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Menopausal Hormone Therapy- Lesneski

Total questions: 44

Worksheet time: 33mins

Name
Class
Date
1.

The most effective treatment to alleviate postmenopausal vasomotor symptoms (hot flashes and night sweats) is

a)

Estrogen therapy

b)

Selective estrogen-receptor modulators (SERMs)

c)

Testosterone therapy

d)

Clonidine

2.

Which of the following CYP450 isoenzymes metabolizes both estrogen and medroxyprogesterone?

a)

3A4

b)

1A2

c)

2D6

d)

All of them

3.

Continued vasomotor symptoms in a 52-year-old postmenopausal woman with a history of hysterectomy receiving 0.3 mg of oral conjugated equine estrogens can best be managed by

a)

Changing to SERM

b)

Changing to gabapentin

c)

Increasing the daily dose of estrogen

d)

Decreasing the daily dose of estrogen

4.

A 54-year-old postmenopausal woman is complaining of vaginal dryness, itching, and pain with intercourse. She has not had any other problems associated with menopause and has an intact uterus. Which of the following recommendations is the best treatment option that balances risks and benefits for the management of this patient’s symptoms?

a)

Oral conjugated estrogen + medroxyprogesterone acetate

b)

Transdermal estradiol + micronized oral progesterone

c)

Intravaginal estrogen cream + oral progestogen

d)

Intravaginal estrogen cream

5.

Conjugated equine estrogen therapy alone has demonstrated to significantly increase the risk of

a)

Coronary heart disease

b)

Stroke

c)

Colorectal cancer

d)

Breast cancer

6.

Which of the following agents would be the best option to treat moderate hot flashes in a 55-year-old woman with history of breast cancer?

a)

Tibolone

b)

Estrogen

c)

Paroxetine

d)

Progestogen

7.

What is the first-line therapy for a 58-year-old postmenopausal woman suffering from mild genitourinary syndrome of menopause?

a)

Intravaginal moisturizer and lubricants

b)

Intravaginal estrogen cream

c)

Paroxetine

d)

Clonidine

8.

A 52-year-old woman had a hysterectomy 6 months ago and is seeking treatment for her vasomotor symptoms. She has no significant family history. Based on the findings from the Women’s Health Initiative (WHI) extended-post intervention study, what would be the most appropriate information to provide the patient regarding menopause hormone therapy (MHT)

a)

Do not initiate hormone therapy now because women younger than 60 years have increased risk of coronary heart disease and stroke and have the least favorable benefit-risk profile with MHT

b)

Initiate hormone therapy now because women younger than 60 years have not shown an increased risk of coronary heart disease and have most favorable benefit-risk profile with MHT

c)

Initiate MHT later because women older than 60 years will be within the “window of opportunity” to reduce risk of breast cancer

d)

Initiate hormone therapy later because women older than 60 years will be within the “window of opportunity” to reduce risk of coronary heart disease

9.

Long-term MHT can be routinely prescribed for which of the following conditions?

a)

Dementia unresponsive to other therapies

b)

Coronary heart disease

c)

Diabetes

d)

None of the above

10.

Which of the following intravaginal estrogens is also approved for treatment of vasomotor symptoms?

a)

Estring (estradiol vaginal ring)

b)

Femring (estradiol vaginal ring)

c)

Femring (estradiol vaginal ring)

d)

Imvexxy (estradiol vaginal insert)

11.

A 47-year-old postmenopausal woman with an intact uterus reports experiencing bothersome vasomotor symptoms. She has a history of gall bladder disease. Which of the following is the best treatment option for management of her symptoms?

a)

Transdermal estrogen

b)

Transdermal estrogen with micronized progesterone

c)

Oral conjugated equine estrogen

d)

Oral conjugated equine estrogen with micronized progesterone

12.

Which of the following is most effective for the treatment of severe hot flashes in a 54-year-old healthy menopausal woman?

a)

Estrogen and progestogen therapy

b)

Black cohosh

c)

Bazedoxifene

d)

Paroxetine

13.

MJ is a healthy 53-year-old female. She reports her last menses was 9 months ago. MJ is likely experiencing?

a)

Menopause

b)

Perimenopause

c)

Postmenopause

d)

Early onset menopause

14.

A 51-year-old woman is experiencing severe vasomotor symptoms. Her past medical history is significant for hysterectomy. Which of the following is the best treatment options to alleviate her vasomotor symptoms?

a)

Black cohosh

b)

Systemic estrogen therapy

c)

Compounded bioidentical hormone therapy

d)

Transdermal estrogen with progestogen therapy

15.

A 54-year-old woman with a history of deep vein thrombosis, dyslipidemia, and depression is seeking treatment for her bothersome vasomotor symptoms. Which of the following is the best treatment options to alleviate her vasomotor symptoms?

a)

Black cohosh

b)

Medroxyprogesterone

c)

Duavee (conjugated estrogen with bazedoxifene)

d)

Paroxetine

16.

Menopause is defined as amenorrhea (following the loss of ovarian follicular activity) for __________.

a)

12 months

b)

6 months

c)

3 months

d)

2 years

17.

Which of the following is associated with perimenopause?

a)

changes in lipids and bone loss

b)

vasomotor symptoms

c)

vulvovaginal symptoms

d)

irregular menstrual cycles

e)

Mood wings

18.

