AGNP Board Exam – Men’s Health Prescription
Question:
Levofloxacin (Levaquin), used to treat acute bacterial prostatitis, is a:
fluoroquinolone. Correct
penicillin.
macrolide.
tetracycline.
Explanation:
Levofloxacin (Levaquin) is classified as a fluoroquinolone. An example of a
penicillin is amoxicillin (Moxatag); macrolide is azithromycin (Zithromax);
and a tetracycline is doxycycline (Doryx).
Question:
Ciprofloxacin, used for the treatment of bacterial prostatitis, is a potent
CYP1A2 inhibitor and is absolutely contraindicated with other CYP1A2
inhibitors. An example of another CYP1A2 inhibitor is:
ketoconazole.
tizanidine (Zanaflex). Correct
fluoxetine hydrochloride (Sarafem).
celecoxib (Celebrex).
Explanation:
Ciprofloxacin, a fluoroquinolone, is a strong CYP1A2 inhibitor and is
absolutely contraindicated for concomitant administration of tizanidine
(Zanaflex). Concomitant use may increase the serum concentration of
tizanidine. If use with another strong inhibitor cannot be avoided, initiate
tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based
on response. Ketoconazole is a CYP3A4 inhibitor; celecoxib is a CYP2D6
inhibitor; and fluoxetine is a YP2C19 inhibitor. CYP1A2 inhibitors are enzymes
that catalyze many reactions involved in drug metabolism and synthesis of
cholesterol, steroids and other lipids.
Question:
A 33-year-old man has been taking sulfamethoxazole/trimethoprim for the
treatment of bacterial prostatitis. Brand names of this medication do NOT
include:
Azulfidine. Correct
Bactrim DS.
SMX-TMP DS.
Sulfatrim.
,Explanation:
Brand names of sulfamethoxazole/trimethoprim does NOT include
sulfasalazine (Azulfidine).
Question:
Patients with uncomplicated acute bacterial prostatitis who are NOT good
candidates for treatment with a fluoroquinolone should take:
levofloxacin.
azithromycin.
trimethoprim-sulfamethoxazole. Correct
ceftriaxone.
Explanation:
Patients with uncomplicated acute bacterial prostatitis who cannot take a
fluoroquinolone should take trimethoprim-sulfamethoxazole. Trimethoprim-
sulfamethoxazole has good to excellent penetration into prostatic and
seminal fluids and tissues. Levofloxacin is a fluoroquinolone. Cephalosporins,
such as ceftriaxone, may not be effective unless an STD is suspected.
Azithromycin is a macrolide and macrolides are indicated for the treatment
of chronic bacterial prostatitis.
Question:
PDE-5 inhibitors, such as tadalafil (Cialis) for the treatment of erectile
dysfunction, should be avoided in patients with:
infertility.
a history of epididymitis.
benign prostatic hyperplasia (BPH).
recent ST elevation myocardial infection (STEMI). Correct
Explanation:
PDE-5 inhibitors (ie. Levitra, Viagra, Cialis) should not be used in men with
underlying cardiovascular disease who have been advised to avoid sexual
activity. These medications have systemic vasodilatory properties that result
in transient decreases in supine blood pressure. Cardiovascular status should
be considered on an individual basis, weighing the risks versus the benefits,
before prescribing PDE-5 inhibitors.
Question:
The choice for initial treatment of acute bacterial prostatitis is:
doxycycline (Vibramycin).
ceftriaxone (Rocephin).
ciprofloxacin (Cipro). Correct
azithromycin (Zithromax).
Explanation:
, The choice of antibiotic for treatment of acute bacterial prostatitis (ABP) is
based on the results of the initial culture and sensitivity. However, initial
therapy should be directed at gram-negative enteric bacteria. Useful agents
include fluoroquinolones, trimethoprim-sulfamethoxazole, and ampicillin with
gentamicin. Examples of fluoroquinolones are ciprofloxacin (Cipro) and
levofloxacin (Levaquin).
Question:
Patients who take sildenafil (Viagra) for the treatment of erectile dysfunction,
should be instructed to avoid:
the ingestion of grapefruit-containing products. Correct
dark green, leafy vegetables.
night time dosing.
omega-3 fatty acids.
Explanation:
Grapefruit and grapefruit juice may interact with sildenafil (Viagra) and lead
to severe hypotension. Similar effects may be seen with concomitant alcohol
use.
Question:
To help with symptoms of chronic prostatitis, in addition to antibiotics,
consider adjunctive therapy with an:
alpha adrenergic antagonist. Correct
anticholinergic.
antispasmodic agent.
antiandrogenic agent.
Explanation:
In addition to antibiotics, consider adding an alpha adrenergic antagonist to
help with obstructive symptoms related to chronic prostatitis including weak
stream, hesitancy, straining during urination, sense of incomplete emptying
and post-void dribbling.
Question:
Patients taking vardenafil (Levitra) should be advised to immediately report:
headache.
flushing.
priapism. Correct
nausea.
