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Introduction to Clinical Pharmacology 9th Edition Visovsky Zambroski Hosler Test Bank
ISBN-13: 978-0323529112
ISBN-10: 0323529119
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Chapter 16: Hormones and Drugs for Osteoporosis
Visovsky: Introduction to Clinical Pharmacology, 9th Edition
MULTIPLE CHOICE
- 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?
| a. | “You will need to take this drug for the rest of your life.” |
| b. | “You will need to take this drug until your symptoms improve.” |
| c. | “You will need to take this drug until your thyroid hormone level normalizes.” |
| d. | “You will need to take this drug incrementally until you reach the maximum tolerated dose.” |
ANS: A
Hypothyroidism is a common problem in which the thyroid gland produces little or no thyroid hormones, slowing all aspects of metabolism, and is treated with thyroid hormone agonists. Usually this therapy is needed for the rest of the person’s life.
DIF: Cognitive Level: Applying REF: p. 293
- A patient taking levothyroxine sodium is pregnant and tells you she plans to breastfeed her baby. What should you tell this patient?
| a. | “While it is safe to breastfeed, this drug will limit your milk supply over time.” |
| b. | “Breast-feeding is safe when taking this drug, but not with other thyroid hormones.” |
| c. | “You should not breastfeed your infant because this drug passes into your breastmilk.” |
| d. | “You may breastfeed while hospitalized and your thyroid hormone levels can be checked.” |
ANS: C
Women taking thyroid hormone agonists are advised not to breastfeed, as the drug can be found in the mother’s breast milk.
DIF: Cognitive Level: Applying REF: p. 294
- The action of which drug is known to be increased by thyroid hormone replacement drugs?
| a. | Warfarin (Coumadin) |
| b. | Acetaminophen (Tylenol) |
| c. | Diphenhydramine (Benadryl) |
| d. | Fiber supplements (FiberCon) |
ANS: A
Thyroid agonists used for thyroid hormone replacement therapy enhance the action of drugs that reduce blood clotting (anticoagulants), especially warfarin. Acetaminophen is a pain reliever. Diphenhydramine is an antihistamine. And fiber supplements are dietary supplements, not drugs, and are unaffected by thyroid hormone replacement therapy although their use can inhibit intestinal uptake of thyroid agonists.
DIF: Cognitive Level: Remembering REF: p. 294
- Which assessment is most important to perform before giving an elderly patient who is prescribed levothyroxine (Synthroid) the first dose of the drug?
| a. | Measuring heart rate and rhythm |
| b. | Determining level of consciousness |
| c. | Asking about an allergy to “sulfa” drugs |
| d. | Checking intake and output for the last 24 hours |
ANS: A
Adults over 65 years are usually prescribed a lower initial dose of thyroid hormone agonists because they are more likely to have serious adverse cardiac and nervous system effects. For this reason, doses are increased more slowly in older adults than in younger adults until an appropriate maintenance dose is reached.
DIF: Cognitive Level: Applying REF: p. 295
- How do thyroid replacement drugs work to treat hypothyroidism?
| a. | Forcing the thyroid gland to secrete more thyroid hormones |
| b. | Inhibiting the enzymes that break down thyroid hormones |
| c. | Preventing damage to thyroid endocrine cells |
| d. | Providing thyroid hormones |
ANS: D
Hypothyroidism is low thyroid functioning, which is demonstrated by very low production of thyroid hormones. Thyroid replacement drugs are thyroid hormone agonists. Taking these drugs provides an exogenous source of thyroid hormones.
DIF: Cognitive Level: Knowing REF: p. 294
- A patient who has been prescribed propylthiouracil (Propacil) asks you how this drug works to reduce thyroid hormone levels. What is your best response?
| a. | “This drug combines with the enzyme that connects iodine to tyrosine.” |
| b. | “This drug works by activating thyroid hormone in the pituitary gland.” |
| c. | “This drug activates the gene for metabolism, speeding up cellular work.” |
| d. | “This drug works by interfering with the thyroid hormone feedback loop.” |
ANS: A
Antithyroid drugs work by entering the thyroid gland and combining with the enzyme responsible for connecting iodine (iodide) with tyrosine. Without this iodide–tyrosine connection, thyroid hormone production is suppressed.
