women touch the site of application or go near the medicine pump.
D
Do not let young children touch the site of application or go near the medicine pump.
E
Apply the medication to the penis or scrotum once daily.

Answer 20

B
AndroGel can catch fire when wet on the skin; it is flammable until dry.
C
Do not let pregnant women touch the site of application or go near the medicine pump.
D
Do not let young children touch the site of application or go near the medicine pump.

Incorrect
Hands must be washed with soap and water after application. AndroGel is flammable until dry. Do not smoke or walk near open flames. Secondary exposure in children can cause early virilization. Testosterone can cause birth defects in a fetus.

Question 21

The use of testosterone can cause which of the following effects?
Answer

A
Decreased risk of blood clots
B
Decreased cholesterol
C
Decreased appetite
D
Hepatotoxicity
E
Increased sperm count

Answer 21

D
Hepatotoxicity

Incorrect
Testosterone use can increase creatinine, appetite, cholesterol, and cause sensitive nipples and acne. It can cause hepatotoxicity and thrombosis. It is contraindicated in breast or prostate cancer.