Deck 38: Hormone Replacement Therapy and Osteoporosis

Question 1

Women with an intact uterus should be treated with both estrogen and progestin due to:

A) Increased risk for endometrial cancer if estrogen alone is used
B) Combination therapy provides the best relief of menopausal vasomotor symptoms
C) Reduced risk for colon cancer with combined therapy
D) Lower risk of developing blood clots with combined therapy

Answer 1

Increased risk for endometrial cancer if estrogen alone is used

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?

A) By selectively activating estrogen pathways in the bone
B) By reducing bone resorption by inhibiting parathyroid hormone (PTH)
C) By reducing bone resorption and inhibiting osteoclastic activity
D) By increasing PTH production

Answer 2

By reducing bone resorption and inhibiting osteoclastic activity

Question 3

Inadequate vitamin D intake can contribute to the development of osteoporosis by:

A) Increasing calcitonin production
B) Increasing calcium absorption from the intestine
C) Altering calcium metabolism
D) Stimulating bone formation

Answer 3

Increasing calcium absorption from the intestine

Question 4

Ongoing monitoring for women on ERT includes:

A) Lipid levels, repeated annually if abnormal
B) Annual health history and review of risk profile
C) Annual mammogram
D) All of the above

Question 5

The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is:

A) Ability to deliver higher doses of estrogen in a non-oral form
B) The vaginal cream formula provides moisture to the vaginal area
C) Relief of symptoms without increasing cardiovascular risk
D) All of the above

Question 6

Bisphosphonate administration education includes:

A) Taking it on a full stomach
B) Requiring sitting erect for at least 30 minutes afterward
C) Drinking it with orange juice
D) Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach

Question 7

What is the duration of SERM use for menopausal issues?

A) It matches the 5 years for estrogen products
B) The bone health impact allows long-term use
C) The increased risk of breast cancer encourages tapering as soon as possible
D) The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur

Question 8

Dosage changes of conjugated equine estrogen (Premarin) are made at _________ intervals.

A) 1 to 2 week
B) 2 to 4 week
C) 6 to 8 week
D) 12 week

Question 9

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:

A) Inhibiting magnesium resorption in the kidneys
B) Increasing calcium absorption from the GI tract
C) Acting on the bone to inhibit osteoblast activity
D) Selectively acting on the estrogen receptors in the bone

Question 10

Drugs that increase the risk of osteoporosis developing include:

A) Oral combined contraceptives
B) Carbamazepine
C) Calcium channel blockers
D) High doses of vitamin D

Question 11

The drug recommended as primary prevention of osteoporosis in women over age 70 years is:

A) Alendronate (Fosamax)
B) Ibandronate (Boniva)
C) Calcium carbonate
D) Raloxifene (Evista)

Question 12

What is the established frequency of repeating DEXA imaging after stating bisphosphonates?

A) Every 2 years
B) Every 5 years
C) There is no evidence-based time line for monitoring after the first 2 years
D) There need to be annual exams

Question 13

The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing:

A) Cardiovascular risk
B) Risk of stroke or other thromboembolic event
C) Breast cancer
D) Vasomotor symptoms

Question 14

Why are SERMS generally not ordered for women early into menopause?

A) The rapid onset of severe hot flashes can be unbearable.
B) The bone remodeling effect results in osteoporosis.
C) They tend to induce intermittent spotting.
D) They create more risk with breast cancer than they are worth.

Question 15

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:

A) Explaining that HRT is totally safe if used short term
B) Telling her to ignore media hype regarding HRT
C) Discussing the advantages and risks of HRT
D) Encouraging the patient to use phytoestrogens with the HRT

Question 16

The drug recommended as primary prevention of osteoporosis in men over age 70 years is:

A) Alendronate (Fosamax)
B) Ibandronate (Boniva)
C) Calcium carbonate
D) Raloxifene (Evista)

Question 17

IV forms of bisphosphonates are used for all the following except:

A) Severe gastric irritation with oral forms
B) Known cancer mets into the bone
C) Persons with advancing renal dysfunction
D) Progression of bone loss on oral formulations

Question 18

The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is:

A) Annual dual-energy x-ray absorptiometry (DEXA) scans
B) Annual vitamin D level
C) Annual renal function evaluation
D) Electrolytes every 3 months

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?

A) She is correct, black women do not have much risk of developing osteoporosis due to their dark skin.
B) Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.
C) If she doesn't drink alcohol, her risk of developing osteoporosis is low.
D) If she has not lost more than 10% of her weight lately, her risk is low.

Question 20

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:

A) 2 years
B) 5 years
C) 10 years
D) 15 years