Week 5 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain

Week 5 Exam: NR566 / NR 566 (Latest 2026 / 2027) Advanced Pharmacology for Care of the Family | Questions & Answers | Grade A | 100% Correct – Chamberlain Quest ion: What are the two main hormones responsible for female maturation and regulation of female reproductive organ activity? Answer Estrogen and progestogens Quest ion: What is the principle Endogenous estrogen Answer estradiol Quest ion: What is the principal Endogenous pro gestational hormone? Answer Progesterone Quest ion: Name the two menstrual cycle phases Answer Follicular phase(1-14) Luteal phase (15-28) Quest ion: During the follicular phase of the menstrual cycle estrogen's are synthesized by what Answer Ovarian follicles Quest ion: During the luteal phase estrogens are synthesized by Answer Corpus luteum Quest ion: True or False Estrogen acts through receptors in the cell Answer True Quest ion: Estrogen receptor alpha is highly expressed where Answer In the vagina uterus ovaries mammary glands vascular epithelium and hypothalamus Quest ion: Estrogen receptor beta is expressed where Answer Ovary and prostate Les extent in the lungs brain bones and blood vessels Quest ion: How does estrogen affect bone loss Answer Without estrogen bone resorption Accelerates leading to loss of bone density shortly after menopause Quest ion: Adverse effects of estrogen therapy Answer Endometrial hyperplasia endometrial cancer breast cancer cardiovascular thromboembolic events Quest ion: Use of estrogen during menopause can Answer Produce or uncover gallbladder disease cause jaundice in women with pre-existing liver dysfunction nausea headache Quest ion: Contraindications of using estrogens Answer Patients with a history of DVTPE stroke myocardial infarction secondary to a thromboembolic event women who are pregnant or have vagina bleeding without a known cause history of liver disease estrogen dependent tumors or breast cancer Quest ion: When can progesterone be used Answer To reduce chances of endometrial hyperplasia and endometrial cancer when using estrogen Quest ion: How would inducers or inhibitors interact with estrogens Answer Inducers lower estrogen levels Inhibitors raise estrogen levels Quest ion: Patient teaching for transdermal patch Answer 1 Apply to an area of clean dry and intact skin on the abdomen or some other region of the trunk but not the breast or waist line by pressing the patch firmly in place for 10 seconds 2 if the patch falls off reapply the same patch or if necessary apply new patch 3 Remove the old patch and apply new patch 1-2 twice weekly according to the product specifications 4 Rotate the application site such that the same site is not used more than once each week Quest ion: Patient teaching for transdermal emulsion Answer Apply the emulsion each morning to the top of both thighs in the back of both calves Quest ion: Patient teaching for transdermal gel Answer Instruct the patient to apply the gel once daily after showering to one arm from the shoulder to the wrist Quest ion: Patient teaching for transdermal spray Answer Apply 1,2, or 3 sprays once daily to the inner forearm Quest ion: What is the therapeutic goal of estrogen prescribing Answer Management of symptoms and structural changes associated with decreased Endogenous estrogen Can also be used for palliation of metastatic breast cancer Quest ion: What is the baseline data when prescribing estrogen Answer Heart rate blood pressure weight pregnancy test TSH serum triglyceride screening for breast cancer and cardiovascular disease gynecological exam Quest ion: Monitoring when estrogens are being used Answer Blood pressure weight serum triglycerides TSH if thyroid replacement required regular breast and pelvic exams as recommended for age scheduled endometrial biopsy for unscheduled bleeding that continues for six months Quest ion: High risk patients for estrogen use Answer Abnormal vagina bleeding estrogen dependent cancer or breast cancer history of deep vein thrombosis or pulmonary embolism stroke myocardial infarction or other arterial thromboembolism occurring within the past year abnormal liver function or disease pregnancy How to evaluate therapeutic effects when prescribing estrogen for menopausal HT Answer Report relief of symptoms and the vagina is pink and moist on exam how to minimize adverse effects Answer Nausea is common in early treatment and will diminish with time but avoid cooking odors and warm stuffy environments dry foods and raw fruits and vegetables Menopausal HT with estrogen alone increases the risk for endometrial carcinoma Adverse effects similar to those caused by oral contraceptives such as abnormal vagina bleeding hypertension benign hepatic adenoma Reduced glucose tolerance When are progestins used Answer To counteract the adverse effects of estrogen on the endometrium and women undergoing menopause HT Dysfunctional uterine bleeding Amenorrhea Endometrial hyperplasia and carcinoma In early pregnancy in women with corpus luteum deficiency syndrome and women undergoing IVF Adverse effects of progestin Answer Breast tenderness HA Fatigue Abdominal discomfort Depression Arthralgias Therapeutical when prescribing progestin Answer Counteract