Charter College, Anchorage - NURSING NU1005

Chapter 31: Drug Therapy for Male Reproductive Problems

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)How do DHT inhibitors work to reduce benign prostatic hyperplasia?

1. 1. Relaxing the muscles of the bladder.
   2. Increasing urine production.
   3. Shrinking the prostate gland.
   4. Relaxing prostate smooth muscle.

2. Which drug belongs to the DHT inhibitor class?
   1. Alfuzosin
   2. Tamsulosin
   3. Silodosin
   4. Dutasteride

3. Which side effect is caused by selective alpha-1 blockers for benign prostatic hyperplasia?
   1. Low blood pressure
   2. Male-pattern baldness
   3. Erectile dysfunction
   4. Urinary retention

4. What is the most common side effect of drugs used for benign prostate hypertrophy (BPH)?
   1. Low blood pressure

1. 2. Decreased libido
   3. Light-headedness
   4. Hair loss

5. Which test or examination does a patient receive before taking any drug for benign prostate hypertrophy (BPH)?
   1. Digital rectal examination
   2. 24-hour urinalysis
   3. Kidney function test
   4. Urine culture

6. When a patient with prostate enlargement has urine in his bladder longer than normal, which adverse effect is likely to occur?
   1. Interstitial cystitis
   2. Bladder infection
   3. Bladder stones
   4. Overactive bladder

7. Which drug is a selective alpha-1 blocker?
   1. Dutasteride (Avodart)
   2. Finasteride (Proscar)
   3. Sildenafil (Viagra)
   4. Silodosin (Rapaflo)

8. Which side effect occurs when a patient is prescribed a DHT Inhibitor?
   1. Dizziness
   2. Back pain
   3. Reduced fertility
   4. Stuffy nose

9. Which statement about testosterone is accurate?
   1. Testosterone levels begin to decrease around the age of 50 years.
   2. Testosterone helps maintain male sexual characteristics.
   3. Too much testosterone leads to decreased body muscle mass.
   4. Adequate red blood cell levels are essential for production of testosterone.

10. Which factor is an organic risk for development of erectile dysfunction?
    1. Depression
    2. Anxiety
    3. Diabetes
    4. Stress

11. Which schedule drug is testosterone?
    1. Schedule II
    2. Schedule III
    3. Schedule IV
    4. Schedule V

12. Which herbal preparation would you caution a patient prescribed a drug for erectile dysfunction to avoid?
    1. St. John’s wort
    2. Saw palmetto
    3. Ginkgo biloba
    4. Valerian

ADVANCED CONCEPTS

13. An 82-year-old-man is prescribed a dihydrotestosterone (DHT) inhibitor to treat benign prostatic hypertrophy (BPH). Which health promotion activity is most important to teach this patient?
    1. Have vision and glaucoma checks yearly.
    2. Participate in yearly prostate cancer screening.
    3. Avoid both alcohol and caffeine while on the drug.
    4. Avoid donating blood when taking the drug and for at least 6 months after drug therapy.

14. A patient taking tamsulosin (Flomax) asks how the drug works. What is your best response?
    1. “This drug works on your prostate gland to decrease its size.”
    2. “This drug signals the cells in your prostate gland not to grow.”
    3. “This drug works by relaxing the detrusor muscle of your bladder.”
    4. “This drug relaxes muscle around your urethra to improve urine flow.”

15. A patient taking finasteride (Proscar) tells you that he is also taking the herbal supplement saw palmetto. What is your best response?
    1. “You should not take finasteride and saw palmetto at the same time.”
    2. “Finasteride and saw palmetto taken together increase your risk of bleeding.”
    3. “Be sure to notify your prescriber if you notice any unusual side effects.”
    4. “Avoid people with viral infections while taking these two substances.”

16. A 58-year-old patient with BPH asks you why he should see his physician for prostate cancer screening. What is your best response?
    1. “BPH increases your risk for developing prostate cancer.”
    2. “At your age it is always best to complete cancer screening tests.”
    3. “If prostate cancer is caught early enough there is a very high cure rate.”
    4. “The signs and symptoms of BPH and prostate cancer are the same.”

17. For which intended response will you monitor when a patient is prescribed finasteride (Proscar) 5 mg orally each day?
    1. Pressure is increased
    2. Urine flow from urethra improves
    3. Nocturia increases
    4. Bladder empties incompletely

18. For which patient should you question an order for the dutasteride (Avodart) 0.5 mg orally once a day?
    1. 55-year-old male with chronic obstructive pulmonary disease (COPD)
    2. 63-year-old male with gastroesophageal reflux disease (GERD)
    3. 71-year-old male with liver disease (hepatotoxicity)
    4. 82-year-old male with kidney disease (nephrotoxicity)

19. What question should you be sure to ask before administering a dose of tamsulosin (Flomax) to a patient?
    1. “Do you have a history of high blood pressure?”
    2. “Have you ever had a problem with liver disease?”
    3. “Are you allergic to any of the sulfa drugs?”
    4. “How often are you sexually active?”