DIF: Cognitive Level: Applying REF: p. 294
- 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?
| a. | Check the pulse rate for irregular rate and rhythm. |
| b. | Check the blood pressure for hypertension. |
| c. | Check the skin and sclera for yellowing. |
| d. | Check the lower extremities for edema. |
ANS: C
These drugs are hepatotoxic. Check the patient’s liver function tests before giving these drugs. Both thyroid-suppressing drugs are hepatotoxic. Check the patient daily for yellowing of the skin or sclera for jaundice.
DIF: Cognitive Level: Applying REF: p. 298
- 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?
| a. | “You will need to have your blood level of the drug checked.” |
| b. | “This drug must be taken for 3 to 4 weeks to start being effective.” |
| c. | “This may mean you have formed thyroid antibodies against this drug.” |
| d. | “I will let your healthcare provider know so your dose can be adjusted.” |
ANS: B
Teach patients that thyroid-suppressing drugs must be taken for 3 to 4 weeks to start being effective because they have no effect on thyroid hormones already stored in the thyroid gland.
DIF: Cognitive Level: Applying REF: p. 296
- 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?
| a. | Decreased complete blood count |
| b. | Increased urine output |
| c. | Decreased blood pressure |
| d. | Increased platelet count |
ANS: A
Older adults taking antithyroid drugs are more likely to have more severe adverse effects. The older patient’s immune system is already lower than that of a younger person, which increases the older person’s risk for infection. Bone marrow suppression from these drugs increases the risk for severe infection.
DIF: Cognitive Level: Knowing REF: p. 297
- A patient you are caring for develops a goiter. What does the appearance of a goiter mean?
| a. | Hypothyroidism |
| b. | Hyperthyroidism |
| c. | Thyroid problem |
| d. | Premature menopause |
ANS: C
Although a goiter is a distinct swelling of the thyroid gland and the neck, it only indicates a thyroid problem. It is associated with some forms of hypothyroidism and some forms of hyperthyroidism.
DIF: Cognitive Level: Remembering REF: p. 296
- 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?
| a. | “This drug acts like natural aldosterone in the body.” |
| b. | “This drug permits potassium to be retained in the body.” |
| c. | “This drug acts to retain glucose for action within the body.” |
| d. | “This drug permits the excretion of sodium from the body.” |
ANS: A
Fludrocortisone (Florinef) is a synthetic drug that acts like natural aldosterone. With the use of this drug, more sodium is retained to prevent excessive sodium wasting, and more potassium is excreted to prevent dangerously high blood potassium levels.
DIF: Cognitive Level: Applying REF: p. 298
- 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?
| a. | “You will need to cut all salt from your diet for a few days to see if this resolves.” |
| b. | “Your diet may contain too many carbohydrates for your body to process.” |
| c. | “I will notify your healthcare provider right away and get back to you.” |
| d. | “This is an expected side effect of this drug.” |
ANS: C
Congestive heart failure (CHF) is a serious adverse effect of fludrocortisone. It requires that the drug dose be either reduced or stopped. A weight gain of 2 lb. in a day or 3 lb. in a week should be reported to the healthcare provider immediately.
DIF: Cognitive Level: Applying REF: p. 298
- Which side effects are most common when taking any drug to manage adrenal gland hyperfunction?
| a. | Decreased urine output and increased sweating |
| b. | Blurred vision and dry mouth |
| c. | Headache and mouth sores |
| d. | Nausea and vomiting |
ANS: D
The most common side effects for any drug used to manage adrenal gland function are nausea and vomiting. They also cause many other gastrointestinal upsets. They are not associated with blurred vision, dry mouth, headache, mouth sores, or increased sweating. Urine output is usually increased, not decreased.
DIF: Cognitive Level: Remembering REF: p. 299
- Which drug is used only for patients with type 2 diabetes and hypercortisolism?
| a. | Mitotane (Lysodren) |
| b. | Mifepristone (Korlym) |
| c. | Liothyronine sodium (Cytomel) |
| d. | Methimazole (Northyx, Tapazole) |
ANS: B
A specialized drug for hypercortisolism is Mifepristone (Korlym). This drug works by blocking corticosteroid receptors. Although this does not reduce cortisol levels, it does inhibit cortisol responses in different tissues. It is approved for use only in people who have type 2 diabetes and hypercortisolism.
