NURP-424- Exam 2 Questions
And Accurate Answers
How do phosphodiesterase type 5 (PDE-5) inhibitors work? - Answer PDE-5 inhibitors
work by blocking the catabolism of cyclic GMP which results in an increased number
and duration of erections in men with ED.
Pharmacokinetics: Pediatrics (2) - Answer - Blood brain barrier is incomplete and more
permeable
- Small infants have less protein binding capability which leads to more free drug in the
body
- Kidneys are not matured so excretion and elimination is slowed
- Skin is thin and more permeable so it absorbs quicker
- Oral bioavailability of weak bases compounds is increased.
( e.g. Beta-lactams)
- Oral bioavailability of weak organic acids is decreased.
(e.g. Phenobarbital and phenytoin)
Which method of contraception has a Black Box Warning due to causing significant
bone mineral density (BMD) loss in adolescents? - Answer Medroxyprogesterone
acetate (Depo shot)
A mother asks the APN about using an over-the-counter (OTC) medication for her child
because the label says, "Consult your provider for use instructions as safety and
effectiveness have not been established." Which response by the APN is most
appropriate? - Answer "Pediatric studies have shown this drug to be either unsafe or
ineffective in children."
Which of these would the APN include in teaching for the transmasculine patient
starting testosterone replacement therapy? - Answer The patient's periods should stop
within 6 months.
A transfeminine patient is preparing for feminizing hormone therapy. Which of these
would the APN include in teaching about the effects of hormone therapy? - Answer It
may take months, and even up to a year, for the patient to see the full effect of the
hormones.
Which of these does testosterone replacement therapy (TRT) cause? - Answer
,Decreased fat mass
Normal aging is associated with a decrease in serum albumin levels. How does this
impact drug distribution? - Answer Fewer protein molecules are available for drug
binding, leading to higher levels of free, unbound drug and an increased risk for drug
toxicity.
Normal age-related changes alter the absorption of medications from the
gastrointestinal (GI) tract. Which of these is caused by age-related changes? - Answer
Decreased acid production
Which of these is a potential pharmacodynamic difference in children as compared with
adults? - Answer Unexpected side effect different than an adult
Which of these would the APN need to consider when selecting the best option for the
patient beginning testosterone replacement therapy? - Answer Injectable testosterone
is the least expensive.
The APN knows that children are often at higher risk for ADRs for which two reasons? -
Answer Inattention to weight-based dosing and immature organ function in the very
young, which makes dosing more complicated
Which statement regarding topical absorption of medications is accurate? - Answer It is
increased in children due to larger body surface in relation to their size.
The APN is following a 68-year-old male who had an acute myocardial infarction (MI)
about 4 months ago. He is not seeing a cardiologist anymore. He is doing well and has
returned to all his regular activities. He is tolerating a low dose beta blocker, which was
started after the heart attack. He has never had any chest pain or exercise intolerance.
He has a prescription for sublingual nitroglycerine when necessary but has never
needed it. He requests a refill on his Viagra. Which action taken by the APN is most
appropriate? - Answer Tell him he has to wait 6 months after his heart attack to use this
medication again.
Gender Differences: Pharmacodynamics - Answer - Opioids have a greater analgesic
effects and side effects in women than men (i.e. N/V)
- Aspirin will lower the risk for stroke but will have little effect if given prophylactically
for an MI in women (the opposite is in men)
- Warfarin will have less benefit to women and more susceptible to adverse effects such
as bleeding
- Tricyclic antidepressants will take longer to reach a steady state and will cause more
adverse effects in women
- Antipsychotics will have better outcomes but more side effects in women
- Medication takes longer to be absorbed due to increased adipose tissue/fat, so
,bioavailability is higher in women
Pharmacokinetics in Women - Answer - Gastric emptying time is slower d/t estrogen
which will give medications more time at the absorption site
- Plasma concentration of alcohol is greater in females with the same amount of alcohol
intake
- Females have a higher proportion of body fat which makes it easier for them to absorb
lipophilic drugs
- Women have a harder time with tricyclic antidepressants which makes them more
likely to experience SE
- Plasma volume is lower in females, drugs with high volumes of distribution will be
concentrated in the plasma
- The pregnancy and lactation risk categories are no longer used, now provides a label
before prescribing
Pharmacokinetics in Pregnancy - Answer - Pregnant women need hydrophilic, high
molecular weight, ionized, and high protein binding drugs
- In pregnancy, plasma volume increases, dilutional anemia occurs which leads to the
need for prenatal vitamins and possible iron supplementation
- Increased plasma volumes affect volume of distribution
- Limited caffeine in pregnancy because caffeine puts more work on the heart which is
already taxed due to the pregnancy
- No smoking or vaping during pregnancy because it decreases the oxygen to the fetus
- Drug absorption through the skin, lungs, and mucous membranes are increased due to
increased cardiac output
- Decreased GI motility and gastric emptying times
Pharmacokinetics in Lactation - Answer - Breastmilk: acidic so a more basic medication
will be more concentrated in the milk than in the plasma
- Lactating women need hydrophilic, high molecular weight, and high protein binding
drugs
- Short acting medications
Breastfeeding - Answer - Breast milk is more acidic so basic compounds will be more
elevated in the milk, while acidic compounds will be decreased
- Larger molecules will pass slower
, Lactation Drug Exposure - Answer - Combined oral contraceptives- decrease breast
milk
- Infant and children's Tylenol is the same concentration, while ibuprofen is not
Pharmacokinetics in Menopause - Answer - Personal history or family history of breast
cancer, hormone therapy is discouraged
- Weight bearing exercise is important due to bone loss from loss of estrogen and other
hormones
- Current recommendations are to use the lowest amount of exogenous hormones for
the shortest duration to alleviate problematic symptoms.
