Exam (elaborations)
NSG 533 ADVANCED PHARMACOLOGY QUESTIONS AND ANSWERS 2024
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NSG 533 ADVANCED PHARMACOLOGY QUESTIONS AND ANSWERS 2024
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NSG 533 ADVANCED PHARMACOLOGYTadalafil adverse reactions: - ANSWERS-◦Use with alpha-blockers,
antihypertensives or substantial amounts of alcohol may lead to hypotension
◦headache, dizziness, flushing, back pain, myalgia, and cyanopsia
Precautions
◦Unstable angina, uncontrolled or high-risk arrhythmias, persistent hypotension,
poorly controlled hypertension, or New York Heart Association Classification IV
congestive heart failure
Contraindication
◦Current use of nitrates
BPH combination therapy - ANSWERS-Alpha-blocker offer immediate relief; 5
alpha-RIs reduce prostate enlargement over time
◦In patients with an enlarged prostate gland and an elevated PSA ≥1.4 ng/mL,
combination drug therapy with an α1-adrenergic antagonist and a 5α-reductase
inhibitor is more beneficial than single drug therapy.
◦Rationale
a-blocker offer immediate relief
5a-RIs reduce prostate enlargement
◦Works better for those with obstructive symptoms
◦May consider stopping a-blocker after 6-12 months, but should continue in those
patients with severe symptoms as long as they are responding
,BPH combination therapy - ANSWERS-◦-blocker and anticholinergic (or β3 agonist)
For men with low post-void residual urine volumes and irritative symptoms (e.g.,
frequency, urgency) that persist during treatment with an alpha-adrenergic
antagonist, combination treatment with an anticholinergic agent can be tried
◦Improved storage voiding parameters and frequency compared with alpha-1-
adrenergic antagonist therapy alone
◦For patients who poorly tolerate anticholinergic adverse effects, an alternative is
Mirabegron
The risk of side effects, increased post-void residual urine volume, decreased
maximal urinary flow rate, or acute urinary retention is low
BPH combination therapy - ANSWERS-◦ a-blocker and PDE-5Is
For men with moderate symptoms of BPH and erectile dysfunction, treatment
with daily tadalafil (5 mg/day) alone or in combination with tamsulosin (0.4
mg/day) can be considered
Addition of PDE-5Is to alpha blockers may improve lower urinary tract symptoms
◦PDE-5i and 5a-RIs
Addition of PDE-5i to 5a-RIs can offset erectile dysfunction commonly seen with
5a-RIs
Red Flag medications in pregnancy
- Commonly used / teratogenic - ANSWERS-Warfarin, Phenytoin, Valproic Acid,
Carbamazepine, Lithium, ACE inhibitors/ARBs, Thalidomide, Ethanol, statins .. etc
,Considerations must be given to not only those who ARE pregnant, but all women
of child bearing years where pregnancy is possible (planned or un-planned)
Note: this is NOT a comprehensive list, but a good representation for exam
purposes
Combined Oral Contraception: - ANSWERS-
Combined Oral Contraceptives - ANSWERS-Risks can include, but not choosing a
formulation based on fertility goals, patient preference, discussion of
risk/benefits, Hx (to rule out contraindications .. see US MEC attached)
World Health Organization and the Food and Drug Administration recommend
using the lowest dose pill that is effective (as noted below, efficacy can be
impacted by several factors .. including other medications. Thus, the lowest dose
available is not always the lowest most effective dose)
limited to cancers, CV events/HTN, VTE, drug interactions
Concomitant use of broad spectrum antibiotics and combination contraceptives
may result in decreased contraceptive efficacy; however this is Category 1 under
US MEC
If a typical failure rate of 1% to 3% is a concern for the patient, consider additional
or alternative forms of birth control
Concomitant use of P450 enzyme inducers (rifampin, phenytoin, carbamazepine,
phenobarbital) may result in decreased contraceptive efficacy
If use COC - use higher doses (at least 35 mcg EE) + high progestin, shorten
hormone free interval to 4 days or less
Avoid low progestin - the patch, POP
, Consider additional or alternative forms of birth control
Concomitant use of Anti-HIV protease inhibitors can either increase or decrease
serum levels of estrogens and progestins - may need backup method
Drospirenone can cause hyperkalemia, especially if used with other agents that
can increase potassium (ACEIs, heparin, aldosterone antagonists, etc)
Benefits can include favorable effect on bone, menstrual effects, improved acne,
improved PMDD, etc
Managing hormone concerns - ANSWERS-Estrogen
Excess - N/V, cervical mucorrhea, hypertension, headache, breast tenderness,
edema, melasma, bloating
Deficiency - Early or mid-cycle breakthrough bleeding, increased spotting,
hypomenorrhea, vasomotor symptoms
Progestin
Excess - breast tenderness, headache, fatigue, changes in mood
Deficiency - Late break through bleeding, hypermenorrhea, dysmenorrhea
Androgen
Excess - increased appetite, weight gain, acne, oily skin, hirsutism, decreased
libido, increased breast size, breast tenderness, increased LDL, decreased HDL
Amenorrhea - rule out other causes. Can increase to more estrogenic formulation
or to triphasic formulation to decrease amenorrhea.Not a concern if patient is
happy.
Acne/ oily skin/ hirsutism - Rule out other causes. Switch to less androgenic
formulation of progestin (or decrease progestin content)3rd generation
Desogestrel, norgestimate4th generation drospirenone
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