DIF: Cognitive Level: Remembering REF: p. 299
- A patient experiencing symptoms related to menopause asks you to explain the cause of her symptoms. What is your best response?
| a. | “Symptoms of menopause are caused by low levels of estrogen and high levels of FSH.” |
| b. | “Symptoms of menopause are caused by high levels of estrogen and low levels of FSH.” |
| c. | “Symptoms of menopause are caused by low levels of estrogen and low levels of FSH.” |
| d. | “Symptoms of menopause are caused by high levels of estrogen and high levels of FSH.” |
ANS: A
Symptoms of menopause are caused by low levels of estrogen and high levels of FSH.
DIF: Cognitive Level: Applying REF: p. 300
- What is one of the adverse effects of hormone replacement therapy for menopause?
| a. | Pregnancy |
| b. | Blood clots |
| c. | Miscarriage |
| d. | Decreased mental concentration |
ANS: B
Hormone replacement therapy for perimenopausal symptoms uses different types of estrogens and sometimes progesterone. Exogenous use of these drugs increases the risk for forming blood clots where they are not needed, leading to the potential venous thromboembolism complications of deep vein thrombosis, strokes, and heart attacks.
DIF: Cognitive Level: Remembering REF: p. 302
- Which side effects are most common among women taking hormone replacement therapy for menopause?
| a. | Nausea, vomiting, and diarrhea |
| b. | Skin itching and dark-colored urine |
| c. | Breast tenderness and fluid retention |
| d. | Increased vaginal dryness and constipation |
ANS: C
The most common side effects of hormone replacement therapy for perimenopausal symptoms are breast tenderness, breakthrough bleeding, fluid retention, weight gain, and acne. Vaginal dryness is reduced, not increased. Skin itching is reduced, not increased. Dark urine would be a symptom of the adverse effect of liver toxicity. These drugs are not commonly a cause of any gastrointestinal problems.
DIF: Cognitive Level: Remembering REF: p. 302
- Which type of oral contraceptive drug must be taken every day of the month to be effective?
| a. | An estrogen–progestin combination. |
| b. | A progestin–drospirenone combination. |
| c. | An estrogen only “mini” pill |
| d. | A progestin only “mini” pill |
ANS: D
Progestin only mini pills contain very low concentrations of only one hormone. As the hormone levels are low, they must be taken daily, without any time off, to be effective.
DIF: Cognitive Level: Remembering REF: p. 303
- Which of the following patients is most at risk for adverse effects related to the use of oral contraceptives?
| a. | A 37-year-old woman who has a history of smoking |
| b. | A 25-year-old woman who had a baby 2 months ago |
| c. | A 32-year-old woman who has never been pregnant |
| d. | A 16-year-old female who has just become sexually active |
ANS: A
Oral contraceptives increase the risk for blood clot formation. This problem can lead to deep vein thrombosis, pulmonary embolism, myocardial infection, and stroke. The risk increases among women who smoke and in those older than 35 years.
DIF: Cognitive Level: Understanding REF: p. 304
- Which oral contraceptive can increase serum potassium levels and potentially lead to irregular heart rhythm?
| a. | Yasmin |
| b. | Camila |
| c. | Ovral |
| d. | Zovia |
ANS: A
Oral contraceptives that use drospirenone as the progestin (Ocella, Yasmin, YAZ28) can increase the serum potassium level, which can lead to heart block and other irregular heart rhythms. Women who have kidney, liver, or adrenal disease and those who are taking other drugs that increase potassium levels (e.g., angiotensin-converting enzyme (ACE) inhibitors for hypertension, potassium-sparing diuretics) are not recommended to use contraceptives containing drospirenone.
DIF: Cognitive Level: Understanding REF: p. 304
- 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?
| a. | “Take oral contraceptives exactly as prescribed.” |
| b. | “You may take over-the-counter drugs with oral contraceptives.” |
| c. | “You may miss up to two doses in a row and still be protected from pregnancy.” |
| d. | “You may use nicotine patches, but stop smoking when taking oral contraceptives.” |
ANS: A
Oral contraceptives are only effective at preventing pregnancy when taken exactly as prescribed.
Patients should not smoke or use nicotine in any form to reduce the risk for blood clots, heart attacks, and strokes. If more than one dose within a cycle is missed, especially two doses in a row, continue not only to use it for the rest of the cycle but also to use another method of contraception for the rest of the cycle. Instruct the patient not to take any over-the-counter drug without checking with your healthcare provider who prescribed the contraceptive to prevent possible interactions.