Specific Hypogonadism - Answer - The gonads fail to produce androgen or sperm
- Primary hypogonadism- an issue in the negative feedback loop (testosterone levels
decrease which leads to increased levels of luteinizing and follicle stimulating
hormones)
- Secondary hypogonadism- nothing to stimulate the hormone to produce
- Treatment includes testosterone
Primary Hypogonadism - Answer - (testicular failure) characterized by low testosterone
and elevated gonadotropins
Secondary Hypogonadism - Answer - (hypothalamic-pituitary failure) characterized by
low testosterone and low or normal gonadotropins
Testosterone Effects in Hypogonadism - Answer - Increased bone mineral density
- Increased cognitive function
- Increased energy, mood, and quality of life
- Increased sexual function and libido
- Increased H&H concentrations
- Increased muscle mass
- Increased prostate gland size
Testosterone Supplementation - Answer - Risks: increased platelet count which can
lead to a stroke, irritability, prostate cancer, decreased sperm production and fertility,
acne, hypercholesteremia, loss of strength, loss of mass, depression
- Contraindications: untreated sleep apnea, elevated PSA, breast carcinoma, abnormal
digital rectal exam, severe HF, prostate carcinoma
And Accurate Answers
How do phosphodiesterase type 5 (PDE-5) inhibitors work? - Answer PDE-5 inhibitors
work by blocking the catabolism of cyclic GMP which results in an increased number
and duration of erections in men with ED.
Pharmacokinetics: Pediatrics (2) - Answer - Blood brain barrier is incomplete and more
permeable
- Small infants have less protein binding capability which leads to more free drug in the
body
- Kidneys are not matured so excretion and elimination is slowed
- Skin is thin and more permeable so it absorbs quicker
- Oral bioavailability of weak bases compounds is increased.
( e.g. Beta-lactams)
- Oral bioavailability of weak organic acids is decreased.
(e.g. Phenobarbital and phenytoin)
Which method of contraception has a Black Box Warning due to causing significant
bone mineral density (BMD) loss in adolescents? - Answer Medroxyprogesterone
acetate (Depo shot)
A mother asks the APN about using an over-the-counter (OTC) medication for her child
because the label says, "Consult your provider for use instructions as safety and
effectiveness have not been established." Which response by the APN is most
appropriate? - Answer "Pediatric studies have shown this drug to be either unsafe or
ineffective in children."
Which of these would the APN include in teaching for the transmasculine patient
starting testosterone replacement therapy? - Answer The patient's periods should stop
within 6 months.
A transfeminine patient is preparing for feminizing hormone therapy. Which of these
would the APN include in teaching about the effects of hormone therapy? - Answer It
may take months, and even up to a year, for the patient to see the full effect of the
hormones.
Which of these does testosterone replacement therapy (TRT) cause? - Answer
,Decreased fat mass
Normal aging is associated with a decrease in serum albumin levels. How does this
impact drug distribution? - Answer Fewer protein molecules are available for drug
binding, leading to higher levels of free, unbound drug and an increased risk for drug
toxicity.
Normal age-related changes alter the absorption of medications from the
gastrointestinal (GI) tract. Which of these is caused by age-related changes? - Answer
Decreased acid production
Which of these is a potential pharmacodynamic difference in children as compared with
adults? - Answer Unexpected side effect different than an adult
Which of these would the APN need to consider when selecting the best option for the
patient beginning testosterone replacement therapy? - Answer Injectable testosterone
is the least expensive.
