Week 11 Reproductive & Joint systems Flashcards
Which is an effect of estrogen for bone density?
Maintenance of bone density by decreasing the rate of bone resorption is an effect of estrogen. This is through the antagonizing effects of the parathyroid hormone.
Which adverse reaction is common with menopausal estrogens?
Elevation of systemic blood pressure
Patients treated with androgen therapy should be instructed to seek emergent evaluation if which adverse reaction occurs?
Priapism is an emergent condition in which a male can experience a sustained erection. It is important that a patient treated with androgen therapy is educated to seek emergent evaluation if this occurs.
Which contraceptive methods contains only progesterone?
Nexplanon (implant)
Which progesterone offers a decrease in androgenicity when compared with the other progesterones?
desogestrel and norgestimate
The decrease in androgenicity is thought to reduce adverse effects on carbohydrate and lipid metabolism, along with improving acne and hirsutism.
The recommended maximum daily dose of acetaminophen for a person who is suffering from moderate osteoarthritis (OA) pain, and has a history of alcohol and drug use with hepatic issues, is a maximum of how many grams per day?
3 grams/day
is the current recommended maximum dose, especially when scheduled, rather than intermittent, dosing is utilized.
Tumor necrosis factor (TNF) inhibitors used for the treatment of rheumatoid arthritis (RA) are associated with serious side effects, such as increased risk of which condition(s)?
Heart failure, vasculitis, and vision issues
TNF inhibitors do slow RA progression, but there are rising concerns about extra-articular risks (heart failure, vasculitis, and vision issues).
Which drug is most appropriate for a patient with high uric acid levels who undersecretes uric acid and has adequate renal function?
Probenecid
What drug is best for patients who overproduce uric acid.
Allopurinol or febuxostat
Which warning would the APN provide to an older patient taking calcium supplements and anticoagulants (such as warfarin)?
Calcium supplements contain high vitamin K levels, and warfarin doses may need increasing.
Which statement is most accurate regarding biosimilar drugs used to treat rheumatoid arthritis (RA)?
All biosimilar drugs must demonstrate patient outcomes similar to the parent drug, and clinicians must monitor for the same side effects.
Usually less expensive
Probenecid, taken to control uric acid levels, should not be prescribed for persons allergic to which of the following?
Sulfa-containing drugs
Which statements are most accurate regarding bone mineral density (BMD) in African American women when compared with white women?
- African American women have higher BMD than white women,
- more likely to die from hip fracture.
- lactose intolerant, which leads to poor calcium intake.
Indomethacin (COX-1 inhibitor) is no longer the first choice for pain and inflammation relief in gout due to which factor?
- gastric bleeding
- gastric peptic ulcers and
- renal dysfunction
- the Beers list.
To minimize gastrointestinal side effects, it is recommended that bisphosphonates should be taken in which manner?
- First thing in the morning on an empty stomach with a full 8 oz glass of water
- decreases the risk of esophagitis and gastric irritation and maximizes absorption in the gut.
Research from a Women’s Health Initiative (WHI) study resulted in which evidence-based recommendation regarding the use of estrogen and selective estrogen receptor modulators (SERMs) for the sole purpose of treatment for osteoporosis?
The WHI findings recommend BISPHOSPHONATES as the first-line treatment of osteoporosis because of potential risks associated with estrogen and SERMs, such as cardiovascular (CV) events and cancer.
Which method of action do injectable parathyroid hormone (PTH) analogues (such as Forteo) have on bone remodeling?
Stimulating osteoblastic activity
PTH analogues differ from other drugs to treat osteoporosis in that instead of preventing bone breakdown, they stimulate new bone formation and osteoblastic activity.
Colchicine, a medication used in treatment of gout, has a primary method of action that includes which of these?
Decreasing inflammation by uric acid crystals
PROPHYLACTIC, reduces inflammation, incidence of acute attack, and relieves residual pain postacute attack.
The rate of decline of bone loss is greatest for women during which period of their lives?
Within 2 years of menopause
When gout occurs in postmenopausal women, it is almost exclusively associated with which factors?
Hypertension, renal insufficiency, and diuretic use
To relieve the acute pain of a flare of gout, which drug is the currently recommended first-line treatment?