endometrial hyperplasia caused by unopposed estrogen during hormone therapy Management of dysfunctional uterine bleeding amenorrhea and endometriosis Support of pregnancy in women with corpus luteum deficiency Prevent prematurity in women at high risk for preterm birth Baseline data when taking progestins Answer Heart rate blood pressure and weight Pregnancy test screening for breast and cardiovascular disease pelvic exam depending on age Monitoring while on progestin Answer Blood pressure assessment for fluid retention including weight referral for a trans vagina ultrasound for hysteroscopy for occurrence of undiagnosed bleeding that continues for six months High-risk patients when taking progestin Answer Undiagnosed abnormal vagina bleeding Relative contraindications include active thrombophlebitis or a history of thromboembolic disorders active liver disease and carcinoma of the breast How to minimize adverse effects when taking progestins Answer Warren patients that they can cause breakthrough bleeding spotting and Amenorrhea And report any abnormal or prolonged vagina bleeding How does hormone therapy prevent osteoporosis Answer By reducing post menopausal Bone loss which decreases the risk for osteoporosis and related fractures How to discontinue hormone therapy Answer Immediate cessation and tapering slowly Tapering slowly involves reducing the dose daily unless intense symptoms return those should remain until symptoms improve ******Progestin dosage to remain unchanged Patient education for estrogen Answer Nausea can be reduced by taking with food and buy dosing at night A small risk of breast cancer and endometrial cancer exist to minimize risk patients need to receive periodic mammograms and report any persistent or recurrent vaginal bleeding To reduce cardiovascular risk advise women to avoid smoking to perform regular exercise decrees intake of saturated fats and take appropriate drugs to treat hypertension diabetes and high cholesterol Estrogen lifespan Considerations Answer Pre-pubertal children and pregnant women CI Breast-feeding women it may affect infant development and decreased quantity and quality of milk Inappropriate for geriatric patients Blackbox warning for estrogen Answer Endometrial cancer risk is increased in women with a uterus who take unopposed estrogen The risk for deep vein thrombosis and stroke is increased Not indicated for cardiovascular disease or dementia and may increase the risk for dementia in women aged 65 years and older Blackbox warning for estrogen and progestin therapy Answer May increase risk for thromboembolic events such as DVT stroke MI and PE Not indicated for cardiovascular disease or dementia and may increase risk for dementia and women aged 65 years and older May increase breast cancer risk Absolute contraindications for combination oral contraceptives Answer Thrombophlebitis thromboembolic disorders Cerebral vascular disease coronary occlusion a history of these conditions or a condition that predisposes to these disorders Abnormal liver function known or suspected breast cancer undiagnosed abnormal vagina bleeding known or suspected pregnancy smoker older than 35 years Relative contraindications for combination oral contraceptives Answer Hypertension cardiac disease diabetes gallbladder disease uterine leiomyoma Epilepsy Migraine history of cholestatic jaundice of pregnancy Patient education on prescribing oral contraceptives Answer Inform patient about symptoms of thrombosis and thromboembolism Leg tenderness or pain sudden chest pain shortness of breath severe headache sudden visual disturbance contact provider if these occur Women with a history of thrombosis can use estrogen progestin products Answer False They should be avoided but they still can use a progestin only method Blackbox warning for oral contraceptive pills Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive pills Side effects caused by estrogen deficiency Early or mid cycle breakthrough bleeding Increased spotting Hypo menorrhea Side effects caused by excess progestin Increased appetite weight gain depression tiredness fatigue hypo menorrhea breast regression monilial vaginitis acne oily scalp hair loss hirsutism Side effects caused by progestin deficiency Late breakthrough bleeding amenorrhea hyper menorrhea by Side effects of excess estrogen Nausea breast tenderness edema bloating hypertension migraine cervical mucorrhea polyposis Products that induce hepatic cytochrome P3A4 can accelerate OC metabolism having what effect on OC Reducing effects OC Have what effect on warfarin and hypoglycemic agents Oral contraceptives can decrease the benefits of warfarin and increasing levels of glucose hypoglycemic agents Therefore warfarin and hypoglycemic agent may require increased dosage What drugs are increased by oral contraceptives Theophylline, tricyclic antidepressants diazepam chlordiazepoxide These drugs may accumulate to toxic levels dosages may need to be decreased while taking OC When should systemic contraceptives be used control of hot flashes and night sweats when should local contraceptives be used treatment of vulval and vaginal atrophy which contraceptive has fewer side effects? transdermal estrogen How do you achieve an extended cycle