6K Competency Exam: Conception & Infertility

An ovulation predictor test kit is positive if this hormone is present in the urine:

Answer

AProgesterone

BFollicle-stimulating hormone

CThyroid-stimulating hormone

DLuteinizing hormone

EEthinyl estradiol

When do patients begin a Seasonale or Seasonique packet?

Answer

AStart on the Sunday after the period has started.

BStart on the Monday after the period has started.

CStart on the Tuesday after the period has started.

DStart on the Wednesday after the period has started.

EAnytime is acceptable.

A patient has vomited out the first dose of Plan B (0.75 mg). The pharmacist should tell her to retake the dose (after taking anti-nausea medicine first) if she has vomited within this time period after having taken the EC tablet/s:

Answer

A60 minutes

B90 minutes

C2 hours

D3 hours

E4 hours

Ruth has started to use the oral contraceptive Ortho Tri-Cyclen. There are some antibiotics/antifungals that can reduce the efficacy of birth control pills. Which of the following medications would not interact with oral contraceptives?

Answer

ASt John's wort

BSmoking

CRifampin

DTopiramate

ELevofloxacin

A young female enters the pharmacy. She asks for the best over-the-counter option to protect against sexually transmitted infections (STis). Which of the following represents the best option for STI protection?

Answer

ALatex male condom

BDelfen Foam

CNonoxynol-9

DPlan B One Step

ENext Choice

A woman is hoping to become pregnant. Choose the correct statement. (Select ALL that apply.)

Answer

AIf a couple is attempting pregnancy, it should occur in about 25% per month, and most become pregnant within a year.

BMales are not contributory to infertility; it is always the females, and largely due to the health of her eggs.

CWomen attempting to become pregnant should begin to take folic acid at a recommended daily intake of 400-800 mcg daily.

DAny women trying to conceive should be started on an ACE inhibitor, as these can increase fertility.

EIf pregnancy has not occurred within six months time, the couple should be referred to a clinician specializing in infertility.

If a patient finds that she cannot tolerate estrogen for any reason, which products might be used as alternatives? (SelectALL that apply.)

Answer

ANor-QD

BIntrauterine device

CDepo-Provera

DOrtho Evra

ESeasonique

Which of the following birth control pill formulations is a multiphasic formulation?

Answer

ANor-QD

BLoestrin 24-Fe

CApri

DAviane

EOrtho-Novum 7/7/7

What is the primary reason that Yaz and Yasmin became best-selling drugs (and this reason could also be considered a "side effect" of the drug)?

Answer

AThey prevent pregnancy more than some of the older formulations.

BThey prevent monthly bleeding.

CThey lower potassium.

DThey cause less headaches.

EThey do not contribute to pre-menstrual and water-weight gain.

A young female enters the pharmacy. She is using birth control pills. She asks if she is protected against HIV and other STIs. Which advice should be provided? (Select ALL that apply.)

Answer

ABirth control pills reduce the risk of gonorrhea.

BBirth control pills reduce the risk of chlamydia.

CBirth control pills reduce the risk of HIV.

DBirth control pills do not protect against sexually transmitted infections.

EThe best protection against STIs is abstinence; the second-best protection is to use condoms (in addition to another contraceptive method, for efficacy against pregnancy).

Which of the following represent possible advantages of using continuous birth control formulation such as Lybrel orAmethyst? (Select ALL that apply.)

Answer

ALong period of time without menstrual cycle bleeding and "period-related" effects, such as moodiness.

BLower risk of pregnancy with missed pills.

CNo withdrawal effects, such as physical and emotional symptoms, that can occur with other formulations during the hormone-free interval.

DReduced risk of acquiring sexually transmitted infections, such as gonorrhea and chlamydia.

EAvoidance of clotting risk.

Ruth has started to use the oral contraceptive Ortho Tri-Cyclen. Which of the following side effects are not expected from the use of this product?

Answer

ABreast tenderness

BHair loss

CBloating

DElevated blood pressure

EBreast fullness

Greg is dispensing ulipristal to a young woman. What are the differences between ulipristal and levonorgestrel?

Answer

AUlipristal is indicated for up to 10 days after unprotected intercourse.

BUlipristal and levonorgestrel EC products are both over-the-counter to people 17 and older.

CUlipristal does not cause nausea.

DUlipristal is pregnancy category C.

EUlipristal can prevent implantation in the uterus.

A pharmacist is filling a prescription for clomiphene for a woman who is attempting pregnancy. Which of the following statements regarding clomiphene are correct? (Select ALL that apply.)

Answer

AThis medication can cause hot flashes, which may be bothersome and can make you feel sweaty and flushed, including during sleep.

BThis medication can cause nausea.

CThis medication is a selective estrogen receptor modulator.

