Advanced Pharm Final Exam With 100% Correct Q&A Top
Verified Solution With Rationale (A+ SCORED)
A patient is given a new diagnosis of rheumatoid arthritis. What is the basis for the provider's decision to
prescribe methotrexate?
A. A methotrexate regimen can reduce overall costs.
B. Starting methotrexate early can help delay joint degeneration.
C. Methotrexate can prevent cancer in addition to managing the arthritis.
D. Methotrexate is the only drug known to cure rheumatoid arthritis. - ANSWER ✔ - B.) Current guidelines
for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within
3 months of diagnosis for most patients—in order to delay joint degeneration. Methotrexate is expensive
and has more toxic side effects. Although methotrexate is also used to treat cancer, it does not have a
role in cancer prevention. There is currently no cure for rheumatoid arthritis.
A provider prescribes transdermal estrogen spray. Which patient statement demonstrates understanding
of the application of this medication?
A. "I will apply the medication to my waistline and shoulders."
B. "My abdomen and arms are the primary point of application."
C. "This medication will work best if applied to my breasts and abdomen."
D. "I need to put the medication on my thighs and calves." - ANSWER ✔ - D.) The top of the thighs and the
back of the calves are the preferred sites for application of the transdermal spray. The waistline and
abdomen are used for the patches. The gel is applied to arms. Breasts are not used for application of
transdermal estrogen.
For which patient situation will a provider select combination estrogen and progestin therapy over
estrogen-only therapy for the management of menopausal symptoms?
A. No history of a hysterectomy
,B. Has osteoporosis
C. At risk for myocardial infarction
D. History of deep vein thrombosis - ANSWER ✔ - A.) In patients who still have a uterus, progestin is
necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density
and do not decrease the risk of MI or DVT.
A patient with osteopenia asks about the benefits of hormone therapy in preventing osteoporosis. Which
statement by the provider is correct?
A. "Estrogen can help reverse bone loss."
B. "Hormone therapy increases bone resorption."
C. "Hormone therapy does not decrease fracture risk."
D. "When hormone therapy is discontinued, bone loss resumes." - ANSWER ✔ - D.) Benefits of HT to
prevent osteoporosis are not permanent; bone loss resumes when HT is discontinued. HT does not reverse
bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk.
The patient who reports vaginal dryness and pain with intercourse is opposed to using lubricants but is
concerned about hormonal adverse effects. Which hormone formulation will the provider choose to
decrease systemic estrogen effects?
A. Medroxyprogesterone acetate
B. Transdermal estrogen
C. Low-dose estrogens
D. A vaginal conjugated estrogen - ANSWER ✔ - D.) Estrogens for intravaginal administration are used for
local effects, primarily to treat vulval and vaginal atrophy, so there is a lower risk of systemic effects.
Medroxyprogesterone is a progesterone used for contraception and is not indicated for this condition.
The other formulations will have more systemic effect than the vaginal formulation.
A prescriber provides teaching to a patient about the risks and benefits of estrogen therapy (ET) in the
peri-menopausal period. Which statement by the patient indicates understanding of the teaching?
,A. "Estrogen therapy can provide protection against breast cancer."
B. "Estrogen therapy decreases the risk for thrombosis and stroke."
C. "Estrogen therapy increases the risk for osteoporosis."
D. "Estrogen therapy is the most effective drug for suppression of menopausal symptoms." - ANSWER ✔
- D.) ET is the most effective means to suppress menopausal symptoms. It can prevent osteoporosis, but
it carries risks of breast cancer and stroke.
A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor
symptoms and is discussing estrogen therapy (ET) with the provider. When the patient expresses concerns
about adverse effects of ET, what information will the provider share with her?
A. An estrogen-progesterone product will reduce side effects.
B. An intravaginal preparation may be best for her.
C. Side effects of ET are uncommon among women her age.
D. Transdermal preparations have fewer side effects. - ANSWER ✔ - D.) Transdermal preparations of
estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen
levels than oral preparations. Progesterone is contraindicated in women who have undergone a
hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency, such as
vaginal and vulvar atrophy, but this patient has severe vasomotor symptoms. Side effects of ET can be
common regardless of age.