with oral contraceptives Skip placebo pills and start new pack Five for 28 day packs and take the active pills for 84 days straight Progestin lifestyle considerations children Not indicated for prepubertal children Pregnancy High-dose therapy during the first 4 months of pregnancy has been associated with an increased incidence of birth defects (limb reductions, heart defects, masculinization of the female fetus). breast feeding neonatal jaundice. older adults only indicated if the patient is taking estrogen and has a uterus. baseline data needed for combo contraceptives Assess for history of hypertension, diabetes, thromboembolism, cerebrovascular or cardiovascular disease, breast cancer. Urine pregnancy test. high risk patients for combo therapy contraindications to use include current pregnancy, history of thromboembolus, breast cancer, and women over 35 years of age who continue to smoke tobacco. Use with caution in women with diabetes, hypertension, and cardiac disease. What effect does CyP450 inhibitors or inducers have on oral Contraceptives Inducers Increases metabolism decreasing the effect of the oral contraceptive therefore if signs of breakthrough bleeding or spotting appear it may be necessary to increase estrogen dosage of the oral contraceptive combined the oral contraceptive with a second form of birth control like a condom and switch to an alternative form of birth control Inhibitors can Lead to adverse effects Monitoring while using combo HT If combination oral contraceptives are being used for menstrual symptoms, it is important to evaluate for decrease in cramping, menstrual flow, or duration of menses. pt teaching while using combo HT educate patients on proper protocol for missed doses (depending on medication type and cycle). Effectiveness of oral contraceptives can be reduced with some medications, including certain common antibiotics. Which contraceptive can be used long term and is reversible? A subdermal system (Nexplanon) for delivery of etonogestrel is available for long-term reversible contraception. Name two combo contraceptives a transdermal patch applied once a week a vaginal ring When should a transdermal contraceptive patch be applied For women not currently using OCs during the first 24 hours of the menstrual period. For women switching from OCs on the first day of withdrawal bleeding. what should pt do if patch comes off if less than 24 hrs reapply if off more than 24 hours, a new cycle should be started, accompanied by backup contraception during the first 7 days. Most common adverse effects of patch breast tenderness headache local irritation nausea and menstrual cramps How is NuvaRing used? inserted once each month, left in place for 3 weeks, and then removed; a new ring is inserted 1 week later. What should pt do if Nuvaring is expelled? Rinse off and reinserted If more than 3 hours elapse between ring expulsion and reinsertion, contraceptive effects may be diminished; hence backup contraception should be used for 7 days. Most common adverse effects of Nuvaring vaginitis, headaches, upper respiratory infection, leukorrhea, sinusitis, weight gain, and nausea What to do if pt misses pill? If one or more pills are missed in the first week, take one pill as soon as possible and then continue with the pack. Use an additional form of contraception for 7 days. • If one or two pills are missed during the second or third week, take one pill as soon as possible and then continue with the active pills in the pack but skip the placebo pills and go straight to a new pack once all the active pills have been taken. • If three or more pills are missed during the second or third week, follow the same instructions given for missing one or two pills but use an additional form of contraception for 7 days. how to minimize thromboembolic phenomena The estrogen dose in OCs should be no greater than required for contraceptive efficacy. • OCs containing drospirenone or desogestrel should generally be avoided because they may pose a higher risk for developing VTE. • OCs should not be prescribed for heavy smokers, women with a history of thromboembolism, or those with other risk factors for thrombosis. • OCs should be discontinued at least 4 weeks before surgery in which postoperative thrombosis might be expected. Monophasic regimen the daily doses of estrogen and progestin remain constant throughout the cycle of use. biphasic, triphasic, and quadriphasic schedules reflect efforts to more closely simulate ovarian production of estrogens and progestins. How is 28 day cycle contraception started The sequence is begun on either the first day of the menstrual cycle or the first Sunday after the onset of menses. If contraception is begun on the first day of the menstrual cycle or the first sunday after the onset of menses how long is protection needed? protection is conferred immediately therefore none When would an alternate protection be needed when starting contraception? With a Sunday start, which is done to have menses occur on weekdays rather than the weekend, protection may not be immediate; hence an alternate form of birth control should be used during the first 7 days of the pill pack. why is extended cycle HT used ? to decreases episodes of withdrawal