Which of the following describes hormonal changes due to perimenopause/menopause?

a)

Increased FSH and LH, Decreased estrogen

b)

Decreased FSH and LH, Increased estrogen

c)

Ovaries are primary site of estrogen and progesterone production

d)

Ovaries primarily secrete androstenedione and testosterone

19.

Select the lifestyle modifications that may help with menopause symptoms.

a)

Using a sauna

b)

Exercising daily

c)

Quitting smoking

d)

Avoiding alcohol, caffeine, and spicy foods

e)

Increasing room temperature

20.

Modulates serotonin, has properties of an antioxidant, anti-inflammatory and SERM, patients need to monitor liver damage risk

a)

Black Cohosh

b)

Soybeans

c)

Flaxseed

d)

Red Clover

21.

Which medication has an associated risk of CHD, Breast cancer, Stroke, Gallbladder disease and VTE events?

a)

Estrogen

b)

Black Cohosh

c)

Progestogens

d)

Bioidentical hormones

22.

Which of the following symptoms would NOT likely be related to the patient being on estrogen therapy?

a)

Nausea/vomiting

b)

Heavy bleeding, bloating, edema, and weight gain

c)

Headache and hypertension

d)

Breast tenderness

e)

GI upset

23.

Conjugated equine estrogens is also known as

a)

Premarin

b)

Femring

c)

Estrone

d)

Combipatch

24.

Estrogen taken PO increases circulating sex hormone binding globulin (SHBG) which __________the bioavailability of androgens and estrogens.

a)

Increases

b)

Decreases

c)

Has no effect

25.

What is the approximate equivalent dose to estrogen for the listed medications?

a)

0.625mg, 1mg, 5mcg, 50mcg

b)

0.625mcg, 1mcg, 5mg, 50mg

c)

0.625mg, 1mcg, 5mcg, 50mg

d)

0.625mcg, 1mg, 5mcg, 50mcg

26.

What are the advantages of transdermal delivery system?

a)

No increase in Blood pressure, SHBG, triglycerides or C-reactive protein

b)

Lower risk of DVT, Stroke, and MI

c)

Increased frequency in dosing

d)

Enters circulation at a variable rate

27.

Patients who __________ must add progesterone or estrogen agonist/antagonist to prevent endometrial hyperplasia and cancer.

a)

have an intact uterus

b)

have had a hysterectomy

c)

have had a stroke

d)

have high blood pressure

28.

What is the most common progestogen compound in the US?

a)

Medroxyprogesterone

b)

Premarin

c)

Norethindrone

d)

Drosperinone

29.

Prempro is a combination of MPA and CE and uses a _________dosing regimen.

a)

cyclic

b)

continuous

c)

continuous pulsed

d)

sequential

30.

Contraindications for MHT include

a)

Breast cancer

b)

History of blood clots

c)

History of stroke and/or MI

d)

Liver dysfunction disease

e)

Undiagnosed abnormal genital bleeding

31.

Patients who have ________ should use MHT with caution.

a)

HTN

b)

Hypothyroidism

c)

Hypotriglyceridemia

d)

Severe hypocalcemia

e)

Fluid retention

32.

HRT should be evaluated for each patient based on their specific benefit/risk profile.

a)

True

b)

False

33.

Symptoms of androgen deficiency include

a)

Unexplained fatigue

b)

Sexual function changes

c)

Diminished sense of wellbeing

d)

Amenorrhea

34.

Which of the following is an ABSOLUTE contraindication for androgens?

a)

Pregnancy/lactation

b)

Known/suspected androgen-dependent cancer

c)

Low SHBG

d)

Clinical hirsutism

e)

Moderate to severe acne

35.

Which of the following is a contraindication for androgens but can still be used with caution?

a)

Pregnancy/lactation

b)

Known/suspected androgen-dependent cancer

c)

Low SHBG

d)

Clinical hirsutism

e)

Moderate to severe acne

36.

Can testosterone be given to postmenopausal women?

a)

Yes but only with estrogen

b)

Yes but only without estrogen

c)

Yes but generalized use is not recommended

d)

No

37.

Which of the following is associated with hot flushes and less often with leg cramps?

a)

SERMs

b)

Androgens

c)

SSRIs

d)

SNRIs

38.

Which medication has a black box warning for stroke and venous thromboembolism and endometrial hyperplasia and cancer in a woman with a uterus who take unopposed estrogen therapy.

a)

Osphena

b)

Combipatch

c)

Duavee

d)

Evista

39.

When should the therapy efficacy be evaluated?

a)

after 6 weeks of therapy

b)

after 2 weeks of therapy

c)

after 12 weeks of therapy

d)

after 8 weeks of therapy

40.

Hormone therapy should be used at the lowest effective dose for the shortest duration needed.

a)

True

b)

False

41.

What doses of CEE and MPA were used for the WHI studies on estrogen and estrogen plus progestin?

a)

0.625mg CEE

b)

6.25 mcg CEE

c)

2.5 mg MPA

d)

2.5 mcg MPA

42.

Estrogen is good for your heart.

a)

True

b)

False

c)

It depends

43.

short term HRT is considered

a)

≤\le  5 years

b)

≤\le  2 years

c)

≤\le  10 years

d)

≤\le  6 months

44.

Osphena can be used to treat moderate to severe vasomotor symptoms.

a)

True

b)

False

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