While reviewing contraceptive options for a patient interested in intrauterine devices (IUDs), which
patient would not be a candidate for an IUD insertion during today's visit?
A. A woman with four children
B. A teenager
C. A woman with a suspected chlamydia infections.
D. A nulliparous woman - ANSWER ✔ - C.) An active infection is a contraindication for today's insertion.
You will need to treat the infection first. All other options are appropriate.
, An adolescent female patient with multiple sexual partners has difficulty adhering to her daily oral
contraceptive schedule. Which contraceptive product will the provider recommend?
A. Pull out method
B. Medroxyprogesterone acetate
C. Tubal ligation
D. Progestin-only oral contraceptives - ANSWER ✔ - B.) The pull-out method is not an effective for of
contraception. Tubal ligation carries surgical risks and should not be used by adolescents because it is
irreversible. Progestin-only oral contraceptives must be taken at the same time every day; therefore, the
issue of adherence remains a concern. MDPA is the best option of the choices.
When changing a patient's combination oral contraceptive (OC) to a different combination product, what
advice will the provider give the patient?
A. Stop the old OC and begin taking the new product immediately.
B. Change products at the beginning of her next cycle.
C. Stop the old OC 1 week before starting the new OC.
D. Use an alternate method of contraception while transitioning to the new OC. - ANSWER ✔ - B.) When
changing one combination OC for another, the change is best made at the beginning of a new cycle. It is
not correct to begin taking the new product immediately or to stop the old product 1 week before starting
the new product. An alternate means of contraception is unnecessary.
A patient who prescribed a combination oral contraceptive begins taking carbamazepine. After several
weeks, the patient reports that she has begun experiencing spotting during her cycle. What action will the
provider discuss with the patient to address this occurrence?
A. Using an alternative form of birth control such as condoms instead of oral contraceptives
B. Changing to an oral contraceptive with increased estrogen
C. Decreasing the carbamazepine dosage
D. Increasing the carbamazepine dosage - ANSWER ✔ - B.) Carbamazepine induces hepatic cytochrome
P450 enzymes and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced
Verified Solution With Rationale (A+ SCORED)
A patient is given a new diagnosis of rheumatoid arthritis. What is the basis for the provider's decision to
prescribe methotrexate?
A. A methotrexate regimen can reduce overall costs.
B. Starting methotrexate early can help delay joint degeneration.
C. Methotrexate can prevent cancer in addition to managing the arthritis.
D. Methotrexate is the only drug known to cure rheumatoid arthritis. - ANSWER ✔ - B.) Current guidelines
for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within
3 months of diagnosis for most patients—in order to delay joint degeneration. Methotrexate is expensive
and has more toxic side effects. Although methotrexate is also used to treat cancer, it does not have a
role in cancer prevention. There is currently no cure for rheumatoid arthritis.
A provider prescribes transdermal estrogen spray. Which patient statement demonstrates understanding
of the application of this medication?
A. "I will apply the medication to my waistline and shoulders."
B. "My abdomen and arms are the primary point of application."
C. "This medication will work best if applied to my breasts and abdomen."
D. "I need to put the medication on my thighs and calves." - ANSWER ✔ - D.) The top of the thighs and the
back of the calves are the preferred sites for application of the transdermal spray. The waistline and
abdomen are used for the patches. The gel is applied to arms. Breasts are not used for application of
transdermal estrogen.
For which patient situation will a provider select combination estrogen and progestin therapy over
estrogen-only therapy for the management of menopausal symptoms?
A. No history of a hysterectomy
,B. Has osteoporosis
C. At risk for myocardial infarction
D. History of deep vein thrombosis - ANSWER ✔ - A.) In patients who still have a uterus, progestin is
necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density
and do not decrease the risk of MI or DVT.
A patient with osteopenia asks about the benefits of hormone therapy in preventing osteoporosis. Which
statement by the provider is correct?
A. "Estrogen can help reverse bone loss."
B. "Hormone therapy increases bone resorption."
C. "Hormone therapy does not decrease fracture risk."
D. "When hormone therapy is discontinued, bone loss resumes." - ANSWER ✔ - D.) Benefits of HT to
prevent osteoporosis are not permanent; bone loss resumes when HT is discontinued. HT does not reverse
bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk.