bleeding, with the associated menstrual pain, premenstrual symptoms, headaches, and other problems. how are birth control methods chosen effectiveness, safety, and personal preference Which contraceptives are most effective etonogestrel subdermal implants (Nexplanon), intramuscular medroxyprogesterone acetate (Depo-Provera), sterilization, and IUDs. Least effective contraceptives condoms, the sponge, diaphragm, cervical cap, spermicides, and periodic abstinence which contraceptive method is best for women whom engage in coitus frequently OCs or a long-term method (e.g., Nexplanon, Depo-Provera, IUD) are reasonable choices which contraceptive method is best for women whom family planning goals have already been met, sterilization of either the male or female partner may be desirable. which contraceptive method is best for women whom have limited sexual activity use of a spermicide, condom, or diaphragm may be more appropriate which contraceptive method is best for individuals who have multiple partners. Because barrier methods combined with spermicides can offer some protection against STDs (as well as providing contraception) The use of a long-term method is best when? adherence is an issue noncontraceptive benefits of HT decrease risk for ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease (PID), benign breast disease, iron deficiency anemia, and acne. OCs favorably affect menstrual symptoms: cramps are reduced, menstrual flow is reduced in volume and duration, and menses are more predictable. In premenstrual disorder or premenstrual dysphoric disorder, OCs can reduce symptom intensity. In some women with menstrual associated migraine, OCs can reduce migraine frequency. Surprisingly, OCs may even benefit women with rheumatoid arthritis. benefits and drawbacks of progestin-only (minimill) therapy less effective and are more likely to cause irregular bleeding (breakthrough bleeding, spotting, amenorrhea, inconsistent cycle length, variations in the volume and duration of monthly flow) Do not cause thromboembolic disorders headaches nausea If progestin only contraception is missed by three hours how should be taken as soon as possible and back up Contraception should be used for two days Drugs whose effects are reduced by oral contraceptives. OCs can decrease the benefits of warfarin and hypoglycemic agents. By increasing levels of clotting factors, OCs can decrease the effectiveness of warfarin, an anticoagulant. By increasing levels of glucose, OCs can counteract the benefits of insulin and other hypoglycemic agents used in diabetes. Accordingly, when combined with OCs, warfarin and hypoglycemic agents may require increased dosage. Which of the following statements best describes why men have higher hematocrit levels in women Men produce more testosterone which results in higher amounts of Erythropoietin and erythrocytes Which hormone is responsible for hypogonadism and replacement therapy for males Testosterone Which hormone is responsible for delayed puberty replacement therapy for males and hypogonadism Methyltestosterone Which hormone is responsible for catabolic states (cachexia) Oxandrolone Testosterone therapy can be used to treat which of the following symptoms and post menopause women Fatigue reduced libido and reduce genital sensitivity Which of the following androgen agents has a black box warning ? Testosterone methyl testosterone or oxandrolone Oxandrolone Can cause peliosis hepatitis, A condition in which blood filled cyst form in the liver leading to liver failure or intra-abdominal hemorrhage Treatment for male hypogonadism IM injection every 2 to 4 weeks for three or four years Patient teaching for testosterone transdermal patches Good handwashing after application cover application site was clothing after medication has dried wash the application site before skin to skin contact with another person Physical side effects of androgen abuse Testicular shrinkage sterility gynecomastia hypertension acne increase in LDL decreasing HDL hepatotoxicity renal damage menstrual irregularities virilization reduction in growth(height) Psychological side effects of androgen abuse Depression manic episodes aggressiveness High doses of androgens can result in testicular shrinkage sterility in gynecomastia due to suppression of which of the following two hormones Luteinizing hormone and follicle-stimulating hormone A transgender woman will require what monitoring Monitoring for prostate cancer unless prostate is removed Estradiol testosterone prolactin triglycerides potassium if spironolactone used as antiandrogen Transgender male will require what monitoring Endometrial and cervical cancer Serum testosterone levels every three months until optimal then 1 to 2 times a year Hematocrit hemoglobin serum cholesterol Risks associated with transgender men Acne male pattern hair loss polycythemia hyper cholesterolemia river impairment thromboembolic disorders w increased risk of myocardial infarction stroke Transgender woman treatment Estrogen antiandrogens gonadotropin releasing hormone agonist or others Transgender male treatment Testosterone Considerations when selecting contraceptive methods Safety and effectiveness of method Age of the patient and related health and