Deck 22: Drugs Affecting the Reproductive System

Question 1

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?

A) Reassurance that some spotting is normal the first few months of Depo and it should improve.
B) Schedule an appointment for an exam as this is not normal.
C) Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding.
D) Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot.

Answer 1

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

Question 2

Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for:

A) Depression
B) Hypertension
C) Weight loss
D) Cataracts

Answer 2

Depression

Question 3

Absolute contraindications to estrogen therapy include:

A) History of any type of cancer
B) Clotting disorders
C) History of tension headaches
D) Orthostatic hypotension

Answer 3

Clotting disorders

Question 4

Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:

A) Development of chest pain or dizziness
B) Weight gain
C) Priapism
D) Renal function

Question 5

William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for ________________ before prescribing sildenafil.

A) Renal dysfunction
B) Unstable coronary artery disease
C) Benign prostatic hypertrophy
D) History of priapism

Question 6

Patients who are prescribed exogenous androgens need to be warned that decreased libido:

A) Is an unusual side effect of androgens and should be reported to the provider
B) Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems
C) May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam
D) May occur with androgen therapy

Question 7

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:

A) Low-dose oral estrogen
B) A low-dose estrogen/progesterone combination
C) A vaginal estradiol ring
D) Vaginal progesterone cream

Question 8

Monitoring for a patient who is using androgens includes evaluation of:

A) Complete blood count and C-reactive protein levels
B) Lipid levels and liver function tests
C) Serum potassium and magnesium levels
D) Urine protein and potassium levels

Question 9

Education when prescribing androgens to male patients includes advising that:

A) Short-term use places the patient at risk for hepatocellular carcinoma.
B) Cholestatic hepatitis and jaundice may occur with low doses of androgens.
C) Gynecomastia is a rare occurrence with the use of androgens.
D) Low sperm levels only occur with long-term use of androgens.

Question 10

The U.S. Food and Drug Administration warns that androgens may cause:

A) Peliosis hepatis
B) Orthostatic hypotension
C) Menstrual irregularities
D) Acne

Question 11

Women who have migraines with an aura should not be prescribed estrogen because of:

A) The interaction between triptans and estrogen, limiting migraine therapy choices
B) An increased incidence of migraines with the use of estrogen
C) An increased risk of stroke occurring with estrogen use
D) Patients with migraines may be prescribed estrogen without any concerns

Question 12

Men who use transdermal testosterone gel (AndroGel) should be advised to avoid:

A) Washing their hands after applying the gel
B) Wearing occlusive clothing while using the gel
C) Exposure to estrogens while using the gel
D) Skin-to-skin contact with pregnant women while using the gel

Question 13

Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for:

A) Impotence when combined with antihypertensives
B) Fatal hypotension if combined with nitrates
C) Weight gain if combined with antidepressants
D) All of the above

Question 14

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?

A) Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour.
B) Both medications are best tolerated if taken on an empty stomach.
C) She should use a back-up method of birth control such as condoms for the rest of the current pill pack.
D) If she gets nauseated with the medications she should call the office for an antiemetic prescription.

Question 15

Postmenopausal women with an intact uterus should not be prescribed:

A) Estrogen/progesterone combination
B) IM medroxyprogesterone (Depo Provera)
C) Estrogen alone
D) Androgens

Question 16

When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects:

A) Hypertension and dysuria
B) Depression and weight gain
C) Abdominal pain and constipation
D) Orthostatic hypotension and dermatitis

Question 17

Long-term use of androgens requires specific laboratory monitoring of:

A) Glucose, calcium, testosterone, and thyroid function
B) Calcium, testosterone, PSA, and liver function
C) Calcium, testosterone, PSA, liver function, glucose, and lipids
D) CBC, testosterone, PSA, and thyroid level

Question 18

The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to:

A) The potential development of significant hypertension
B) Increased risk of strokes
C) Decreased bone density
D) The risk of a life-threatening rash such as Stevens-Johnson

Question 19

Male patients require ______________________ before and during androgen therapy.

A) A digital prostate exam
B) A Doppler exam of testicular blood flow
C) Urine analysis for proteinuria
D) Serial orthostatic blood pressures

Question 20

A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes:

A) Counseling regarding decreasing or not smoking while taking oral contraceptives
B) Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive
C) Advising that she may miss two pills in a row and not be concerned about pregnancy
D) Recommending that her next follow-up visit is in 1 year for a refill and annual exam

Question 21

Effects of estrogen include:

A) Regulation of the menstrual cycle
B) Maintenance of bone density by increasing bone reabsorption
C) Maintenance of the normal structure of the skin and blood vessels
D) A and C
E) All of the above

Question 22

Absolute contraindications that clinicians must consider when initiating estrogen therapy include:

A) Undiagnosed dysfunctional uterine bleeding
B) Deep vein or arterial thromboemboli within the prior year
C) Endometriosis
D) 1 and 2
E) All of the above

Question 23

Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent:

A) Nausea
B) Breakthrough bleeding
C) Breast tenderness
D) Pregnancy