The patient who reports vaginal dryness and pain with intercourse is opposed to using lubricants but is
concerned about hormonal adverse effects. Which hormone formulation will the provider choose to
decrease systemic estrogen effects?
A. Medroxyprogesterone acetate
B. Transdermal estrogen
C. Low-dose estrogens
D. A vaginal conjugated estrogen - ANSWER ✔ - D.) Estrogens for intravaginal administration are used for
local effects, primarily to treat vulval and vaginal atrophy, so there is a lower risk of systemic effects.
Medroxyprogesterone is a progesterone used for contraception and is not indicated for this condition.
The other formulations will have more systemic effect than the vaginal formulation.
A prescriber provides teaching to a patient about the risks and benefits of estrogen therapy (ET) in the
peri-menopausal period. Which statement by the patient indicates understanding of the teaching?
,A. "Estrogen therapy can provide protection against breast cancer."
B. "Estrogen therapy decreases the risk for thrombosis and stroke."
C. "Estrogen therapy increases the risk for osteoporosis."
D. "Estrogen therapy is the most effective drug for suppression of menopausal symptoms." - ANSWER ✔
- D.) ET is the most effective means to suppress menopausal symptoms. It can prevent osteoporosis, but
it carries risks of breast cancer and stroke.
A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor
symptoms and is discussing estrogen therapy (ET) with the provider. When the patient expresses concerns
about adverse effects of ET, what information will the provider share with her?
A. An estrogen-progesterone product will reduce side effects.
B. An intravaginal preparation may be best for her.
C. Side effects of ET are uncommon among women her age.
D. Transdermal preparations have fewer side effects. - ANSWER ✔ - D.) Transdermal preparations of
estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen
levels than oral preparations. Progesterone is contraindicated in women who have undergone a
hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency, such as
vaginal and vulvar atrophy, but this patient has severe vasomotor symptoms. Side effects of ET can be
common regardless of age.
While reviewing contraceptive options for a patient interested in intrauterine devices (IUDs), which
patient would not be a candidate for an IUD insertion during today's visit?
A. A woman with four children
B. A teenager
C. A woman with a suspected chlamydia infections.
D. A nulliparous woman - ANSWER ✔ - C.) An active infection is a contraindication for today's insertion.
You will need to treat the infection first. All other options are appropriate.
, An adolescent female patient with multiple sexual partners has difficulty adhering to her daily oral
contraceptive schedule. Which contraceptive product will the provider recommend?
A. Pull out method
B. Medroxyprogesterone acetate
C. Tubal ligation
D. Progestin-only oral contraceptives - ANSWER ✔ - B.) The pull-out method is not an effective for of
contraception. Tubal ligation carries surgical risks and should not be used by adolescents because it is
irreversible. Progestin-only oral contraceptives must be taken at the same time every day; therefore, the
issue of adherence remains a concern. MDPA is the best option of the choices.
When changing a patient's combination oral contraceptive (OC) to a different combination product, what
advice will the provider give the patient?
A. Stop the old OC and begin taking the new product immediately.
B. Change products at the beginning of her next cycle.
C. Stop the old OC 1 week before starting the new OC.
D. Use an alternate method of contraception while transitioning to the new OC. - ANSWER ✔ - B.) When
changing one combination OC for another, the change is best made at the beginning of a new cycle. It is
not correct to begin taking the new product immediately or to stop the old product 1 week before starting
the new product. An alternate means of contraception is unnecessary.
A patient who prescribed a combination oral contraceptive begins taking carbamazepine. After several
weeks, the patient reports that she has begun experiencing spotting during her cycle. What action will the
provider discuss with the patient to address this occurrence?
A. Using an alternative form of birth control such as condoms instead of oral contraceptives
B. Changing to an oral contraceptive with increased estrogen
C. Decreasing the carbamazepine dosage
D. Increasing the carbamazepine dosage - ANSWER ✔ - B.) Carbamazepine induces hepatic cytochrome
P450 enzymes and thus accelerates the metabolism of oral contraceptives. Spotting is a sign of reduced