DThis medication is a synthetic form of estradiol.

EIf you are going to be sitting or lying down for a long period of time, such as in an airplane, get up regularly and walk and exercise your calves.

Mark is sixteen years old. He wants to purchase emergency contraception for his girlfriend, who he says is 20 years old. Choose the correct statements. (Select ALL that apply.)

Answer

AThe levonorgestrel EC pill that contains two 0.75 mg tablets can be purchased by Mark as an OTC product.

BMark can purchase Plan B One-Step, since it does not have age restrictions.

CPlan B contains ethinyl estradiol which provides some protection against Chlamydia.

DThe pharmacy can sell EC over-the-counter (other forms than Plan B) to females, and to males; there are no sex restrictions, if the patient meets the age requirements.

EThe parents of both individuals should be contacted regarding this request.

Which of the following products requires that the pharmacist dispense a patient package insert (PPI) with each prescription and refill? (Select ALL that apply.)

Answer

ALoSeasonique

BDiaphragms

CNorethindrone mini-pill (progestin only pill)

DDelfen Foam

EYasmin

Which of the following contraception formulations would have a higher risk of clotting than the Loestrin Fe 1.5/30 formulation? (Select ALL that apply.)

Answer

AOrtho Evra

BYaz or Yasmin

CA 35 mcg ethinyl estradiol/norethindrone formulation

DThe mini-pill (POP)

ECondoms and foam

Which combination oral contraceptive product comes in a patch formulation?

Answer

AMircette

BOrtho Evra

CNuvaRing

DLybrel

EYasmin

Certain medications taken concurrently with birth control pills can reduce the contraceptive's efficacy. Which of the following medications, if taken with birth control pills, could cause this problem and require back-up contraception or a different method of contraception with long-term therapy? (Select ALL that apply.)

Answer

ARifampin

BCarbamazepine

CErythromycin

DAzithromycin

EMycophenolate

The following are contraindications to the use of estrogen therapy, in any dose or formulation. (Select ALL that apply.)

Answer

AHistory of myocardial infarction

BHistory of deep vein thrombosis

CUnexplained vaginal bleeding

DHistory of pregnancy

EHistory of cerebrovascular accident

A young woman went on a weekend trip with her boyfriend and forgot her pill packet. She missed taking her birth control pills during days 18th-20th. The woman has come into the pharmacy to get her next month's packet, which is ready for pick-up. Choose the correct advice the pharmacist should relate to the patient:

Answer

AReport at once to the doctor to get a pregnancy blood test.

BContinue to take the old packet, take the placebo week as usual, and begin the new packet on time. Try not to miss future pills.

CUse back-up contraception for 14 days.

DUse back-up contraception for 30 days, then start the new packet.

EDo not use the "placebo week" (or sugar or "dummy" pills); go ahead and begin the new packet.

Chantelle is using an estrogen-progestin oral contraceptive. She is started on Trileptal for seizures by her primary care physician. Despite perfect adherence with the daily birth control pills, she became pregnant within a few months of starting the Trileptal. What is the likely cause of the pregnancy?

Answer

AThe Trileptal decreased the absorption of the birth control pills.

BThe Trileptal increased the absorption of the birth control pills.

CThe Trileptal induced the metabolism of the birth control pills.

DThe Trileptal inhibited the metabolism of the birth control pills.

EThere is no interaction between Trileptal and birth control pills; the pregnancy is a mystery.

Nonoxynol-9 is the most commonly used spermicide and is present in the contraceptive sponge, film and vaginal spermicides. Choose the correct statements concerning nonoxynol-9. (Select ALL that apply.)

Answer

ANonoxynol-9 is prescription only.

BSpermicide kills sperm, but does not reduce the risk of catching a sexually transmitted infection.

CSome people are allergic to spermicides or get skin irritations from them; this is often mistaken for an allergy to the latex condom (which some people have as well).

DIf Nonoxynol-9 is used many times a day, or if it is used by people at risk for HIV, it can irritate tissue and increase the risk of contracting HIV and other sexually transmitted infections.

EWhen used alone, spermicide is not very effective for pregnancy prevention; it is more effective when used with a condom or with a diaphragm.

Chantelle started on the contraceptive Ortho Tri-Cyclen Lo five months ago. Initially, she had spotting over several weeks but was instructed by the pharmacist that she should get used to the formulation within 2-3 months. She feels the side effects are better, except that she continues to spot during the week before the placebo pills (days 18-19-20-21). What is the likely cause of the spotting?

Answer

AToo much estrogen

BToo little estrogen

CToo much progestin

DToo little progestin

EUsing a triphasic formulation

The pharmacist is dispensing the Ortho Evra contraceptive patch to Sue-Ellen. The patient's vitals today include a blood pressure of 106/68 mmHg, pulse 72 BPM, height 5'6" and weight 212 pounds. Select the correct statement:

Answer

AA new patch is applied daily.

