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Chapter 16: Hormones and Drugs for Osteoporosis

Visovsky: Introduction to Clinical Pharmacology, 9th Edition

MULTIPLE CHOICE

1)A patient diagnosed with hypothyroidism has been prescribed treatment with a thyroid hormone agonist. The patient asks you how long this drug will need to be taken. What is your best response?

1. 1. “You will need to take this drug for the rest of your life.”
   2. “You will need to take this drug until your symptoms improve.”
   3. “You will need to take this drug until your thyroid hormone level normalizes.”
   4. “You will need to take this drug incrementally until you reach the maximum tolerated dose.”
2. A patient taking levothyroxine sodium is pregnant and tells you she plans to breastfeed her baby. What should you tell this patient?
   1. “While it is safe to breastfeed, this drug will limit your milk supply over time.”
   2. “Breast-feeding is safe when taking this drug, but not with other thyroid hormones.”
   3. “You should not breastfeed your infant because this drug passes into your breastmilk.”
   4. “You may breastfeed while hospitalized and your thyroid hormone levels can be checke”
3. The action of which drug is known to be increased by thyroid hormone replacement drugs? a.           Warfarin (Coumadin)
   2. Acetaminophen (Tylenol)
   3. Diphenhydramine (Benadryl)
   4. Fiber supplements (FiberCon)
4. Which assessment is most important to perform before giving an elderly patient who is prescribed levothyroxine (Synthroid) the first dose of the drug?

1. Measuring heart rate and rhythm
2. Determining level of consciousness
3. Asking about an allergy to “sulfa” drugs
4. Checking intake and output for the last 24 hours

5. How do thyroid replacement drugs work to treat hypothyroidism?
   1. Forcing the thyroid gland to secrete more thyroid hormones
   2. Inhibiting the enzymes that break down thyroid hormones
   3. Preventing damage to thyroid endocrine cells
   4. Providing thyroid hormones
6. A patient who has been prescribed propylthiouracil (Propacil) asks you how this drug works to reduce thyroid hormone levels. What is your best response?
   1. “This drug combines with the enzyme that connects iodine to tyrosine.”
   2. “This drug works by activating thyroid hormone in the pituitary gland.”
   3. “This drug activates the gene for metabolism, speeding up cellular work.”
   4. “This drug works by interfering with the thyroid hormone feedback loop.”
7. You are caring for a patient who is taking an antithyroid drug for the treatment of hyperthyroidism. Which assessment should be performed before giving this drug?
   1. Check the pulse rate for irregular rate and rhythm.
   2. Check the blood pressure for hypertension.
   3. Check the skin and sclera for yellowing.
   4. Check the lower extremities for edema.
8. A patient taking an antithyroid drug for one week calls you and states that the symptoms of hyperthyroidism have not improved yet. What is your best response?
   1. “You will need to have your blood level of the drug checked.”
   2. “This drug must be taken for 3 to 4 weeks to start being effective.”
   3. “This may mean you have formed thyroid antibodies against this drug.”
   4. “I will let your healthcare provider know so your dose can be adjuste”
9. You are caring for an elderly patient taking an antithyroid drug. Which of the following conditions is associated with an adverse effect in this patient?
   1. Decreased complete blood count
   2. Increased urine output
   3. Decreased blood pressure
   4. Increased platelet count
10. A patient you are caring for develops a goiter. What does the appearance of a goiter mean? a.           Hypothyroidism
    2. Hyperthyroidism
    3. Thyroid problem
    4. Premature menopause
11. A patient with adrenal hypofunction has a known aldosterone deficiency and has been prescribed Fludrocortisone (Florinef). The patient asks you how this drug works to treat this problem. What is your best response?
    1. “This drug acts like natural aldosterone in the body.”
    2. “This drug permits potassium to be retained in the body.”
    3. “This drug acts to retain glucose for action within the body.”
    4. “This drug permits the excretion of sodium from the body.”
12. A patient prescribed Fludrocortisone (Florinef) calls to report a weight gain of 3 lb. in the last week to you. What is your best response to this patient?
    1. “You will need to cut all salt from your diet for a few days to see if this resolves.”
    2. “Your diet may contain too many carbohydrates for your body to process.”
    3. “I will notify your healthcare provider right away and get back to you.”
    4. “This is an expected side effect of this drug.”
13. Which side effects are most common when taking any drug to manage adrenal gland hyperfunction?
    1. Decreased urine output and increased sweating
    2. Blurred vision and dry mouth
    3. Headache and mouth sores
    4. Nausea and vomiting
14. Which drug is used only for patients with type 2 diabetes and hypercortisolism?
    1. Mitotane (Lysodren)
    2. Mifepristone (Korlym)
    3. Liothyronine sodium (Cytomel)
    4. Methimazole (Northyx, Tapazole)
15. A patient experiencing symptoms related to menopause asks you to explain the cause of her symptoms. What is your best response?
    1. “Symptoms of menopause are caused by low levels of estrogen and high levels of

FSH.”

