Week 3 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain

Week 3 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain Question: Estrogen MOA Answer acts primarily through the receptors in the cell nucleus, not on the cell surface. estrogen must diffuse into cells, migrate to the nucleus and then bind with an estrogen receptor Question: What is the primary mechanism of action (MOA) of estrogen? Answer Acts primarily through the receptors in the cell nucleus. Question: How does estrogen enter the cell to exert its effects? Answer Estrogen must diffuse into cells. Question: After diffusing into the cell, where does estrogen migrate to? Answer Estrogen migrates to the nucleus. Question: What does estrogen bind to after migrating to the nucleus? Answer Estrogen binds with an estrogen receptor. Question: Estrogen metabolic terms Answer have a positive effect on bone mass cardiovascular effects is much less common in premenpaul women compared to postmenopausal women blood coagulation- estrogens promote and suppress blood coagulation central nervous system effects- estrogens have a neuroprotective effects by defending neurons from the oxidative stress and injury estrogens play a role in maintaining glucose levels Question: What effect does estrogen have on bone mass? Answer Estrogen has a positive effect on bone mass. Question: How do cardiovascular effects of estrogen differ between premenopausal and postmenopausal women? Answer Cardiovascular effects are much less common in premenopausal women compared to postmenopausal women. Question: What role do estrogens play in blood coagulation? Answer Estrogens promote and suppress blood coagulation. Question: What neuroprotective effects do estrogens have? Answer Estrogens defend neurons from oxidative stress and injury. Question: What role do estrogens play in glucose levels? Answer Estrogens help maintain glucose levels. Question: Female hypogonadism - estrogen Answer in the absence of ovarian estrogens, pubertal transformation will not take place. Causes of estrogen deficiency include primary ovarian failure, hypopituitarism, bilateral oophorectomy ( removal of both ovaries), and turner syndrome ( genetic syndrome that impairs the goal function.) in girls with estrogen insufficiency , puberty can be induced by giving exogenous estrogens. this treatment promotes great development maturation of the reproductive organs and development of axillary hair. Question: What happens in the absence of ovarian estrogens in females? Answer Pubertal transformation will not take place. Question: What are some causes of estrogen deficiency in females? Answer Primary ovarian failure, hypopituitarism, bilateral oophorectomy, and Turner syndrome. Question: How can puberty be induced in girls with estrogen insufficiency? Answer By giving exogenous estrogens. Question: What effects does exogenous estrogen treatment have on girls? Answer promotes greater development and maturation of the reproductive organs and development of axillary hair. Question: Estrogen interactions Answer estrogens are major substrates of CYP1a2 and CYP3A4,. inducers of these isoenzymes may lower estrogen levels whereas the drugs that are inhibitors may raise estrogen levels. Question: What are estrogens major substrates of? Answer CYP1A2 and CYP3A4 Question: What effect do inducers of CYP1A2 and CYP3A4 have on estrogen levels? Answer They may lower estrogen levels. Question: What effect do inhibitors of CYP1A2 and CYP3A4 have on estrogen levels? Answer They may raise estrogen levels. Question: routes of administration estrogen Answer oral, transdermal, intravaginal, parenteral Question: cancer palpation - estrogen Answer estrogens are sometimes used for palliative therapy in management of advanced prostate cancer in men and in a select type of metastatic breast cancer in both men and women. This use is directed by an oncologist or other specialist in the field. Question: What is the role of estrogens in advanced prostate cancer management? Answer Estrogens are sometimes used for palliative therapy in the management of advanced prostate cancer in men. Question: In which type of cancer are estrogens used for palliative therapy in both men and women? Answer Estrogens are used for palliative therapy in a select type of metastatic breast cancer. Who directs the use of estrogens in cancer therapy? Answer The use of estrogens in cancer therapy is directed by an oncologist or other specialist in the field. Progestinso Contraindications