The APN knows that children are often at higher risk for ADRs for which two reasons? -
Answer Inattention to weight-based dosing and immature organ function in the very
young, which makes dosing more complicated
Which statement regarding topical absorption of medications is accurate? - Answer It is
increased in children due to larger body surface in relation to their size.
The APN is following a 68-year-old male who had an acute myocardial infarction (MI)
about 4 months ago. He is not seeing a cardiologist anymore. He is doing well and has
returned to all his regular activities. He is tolerating a low dose beta blocker, which was
started after the heart attack. He has never had any chest pain or exercise intolerance.
He has a prescription for sublingual nitroglycerine when necessary but has never
needed it. He requests a refill on his Viagra. Which action taken by the APN is most
appropriate? - Answer Tell him he has to wait 6 months after his heart attack to use this
medication again.
Gender Differences: Pharmacodynamics - Answer - Opioids have a greater analgesic
effects and side effects in women than men (i.e. N/V)
- Aspirin will lower the risk for stroke but will have little effect if given prophylactically
for an MI in women (the opposite is in men)
- Warfarin will have less benefit to women and more susceptible to adverse effects such
as bleeding
- Tricyclic antidepressants will take longer to reach a steady state and will cause more
adverse effects in women
- Antipsychotics will have better outcomes but more side effects in women
- Medication takes longer to be absorbed due to increased adipose tissue/fat, so
,bioavailability is higher in women
Pharmacokinetics in Women - Answer - Gastric emptying time is slower d/t estrogen
which will give medications more time at the absorption site
- Plasma concentration of alcohol is greater in females with the same amount of alcohol
intake
- Females have a higher proportion of body fat which makes it easier for them to absorb
lipophilic drugs
- Women have a harder time with tricyclic antidepressants which makes them more
likely to experience SE
- Plasma volume is lower in females, drugs with high volumes of distribution will be
concentrated in the plasma
- The pregnancy and lactation risk categories are no longer used, now provides a label
before prescribing
Pharmacokinetics in Pregnancy - Answer - Pregnant women need hydrophilic, high
molecular weight, ionized, and high protein binding drugs
- In pregnancy, plasma volume increases, dilutional anemia occurs which leads to the
need for prenatal vitamins and possible iron supplementation
- Increased plasma volumes affect volume of distribution
- Limited caffeine in pregnancy because caffeine puts more work on the heart which is
already taxed due to the pregnancy
- No smoking or vaping during pregnancy because it decreases the oxygen to the fetus
- Drug absorption through the skin, lungs, and mucous membranes are increased due to
increased cardiac output
- Decreased GI motility and gastric emptying times
Pharmacokinetics in Lactation - Answer - Breastmilk: acidic so a more basic medication
will be more concentrated in the milk than in the plasma
- Lactating women need hydrophilic, high molecular weight, and high protein binding
drugs
- Short acting medications
Breastfeeding - Answer - Breast milk is more acidic so basic compounds will be more
elevated in the milk, while acidic compounds will be decreased
- Larger molecules will pass slower
, Lactation Drug Exposure - Answer - Combined oral contraceptives- decrease breast
milk
- Infant and children's Tylenol is the same concentration, while ibuprofen is not
Pharmacokinetics in Menopause - Answer - Personal history or family history of breast
cancer, hormone therapy is discouraged
- Weight bearing exercise is important due to bone loss from loss of estrogen and other
hormones
- Current recommendations are to use the lowest amount of exogenous hormones for
the shortest duration to alleviate problematic symptoms.
Specific Hypogonadism - Answer - The gonads fail to produce androgen or sperm
- Primary hypogonadism- an issue in the negative feedback loop (testosterone levels
decrease which leads to increased levels of luteinizing and follicle stimulating
hormones)
- Secondary hypogonadism- nothing to stimulate the hormone to produce
- Treatment includes testosterone
Primary Hypogonadism - Answer - (testicular failure) characterized by low testosterone
and elevated gonadotropins
Secondary Hypogonadism - Answer - (hypothalamic-pituitary failure) characterized by
low testosterone and low or normal gonadotropins
Testosterone Effects in Hypogonadism - Answer - Increased bone mineral density
- Increased cognitive function
- Increased energy, mood, and quality of life
- Increased sexual function and libido
- Increased H&H concentrations
- Increased muscle mass
- Increased prostate gland size
Testosterone Supplementation - Answer - Risks: increased platelet count which can
lead to a stroke, irritability, prostate cancer, decreased sperm production and fertility,
acne, hypercholesteremia, loss of strength, loss of mass, depression
- Contraindications: untreated sleep apnea, elevated PSA, breast carcinoma, abnormal
digital rectal exam, severe HF, prostate carcinoma
