How do bisphosphonates treat osteoporosis?


Question 1. A twenty-two-year-old woman receives a prescription for oral contraceptives. Education for this patient includes:

Counseling regarding decreasing or not smoking while taking oral contraceptives

Advising a monthly pregnancy test for the first three months she is taking the contraceptive

Advising that she may miss two pills in a row and not be concerned about pregnancy

Informing her that her next follow-up visit is in one year for a refill and “annual exam”

Question 2. Sallie has been diagnosed with osteoporosis and is asking about the once-a-month pill to treat her condition. How do bisphosphonates treat osteoporosis?

By selectively activating estrogen pathways in the bone

By reducing bone resorption by inhibiting PTH

By reducing bone resorption and inhibiting osteoclastic activity

By increasing PTH production

Question 3. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:

Excessive sedation

Tachycardia and angina

Weight gain

Cold intolerance

Question 4. Intranasal calcitonin is used in the treatment of osteoporosis. For which patient is Calcitonin therapy appropriate?

Thin, Caucasian perimenopausal women

Men over the age of sixty-five years with osteoporosis

Women over the age of sixty-five years with osteopenia

Women over the age of sixty-five years with severe osteoporosis

Question 5. The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is:

Annual dual energy X-ray absorptiometry (DEXA) scans

Annual vitamin D level

Annual renal function evaluation

Electrolytes every three months

Question 6. When starting a patient with hypothyroidism on thyroid replacement hormones, patient education would include the following:

He or she should feel symptomatic improvement in one to two weeks.

Drug-related adverse effects such as lethargy and dry skin may occur.

It may take four to eight weeks to get to euthyroid symptomatically and by lab testing.

Due to the short half-life of levothyroxine, its doses should not be missed.

Question 7. Medroxyprogesterone (Depo Provera) injection has an US Food and Drug Administration (FDA) black box warning due to:

Development of significant hypertension

Increased risk of strokes when on Depo

Decreased bone density while on Depo

Risk of life-threatening rash such as Stevens-Johnson

Question 8. A woman who has migraine with aura:

Should not be prescribed estrogen due to the interaction between triptans and estrogen, limiting migraine therapy choices

Should not be prescribed estrogen due to an increased incidence of migraines with the use of estrogen

Should not be prescribed estrogen due to an increased risk of stroke occurring with estrogen use

May be prescribed estrogen without any concerns

Question 9. The drug recommended as primary prevention of osteoporosis in women over seventy years old is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 10. The drug recommended as primary prevention of osteoporosis in men over seventy years is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 11. Drugs that increase the risk of development of osteoporosis include:

Oral combined contraceptives


Calcium channel blockers

High doses of vitamin D

Question 12. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for:

A calcium channel blocker

A beta blocker


An alpha blocker

Question 13. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:

Recommending she return to the clinic at the start of her next menses to get a Depo Provera shot

Prescribing oral combined contraceptives and recommending that she start them at the beginning of her next period and use a back-up method for the first seven days

Prescribing oral contraceptives and having her start them the same day, with a back-up method used for the first seven days

Discussing the advantages of using the topical birth control patch and recommending she consider using the patch

Question 14. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team that will most likely treat her with:



Radioactive iodine.

Nothing; treatment is best delayed until after her pregnancy ends.

Question 15. Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:

The cortical bone

The femoral neck

Cervical vertebrae

Pelvic bones

Question 16. Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include:

Explaining that HRT is totally safe if used for a short term

Telling her to ignore media hype regarding HRT

Discussing the advantages and risks of HRT

Encouraging the patient to use phytoestrogens with the HRT

Question 17. A contraindication to the use of combined contraceptives is:

Adolescence (not approved for this age)

A history of clotting disorder

Recent pregnancy


Question 18. Absolute contraindications to estrogen therapy include:

A history of any type of cancer

Clotting disorders

A history of tension headache

Orthostatic hypotension

Question 19. Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?

She is ; black women do not have much risk of developing osteoporosis due to their dark skin.

Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.

If she doesn’t drink alcohol, her risk of developing osteoporosis is low.

If she has not lost more than 10% of her weight lately, her risk is low.

Question 20. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for:

The development of chest pain or dizziness

Weight gain


Renal function

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