⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
NURP 424 Exam 2 with verified solutions
How !do !phosphodiesterase !type !5 !(PDE-5) !inhibitors !work? !- !correct !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) !- !correct !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? !- !correct !answer
!✔Medroxyprogesterone !acetate !(Depo !shot)
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
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? !- !correct !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? !- !correct !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? !- !correct !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? !- !correct
!answer !✔Decreased !fat !mass
Normal !aging !is !associated !with !a !decrease !in !serum !albumin !levels. !How !does
!this !impact !drug !distribution? !- !correct !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? !-
!correct !answer !✔Decreased !acid !production
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
Which !of !these !is !a !potential !pharmacodynamic !difference !in !children !as
!compared !with !adults? !- !correct !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? !- !correct
!answer !✔Injectable !testosterone !is !the !least !expensive.
The !APN !knows !that !children !are !often !at !higher !risk !for !ADRs !for !which !two
!reasons? !- !correct !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? !-
!correct !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? !- !correct
!answer !✔Tell !him !he !has !to !wait !6 !months !after !his !heart !attack !to !use !this
!medication !again.
Gender !Differences: !Pharmacodynamics !- !correct !answer !✔- !Opioids !have !a
!greater !analgesic !effects !and !side !effects !in !women !than !men !(i.e. !N/V)
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
- !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 !- !correct !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
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
NURP 424 Exam 2 with verified solutions
How !do !phosphodiesterase !type !5 !(PDE-5) !inhibitors !work? !- !correct !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) !- !correct !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? !- !correct !answer
!✔Medroxyprogesterone !acetate !(Depo !shot)
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
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? !- !correct !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? !- !correct !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? !- !correct !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? !- !correct
!answer !✔Decreased !fat !mass
Normal !aging !is !associated !with !a !decrease !in !serum !albumin !levels. !How !does
!this !impact !drug !distribution? !- !correct !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? !-
!correct !answer !✔Decreased !acid !production
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
Which !of !these !is !a !potential !pharmacodynamic !difference !in !children !as
!compared !with !adults? !- !correct !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? !- !correct
!answer !✔Injectable !testosterone !is !the !least !expensive.
The !APN !knows !that !children !are !often !at !higher !risk !for !ADRs !for !which !two
!reasons? !- !correct !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? !-
!correct !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? !- !correct
!answer !✔Tell !him !he !has !to !wait !6 !months !after !his !heart !attack !to !use !this
!medication !again.
Gender !Differences: !Pharmacodynamics !- !correct !answer !✔- !Opioids !have !a
!greater !analgesic !effects !and !side !effects !in !women !than !men !(i.e. !N/V)
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
, ⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
- !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 !- !correct !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
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
⪛⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙ ΙμλΜι Ιππππ ιΤΜΜτλ μτΧ⪛ ⪴⪴⪷⪱⪘ ⪞⪴⪸εΘΙΙμλΜ ιΙππππ ιΤΜΜτλ μτΧ