medical conditions Ability to comply with the chosen method Frequency of sexual encounters Risk of sexual transmitted diseases Availability or access to the selected method Cost Which method does not require seven days a pack of contraceptives First day start When treating delayed puberty in boys when should a long-term replacement therapy be used If delay is result of true hypogonadism Treatment of delayed puberty Only if psychological pressures are causing the stress Short course of androgen therapy using both fluoxymesterone (androxy, halotestin) and methyltestosterone (methitest) - Until testicular enlargement occurs Treatment of menopause symptoms Testosterone therapy Which anemias respond better to Testosterone therapy Aplastic anemia anemia associated with renal failure Fanconi anemia anemia caused by cancer chemotherapy How do you androgens help relieve anemia Promoting synthesis of erythropoietin Baseline data need it when using testosterone Serum testosterone lupus liver function PSA after one year High risk patients for testosterone include Pregnant women men with prostate cancer or breast cancer and enhancing athletic performance Treatment for erectile dysfunction Lifestyle measures increase exercise and smoking cessation changing drug regimens and drug therapy with sildenafil (viagra) Which drugs are used for Erectile dysfunction Oral agents like PDE five inhibitor's Non-oral agents like papaverine plus phentolamine and alprostadil Administration route of alprostadil Intra-cavernosal injection Intra-urethral insertion of pellets (least side effects) PDE-5 inhibitors Sildenafil Tadalafil Considerations when prescribing tadalafil Reducing dosage of taking inhibitor grapefruit juice can elevate drug levels Take it the same time each day to take in daily Concurrent use of nitrates is contraindicated Do not combine with blockers except Tamsulosin Which hormone is contraindicated in women who have had a hysterectomy Progesterone Drugs used for BPH 5 Alpha reductase inhibitor (finasteride) Alpha andrenergic antagonist(tamsulosin) Best drug for males with very large prostate or a mechanical extraction 5 alpha reductase inhibitors Best drug for males with small prostate or dynamic obstruction Alpha blockers Adverse effects of 5 alpha reductase inhibitors Decreased ejaculate volume and libido Teratogenic to male fetus When will Benefits develop for 5 alpha reductase inhibitors Months Adverse effects of selective Alpha 1 a Blockers Abnormal ejaculation(ejaculation failure reduce ejaculate volume retrograde ejaculation) risk of floppy Iris syndrome during cataract surgery Adverse effect of nonselective alpha-1 blockers Hypotension fainting dizziness nasal congestion somnolence Adverse effects of phosphodiesterase 5 inhibitor Hypotension priapism Alpha 1a blocker/5 alpha reductase inhibitor Decreased libido and Abnormal ejaculation (ejaculation failure reduced ejaculate volume retrograde ejaculation) Baseline information when using five alpha reductase inhibitors PSA High risk patients using five alpha reductase inhibitors Prostate cancer How to evaluate therapeutic effects when using five alpha reductase inhibitors Anticipate symptom improvement after 6 to 12 months Monitoring when using five alpha reductase inhibitors PSA at six months if no decrease evaluate for prostate cancer repeat periodically How to minimize adverse affects when using five alpha reductase inhibitors Sexual dysfunction -Patient should return for possible dosage adjustment Or changing medications if this concerns the patient What is an alternative medicine for bpH Saw palmetto Mechanism mechanism of action for alpha-1 andrenergic antagonist Relax smooth muscles of the bladder neck to improve urinary symptoms experience with BPH Where should transdermal estrogen sprays be applied Top of Thighs and back of calves Where should estrogen gel be applied Arms Where should estrogen patches be applied? Waist line and abdomen Which drug is used to prevent and treat osteoporosis or prevention of breast cancer and high-risk women Raloxifene Adverse effects of Roloxifene Thromboembolism and hot flashes (vasomotor symptoms) When can Oral contraceptives be switched ? Beginning of a new cycle Chlamydia Doxycycline 100mg PO BID x7 days Chlamydia Doxycycline 100mg PO BID x7 days Uncomplicated gonoccal urethritis Ceftriaxone, 500 mg IM once (if chlamydia infection is excluded) Ceftriaxone, 500mg IM once + Doxycycline 100mg PO 2 times a day x 7 days (if chlamydia infection has not been excluded) Uncomplicated gonoccal urethritis Ceftriaxone, 500 mg IM once (if chlamydia infection is excluded) Ceftriaxone, 500mg IM once + Doxycycline 100mg PO 2 times a day x 7 days (if chlamydia infection has not been excluded) Bacterial Vaginosis Metronidazole 500 mg orally twice a day x 7 days OR Metronidazole gel 0.75%, one full applicator (5g) intravaginally, once a day for 5 days OR Clindamycin vaginal cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days Bacterial Vaginosis Metronidazole 500 mg orally twice a day x 7 days OR Metronidazole gel 0.75%, one full applicator (5g) intravaginally, once a day for 5 days OR Clindamycin vaginal cream 2%, one full applicator (5g) intravaginally at bedtime for 7 days Herpes Simplex Virus (First Clinical Episode) Acyclovir 400mg, PO, 3 times a day x 7-10 days OR Famciclovir 250mg, PO, 3 times a day x 7-10 days OR Valacyclovir, 1G, PO, once daily x 7-10 days Herpes Simplex Virus (First Clinical Episode) Acyclovir 400mg, PO, 3 times a day x 7-10 days OR Famciclovir 250mg, PO, 3 times a day x 7-10 days OR Valacyclovir, 1G, PO, once daily x 7-10 days Trichomoniasis Men: Metronidazole 2g orally in a single dose Women: 500mg orally twice a day x 7 days Trichomoniasis Men: Metronidazole 2g orally in a single dose Women: 500mg orally twice a day x 7 days Syphilis (Primary and Secondary) Benzathine penicillin G 2.4 million Units, IM , once Syphilis (Primary and Secondary) Benzathine penicillin G 2.4 million Units, IM , once Pelvic Inflammatory Disease (PID) (IM or Oral Regimens) (p768 caused by N. gonorrhoeae, C. Trachomatis) Combination therapy required: (Doxycycline, PO twice a day x 7 days) IV Clindamycin plus IV /IM gentamicin Pelvic Inflammatory Disease (PID) (IM or Oral Regimens) (p768 caused by N. gonorrhoeae, C. Trachomatis) Combination therapy required: (Doxycycline, PO twice a day x 7 days) IV Clindamycin plus IV /IM gentamicin Side effects of Doxazosin (non-selective x1 blocker) Hypotension, fainting, dizziness, somnolence, and nasal congestion Side effects of Doxazosin (non-selective x1 blocker) Hypotension, fainting, dizziness, somnolence, and nasal congestion Dutasteride (5-alpha-reductase inhibitor) Patient teaching and response to delayed onset of therapeutic effect it can be absorbed through the skin, pregnant women should not handle the drug, men should not donate blood while taking the medication or for at least 6 months after stopping the medication to avoid transmission to women through administration of blood products. The medication can cause sexual dynsfunction so dose adjustments could be needed. Symptom improvement will be in 6-12 months. Capsules must be swallowed whole with a full glass of water. Dutasteride (5-alpha-reductase inhibitor) Patient teaching and response to delayed onset of therapeutic effect it can be absorbed through the skin, pregnant women should not handle the drug, men should not donate blood while taking the medication or for at least 6 months after stopping the medication to avoid transmission to women through administration of blood products. The medication can cause sexual dynsfunction so dose adjustments could be needed. Symptom improvement will be in 6-12 months. Capsules must be swallowed whole with a full glass of water. What type of medication is Dutasteride 5-alpha-reductase inhibitor-reduces prostate size by suppressing production of DHT (hihydrotestosterone) What type of medication is Dutasteride 5-alpha-reductase inhibitor-reduces prostate size by suppressing production of DHT (hihydrotestosterone) How do we know Terazosin is working? Symptomatic improvement and increased urinary flow How do we know Terazosin is working? Symptomatic improvement and increased urinary flow Various routes of administration of estrogen therapy and when each would be used Oral Most convenient Transdermal Emulsion, spray, gels, and patches The total dose of estrogen is greatly reduced, there is less nausea and vomiting, blood levels of estrogen fluctuate less, and there is lower risk for DVT, pulmonary embolism, and stroke. Intravaginal Can be used for systemic effects like hot flashes and night sweats or local effects-treatment of vulval and vaginal atrophy. Parenteral IV/IM-acute emergency control of heavy uterine bleeding Various routes of administration of estrogen therapy and when each would be used Oral Most convenient Transdermal Emulsion, spray, gels, and patches The total dose of estrogen is greatly reduced, there is less nausea and vomiting, blood levels of estrogen fluctuate less, and there is lower risk for DVT, pulmonary embolism, and stroke. Intravaginal Can be used for systemic effects like hot flashes and night sweats or local effects-treatment of vulval and vaginal atrophy. Parenteral IV/IM-acute emergency control of heavy uterine bleeding When is it safe to prescribe progesterone (AKA: progestin) Prescribe for dysfunctional uterine bleeding, amenorrhea, endometriosis, endometrial hyperplasia and endometrial carcinoma, and support an early pregnancy in women with corpus luteum deficiency syndrome and women undergoing IVF When is it safe to prescribe progesterone (AKA: progestin) Prescribe for dysfunctional uterine bleeding, amenorrhea, endometriosis, endometrial hyperplasia and endometrial carcinoma, and support an early pregnancy in women with corpus luteum deficiency syndrome and women undergoing IVF When is in not safe to prescribe progesterone In the presence of UNDIAGNOSED abnormal vaginal bleeding, active thrombophlebitis or hx of thromboembolic disorder, active liver disease, and carcinoma of the breast Do not use prepubertal children Do not use high-dose therapy in first 4 months of pregnancy (birth defects) When is in not safe to prescribe progesterone In the presence of UNDIAGNOSED abnormal vaginal bleeding, active thrombophlebitis or hx of thromboembolic disorder, active liver disease, and carcinoma of the breast Do not use prepubertal children Do not use high-dose therapy in first 4 months of