DIF: Cognitive Level: Applying REF: p. 304
- 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?
| a. | Blood pressure decrease of 10 mm Hg systolic |
| b. | Urine output increase of 200 mL/day |
| c. | Fluid retention |
| d. | Increased prostate size |
ANS: C
Teach patients to check weight every day to assess for fluid retention and report weight gain of 5 or more pounds (indicating significant fluid retention) to the prescriber.
DIF: Cognitive Level: Applying REF: p. 305
- Which bone or joint is most likely to be adversely affected by bisphosphonates?
| a. | Eye orbit |
| b. | Jawbone |
| c. | Big toe |
| d. | Wrist |
ANS: B
The most serious adverse effect of the bisphosphonates is the development of jawbone necrosis (osteonecrosis), especially with tooth extraction or other invasive dental procedures involving the jawbone in which the bone is damaged. The exact mechanism by which these drugs cause osteonecrosis is not known but is thought to occur because the drugs interfere with bone healing.
DIF: Cognitive Level: Knowing REF: p. 306
- A patient is to receive a subcutaneous injection of denosumab (Prolia) for severe osteoporosis. What action should you take before giving this injection?
| a. | Place emergency equipment in the room with the patient. |
| b. | Assess for circulation in the umbilical area. |
| c. | Assess the patient’s ability to walk. |
| d. | Monitor the patient’s liver function tests. |
ANS: A
Assess the patient for an allergic reaction during and after subcutaneous injection of denosumab (Prolia). Keep emergency equipment in the room with the patient.
DIF: Cognitive Level: Applying REF: p. 307
MULTIPLE RESPONSE
- Which findings indicate that thyroid hormone drug dose is appropriate and effective in a patient with hypothyroidism? (Select all that apply.)
| a. | The patient’s vital signs are within normal limits. |
| b. | The patient reports an increase in activity levels. |
| c. | The patient’s body weight remains consistent. |
| d. | The patient reports mild, bilateral edema. |
| e. | The patient has a bowel movement daily. |
| f. | The patient’s goiter is reduced in size. |
ANS: A, C, E
These changes indicate that the drug is effective and the dose is appropriate:
The patient’s vital signs (body temperature, heart rate, blood pressure, and respiratory rate) are within normal limits. Patient’s activity level and mental status are normal for him or her.
Patient’s body weight is consistent with the amount of calories he or she eats and his or her activity level. Patient’s bowel habits are what they were before the thyroid problem occurred.
DIF: Cognitive Level: Applying REF: p. 295
- Which statements about the adrenal glands are true? (Select all that apply.)
| a. | Adrenal hormones differ by age and gender. |
| b. | Glucocorticoid hormones are necessary for life. |
| c. | Aldosterone controls sodium and water balance. |
| d. | Low levels of adrenal hormones can lead to stroke. |
| e. | The adrenal cortex secretes aldosterone and cortisol. |
| f. | When adrenal hormones are overproduces, cancer can result. |
ANS: B, C, E
The adrenal cortex secretes aldosterone and cortisol. Aldosterone controls sodium and water balance. Cortisol, of which there are many types, has many more functions that are essential for life. Cortisol helps maintain critical blood glucose levels, the stress response, excitability of cardiac muscle, immunity, and blood sodium levels. Since cortisol was first discovered to affect blood glucose levels, it is also known as a glucocorticoid.
DIF: Cognitive Level: Remembering REF: p. 297
- 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.)
| a. | Craving for salty food |
| b. | Hyperglycemia |
| c. | Feeling weak |
| d. | Hypertension |
| e. | Fatigue |
| f. | Nausea |
ANS: A, C, E
Teach patients the signs and symptoms of adrenal insufficiency: hypoglycemia, salt craving, muscle weakness, hypotension, and fatigue.
DIF: Cognitive Level: Applying REF: p. 299
- Which drugs belong to the bisphosphonate class of drug? (Select all that apply.)
| a. | Alendronate (Fosamax) |
| b. | Denosumab (Prolia) |
| c. | Estrogen/bazedoxifene (Duavee) |
| d. | Ibandronate (Boniva) |
| e. | Raloxifene (Evista) |
| f. | Risedronate (Actonel) |
| g. | Zoledronic acid (Reclast) |
ANS: A, D, F, G
Alendronate, ibandronate, risedronate, and zoledronic acid all belong to the bisphosphonate class of drug. Denosumab is a monoclonal antibody. Estrogen/bazedoxifene and raloxifene are from the estrogen agonist/antagonist class of drugs.
DIF: Cognitive Level: Remembering REF: p. 306
