WHI Study
Comparison of Arms
Osteoporosis
Botanicals
Menopause
100
Benefits of HRT in the WHI study included decreased risk of hip fractures and this disease state
What is colorectal carcinoma?
100
When compared to placebo estrogen only arm showed a statistically significant higher risk of what cardiovascular event?
Stroke
100
The new classification of bone mass encompassing t-score of -1 to -2.5
What is low bone mass-formerly osteopenia
100
Leading botanical sold in Germany; may be helpful in short term treatment of vasomotor symptoms
Black Cohosh
100
What is the earliest hormonal event involved in the onset of transition to menopause?
reduced inhibin production by shrinking follicle count
200
What was the average age of women in WHI study
63
200
In Estrogen only HRT the WHI study showed no increased risk of breast cancer if used less than what period of time?
5 years
200
The 10 year risk of major osteoporotic fracture in risk-free Caucasian women at age 65?
9.3%
200
May be helpful in treatment of vasomotor symptoms (<2 years), but also may interact with estrogen leading to potential harm in patients with estrogen dependent cancers
Soy and Isoflavones
200
Treatment with “traditional” doses of estrogen replacement in menopausal women can be expected to reduce or eliminate symptoms in what percentage of patients?
80%
300
The WHI study showed increased diagnosis of breast cancer after how many years of HRT?
3-5 years
300
Which treatment arm showed an increased risk of CVD?
Both arms
300
Frequency at which DXA may be repeated for patients with score between -2.0 and -2.5
1 year
300
May be helpful in short-term treatment of mild to moderate depression in women
St. John's Wart
300
What non-hormonal pharmacologic agent is closest in effectiveness to hormone therapy?
Gabapentin
400
Which arm of the WHI study did not show a statistically significant increased risk of Breast Cancer?
Estrogen only
400
What was the mean duration of use in the estrogen only arm of the WHI study?
7 years
400
Daily Double
Name 5 parameters used to determine a FRAX score.
400
This botanical agent commonly used for vasomotor symptoms has a coumarin like derivatives and may cause excessive bleeding, or interaction with other anticoagulants
Dong Quai
400
What percentage of patients experience menopausal vasomotor symptoms?
80%
500
Primary outcome measurement in the WHI study of the HRT group (estrogen alone and estrogen + progesterone) showed an increased incidence of MI, stroke and which other major cardiovascular event?
Pulmonary Embolism
500
How many years following menopause did combined estrogen-progesterone therapy show a statistically significant increased risk of cardiovascular events compared to placebo?
20
500
The mechanism of action of this drug includes stimulation of new bone formation on trabecular and cortical bone surfaces by preferential stimulation of osteoblasts over osteoclasts
Teraparatide-recombinant PTH
500
Daily Double
A 54 year old woman who had her final menstrual period 4 years ago requests a prescription for ‘bioidentical hormones’ to treat her hot flushes. As you discuss this topic with the patient, you make her aware that individually compounded pharmaceutical perparations of hormones have not demonstrated sufficient efficacy and safety to have FDA approval. She requests a hormone preparation that is “as natural as possible.” Which one of the following is the most appropriate prescription and regimen for this patient? a. Estradiol 2 mg by mouth daily with medroxyprogesterone acetate 2.5 mg daily b. Transdermal estradiol 50 mcg weekly plus micronized progesterone 200 mg for 12 days each month c. Conjugated equine estrogens 0.625 mg daily plus medroxyprogesterone acetate, 10 mg for 12 days each month d. Transdermal estradiol plus norethindrone patch (50 mcg/140mg) e. Ethinyl estradiol 20 mcg plus drospirenone 1 mg daily
500
Which of these is not a contraindication to HRT? a. Established coronary artery disease b. History of breast cancer c. Previous PE d. Smoking e. Active liver disease
Smoking
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