NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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Which medication decreases the effectiveness of hormonal contraceptives in PAH treatment?

  1. Bosentan (Tracleer)

  2. Sildenafil (Revatio)

  3. Riociguat (Adempas)

  4. Epoprostenol (Flolan)

The correct answer is: Bosentan (Tracleer)

Bosentan (Tracleer) is the correct answer because it is known to decrease the effectiveness of hormonal contraceptives in pulmonary arterial hypertension (PAH) treatment. Bosentan is an endothelin receptor antagonist that induces the liver enzyme CYP3A4, which can lead to increased metabolism of estrogen components in hormonal contraceptives, thus reducing their effectiveness. This interaction can result in decreased contraceptive efficacy and may lead to unintended pregnancies in women taking hormonal contraceptives concurrently with bosentan. The other options, including Sildenafil (Revatio), Riociguat (Adempas), and Epoprostenol (Flolan), do not have a significant impact on the effectiveness of hormonal contraceptives and are not typically associated with decreased contraceptive efficacy in PAH treatment.