Answer in the presence of undiagnosed abnormal vaginal bleeding, active thrombopheblitis or history of thromboembolic disorders, active liver disease and carcinoma of the heart What is a contraindication for progestins related to vaginal health? Answer Undiagnosed abnormal vaginal bleeding What is a contraindication for progestins related to blood clots? Answer Active thrombophlebitis or history of thromboembolic disorders What is a contraindication for progestins related to liver health? Active liver disease What is a contraindication for progestins related to cancer? Carcinoma of the breast Hormone Therapy- Treatment of Genitourinary syndrome of menopause estrogen is the most effective treatment HT FDA recommends that if HT is being used solely to manage vulvar and vaginal symptoms a topical formulation should be considered o Patient Education hormonal therapy nausea can be reduced at night explain that nausea diminishes over time remind patients that estrogens present a small risk of breast cancer and endometrial cancer remind patients to receive periodic mammograms instruct patient sot report any persistent to recurrent vaginal bleeding to reduce cardiovascular risk, advise women to avoid smoking , perform the regular exercise , decrease saturated fats, take apporpraite drugs to treat HTN, diabetes and high cholesterol How can nausea from hormonal therapy be managed? Nausea can be reduced at night. What should patients be informed about the duration of nausea from hormonal therapy? Nausea diminishes over time. What is a risk associated with estrogen use in hormonal therapy? Estrogens present a small risk of breast cancer and endometrial cancer. What routine screening should patients on hormonal therapy receive? Patients should receive periodic mammograms. What symptom should patients report while on hormonal therapy? Patients should report any persistent or recurrent vaginal bleeding. What lifestyle changes can help reduce cardiovascular risk for women on hormonal therapy? Avoid smoking, perform regular exercise, decrease saturated fats, and take appropriate drugs to treat HTN, diabetes, and high cholesterol. Treatment of Vasomotor Symptoms- HT HT is the most effective treatment for vasomotor symptoms. To increase the safety, the lowest dosage should be used What is the most effective treatment for vasomotor symptoms? Hormone Therapy (HT) What dosage should be used for Hormone Therapy to increase safety? The lowest dosage should be used. Management of Menopausal Symptoms- HT should be used at the lowest dosage and for the shortest time needed to accomplish treatment goals. Prevention of Osteoporosis HT reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures. When HT is stopped, bone mass rapidly decreases by approx 12 %. To maintain bone health , HT must continue lifelong. How does hormone therapy (HT) affect postmenopausal bone loss? HT reduces postmenopausal bone loss. What is the effect of stopping hormone therapy (HT) on bone mass? Bone mass rapidly decreases by approximately 12%. How long must hormone therapy (HT) continue to maintain bone health? HT must continue lifelong. What risk does hormone therapy (HT) decrease in postmenopausal women? HT decreases the risk for osteoporosis and related fractures. Contraceptives Selection w/history of thrombus patients with a history of thrombosis should avoid stin products but can still use a progestin- only method. Options include levonorgestrel intrauterine system ( Mirena), medroxyprogesterone acetate injection. ( DEPO) and the mini pill What should patients with a history of thrombosis avoid? Estrogen-progestin products What contraceptive method can patients with a history of thrombosis still use? Progestin-only method What is one option for a progestin-only contraceptive? Levonorgestrel intrauterine system (Mirena) What is another option for a progestin-only contraceptive? Medroxyprogesterone acetate injection (DEPO) What is the mini pill? A progestin-only contraceptive method What can induce CYP450 enzymes and reduce the effectiveness of oral contraceptives? Drugs and herbs such as rifampin, ritonavir, carbamazepine, phenobarbital, phenytoin, primidone, and St John's Wort. How do CHCs/COCs affect warfarin? They can decrease the effectiveness of warfarin by increasing clotting factors. What effect do CHCs/COCs have on glucose levels? They can increase glucose levels, counteracting the beneficial effects of hypoglycemic agents. Which medications' hepatic metabolism can