pregnancy (birth defects) Side effects of progestin-only oral contraceptives Breast tenderness, headache, abdominal discomfort, arthralgias, depression Breakthrough bleeding, spotting, and amenorrhea (irregular menses) Side effects of progestin-only oral contraceptives Breast tenderness, headache, abdominal discomfort, arthralgias, depression Breakthrough bleeding, spotting, and amenorrhea (irregular menses) What are the benefits of progestin-only contraception? Do not cause thromboembolic disorders, headaches, nausea What are the benefits of progestin-only contraception? Do not cause thromboembolic disorders, headaches, nausea What are the drawbacks of progestin-only contraception? Less effective, more irregular bleeding, must take at exact same time daily What are the drawbacks of progestin-only contraception? Less effective, more irregular bleeding, must take at exact same time daily Transdermal Testosterone (Patches, Gels, topical solution) Patches can cause irritation to application site Gels can cause secondary exposure/ transfer from unwashed clothing, skin to skin contact (application site dependant on brand- shoulders, upper arms, abdomen, inner thighs, NEVER to genitalia) Patient education (p. 453) Wash hands with soap and water after every application, cover site with clothing when gel dries, wash the site before skin to skin contact with another person, women and children should avoid skin to skin contact with site (risk of virilization), if they do come into contact with site- wash contaminated skin immediately topical solution (liquid)- application underarms, before deodorant or antiperspirant (Do not apply to other areas) Do not swim for 2 hours after application Product is alcohol based= flammable Transdermal Testosterone (Patches, Gels, topical solution) Patches can cause irritation to application site Gels can cause secondary exposure/ transfer from unwashed clothing, skin to skin contact (application site dependant on brand- shoulders, upper arms, abdomen, inner thighs, NEVER to genitalia) Patient education (p. 453) Wash hands with soap and water after every application, cover site with clothing when gel dries, wash the site before skin to skin contact with another person, women and children should avoid skin to skin contact with site (risk of virilization), if they do come into contact with site- wash contaminated skin immediately topical solution (liquid)- application underarms, before deodorant or antiperspirant (Do not apply to other areas) Do not swim for 2 hours after application Product is alcohol based= flammable Intranasal (newest formulation)-testosterone therapy Risk of localized reactions (rhinorrhea, epistasis, nasopharyngitis) Instructions for use (pg 451) The pump should be primed before use and excess gel should be removed. The patient should blow his nose before administration. The pump is inserted into the nostril with the tip aimed toward the lateral nostril wall. The pump should be depressed slowly until it stops. As the tip is withdrawn, it should be wiped against the lateral nostril wall to ensure that any remaining gel is distributed to the nostril. After administration in both nostrils, the nose should be lightly massaged below the nasal bridge. The patient should avoid blowing or sniffing for at least 1 hour after administration. Intranasal (newest formulation)-testosterone therapy Risk of localized reactions (rhinorrhea, epistasis, nasopharyngitis) Instructions for use (pg 451) The pump should be primed before use and excess gel should be removed. The patient should blow his nose before administration. The pump is inserted into the nostril with the tip aimed toward the lateral nostril wall. The pump should be depressed slowly until it stops. As the tip is withdrawn, it should be wiped against the lateral nostril wall to ensure that any remaining gel is distributed to the nostril. After administration in both nostrils, the nose should be lightly massaged below the nasal bridge. The patient should avoid blowing or sniffing for at least 1 hour after administration. Implantable pellets (long acting formulation indicated for hypogonadism and delayed puberty) 2-6 (75 mg each) pellets are implemented subdermally in the hip area or abdominal wall lateral to the umbilicus every 3-6 months. Implantable pellets (long acting formulation indicated for hypogonadism and delayed puberty) 2-6 (75 mg each) pellets are implemented subdermally in the hip area or abdominal wall lateral to the umbilicus every 3-6 months. Buccal tablets (produce steady blood levels of testosterone) Applied adhesively to the gum area above the incisor tooth. hold in place with finger over lip for 30 seconds. recommended dosage 1 tab q 12 hours alternating sides. if it falls out before 8 hours should be replaced with a new one. if falls out after 8 hours place a new one and skip the next dose (ie leave on for 16 hours). Not affected by eating, drinking, chewing gum or brushing teeth Adverse effects are transient- local irritation, bitter taste, taste distortion Risk of transfer with saliva/kissing Buccal tablets (produce steady blood levels of testosterone) Applied adhesively to the gum area above the incisor tooth. hold in place with finger over lip for 30 seconds. recommended