NAPLEX / Men’s and women’s health

Pharmacy Question Bank / NAPLEX / Men’s and women’s health

NAPLEX

The questions in this section are intended to test your knowledge and skills in pharmacy practice including pharmacy calcuations and biostatistics for pharmacy student pursuing to get license. Select all that applies. May have multiple answers. 
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NAPLEX | Men’s and women’s health

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Question 1
Dihydrotestosterone is the hormone responsible for the growth and enlargement of prostate gland. Which of the following drug is an inhibitor of 5- alpha- reductase that blocks the conversion of testosterone to dihydrotestosterone?
A
Silodosin
B
Alfuzosin
C
Dutasteride
D
Tadalafil
E
Finasteride
Question 1 Explanation: 
Answer C. D. Both dutasteride and finasteride are alpha-reductase inhibitors and are isoenzymes of dihydrotestererone and block the conversion testosterone to dihydrotestosterone. Both silodosin and alfuzosin are alpha-adrenergic blockers (prevent smooth muscle contraction in bladder muscles) and tadalafil is a phosphodiesterase-5 inhibitor (promotes smooth muscle relaxation in bladder muscles).
Reference:
McVaryKT, et al. Update on AUA guideline on the management of benign prostatic hyperplasia.J Urol. 2011 May;185(5):1793-803. Epub2011 Mar 21.
Question 2
Which of the following phosphodiesterase type 5 inhibitor has indication to treat signs and symptoms of benign prostatic hyperplasia (BPH)?
A
Tadalafil
B
Sildenafil
C
Vardenafil
D
Avanafil
Question 2 Explanation: 
Answer A. Tadalafil is the only PDE5 inhibitor that has the potentail to treat BPH and BPH-related LUTS. It does this by increasing levels of cGMP, which relax essential smooth muscles located in the prostate and bladder. Sildenafil, vedenafil, and avanafil are all PDEF inhibitors, but only have indications for treatment of ED.
Reference:
Product information for Cialis. Lilly USA, LLC Indianapolis, IN 46285, USA. April, 2016
Question 3
Which of the following alpha-1 adrenergic blocker is not contraindicated in patients with severe renal impairment?
A
Silodosin
B
Tamsulosin
C
Alfuzosin
D
A and B
Question 3 Explanation: 
Answer B. Both sildosin and alfuzosin cannot be used in patients with poor renal function (CrCl <30 ml/min), but tamsulosin has no renal dose adjustments.
Reference:
LeporH, KazzaziA, DjavanB. Alpha-blockers for benign prostatic hyperplasia: the new era. CurrOpinUrol2012;22:7-15.
Question 4
PJ is a 68-year-old male who is picking up a few over the counter medication for is allergy/ congestion. His past medical history is benign prostatic hyperplasia (BPH), and takes finasteride 5mg and tamsulosin 0.4mg daily. Which of the following over-the counter medication is not appropriate for PJ?
A
Pseudoephedrine
B
Diphenhydramine
C
Guaifenesin
D
A and B.
Question 4 Explanation: 
Answer D. Pseudoephedrine is an adrenergic agent, so may prevent muscle relaxation in both the bladder and prostate, which can further exasperate symptoms of BPH. Diphenhydramine and other first generation antihistamines are anticholinergic and can inhibit relaxation of essential bladder muscles (i.e. detrusor), further preventing urination and aggravating symptoms of BPH. Diphenhydramine is also on the BEER’s list (sedative effects may increase the incidence of falls), so should be avoided in patients over the age of 65. Guaifenesin is appropriate for this patient.
Reference:
McVaryKT, et al. Update on AUA guideline on the management of benign prostatic hyperplasia.J Urol. 2011 May;185(5):1793-803. Epub2011 Mar 21.
Question 5
Which of the following statement is true regarding 5-alpha reductase inhibitors?
A
They relieve symptoms faster than alpha-1 adrenergic blocker.
B
They cause no sexual dysfunction.
C
They cause PSA levels to increase
D
Patients of 5-alpha reductase inhibitors cannot donate blood.
Question 5 Explanation: 