be reduced by CHCs/COCs, increasing toxicity risk? Theophylline, tricyclics, diazepam, and chlordiazepoxide. Oral contraceptives Contraindications: Contraindicated in pregnancy, up to 4 weeks post-partum, and in lactating clients until milk supply is established. Contraindicated in individuals with conditions that predispose them to thrombophlebitis, thromboembolic disorders, cerebral vascular disease, or coronary occlusion. Contraindicated in individuals with abnormal liver function. Contraindicated in individuals with known or suspected breast cancer. Contraindicated in individuals with undiagnosed abnormal vaginal bleeding. Contraindicated in individuals who are smokers and over 35 years of age. Risk of Thrombotic Stroke inMigraine Patients- OC When women experience migraine headaches, OCs may increase the risk for thrombotic stroke. Because the risk is low, OC are generally safe with women with migraines, given that they are younger than 35, do not smoke, and are healthy , and their headaches are not provided by a visual change. Contraception During Lactation combination OCs enter the breast milk and reduce milk production, especially in the early stages oof lactation. progestin-only OCs have little to no effect on the milk production and hence are preferred for contraception during lactation, at least early on ( later the the milk supply is well established and especially with the addition of solids to the infants diet, use of OCs may resume ). What effect do combination oral contraceptives (OCs) have on breast milk production during lactation? Combination OCs enter the breast milk and reduce milk production, especially in the early stages of lactation. What type of oral contraceptives are preferred during early lactation? Progestin-only OCs are preferred for contraception during lactation, especially early on. When can the use of combination OCs resume during lactation? The use of combination OCs may resume once the milk supply is well established and especially with the addition of solids to the infant's diet. Mechanism of Thrombosis - OC OCs promote thrombosis in part by raising levels of clotting factors Testosterone Anabolic Effects promotes growth of skeletal muscle. This anabolic effects results from binding of androgens to the same type of receptor that mediates androgen actions in other tissues. What are the anabolic effects of testosterone? Promotes growth of skeletal muscle. How do androgens mediate their actions in tissues? By binding to specific receptors. Clinical Pharmacology ofAndrogens all of these agents can bind to androgen receptors and therefor all can elicit a similar response - testosterone Premature Epiphyseal Closure androgens can accelerate epiphyseal closure, thereby decreasing adult height. examination of the wrist and hand should be preformed every 6 months What effect do androgens have on epiphyseal closure? Androgens can accelerate epiphyseal closure, thereby decreasing adult height. How often should examination of the wrist and hand be performed to monitor for premature epiphyseal closure? Every 6 months. Replacement Therapy of androgens is beneficial when testicular failure occurs in adult males. some studies demonstrate the treatment that restores libido increases ejaculate volume, and supports expression of secondary sex characteristics. treatment will not restore infertility.. principle drugs are employed for testosterone replacement are testosterone itself and two testosterone esters When is androgen replacement therapy beneficial? When testicular failure occurs in adult males. What are some benefits of androgen replacement therapy? It restores libido, increases ejaculate volume, and supports expression of secondary sex characteristics. Does androgen replacement therapy restore infertility? No, it will not restore infertility. What are the principal drugs used for testosterone replacement? Testosterone itself and two testosterone esters. testosterone Therapeutic Uses Male Hypogonadism: Testosterone therapy is indicated for the treatment of male hypogonadism, a condition characterized by the insufficient production of natural testosterone, affecting normal male development and reproductive function. Delayed Puberty: Testosterone is used to manage delayed puberty in males, helping stimulate the development of secondary sexual characteristics, such as increased muscle mass, voice deepening, and the growth of facial and body hair. Gender Transition: Testosterone is indicated for transgender