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Week 11 Fertility Pharm 315 Questions With Complete Solutions
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Week 11 Fertility Pharm 315 Questions With Complete Solutions
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Week 11 Fertility Pharm 315 Questions With CompleteSolutions
**EE + Etonogestrel Vaginal Ring
-If a ring is expelled before 3 weeks have passed, it can be
washed off in warm water (not hot water) and reinserted.
-If the expelled ring cannot be reused, a new one should be
inserted. If more than 3 hours elapse between ring expulsion and
reinsertion during weeks 1 or 2, contraceptive effects may be
diminished, and a backup contraceptive should be used for 7
days. Correct Answer I=f the ring has been out of the vagina
for more than 3 hours during week 3, the patient should either
start a new ring immediately or insert a ring no later than 7 days
following the expulsion. Backup contraception should be used
during the first 7 days.
**Missed Doses:
1 active tablet in weeks 1, 2, or 3
The patient should take the tablet as soon as she remembers and
continue taking once daily.
2 active tablets in weeks 1 or 2
The patient should take the 2 missed tablets as soon as she
remembers and the next 2 active tablets the next day. Continue
taking 1 tablet daily until the package is finished. Nonhormonal
backup contraception such as condom and spermicide should be
used within 7 days after missing the tablets. Correct Answer 2
active tablets in week 3 OR 3+ tablets in weeks 1, 2, or 3
For women who started taking the CHC on day 1 of menses, she
should throw out the rest of the pack and start a new pack that
same day. For women who started taking the CHC on Sunday,
,she should continue taking 1 tablet daily until Sunday, throwing
out the pack and starting a new pack that day. Nonhormonal
backup contraception such as condom and spermicide should be
used within 7 days after missing the tablets.
BPH
Side Effects:
Tamsulosin
Dizziness, headache, orthostatic hypotension, nausea, diarrhea,
abnormal ejaculation, decreased libido, back pain, cough
Adverse Effects:
Although rare, first-dose syncope occurring within 30 to 90
minutes of first dose, which may be preceded by tachycardia
Tamsulosin
-Advise the patient to report any changes in blood pressure to
the health care provider.
-Encourage the patient to maintain routine follow up to assess
the effectiveness of therapy.
-Educate the patient to avoid crushing, chewing, or splitting the
capsules.
-Educate the patient that effects of tamsulosin typically occur
quickly (i.e., within 1 to 3 weeks). Correct Answer Side
Effects:
Finasteride
Impotence, decreased libido, sexual dysfunction, decreased
volume of ejaculate fluid, gynecomastia, rash, breast tenderness
Adverse Effects:
Hypersensitivity reactions, swelling of the mouth, testicular pain
Finasteride
,-Advise caregivers that are pregnant or may be pregnant to avoid
handling crushed or broken tablets as well as coming in contact
with the semen of men who are using finasteride.
-Remind patients to routinely follow up with their health care
provider to assess PSA levels every 6 to 12 months.
-Educate the patient that it takes a while (about 6 to 12 months)
to see effects and the patient should not expect to "feel better"
soon after initiation.
-Inform the patient he cannot donate blood while receiving
finasteride and for at least one month after the last dose due to
the risk for transferring the medication to a pregnant woman
Case Study
Mrs. Shell is a 38-year-old woman with difficulty conceiving.
She and her husband have one 10-year-old son but had some
delay in conceiving him. They held off on having a second child
to pursue their careers. After 18 months now of trying with no
success, they have consulted with a health care provider who has
determined that Mrs. Shell has ovulatory dysfunction. She has
been prescribed clomiphene citrate 50 mg PO daily for 5 days
but is a bit anxious based on the things she has read about the
drug. Correct Answer
CEE Undiagnosed abnormal vaginal bleeding, breast or other
estrogen-dependent cancer; venous or arterial thromboembolism
(deep vein thrombosis [DVT], pulmonary embolism [PE],
myocardial infarction [MI], stroke); anaphylactic reaction to
CEE; liver dysfunction; protein C, S, or antithrombin deficiency;
and pregnancy Correct Answer Black Box WarningCEE
carries a black box warning for increased risk for endometrial
cancer in women with an intact uterus who are not receiving
, progesterone in combination with estrogen. Additionally, this
warning is extended to state that CEE should not be used for
prevention of cardiovascular disease or dementia, and the
Women's Health Initiative demonstrated that estrogen can
increase the risk for stroke and deep vein thrombosis. There is
also a risk for dementia in older patients.
CHCs as a method of birth control.
Contraindications (Absolute)
Pregnancy (known or suspected) or postpartum <3 weeks
Venous thrombosis history or risk factors
Vascular disease, including coronary artery disease,
cerebrovascular accident, and past or current history of deep
vein thrombosis or pulmonary embolism
Ischemic heart disease
Complicated valvular heart disease
Liver disease, including cirrhosis, viral hepatitis, and benign or
malignant liver tumors
Undiagnosed vaginal bleeding or known or suspected
endometrial cancer
Breast cancer
Smokers over the age 35 years of age Correct Answer
Clomiphene Citrate
Clomiphene citrate is a nonsteroidal drug that blocks estrogen
receptors in the hypothalamus and pituitary gland. As a result,
the body receives a false signal that estrogen levels are low
causing the pituitary gland to secrete follicle stimulating
hormone (FSH) and luteinizing hormone (LH).
Therapeutic Use
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