BThis patient is not a good candidate to use the Ortho Evra patch.

CThe patch has a low risk of blood clots compared to the orally administered contraceptives.

DOne patch stays on for three weeks; on the fourth week the patch is left off.

EThe patch should be applied to either breast.

Jane has just received the Ortho Evra patch at the pharmacy. It is a good choice for her because she sometimes forgets to take the pill. Counseling points for Ortho Evra should include all of the following recommendations: (Select ALL that apply.)

Answer

AThe patch provides some protection from sexually transmitted infection, but not as much as condoms.

BOrtho Evra cannot be used in women with a history of blood clots, or > 198 pounds.

COne patch is placed on the upper outer arm, abdomen, buttock or back-when applying press firmly for ten seconds.

DIf the patch is left off for more than 36 hours, you may not be protected from pregnancy.

EStart the patch on the first Sunday after the period begins or apply during the first day of the period.

Which of the following are correct statements concerning missed pills with an estrogen-progestin birth control pill formulation? (Select ALL that apply.)

Answer

ABack-up methods could include condoms and a spermicide (such as foam).

BThe spermicide contains levonorgestrel.

CBack-up contraception is generally needed if two or more consecutive hormonal pills are missed.

DIf a single pill is missed anywhere in the packet, the forgotten pill needs to be taken when noticed and the next pill is taken the next day, which may mean taking two pills on the same day.

EIf a single pill is missed in week 1 or 2 the woman should continue the same packet until it is all taken, and use back-up until a new packet is started.

A pharmacist will counsel a patient beginning oral contraceptives for pregnancy prevention. Which of the following are correct counseling statements? (Select ALL that apply.)

Answer

AThe FDA requires that the patient package insert be dispensed the first time the patient receives the medication. With refills it is not required.

BIf you have had any type of clotting disorder, such as a DVT, you cannot use this medication.

CCigarette smoking with this medication must be kept under 20 cigarettes daily.

DIf you take any new medications or over-the-counter medicines, check with one of the pharmacists first to see if they are safe to use with your birth control pills.

EThe most common side effects are nausea, light bleeding between periods (talk with your doctor if this does not go away after three months), and possibly some weight gain and breast tenderness.

Carol comes into the pharmacy to pick up a prescription for Sarafem for premenstrual dysphoric disorder (PMDD). Which birth control formulation is approved for PMDD?

Answer

AYasmin

BYaz

CNuvaRing

DOrtho Evra

EParaGard

If a woman takes levonorgestrel EC while pregnant, what is expected to happen? (Select ALL that apply.)

Answer

AThe EC could cause infertility.

BThe EC will terminate the pregnancy.

CThe EC could cause birth defects.

DThe EC will not affect her future fertility, nor will it terminate an established pregnancy.

EShe will need to consider how the unprotected sex occurred, in order to reduce future risk.

Which of the following birth control pill formulations is not a mini-pill?

Answer

ACamila

BNor-QD

CErrin

DCyclessa

ENora-BE

A pharmacist remembers that he was taught in school to warn patients using oral contraceptives about watching for severe leg pain, chest pain or trouble breathing. This is due to a risk of:

Answer

AClots

BHemorrhagic strokes

CSevere depression

DLiver cancer

EBreast cancer

Andrea is a 28 year old female with lupus-induced nephropathy. Her renal function has declined and is currently estimated at a creatinine clearance of 23 mL/minute. Her serum potassium is 4.8 mEq/L. Her medications include lisinopril 10 mg twice daily, methotrexate once weekly, a vitamin D supplement and simvastatin. Andrea has met a young man and went to her physician to get a contraceptive method. Andrea should not receive any of these contraceptive options: (Select ALLthat apply.)

Answer

AMirena

BCondoms and foam

CParaGard

DYaz

EYasmin

Holly is a 30 year-old woman who has been using Nor-QD for contraception since she had her baby. Holly was primarily breast-feeding, but she stopped when the baby was seven months. The baby is now eight months old. Holly knows that she needs to be switched to a pill that includes estrogen but she has been too busy to see the doctor. She forgot to take her Nor-QD this morning and had intercourse later that evening. Is she at risk for pregnancy?

Answer

ANo, unless she has missed 2 consecutive pills.

BNo, unless she has missed 3 consecutive pills.

CNo, unless she has missed 4 consecutive pills

DYes, pregnancy could result, and the patient may wish to use emergency contraception.

EThis cannot be determined because it depends on the date of the last menstrual cycle.