1. 2. “Symptoms of menopause are caused by high levels of estrogen and low levels of

FSH.”

1. 3. “Symptoms of menopause are caused by low levels of estrogen and low levels of

FSH.”

15. 4. “Symptoms of menopause are caused by high levels of estrogen and high levels of FSH.”
16. What is one of the adverse effects of hormone replacement therapy for menopause?
    1. Pregnancy
    2. Blood clots
    3. Miscarriage
    4. Decreased mental concentration
17. Which side effects are most common among women taking hormone replacement therapy for menopause?
    1. Nausea, vomiting, and diarrhea
    2. Skin itching and dark-colored urine
    3. Breast tenderness and fluid retention
    4. Increased vaginal dryness and constipation
18. Which type of oral contraceptive drug must be taken every day of the month to be effective?
    1. An estrogen–progestin combination.
    2. A progestin–drospirenone combination.
    3. An estrogen only “mini” pill
    4. A progestin only “mini” pill
19. Which of the following patients is most at risk for adverse effects related to the use of oral contraceptives?
    1. A 37-year-old woman who has a history of smoking
    2. A 25-year-old woman who had a baby 2 months ago
    3. A 32-year-old woman who has never been pregnant
    4. A 16-year-old female who has just become sexually active
20. Which oral contraceptive can increase serum potassium levels and potentially lead to irregular heart rhythm?
    1. Yasmin
    2. Camila
    3. Ovral
    4. Zovia
21. You are teaching a young female patient about the oral contraceptive she has been prescribed. What instructions should be included in the teaching plan for this patient?
    1. “Take oral contraceptives exactly as prescribed.”
    2. “You may take over-the-counter drugs with oral contraceptives.”
    3. “You may miss up to two doses in a row and still be protected from pregnancy.”
    4. “You may use nicotine patches, but stop smoking when taking oral contraceptives.”
22. A male patient is prescribed androgen therapy with testosterone 100 mg IM every 4 weeks.

What finding will you teach the patient to report to the prescriber immediately?

22. 1. Blood pressure decrease of 10 mm Hg systolic
    2. Urine output increase of 200 mL/day
    3. Fluid retention
    4. Increased prostate size
23. Which bone or joint is most likely to be adversely affected by bisphosphonates? a.          Eye orbit
    2. Jawbone
    3. Big toe
    4. Wrist
24. A patient is to receive a subcutaneous injection of denosumab (Prolia) for severe osteoporosis. What action should you take before giving this injection?
    1. Place emergency equipment in the room with the patient.
    2. Assess for circulation in the umbilical area.
    3. Assess the patient’s ability to walk.
    4. Monitor the patient’s liver function tests.

MULTIPLE RESPONSE

1.   Which findings indicate that thyroid hormone drug dose is appropriate and effective in a patient with hypothyroidism? (Select all that apply.)

1. 1. 1. The patient’s vital signs are within normal limits.
      2. The patient reports an increase in activity levels.
      3. The patient’s body weight remains consistent.
      4. The patient reports mild, bilateral edema.
      5. The patient has a bowel movement daily.
      6. The patient’s goiter is reduced in size.

2.  Which statements about the adrenal glands are true? (Select all that apply.)

1. 1. 1. Adrenal hormones differ by age and gender.
      2. Glucocorticoid hormones are necessary for life.
      3. Aldosterone controls sodium and water balance.
      4. Low levels of adrenal hormones can lead to stroke.
      5. The adrenal cortex secretes aldosterone and cortisol.
      6. When adrenal hormones are overproduces, cancer can result.

3.   You are teaching a patient with adrenal gland hyperfunction taking Mitotane (Lysodren) about this drug. What signs and symptoms of adrenal insufficiency should you teach this patient to report? (Select all that apply.)

1. 1. 1. Craving for salty food
      2. Hyperglycemia

      3. d.

         Hypertension

         e.

         Fatigue

         f.

         Nausea

         4.

         Which drugs belong to the bisphosphonate class of drug? (

         Select all that apply.

         )

         a.

         Alendronate (Fosamax)

         b.

         Denosumab (Prolia)

         Estrogen/bazedoxifene (Duavee)

         d.

         Ibandronate (Boniva)

         e.

         Raloxifene (Evista)

         f.

         Risedronate (Actonel)

         g.

         Zoledronic acid (Reclast)

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