(NSAIDS)
Which recommendation should be made to a patient with a creatinine clearance (CCr) less than 30 to 35 mL/min and a serum creatinine of 5.1 regarding consideration of drug therapy with a bisphosphonate for osteoporosis treatment?
Bisphosphonates are not recommended for patients with moderate to severe renal impairment (CCr less than 30 to 35 and serum creatinine greater than 4.9) because the drug is mainly excreted in the urine.
Current (USPSTF) guidelines make which recommendation for the use of raloxifene (a selective estrogen receptor modulator [SERM]) for primary prevention of osteoporotic fragility fracture in postmenopausal women?
Raloxifene is a second-line therapy for those unable to tolerate other osteoporotic prevention therapies.
Raloxifene may be used for those unable to tolerate other therapies for osteoporosis; however, the same precautions are in place, including avoidance of use in those with history of deep vein thrombosis (DVT) or embolism because of increased risk of thromboembolic events.
Tumor necrosis factor (TNF) inhibitors used for the treatment of rheumatoid arthritis (RA) are associated with serious side effects, such as increased risk of which condition(s)?
Heart failure, vasculitis, and vision issues
Gout is caused by an alteration in purine metabolism, resulting in high levels of which of these?
Uric acid
hyperuricemia and deposition of urate crystals in various body tissues.
How do rates of hip fracture and vertebral fracture among Asian American women compare with those among white women?
Asian American women have lower hip fracture rates and higher vertebral fracture rates.
Asian women consume less calcium, because 90% of Asians are lactose-intolerant.
Colchicine, a medication used in treatment of gout, has a primary method of action that includes which of these?
Decreasing inflammation by uric acid crystals
Colchicine is prophylactic, reduces inflammation, incidence of acute attack, and relieves residual pain postacute attack.
Testosterone
MOA Indication ADR #4 Contraindication #6 Drug Interactions #3 Monitoring Parameters #4
MOA:
-highly protein bound
Indication: **only for testosterone deficiency, not spermatogenesis
- male primary hypogonadism (Kleinfelter’s)
- male hypogonadotropic hypogonadism (Pituitary condition, DM, cirrhosis, steroids)
- Delayed male puberty
- Transgender males
- Endometriosis & postmenopausal (Not FDA approved)
ADR:
- Acne
- Prostate disorder
- Sleep apnea
- Erythrocytosis
Contraindication:
- “Trial basis” on healthy, middle aged men
- Prostate/male breast cancer
- lower urinary tract symptoms (because prostate responsive to testosterone = BPH symptoms)
- erythrocytosis (HCT >50)
- severe untreated sleep apnea (CPAP its ok)
- CHF (increased Na+ retention)
Drug Interactions:
- Anticoagulants (Warfarin effects will be increased)
- Diabetic Agents (profound hypoglycemia)
- Corticosteroids (enhanced fluid retention r/t Na+ effects)
Education:
Minimize exposure to children (gel)
Monitoring Parameters:
- Reevaluate for prostate cancer @3 months & year
- HCT 3-6 months, then annually
- Lipids
- LFTs
When can the effects of testosterone be seen?
3-6 months, bone density in 2 years
Finasteride (Proscar, Propecia)
Drug Class
Indication
MOA
Monitoring Parameters
5-Alpha Reductase Inhibitors
Indication:
- BPH
- Male pattern baldness
MOA:
- Inhibits enzymes that coverts testosterone to DHT
- Anti Androgen Effects
Monitoring Parameters:
Prostate evaluation for increase in PSA
**Risk of high-grade prostate cancer
Leuprolide (Lupron)
Drug Class
MOA #2
Indication #4
GnRH Analogues
MOA:
- LH antagonist
- Anti Androgen Effects
Indication:
- Advanced prostate/breast cancer
- Endometriosis & fibroids
- Precocious Puberty
- Suppress puberty in transgender
Spironolactone
Drug Class MOA #3 Indication #3 ADR #2 Pregnancy
Aldosterone Antagonist
MOA:
- Aldosterone antagonist
- 5-alpha reductase inhibitor
- potassium sparing diuretic
Indication:
- PCOS
- Acne
- Hirsutism
ADR:
GI
Gynecomastia
PREGNANCY: NO
