AGNP Board Exam – Men’s Health Prescription Exam

AGNP Board Exam – Men’s Health Prescription Question: Levofloxacin (Levaquin), used to treat acute bacterial prostatitis, is a: fluoroquinolone. Correct penicillin. macrolide. tetracycline. Explanation: Levofloxacin (Levaquin) is classified as a fluoroquinolone. An example of a penicillin is amoxicillin (Moxatag); macrolide is azithromycin (Zithromax); and a tetracycline is doxycycline (Doryx). Question: Ciprofloxacin, used for the treatment of bacterial prostatitis, is a potent CYP1A2 inhibitor and is absolutely contraindicated with other CYP1A2 inhibitors. An example of another CYP1A2 inhibitor is: ketoconazole. tizanidine (Zanaflex). Correct fluoxetine hydrochloride (Sarafem). celecoxib (Celebrex). Explanation: Ciprofloxacin, a fluoroquinolone, is a strong CYP1A2 inhibitor and is absolutely contraindicated for concomitant administration of tizanidine (Zanaflex). Concomitant use may increase the serum concentration of tizanidine. If use with another strong inhibitor cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based on response. Ketoconazole is a CYP3A4 inhibitor; celecoxib is a CYP2D6 inhibitor; and fluoxetine is a YP2C19 inhibitor. CYP1A2 inhibitors are enzymes that catalyze many reactions involved in drug metabolism and synthesis of cholesterol, steroids and other lipids. Question: A 33-year-old man has been taking sulfamethoxazole/trimethoprim for the treatment of bacterial prostatitis. Brand names of this medication do NOT include: Azulfidine. Correct Bactrim DS. SMX-TMP DS. Sulfatrim. Explanation: Brand names of sulfamethoxazole/trimethoprim does NOT include sulfasalazine (Azulfidine). Question: Patients with uncomplicated acute bacterial prostatitis who are NOT good candidates for treatment with a fluoroquinolone should take: levofloxacin. azithromycin. trimethoprim-sulfamethoxazole. Correct ceftriaxone. Explanation: Patients with uncomplicated acute bacterial prostatitis who cannot take a fluoroquinolone should take trimethoprim-sulfamethoxazole. Trimethoprim-sulfamethoxazole has good to excellent penetration into prostatic and seminal fluids and tissues. Levofloxacin is a fluoroquinolone. Cephalosporins, such as ceftriaxone, may not be effective unless an STD is suspected. Azithromycin is a macrolide and macrolides are indicated for the treatment of chronic bacterial prostatitis. Question: PDE-5 inhibitors, such as tadalafil (Cialis) for the treatment of erectile dysfunction, should be avoided in patients with: infertility. a history of epididymitis. benign prostatic hyperplasia (BPH). recent ST elevation myocardial infection (STEMI). Correct Explanation: PDE-5 inhibitors (ie. Levitra, Viagra, Cialis) should not be used in men with underlying cardiovascular disease who have been advised to avoid sexual activity. These medications have systemic vasodilatory properties that result in transient decreases in supine blood pressure. Cardiovascular status should be considered on an individual basis, weighing the risks versus the benefits, before prescribing PDE-5 inhibitors. Question: The choice for initial treatment of acute bacterial prostatitis is: doxycycline (Vibramycin). ceftriaxone (Rocephin). ciprofloxacin (Cipro). Correct azithromycin (Zithromax). Explanation: The choice of antibiotic for treatment of acute bacterial prostatitis (ABP) is based on the results of the initial culture and sensitivity. However, initial therapy should be directed at gram-negative enteric bacteria. Useful agents include fluoroquinolones, trimethoprim-sulfamethoxazole, and ampicillin with gentamicin. Examples of fluoroquinolones are ciprofloxacin (Cipro) and levofloxacin (Levaquin). Question: Patients who take sildenafil (Viagra) for the treatment of erectile dysfunction, should be instructed to avoid: the ingestion of grapefruit-containing products. Correct dark green, leafy vegetables. night time dosing. omega-3 fatty acids. Explanation: Grapefruit and grapefruit juice may interact with sildenafil (Viagra) and lead to severe hypotension. Similar effects may be seen with concomitant alcohol use. Question: To help with symptoms of chronic prostatitis, in addition to antibiotics, consider adjunctive therapy with an: alpha adrenergic antagonist. Correct anticholinergic. antispasmodic agent. antiandrogenic agent. Explanation: In addition to antibiotics, consider adding an alpha adrenergic antagonist to help with obstructive symptoms related to chronic prostatitis including weak stream, hesitancy, straining during urination, sense of incomplete emptying and post-void dribbling. Question: Patients taking vardenafil (Levitra) should be advised to immediately report: headache. flushing. priapism. Correct nausea. Explanation: There have been rare reports of prolonged erections greater than 4 hours and priapism (painful erections greater than 6 hours in duration) associated with PDE-5 inhibitors,