Reproductive Meds Flashcards
A 50-year-old male patient presents for an appointment for follow-up on his laboratory report and to initiate testosterone therapy. The APN notices that his prostate-specific antigen is elevated at 6 ng/mL and his hematocrit is greater than 60%. Which is the most appropriate action?
A. Instruct him that initiation of testosterone therapy is contraindicated due to the elevated prostate-specific antigen and hematocrit levels.
B. Initiate testosterone therapy and make an appointment for the patient to repeat his prostate-specific antigen and testosterone in 1 month.
C. Initiate testosterone therapy and make a follow-up appointment in 6 months.
D. Examine the prostate and initiate testosterone therapy if no prostate nodules or indurations are noted.
A. Testosterone is contraindicated if the prostate-specific antigen is greater than 4 ng/mL or greater than 3 ng/mL in men at high risk of prostate cancer. It is also contraindicated if the hematocrit is greater than 50%.
A female patient presents for evaluation of vomiting and diarrhea associated with a recent gastrointestinal illness. She uses combination oral contraception as her only method of contraception. Which action taken by the APN is most appropriate?
A. Advise the use of a backup contraceptive method for at least 7 days after a gastrointestinal illness.
B. Suggest taking the oral contraception at night to decrease the associated nausea, diarrhea, and vomiting.
C. Stop the oral contraceptives because this can exacerbate the current illness.
D. Take no action because none is required at this time.
A. Vomiting and diarrhea that accompany gastrointestinal illness can decrease oral contraceptive effectiveness by decreasing absorption. An important part of patient education is to use a backup method for at least 7 days after a gastrointestinal illness.
Which information should the APN include when counseling a female patient about the use of a long-acting reversible contraceptive (LARC) product?
A. Discussion of when the patient may want to become pregnant
B. All LARCs involve surgical insertion into the uterus
C. Signs and symptoms related to increased estrogen levels
D. Daily adherence with LARC
A. Timing of a subsequent pregnancy should also be discussed. For some methods, a return to fertility is delayed after cessation of use. If pregnancy is desired in a shorter time frame, certain LARCs may not be a logical choice. LARCs have a lower amount of estrogen compared with other contraceptive products; therefore, estrogen levels are not increased. As LARCs are implanted either as IUDs or as a subdermal implant, patient adherence is not an issue.
Which is considered a positive effect of estrogen on the body?
A. Increases insulin levels
B. Increases serum triglycerides
C. Stimulates coagulation pathways
D. Increases bone mass
D. Estrogen has a positive impact on increasing bone mass in the body. Estrogen stimulates coagulation and fibrinolytic pathways, which increases hypercoagulability; this is not considered a positive effect on the body. Increasing serum triglycerides is not considered a positive effect on the body. Progesterone, not estrogen, increases insulin levels in the body.
Which treatment should the APN prescribe for a 68-year-old female who has dyspareunia (painful sex)?
A. Topical estrogen
B. Antibiotic therapy
C. Increased fluids
D. Short-term oral contraceptives (OCs)
A. Topical estrogen has been effective in helping to relieve these symptoms related to urogenital tract changes associated with menopause.
With patients using supplemental and replacement androgen therapy, which of these should be included in the plan?
A. Perform a cardiovascular stress test at the midpoint of treatment in younger men.
B. Perform a baseline digital prostate examination and prostate-specific antigen laboratory in males before initiation of therapy and throughout the duration of treatment.C. Order an x-ray every 3 months to monitor for early epiphyseal centers in middle-aged males.
D. Monitor follicle-stimulating hormone and prolactin levels every 4 months for 1 year and then yearly thereafter.
B. Males should have a digital prostate examination and prostate-specific antigen laboratory before initiating therapy and throughout the duration of treatment due to the increased risk of prostate hypertrophy and cancer associated with androgen therapy.
Which action of progesterone leads to prevention of pregnancy?
A. Facilitating tubal mobility
B. Increasing vascularity of the endometrium
C. Enhancing LH surge
D. Thickening of cervical mucus
D. Progesterone causes thickening of cervical mucus, making penetration by sperm difficult.
In patients taking testosterone, the healthcare provider should be aware of a possible increased risk of which condition?