Answer D. 5-alpha reductase inhibitors block the conversion of testosterone to DHT and have the potential to shrink the prostate and treat BPH. They have a longer duration of action than alpha-adrenergic agents (2-6 months). They also lead to a decrease in PSA and have a common side effect of ED. This drug is a pregnancy category X; therefore patients taking this medication may not donate blood, due to the risk of the blood product being received by a pregnant (or soon to be pregnant) mother.
Reference:
TheoretMR, Ning YM, Zhang JJ, Justice R, Keegan P, PazdurR. The risks and benefits of 5a-reductase inhibitors for prostate-cancer prevention.N EnglJ Med. 2011
Question 6
Which of the following statement is true regarding alpha-1 adrenergic blocker?
A
They decrease American Urological Association (AUA) symptoms score by 30-50%.
B
They decrease prostate size by 20-30%.
C
They decrease PSA levels.
D
All of the above are true.
Question 6 Explanation: 
Answer A. Alpha-1 adrenergic blockers decrease the AUA score by 30-50%, making them a first-line mediction choice for BPH. 5-alpha reductase inhibitors are the class of medications that decrease PSA levels and prostate size.
Reference:
LeporH, KazzaziA, DjavanB. Alpha-blockers for benign prostatic hyperplasia: the new era. CurrOpinUrol2012;22:7-15.
Question 7
It is important to notify surgeon prior to the cataract surgery if the patient is on which of the following medication to prevent “floppy iris syndrome”?
A
Finasteride
B
Tadalafil
C
Dutasteride
D
Tamsulosin
Question 7 Explanation: 
Answer D. Tamsulosin and other alpha-1 adrenergic agents can cause poor iris dilation, leading to complications during cataract surgery. Finasteride and dutasteride are 5-alpha reductase inhibitors and taldalafil is a PDE5 inhibitor; these medications do not have this contraindication.
Reference:
Bell CM, et al. Association between tamsulosinand serious ophthalmic adverse events in older men following cataract surgery.JAMA. 2009 May 20;301(19):1991-6.
Question 8
PL’s past medical history includes hypertension, diabetes, renal failure failure stage 3. He would like to start a medication that will relieve his BPH symptoms soon. Which of the following medication would be most appropriate?
A
Finasteride
B
Tadalafil
C
Silodosin
D
Tamsulosin
Question 8 Explanation: 
Answer D. Tamsulosin is a first-line therepy option for treatment of BPH and does not have to be adjusted for patients with renal complications. In addition, this medication does not increase blood pressure or blood glucose, making it an appropriate therapy option for this patient. Sildosin (alpha adrenergic blocker) and tadalfil (PDEF inhibitor) should not be used in patients with poor renal function (CrCl <30 ml/min), so would not be appropriate for this patient . Finasteride (5-alpha reductase inhibitor) is a second line treatment option for BPH due to its longer treatment duration and increased side effect profile.
Reference:
McVaryKT, et al. Update on AUA guideline on the management of benign prostatic hyperplasia.J Urol. 2011 May;185(5):1793-803. Epub2011 Mar 21.
Question 9
PL is back after 10 months complaining that his BPH symptoms are back and that tamsulosin helped with the urinary symptoms until a month ago, now his symptoms are worse. Which of the following pharmacological changes would be the most appropriate?
A
Change tamsulosin to silodosin
B
Change tamsulosin to finasteride
C
Add finasteride
D
Add tadalafil
Question 9 Explanation: 
Answer C. Finasteride (5-alpha reducatse inhibitor) can be added to tamsulosin (alpha adrenergic antagonist) to further help manage this patients BPH. These agents can be used in combination to treat BPH patients that are nonresponsive to first-line monotherapy or for patients who have an enlarged prostate or LUTS. A change of medication would not be appropriate for this patient, nor would the addition of tadalafil. (can interact with tamsulosin: alpha blockers and PDE5 inhibitors should not be used together, as they may cause orthostatic hypotension).
Reference:
McVaryKT, et al. Update on AUA guideline on the management of benign prostatic hyperplasia.J Urol. 2011 May;185(5):1793-803. Epub2011 Mar 21.
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