Block 7 Pharm Dr Thomas
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Use the following stem for questions 8-11: Progestin-only contraception can be administered orally, intravaginally, subcutaneously or intramuscularly. Which of these routes requires daily administration?
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Oral
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Intravaginal
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Subcutaneous
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Intramuscular
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From her workshop. If anyone took good notes/explanations on any of these questions, send them to me and I will include them in the questions.
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- 2.
(NBME-type) A 62-year-old man complains to his physician that he frequently feels the urge to urinate, but then he has trouble starting the flow and is sometimes troubled by dribbling when he has finished urinating. His prostate gland is found to be significantly enlarged, and following additional tests, benign prostatic hyperplasia is diagnosed. The physician prescribes a drug to help prevent further enlargement of the prostate and possibly to help reduce the size. Which of the following drugs was most likely prescribed to achieve these effects?
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Fluoxetine
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Flutamide
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Medroxyprogesterone
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Finasteride
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Leuprolide
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Testosterone enanthate
Correct Answer
A. FinasterideExplanation
Finasteride is a 5-alpha reductase inhibitor that is commonly prescribed for the treatment of benign prostatic hyperplasia (BPH). BPH is characterized by the enlargement of the prostate gland, which can lead to urinary symptoms such as increased frequency, difficulty starting and stopping urination, and dribbling after urination. Finasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that is responsible for the growth of the prostate gland. By reducing DHT levels, finasteride helps to prevent further enlargement of the prostate and may even reduce its size. This makes finasteride the most likely drug to be prescribed for this patient.Rate this question:
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- 3.
Is bromocriptine acting as an agonist or an antagonist in the above situation?
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Agonist
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Antagonist
Correct Answer
A. AgonistExplanation
I DON'T HAVE THE CORRECT ANSWER TO THIS ONE!!!Rate this question:
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- 4.
Which of the following clinical diagnoses would be an indication for using bromocriptine to address infertility in a 25-year-old woman?
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Hypothyroidism
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Hyopituitarism
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Hypogonadism
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Hyperprolactinemia
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Oligomenorrhea
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Addison’s Disease
Correct Answer
A. HyperprolactinemiaExplanation
Hyperprolactinemia is a condition characterized by high levels of prolactin, a hormone that stimulates milk production in the breasts. Elevated prolactin levels can disrupt the normal hormonal balance and lead to infertility in women. Bromocriptine is a medication that inhibits the release of prolactin and can be used to treat hyperprolactinemia. Therefore, using bromocriptine would be an indication for addressing infertility in a 25-year-old woman with hyperprolactinemia.Rate this question:
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- 5.
Use the following stem for questions 8-11: Progestin-only contraception can be administered orally, intravaginally, subcutaneously or intramuscularly. Which of these routes bypass the “first pass” effect?
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Oral
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Intravaginal
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Subcutaneous
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Intramuscular
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All but the oral route
Correct Answer
A. All but the oral routeExplanation
The "first pass" effect refers to the metabolism of a drug that occurs in the liver before it reaches the systemic circulation. When a drug is administered orally, it is absorbed through the gastrointestinal tract and passes through the liver before reaching the rest of the body. This can result in a significant portion of the drug being metabolized and rendered inactive before it can have its intended effect. In contrast, when a drug is administered intravaginally, subcutaneously, or intramuscularly, it bypasses the liver and enters the systemic circulation directly, avoiding the first pass effect. Therefore, all routes mentioned in the answer (intravaginal, subcutaneous, and intramuscular) bypass the first pass effect, except for the oral route.Rate this question:
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- 6.
Use the following stem for questions 8-11: Progestin-only contraception can be administered orally, intravaginally, subcutaneously or intramuscularly. Which of these routes access the primary site of contraceptive action without significantly increasing circulating blood levels?
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Oral
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Intravaginal
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Subcutaneous
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Intramuscular
Correct Answer
A. IntravaginalExplanation
Intravaginal administration of progestin-only contraception allows the medication to directly access the primary site of contraceptive action without significantly increasing circulating blood levels. This route of administration bypasses the digestive system and liver metabolism that can occur with oral administration, leading to lower systemic levels of the medication. By delivering the progestin directly to the vaginal tissues, it can exert its contraceptive effects locally while minimizing systemic side effects.Rate this question:
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- 7.
(NBME type) A 25-year-old woman is conferring with her gynecologist regarding treatment options for debilitating endometriosis. She wishes to have children in the future and hopes to get her endometriosis under control without further compromising her fertility. They decide to try depot injections of leuprolide for the next 6 months and then re-evaluate the condition. In addition, the physician prescribes a low dose combined oral contraceptive preparation. What is the most important therapeutic reason for adding the low-dose OC?