A. Worsening of postmenopausal symptoms
B. Heart attack and stroke
C. Diabetes
D. Endometriosis
B. Heart attack and stroke
Based on evidence-based practice (EBP), which statement best identifies the correlation between use of oral contraceptives (OCs) and venous thromboembolism (VTE) events?
A. Estrogen remains the primary initiator of VTE events.
B. Estrogen and progestin lead to increased risk of VTE.
C. There are no general conclusions based on limited nature of studies.
D. Age plays a more significant factor than other variables when researching the relationship between OC use and VTE events.
B. Increased risks once thought to be primarily associated with estrogen are now also being correlated with progestin. Given the popularity and widespread use of estrogen–progestin combinations, any increase in the relative risk of VTE for particular formulations has the potential to translate into a significant increase in absolute risk across all users.
An APN plans to initiate estrogen therapy in a 56-year-old patient. Which should be included in her plan?
A. Start at a higher dose of conjugated equine estrogen (Premarin) at 0.3 mg daily.
B. Dosage increases should occur at 6- to 8-week intervals.
C. Increase the dose by 1-week increments if the patient continues to have vasomotor symptoms.
D. Instruct the patient that estrogen requires lifelong treatment once the therapy is initiated.
B. It is noted that symptoms decrease by the second week of estrogen therapy; however, it may take 8 weeks of therapy to determine the maximal effect. The APN should avoid increasing the medication dose too early to provide enough time for the medication to provide maximal effects. Suppression of hot flashes can commonly occur at the lower dose at 0.625 mg, so the APN should start lower and titrate up as needed. To decrease adverse effects, it is advisable to use estrogen for the shortest duration possible. Estrogen is not required to be taken lifelong; however, some of the beneficial effects may not continue after the medication is discontinued.
A patient has had long-term use of gonadotropin-releasing hormone (GnRH). Which of these should be ordered as part of monitoring?
A. Yearly full-body skin assessment
B. Radiographs of the patella
C. Dual-energy x-ray absorptiometry (DEXA) scans
D. Sodium levels
C. Ongoing treatment of GnRH may result in bone demineralization. DEXA scans should be ordered to monitor for bone demineralization in any patient undergoing long-term use.
Which of these represents a mechanism of pregnancy prevention of progestin?
A. Increasing transport of the ovum and sperm through contractions of the fallopian tube
B. Exhibiting a negative effect in the hypothalamic–pituitary–ovarian axis to suppress the luteinizing hormone (LH) surge
C. Causing hypertrophy of the endometrium
D. Increasing production of follicle-stimulating hormone (FSH) and preventing growth of a dominant follicle
B. One of the mechanisms of pregnancy prevention of progestins is to exhibit a negative effect in the hypothalamic–pituitary–ovarian axis to suppress the LH surge. The effect of progestin regarding pregnancy prevention is to slow tubal motility and delay transport of the ovum and sperm. Progestins cause atrophy, which prevents implantation. The estrogen component of hormonal contraception improves efficacy by suppressing FSH release and development of a dominant follicle.
Which of these is a primary clinical use for androgens?
correct
A. Hypogonadism
B. Infertility in males
C. Height stimulator in pediatric patients
D. Increased libido
A. The primary use for testosterone and androgens is to replace or augment endogenous androgens for primary hypogonadal males or hypogonadotropic hypogonadism and for male climacteric. Use of androgens can decrease sperm counts in males by altering the normal feedback mechanism, thereby negatively affecting fertility.
Which hormone is primarily responsible for the genitourinary syndrome of menopause?
A. Progesterone
B. Relaxin
C. Follicle-stimulating hormone (FSH)
D. Estrogen
D. Estrogen maintains lubrication regulation of the vagina; decline in this function results in vulvovaginal dryness, dyspareunia, and vaginal atrophy, known collectively as genitourinary syndrome of menopause. FSH assists with the menstrual cycle and production of eggs by the ovaries. Relaxin helps to relax muscles and joints during pregnancy. Progesterone is known as a hormone of pregnancy.
Impairment of fertility can occur in men taking large doses of exogenous testosterone through which process?
A. Increase in estrogen levels
B. Paradoxical suppression of testosterone
C. Decrease in total hematocrit levels
D. Suppression of follicle-stimulating hormone (FSH)
D. Large doses of exogenous testosterone can affect the normal feedback mechanism and reduce spermatogenesis through suppression of FSH. Testosterone is noted to possibly increase hematocrit levels.