or nonbinary individuals undergoing gender transition, supporting the development of masculinizing physical traits to align their physical appearance more closely with their gender identity. Supplement Strength and Sexual Function: Testosterone can be used as a supplement to improve muscle strength and sexual function in men who, due to aging or chronic health conditions, experience declines in testosterone levels leading to reduced libido, decreased muscle mass, and energy levels. Menopause: Testosterone replacement therapy can help alleviate symptoms of menopause, such as fatigue, reduced libido, and decreased genital sensitivity, though it is not approved for this use in the United States. Cachexia: In conditions like AIDS, severe trauma, and chronic infections, where cachexia or body wasting occurs, testosterone therapy is used to mitigate the loss of muscle mass and prevent further wasting. Anemia: Testosterone is sometimes employed to treat various forms of anemia that are unresponsive to standard treatments, particularly by promoting the synthesis of erythropoietin, which stimulates the production of red blood cells. What is a therapeutic use of testosterone? Testosterone is used for patients with confirmed testosterone deficiency. What condition must be confirmed for testosterone therapy to be approved? Hypogonadism Erythropoietic Effects- testosterone androgens help relive anemia by promoting synthesis of erythropoietin, the renal hormone that helps stimulate production of the red blood cells, and possibly white blood cells and platelets. What hormone do androgens promote the synthesis of to help relieve anemia? Erythropoietin What is the role of erythropoietin in the body? It stimulates the production of red blood cells. In addition to red blood cells, what other blood components might androgens influence the production of? White blood cells and platelets. What is testosterone therapy indicated for in male hypogonadism? Testosterone therapy is indicated for the treatment of male hypogonadism, a condition characterized by insufficient production of natural testosterone. How is testosterone used to manage delayed puberty in males? Testosterone is used to manage delayed puberty in males by stimulating the development of secondary sexual characteristics. What role does testosterone play in gender transition for transgender or nonbinary individuals? Testosterone supports the development of masculinizing physical traits to align physical appearance with gender identity. How can testosterone supplementation improve sexual function in aging men? Testosterone can improve sexual function in men experiencing declines in testosterone levels due to aging or chronic health conditions. What symptoms of menopause can testosterone replacement therapy help alleviate? Testosterone replacement therapy can help alleviate symptoms of menopause such as fatigue and reduced libido. In what conditions is testosterone therapy used to mitigate cachexia? Testosterone therapy is used in conditions like AIDS, severe trauma, and chronic infections to mitigate cachexia or body wasting. How is testosterone used in the treatment of anemia? Testosterone is sometimes employed to treat various forms of anemia by promoting the synthesis of erythropoietin. Adverse Effects in Women Virilization-Children and females may develop premature sexual development or other masculinizing effects if they are exposed to testosterone gels or creams; also menstrual irregularities What is a potential effect of testosterone gels or creams in children? Virilization or premature sexual development What adverse effect can testosterone gels or creams have on females? Menstrual irregularities nonpharm treatment of ED nonpharmacologic interventions targeted to the underlying cause, including counseling clients on implementing lifestyle modifications that can successfully improve ED symptoms (e.g., smoking cessation, exercise, psychotherapy, or modifying current medication regimens What are nonpharmacologic interventions for erectile dysfunction (ED)? Interventions targeted to the underlying cause of ED. What lifestyle modifications can improve erectile dysfunction symptoms? Smoking cessation, exercise, psychotherapy, or modifying current medication regimens. Drug for ED Viagra ( sildenafil) Sildenafil Contraindications Contraindicated with concomitant use of nitrates. Contraindicated in clients with severe cardiovascular conditions. 