dosage 1 tab q 12 hours alternating sides. if it falls out before 8 hours should be replaced with a new one. if falls out after 8 hours place a new one and skip the next dose (ie leave on for 16 hours). Not affected by eating, drinking, chewing gum or brushing teeth Adverse effects are transient- local irritation, bitter taste, taste distortion Risk of transfer with saliva/kissing Intramuscular Testosterone Esters (formulated in oil) (long acting) slowly absorbed and hydrolyzed to release free testosterone blood levels vary widely (higher than normal immediately after dosing then dissipates) = pts experience variations in libido, energy, and mood. Intramuscular Testosterone Esters (formulated in oil) (long acting) slowly absorbed and hydrolyzed to release free testosterone blood levels vary widely (higher than normal immediately after dosing then dissipates) = pts experience variations in libido, energy, and mood. When is androgen therapy appropriate vs. not needed related to puberty? if familial pattern of delayed puberty, androgen therapy is not indicated "Some providers will prescribe limited course if psychological pressures of delayed sexual maturation are causing significant distress" If delayed puberty is a result of true hypogonadism, long term replacement therapy is indicated When is androgen therapy appropriate vs. not needed related to puberty? if familial pattern of delayed puberty, androgen therapy is not indicated "Some providers will prescribe limited course if psychological pressures of delayed sexual maturation are causing significant distress" If delayed puberty is a result of true hypogonadism, long term replacement therapy is indicated Common side effects with androgen therapy Virilization (acne, changes in body and facial hair, menstrual irregularities), increased risk of cancers such as polycythemia, prostate and possibly endometrial cancers, increasing LDL while decreasing HDL, liver impairment, thromboembolic disorders (MI, stroke, PE, CVA), stunted growth in children, edema, masculinization of female fetus, Common side effects with androgen therapy Virilization (acne, changes in body and facial hair, menstrual irregularities), increased risk of cancers such as polycythemia, prostate and possibly endometrial cancers, increasing LDL while decreasing HDL, liver impairment, thromboembolic disorders (MI, stroke, PE, CVA), stunted growth in children, edema, masculinization of female fetus, Alprostadil-Intracavernosal injection self administered into penis, lasts no more than 1 hour, limit total dosing to 3 times per week, only one time per 24hr period. Alprostadil-Intracavernosal injection self administered into penis, lasts no more than 1 hour, limit total dosing to 3 times per week, only one time per 24hr period. Alprostadil-Intraurethral pellet effects lasts 30-60 mins, self administered in urethra, limit use to twice daily, typically has less side effects (Class Lecture) Alprostadil-Intraurethral pellet effects lasts 30-60 mins, self administered in urethra, limit use to twice daily, typically has less side effects (Class Lecture) How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? Carbamazepine is a CYP450 inducer. It accelerates the metabolism of oral contraceptives and decreasing or increasing the dose of Carbamazepine can cause toxic doses. (Dr. Thompson lecture). Agents that induce CYP450 enzymes may reduce the efficacy of OC How does carbamazepine impact oral contraceptives and what symptoms may be associated with that? Carbamazepine is a CYP450 inducer. It accelerates the metabolism of oral contraceptives and decreasing or increasing the dose of Carbamazepine can cause toxic doses. (Dr. Thompson lecture). Agents that induce CYP450 enzymes may reduce the efficacy of OC Benefits of Etonogestrel subdermal implant [Nexplanon] Long-term reversible contraception Among the most effective available Safe to use during breastfeeding after the 21st postpartum day Benefits of Etonogestrel subdermal implant [Nexplanon] Long-term reversible contraception Among the most effective available Safe to use during breastfeeding after the 21st postpartum day Papaverine plus Phentolamine ( non-oral ED drug, NOT FDA approved) patient education Contraindicated for men taking nitrates (e.g., nitroglycerin) and should generally be avoided by men taking α blockers Development of painless fibrotic nodules in the corpus cavernosum is common. Other adverse effects include orthostatic hypotension with dizziness, transient paresthesias, ecchymosis (extravasation of blood into subcutaneous tissue), and difficulty in achieving orgasm or ejaculation. Patient self-injects into penis so teach-back on med administration Papaverine plus Phentolamine ( non-oral ED drug, NOT FDA approved) patient education Contraindicated for men taking nitrates (e.g., nitroglycerin) and should generally be avoided by men taking α blockers Development of painless fibrotic nodules in the corpus cavernosum is common. Other adverse effects include orthostatic hypotension with dizziness, transient paresthesias, ecchymosis (extravasation of blood into subcutaneous tissue), and difficulty in achieving orgasm or ejaculation. Patient self-injects into penis so teach-back on med administration