A pregnancy test kit is positive if this hormone is present in the urine:

Answer

AParathyroid hormone

BLuteinizing hormone

CProgesterone

DEthinyl estradiol

EHuman chorionic gonadotropin

Mark has entered the pharmacy to get emergency contraception (EC) for his girlfriend. Which statements regarding EC are correct? (Select ALL that apply.)

Answer

AIf the period is more than a week late, a pregnancy test should be taken.

BA patient must be over 17 years of age to purchase Plan B One Step over the counter.

CEmergency contraception is a form of contraception that prevents pregnancy after sexual intercourse.

DPlan B One Step contains one 0.75 mg tab of levonorgestrel.

EThe levonorgestrel EC formulations are indicated for use up to 3 days after unprotected intercourse.

Select the correct statement concerning the Ortho Evra patch:

Answer

AApply the patch on the first Sunday following the beginning of your menstrual period or on the first day of your period.

BApply the patch the day you receive it from the pharmacy; timing with the patch is not important.

CApply the patch on the third Monday of the month, regardless of your menstrual cycle.

DApply the patch exactly five days after the period has started.

EApply the patch exactly ten days after the period has started.

A woman is using Alesse combination oral contraceptive pills. She does not enjoy getting a monthly menstrual cycle and has heard about new pill formulations where you get less periods. Choose the formulation/s which results in menstruation once every 3 months: (Select ALL that apply.)

Answer

ASeasonale

BAmethyst

CLybrel

DSeasonique

ECamilla

Choose the correct statement concerning Lybrel.

Answer

ALybrel is another formulation of progestin only pills.

BLybrel is associated with more PMS symptoms compared to other birth control formulations.

CLybrel causes less clotting than other birth control formulations.

DLybrel comes as continuous pills; no placebo/off week.

ELybrel causes less spotting compared to other birth control formulations.

Judy has just received a NuvaRing at the pharmacy. It is a good choice for her because she sometimes forgets to take the pill. Counseling points for the NuvaRing should include all of the following recommendations: (Select ALL that apply.)

Answer

AInsert the ring between days 1 and 5 of menses and leave in for three weeks; remove at the end of three weeks.

BIf the ring is out for more than 24 hours, you could be pregnant and may wish to consider emergency contraception.

CThe ring can be stored at room temperature for up to four months.

DThe ring does not protect you from sexually transmitted diseases.

ENuvaRing cannot be used in women with a history of blood clots, stroke, heart attack or in women over age 35 who smoke.

A 24 year-old female patient uses the following medications on a daily basis: Ortho Tri Cyclen (for contraception), sertraline (for depression) and buspirone (for anxiety). She complains of nausea and weight gain. Which of the following statements represents the most appropriate course of action?

Answer

AChange the sertraline to citalopram.

BChange the Ortho Tri Cyclen to Ortho Tri Cyclen Lo.

CChange the buspirone to alprazolam.

DAdd meclizine, as needed.

EAdd loratidine, as needed.

Holly is a 30 year-old woman who just had a baby. She has been prescribed the progestin-only mini-pill, Nor-QD. Her doctor told her that she will use this type of birth control pill until she is done breastfeeding her baby. Which of the following counseling points on the "mini pill" should be relayed to the patient?

Answer

AThe mini pill can be started at any time.

BUse another method of birth control for the first 7 days.

CIf more than 6 hours have elapsed from the regularly scheduled time you take your pill, you could get pregnant.

DThis method offers better protection against pregnancy than estrogen and progestin combination pills, for most women.

EThis formulation causes more nausea than most estrogen and progestin combination pills.

Carol has just been at the pharmacy to pick up a new prescription for combination oral contraceptives. The pharmacist has instructed Carol to be seen at once if she experiences severe chest pain, severe headache, a swollen or painful calf, vision problems, shortness of breath, is coughing up blood or has severe abdominal pain. The pharmacist understands that the use of estrogen may increase risk for these complications: (Select ALL that apply.)

Answer

AStroke

BDeep vein thrombosis

CClotting

DMigraine headaches

EHeart failure

Greg is dispensing Next Choice to a young woman. Greg is aware that nausea is the primary side effect of the EC pills. He asks if she gets easily nauseated, and she replies that she does and states that she vomits easily. Choose the correct recommendation for managing the nausea:

Answer

AHe can recommend two tablets of the OTC version of Compazine one hour before the EC is taken.

BThe nausea medication will make her "wired" and could cause insomnia.

CShe will need to get a prescription for a trimethobenzamide suppository.

DShe can use two 25 mg tablets of meclizine an hour before she uses the EC.

EEmergency contraception pills do not cause nausea since they contain no estrogen.

With a regular estrogen-progestin birth control pill formulation, when is the highest risk time for pregnancy if a pill is missed?

Answer

AWeek 1

BWeek 2

CWeek 3

DWeek 4

EAll the weeks are equally risky for pregnancy