Explanation:
There have been rare reports of prolonged erections greater than 4 hours
and priapism (painful erections greater than 6 hours in duration) associated
with PDE-5 inhibitors, including vardenafil (Levitra). In the event that an
Question:
Levofloxacin (Levaquin), used to treat acute bacterial prostatitis, is a:
fluoroquinolone. Correct
penicillin.
macrolide.
tetracycline.
Explanation:
Levofloxacin (Levaquin) is classified as a fluoroquinolone. An example of a
penicillin is amoxicillin (Moxatag); macrolide is azithromycin (Zithromax);
and a tetracycline is doxycycline (Doryx).
Question:
Ciprofloxacin, used for the treatment of bacterial prostatitis, is a potent
CYP1A2 inhibitor and is absolutely contraindicated with other CYP1A2
inhibitors. An example of another CYP1A2 inhibitor is:
ketoconazole.
tizanidine (Zanaflex). Correct
fluoxetine hydrochloride (Sarafem).
celecoxib (Celebrex).
Explanation:
Ciprofloxacin, a fluoroquinolone, is a strong CYP1A2 inhibitor and is
absolutely contraindicated for concomitant administration of tizanidine
(Zanaflex). Concomitant use may increase the serum concentration of
tizanidine. If use with another strong inhibitor cannot be avoided, initiate
tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based
on response. Ketoconazole is a CYP3A4 inhibitor; celecoxib is a CYP2D6
inhibitor; and fluoxetine is a YP2C19 inhibitor. CYP1A2 inhibitors are enzymes
that catalyze many reactions involved in drug metabolism and synthesis of
cholesterol, steroids and other lipids.
Question:
A 33-year-old man has been taking sulfamethoxazole/trimethoprim for the
treatment of bacterial prostatitis. Brand names of this medication do NOT
include:
Azulfidine. Correct
Bactrim DS.
SMX-TMP DS.
Sulfatrim.
,Explanation:
Brand names of sulfamethoxazole/trimethoprim does NOT include
sulfasalazine (Azulfidine).
Question:
Patients with uncomplicated acute bacterial prostatitis who are NOT good
candidates for treatment with a fluoroquinolone should take:
levofloxacin.
azithromycin.
trimethoprim-sulfamethoxazole. Correct
ceftriaxone.
Explanation:
Patients with uncomplicated acute bacterial prostatitis who cannot take a
fluoroquinolone should take trimethoprim-sulfamethoxazole. Trimethoprim-
sulfamethoxazole has good to excellent penetration into prostatic and
seminal fluids and tissues. Levofloxacin is a fluoroquinolone. Cephalosporins,
such as ceftriaxone, may not be effective unless an STD is suspected.
Azithromycin is a macrolide and macrolides are indicated for the treatment
of chronic bacterial prostatitis.
Question:
PDE-5 inhibitors, such as tadalafil (Cialis) for the treatment of erectile
dysfunction, should be avoided in patients with:
infertility.
a history of epididymitis.
benign prostatic hyperplasia (BPH).
recent ST elevation myocardial infection (STEMI). Correct
Explanation:
PDE-5 inhibitors (ie. Levitra, Viagra, Cialis) should not be used in men with
underlying cardiovascular disease who have been advised to avoid sexual
activity. These medications have systemic vasodilatory properties that result
in transient decreases in supine blood pressure. Cardiovascular status should
be considered on an individual basis, weighing the risks versus the benefits,
before prescribing PDE-5 inhibitors.
Question:
The choice for initial treatment of acute bacterial prostatitis is:
doxycycline (Vibramycin).
ceftriaxone (Rocephin).
ciprofloxacin (Cipro). Correct
azithromycin (Zithromax).
Explanation:
, The choice of antibiotic for treatment of acute bacterial prostatitis (ABP) is
based on the results of the initial culture and sensitivity. However, initial
therapy should be directed at gram-negative enteric bacteria. Useful agents
include fluoroquinolones, trimethoprim-sulfamethoxazole, and ampicillin with
gentamicin. Examples of fluoroquinolones are ciprofloxacin (Cipro) and
levofloxacin (Levaquin).
Question:
Patients who take sildenafil (Viagra) for the treatment of erectile dysfunction,
should be instructed to avoid:
the ingestion of grapefruit-containing products. Correct
dark green, leafy vegetables.
night time dosing.
omega-3 fatty acids.
Explanation:
Grapefruit and grapefruit juice may interact with sildenafil (Viagra) and lead
to severe hypotension. Similar effects may be seen with concomitant alcohol
use.
Question:
To help with symptoms of chronic prostatitis, in addition to antibiotics,
consider adjunctive therapy with an:
alpha adrenergic antagonist. Correct
anticholinergic.
antispasmodic agent.
antiandrogenic agent.
Explanation:
In addition to antibiotics, consider adding an alpha adrenergic antagonist to
help with obstructive symptoms related to chronic prostatitis including weak
stream, hesitancy, straining during urination, sense of incomplete emptying
and post-void dribbling.
Question:
Patients taking vardenafil (Levitra) should be advised to immediately report:
headache.
flushing.
priapism. Correct
nausea.
Explanation:
There have been rare reports of prolonged erections greater than 4 hours
and priapism (painful erections greater than 6 hours in duration) associated
with PDE-5 inhibitors, including vardenafil (Levitra). In the event that an