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To prevent pregnancy during exposure to leuprolide
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To prevent bone loss
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To maintain normal menstrual periods
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To maintain body weight
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To prevent hypotension
Correct Answer
A. To prevent bone lossExplanation
The most important therapeutic reason for adding the low-dose oral contraceptive (OC) is to prevent bone loss. Leuprolide, a gonadotropin-releasing hormone (GnRH) agonist, suppresses ovarian function and decreases estrogen levels, which can lead to bone loss and increase the risk of osteoporosis. The low-dose OC contains estrogen and progestin, which helps to maintain bone density and prevent bone loss. Additionally, the OC can also help to regulate menstrual periods and prevent pregnancy during the treatment with leuprolide. However, the primary reason for adding the OC is to prevent bone loss.Rate this question:
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- 8.
A 20-year-old female college student complains of breakthrough bleeding 3 months after starting to use a low-dose combined oral contraceptive regimen. Her physician questions her carefully about her pill-taking habits, and is satisfied that the patient has been taking the pills on a regular basis. Which of the following might be the most reasonable next step for this patient to continue to sustain reliable contraception with minimal adverse events?
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Switch to a progestin-only mini-pill
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Switch to a depot progesterone method
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Switch to a combined OC with a different E component
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Switch to a combined OC with a higher dose E component
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Switch to a combined OC with a higher dose P component
Correct Answer
A. Switch to a combined OC with a higher dose E componentExplanation
Explanation: estrogen is needed to support the endometrium.Rate this question:
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- 9.
(NBME) A 13-year-old girl has no signs of puberty. She was previously diagnosed with a condition that includes hypogonadotropic hypogonadism. Which of the following best describes an appropriate first step for hormone replacement therapy for this girl?
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An estradiol patch at night
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Bromocriptine
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Leuprolide
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Low dose oral contraceptive
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Medroxyprogesterone depot injections
Correct Answer
A. An estradiol patch at nightExplanation
An estradiol patch at night is the appropriate first step for hormone replacement therapy in a 13-year-old girl with hypogonadotropic hypogonadism. Hypogonadotropic hypogonadism is characterized by low levels of sex hormones due to a dysfunction in the hypothalamic-pituitary-gonadal axis. In this condition, the ovaries do not receive appropriate signals to produce sex hormones, leading to delayed or absent puberty. An estradiol patch at night provides a continuous release of estrogen, which helps stimulate the development of secondary sexual characteristics and promotes normal pubertal growth.Rate this question:
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- 10.
Which of the following is most likely to be an effective drug target for a man with prostate cancer?
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Aromatase enzyme
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5a-reductase enzyme
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Adenylate cyclase enzyme
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DHT receptors
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GnRH receptors
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LH receptors
Correct Answer
A. GnRH receptorsExplanation
GnRH receptors are most likely to be an effective drug target for a man with prostate cancer because GnRH (gonadotropin-releasing hormone) is responsible for stimulating the production of testosterone, which can fuel the growth of prostate cancer cells. By targeting and blocking GnRH receptors, the production of testosterone can be suppressed, helping to slow down the progression of the cancer.Rate this question:
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- 11.
Use the following stem for questions 8-11: Progestin-only contraception can be administered orally, intravaginally, subcutaneously or intramuscularly. Which of these routes is most likely to employ release from a silastic (or other polymer) substrate?
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Oral
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Intravaginal
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Subcutaneous
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Intramuscular
Correct Answer
A. IntravaginalExplanation
Progestin-only contraception can be administered through various routes, including orally, intravaginally, subcutaneously, or intramuscularly. The question asks which route is most likely to employ release from a silastic or other polymer substrate. Silastic is a type of silicone elastomer that is often used as a drug delivery system. In this case, the most likely route to employ release from a silastic or other polymer substrate would be intravaginal administration. This suggests that the progestin-only contraception is likely delivered through a vaginal ring or other device that slowly releases the medication from a polymer substrate.Rate this question:
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- 12.
What is the primary direct site of action of combined oral contraceptives?
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Ovary
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Uterus
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Cerebellum
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Hypothalamus
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Posterior pituitary
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Anterior pituitary
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Fallopian tube
Correct Answer
A. HypothalamusExplanation
Combined oral contraceptives primarily act on the hypothalamus. The hormones in these contraceptives inhibit the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This, in turn, suppresses the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland. By inhibiting the release of FSH and LH, combined oral contraceptives prevent the development and release of eggs from the ovaries, thus preventing pregnancy.Rate this question:
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- 13.
Which of the following is the best explanation for why oral testosterone is not used for androgen replacement?
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High “first pass effect”
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Hepatoxicity
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Increased DHT/T
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Poor oral absorption
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High abuse potential
Correct Answer
A. HepatoxicityExplanation
Hepatoxicity is the best explanation for why oral testosterone is not used for androgen replacement. This means that oral testosterone can cause damage to the liver, making it unsafe for use.Rate this question:
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Mar 21, 2023Quiz Edited by
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Mar 30, 2012Quiz Created by
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