5-α-Reductase Inhibitors Indications reduce prostate size 5-α-reductase inhibitors MOA acts in reproductive tissue to inhibit 5-a-redcutase, an enzyme that converts testosterone to dihydrotestosterone (DHT), the active form of testosterone in the prostate Adverse Effects 5-α-reductase inhibitors decreases ejaculation volume and libido, tetrogenic in women while pregnant 5-a reductase inhibitors therapeutic goal reduction in prostate size relieves symptoms of bladder outlet obstruction 5-a reductase inhibitors baseline PSA 5-a reductase inhibitors monitoring repeat PSA at 6 months if there is no decrease , evaluate for prostate cancer. repeat PSA periodically 5-a reductase inhibitors identifying high risk patients do not prescribe for patients suspected to have prostate cancer 5-a reductase inhibitors evaluating therapeutic effects anticipate symptoms improvement after 6-12 months 5-a reductase inhibitors minimize adverse affects the most common adverse effect is sexual dysfunction, because these changes can be permanent, the patient should return for a possible dosage adjustment or change in medications if this concerns the patient. What is the most common adverse effect of 5-a reductase inhibitors? Sexual dysfunction Why should a patient return for a possible dosage adjustment when taking 5-a reductase inhibitors? If sexual dysfunction concerns the patient, as these changes can be permanent. Finasteride Indications promotes regression of prostate epithelial tissue and thereby decreases mechanical obstruction of the urethra α1-Adrenergic Antagonists MOA block of a1 receptors relaxes smooth muscle in the bladder neck (trigone and sphincter, prostate capsule and prostatic urethra by decreasing dynamic obstruction of the urethra α1-Adrenergic Antagonists adverse effects hypotension, fainting, dizziness, somnolence and nasal congestion Drug Interactions - α1-Adrenergic Antagonists drugs that can lower BP , nitrates , PDE 5- inhibitors ( viagra ) Alprostadil Adverse Effects a dull ache in the penis urethral burning minor bleeding or spotting and testicular pain Treatment of glaucoma- beta blockers -approved for topical use in treating open-angle glaucoma are: Betaxolol, Carteolol, Levobunolol, and Timolol. -treat by reducing IOP which can slow or even stop the disease progression -lower IOP by decreasing production of aqueous humor Adverse reactions of Glaucoma Beta Blockers use local stinging, conjunctivitis, blurred vision, photophobia, and dry eyes -bradycardia and AV heart block can also occur -pulse should be monitored -use caution with HF pts- can cause bronchospasms How to treat someone with glaucoma and either asthma or COPD use only Betaxolol as treatment of choice because its a beta 1 selective S/S of Otitis media ear pain, fever, vomiting, anorexia, irritability, insomnia, and diarrhea bulging tympanic membrane, inflammation, and swelling of the eustchian tube treatment of otitis media Amoxicillin -heating pads help (alternate with ice) -avoid chewing (soft foods) -lie on the affected side -may not hear you -avoid smoke -May require PE (pressure equalizing) tubes to keep the middle ear drained. The ear tube (grommet) stays in about 6 months and then falls out Otitis Externa (Swimmer's Ear) Bacterial s/s An infection of the outer ear, with severe painful movement of the pinna and tragus, redness and swelling of pinna and canal, scanty purulent discharge, ear fullness common cause: pseudomonas aeruginosa and staph aureus Treatment for Otitis Externa: Bacterial pain relievers, ear drops of acetic acid and alcohol, if this treatment fails give cipro drops oral meds is indicated if infection extends beyond the external auditory canal and involves the pinna. Give oral cipro in pts over 18 years and cephalexin (Keflex) in children Fungal/Otomycosis s/s Otitis Externa common pathogen: Aspergillus and candida intense itching and redness w/w/o pain or hearing loss Fungal/Otomycosis Otitis Externa Treatment: cleansing application of 2% acetic acid solution 3-4 times a day for 7 days. If treatment fails prescribe 1% clotrimazole (Lotrimin) drops twice daily for 7 days, if treatment fails prescribe oral antifungal such as itraconzole (sporanox) or Fluconazole (Diflucan) Treatment for Acne: mild Benzoyl Peroxide or topical retinoid (Vitamin A) or topical combo therapy of benzoyl peroxide plus antibiotic or retinoid plus benzoyl peroxide Treatment for Acne: Moderate topical combo Treatment for Acne: Severe (Two agents) oral antibiotics (Doxycycline or minocycline) and topical combo