20. A patient who was prescribed finasteride (Proscar) 2 months ago asks you why his prostate has not gotten smaller. What is your best response?
    1. “I will contact your prescriber with this information because you may need a different drug.”
    2. “Your prescriber will likely order a CT scan to determine if there is any improvement.”
    3. “Have you had your annual screening for prostate cancer this year?”
    4. “It could be too early to tell because this drug can take 3 to 6 months to work.”

21. Which individual should be cautioned to avoid handling a DHT inhibitor drug?
    1. 55-year-old woman who is postmenopausal
    2. 25-year-old woman who is 3 months pregnant
    3. 35-year-old man whose sister is 5 months pregnant
    4. 45-year-old man who has diabetes and hypertension

22. A patient is prescribed the testosterone patch (Androderm) 4 mg/day applied to the upper body once daily at night. Which side effect(s) will you teach the patient may occur?
    1. Itching and redness at the application site
    2. Acne and dry skin in the genital region

1. 3. Increased ease with starting urine stream
   4. Increased testicular size

23. For which patient would you question the prescriber about an order for testosterone therapy?
    1. 75-year-old male with history of gastric ulcers
    2. 65-year-old male with history of breast cancer
    3. 55-year-old male with history of overactive bladder
    4. 45-year-old male with history of asthma

24. A patient is prescribed testosterone 100 mg IM every 4 weeks. What finding will you teach the patient to report to the prescriber immediately?
    1. Blood pressure decrease of 10 mm Hg systolic
    2. Urine output increase of 200 mL/day
    3. Weight gain of 5 lb
    4. Increased prostate size

25. A 58-year-old male prescribed testosterone replacement is married to a 34-year-old woman who is expecting their first child. What safety measure would you teach the patient and his wife?
    1. “Wear a condom if you have sex with your wife at any time while she is pregnant.”
    2. “Do not touch linens that have been in contact with your husband’s testosterone gel.”
    3. “Never enter the bathroom while your husband is applying the testosterone gel.”
    4. “Avoid high protein containing foods because they can interact with the testosterone gel.”

26. You are providing teaching for a patient who is interested in exploring the use of drug therapy for erectile dysfunction. The patient asks how the drugs work. What response is accurate?
    1. “The drugs are Phosphodiesterase-5 inhibitor drugs (PDE-5) that start working in 2 to 4 hours.”
    2. “Effects of these drugs can last 3 to 5 days or more.”
    3. “Sexual stimulation is required to achieve an erection.”
    4. “Phosphodiesterase-5 inhibitor drugs (PDE-5) cause smooth muscle to constrict to achieve an erection.”

27. A patient is prescribed tadalafil (Cialis). The pharmacy sends vardenafil (Levitra). What is your best action?
    1. Give the drug because these drugs can be used interchangeably.
    2. Notify the prescriber to clarify the order.
    3. Ask the patient which drug he would prefer to take.
    4. Contact the pharmacy and request the correct drug.

28. The patient prescribed sildenafil (Viagra) tells you that he has a painful erection that has lasted almost 7 hours. What is your best action?
    1. Instruct the patient to think of a quiet, peaceful place so the erection will subside.
    2. Tell the patient to get up and take a cool shower until the erection subsides.
    3. Contact the pharmacy to send an antidote for this drug.
    4. Notify the prescriber about the length of time and the pain associated with the erection.

29. For which patient should you question the prescriber about an order for the PDE-5 drug vardenafil (Levitra)?
    1. Patient with a history of cardiac disease who is also prescribed nitroglycerin (NTG) for angina.
    2. Patient with a history of type 1 diabetes and hypertension who is prescribed insulin and metoprolol.
    3. Patient with a history of kidney stones and bladder infection who is receiving antibiotics.
    4. Patient with a history of chronic obstructive pulmonary disease (COPD) who is prescribed bronchodilators.

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. What are the signs and symptoms of benign prostatic hyperplasia (BPH)? (select all that apply)
   1. Burning with urination
   2. Frequency of urination
   3. Decreased urination at night
   4. Difficulty starting and continuing urination
   5. Increased force and size of urine stream
   6. Dribbling after urination
   7. Feeling of incomplete bladder emptying

2. Which symptoms indicate insufficient testosterone? (select all that apply)
   1. Increased muscle and decreased body fat
   2. Decreased interest in sex
   3. Increased bone density
   4. Decreased body hair