Lippincott Chapter 26:Estrogens and Androgens

Question 1

26.1 A 53-year-old woman has severe vasomotor symptoms
(hot flushes) associated with menopause. She has no
pertinent past medical or surgical history. Which of the
following would be most appropriate for her symptoms?
A. Conjugated estrogens vaginal cream.
B. Estradiol transdermal patch.
C. Oral estradiol and medroxyprogesterone acetate.
D. Injectable medroxyprogesterone acetate.

Answer 1

Correct answer = C. Estrogen vaginal cream only treats
vaginal symptoms of menopause such as vaginal atrophy
and does not treat hot flushes. Since this patient has an
intact uterus, a progestin such as medroxyprogesterone
needs to be used along with the estrogen to prevent the
development of endometrial hyperplasia. Unopposed estrogen
(for example, the estradiol transdermal patch) should
not be used. Injectable medroxyprogesterone acetate is
used for contraception.

Question 2

26.2 A 70-year-old woman is being treated with raloxifene for
osteoporosis. Which of the following is a concern with
this therapy?
A. Breast cancer.
B. Endometrial cancer.
C. Venous thrombosis.
D. Hypercholesterolemia.

Answer 2

Correct answer = C. Raloxifene can increase the risk of
venous thromboembolism. Unlike estrogen and tamoxifen,
raloxifene does not result in an increased incidence of endometrial
cancer. Raloxifene lowers the risk of breast cancer
in high-risk women, and it also lowers LDL cholesterol.

Question 3

26.3 Which of the following is the most appropriate oral
contraceptive for a patient with moderate acne?
A. Ethinyl estradiol/levonorgestrel.
B. Ethinyl estradiol/norethindrone acetate.
C. Ethinyl estradiol/norgestimate.
D. Ulipristal.

Answer 3

Correct answer = C. The progestins levonorgestrel and norethindrone
acetate may have androgenic activity and contribute
to acne. Norgestimate has less androgenic activity
and is preferred for this patient. Ulipristal is an emergency
contraceptive and should not be used as a regular method
of contraception.

Question 4

26.4 A 26-year-old female is using injectable medroxyprogesterone
acetate as a method of contraception.
Which of the following adverse effects is a concern if she
wishes to use this therapy long-term?
A. Hyperkalemia.
B. Male pattern baldness.
C. Osteoporosis.
D. Weight loss.

Answer 4

Correct answer = C. Medroxyprogesterone acetate may
contribute to bone loss and predispose patients to osteoporosis
and/or fractures. Therefore, the drug should not be
continued for more than 2 years if possible. The drug often
causes weight gain, not weight loss. The other adverse
effects are not associated with medroxyprogesterone.