therapy of benozyl peroxide plus antibiotic or retiniod plus benzoyl or oral isotretinoin (accutane) side effect for Benzoyl Peroxide and retinoids: local irritation including burning, blistering, scaling, swelling and hypersensitivity reactions Side effects of isotretinoin (accutane) nose bleeds, inflammation of the lips and eyes, dryness of skin nose and mouth, high risk defects in fetus, do not use in pregnancy, and use protection the sunlight, avoid ETOH Treatment of eczema moisturizers and glucocosticoids (complications include skin atrophy, hypopigmentation, permanent focal red lesions, and high doses of adrenal suppression if those do not work topical immunosuppressants (tacrolimus and pimercrolimus) can be used - they can pose risk for skin cancer and lymphoma avoid tanning beds and sunlight, do use in prolong treatments Key Ingredients in sunscreen organic: aminobenzoic acid derivates, cinnamates, salicylates. benzophenones others: avobenzone, ecamsule, ensulizole, meradimate, octocrylene inorganic: titanium dioxide, zinc oxide, avobezone to protect against UVA1 rays need coverage for protection against UVA and UVB rays and SPF at least 15 MOA of expectorants increase the output of respiratory tract fluid by decreasing adhesiveness & surface tension of respiratory tract & facilitate removal of viscous mucous Ex. Guaifenesin (Mucinex Humibid) max dose: 200-400mg PO every 4 hours as needed 6 doses/day 2400mg/day) Montelukast adverse effects Neuropsychiatric: -Dream abnormalities -Insomnia -Anxiety -Depression -Suicidal idealization -Suicide Intranasal Glucocorticoids adverse reactions nasal drying, burning, itching, throat pain, epistaxis and HA. systemic effects are adrenal suppression and slowing of linear growth in children is rare but possible pt teaching: give daily, may take a week for effects to develop - Sympathimimetics: Phenyleprhine rebound congestion if topical use, restlessness, irritability, anxiety, insomnia in oral use, vasoconstriction Sympathimimetics: Pseudoephedrine potential for abuse Brimomidine topical a adrenergic agonist for glaucoma adverse: dry mouth, ocular hyperemia, burning, stinging, HA, blurred vision, foreign body sensation, and itching, cause drowsiness, fatigue, and hypotension pt teaching: absorbed through soft contact lens at least 15 minutes should elapse between drug admin and lens installation Prostaglandin anaolg first line therapy for glaucoma adverse: harmless heighed brown pigmentation of the iris and eyelid, blurred vision, burning, stinging, conjunctival hypermia/edema, and puncatate keratopathy teaching: apply 1 drop in the evening daily. notify if vision is loss, eye pain, HA, n/v, do not dropper to the eye, close eyes for 3 minutes after administration Salicylic acid for acne toxicity (salicylism) tinnitus, hyperpnea, physiological distubances teaching: avoid prolonged use benzoyl peroxide adverse: irritation, burning, scaling, swelling, and hypersensitivity reactions teaching: avoid sun exposure, avoid irriant soaps, wash and dry skin before use, oeep aware from eyes, mouth and mucus membranes, reporting blistering Isotrentinoin (Accutane) adverse: nose bleeds, inflammation of lips and eyes, dryness of skin, nose and mouth, depression teaching: fetus harm, do not use in pregnancy, avoid sun, avoid ETOH, avoid driving at night, reliable birth control, waxing, laser therapy, microdermabrasion Intranasal Glucocorticoids Ex. Fluticasone most effective for preventing seasonal and perennial they prevent or suppress allergic rhinitis (congestion, rhinorrhea, sneezing, itching, and erythema) Pseudoephedrine MOA reduces nasal congestion only Loratadine oral antihistamine, reduces sneezing, rhinorrhea, nasal itching, and are less effective than intranasal glucocorticoids Intranasal cromolyn sodium moderately effective in treating allergic rhinitis, but the benefits are much less than those intranasal glucocorticoids how to manage rebound congestion larger and more frequent dose of medication-can lease to cycle of congestion and increased drug use. Use intranasal glucocorticoid in both nostrils for 2-6 weeks starting 1 week before discontinuing the decongestant. Limit topical decongestant application to 3-5 days to reduce the development of rebound congestion Role of biologics in treating allergies omalizumab is a biologic that works against IgE. plays a central role in the allergic release of inflammatory mediators from mast cells and basophils approved only for allergy-mediated asthma