Womens Health NURS 5334 UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Estrogen Systemic Effects - CORRECT ANSWER - Estrogen also have an important
roles glucose homeostasis. Estrogens have a positive effect on bone by blocking bone resorption.
Estrogens also promote mineral deposition in bone. Estrogens lower CV risk by decreasing
vasoconstriction by activating vascular smooth muscle and they lower LDL and raise HDL. They
promote blood coagulation. Estrogens have a neuroprotective effect by defending neurons from
the effects of oxidative stress and injury. Estrogens preserve cognitive function, enhance short-
term memory and regulate mood. Estrogens have an active role in maintaining glucose levels.
Therapeutic uses of estrogens - CORRECT ANSWER - menopausal hormone therapy
(HT)
female hypgonadism
acne (oral contraceptives)
cancer palliation
gender affirmation therapy for transgender women
Estrogen AE - CORRECT ANSWER - endometrial hyperplasia, endometrial cancer
;breast cancer; CV thromboembolic events/ gallbladder disease, jaundice, headache; nausea,
fluid retention, and chloasma.
Estrogen Contraindications - CORRECT ANSWER - Estrogens should not be taken by
patients with a history of deep vein thrombosis (DVT), pulmonary embolus, or conditions such
as stroke or myocardial infarction (MI) that occurred secondary to a thromboembolic event. They
should not be prescribed to women who are pregnant or who have vaginal bleeding without a
known cause. Patients with a history of liver disease, estrogen-dependent tumors, or breast
cancer (except when indicated for management) also should not take estrogens.
Estrogen D/I - CORRECT ANSWER - major substrates of CYP1A2 and CYP3A4.
Inducers of these isoenzymes may lower estrogen levels, whereas drugs that are inhibitors may
raise estrogen levels. In addition, they may decrease the effectiveness of some antidiabetic drugs
,and thyroid preparations. Estrogens can also interact with anticoagulants and other drugs that
affect clotting.
Estrogen type of forms - CORRECT ANSWER - Estrogen is available in conjugated and
esterified forms. Esterified estrogens are plant based; conjugated estrogens are natural
preparations derived from the urine of pregnant horses. Until mid-2016, synthetic conjugated
estrogens A (Cenestin) and B (Enjuvia) were available; however, the manufacturer has
withdrawn them from the market.
Phytoestrogens and types - CORRECT ANSWER - plant-based compounds that have
weak estrogenic activity. There are three types: isoflavones, lignins, and coumestans.
Phytoestrogens uses - CORRECT ANSWER - Phytoestrogens are commonly used by
women as a "natural" way to manage symptoms associated with menopause.
Phytoestrogens risks - CORRECT ANSWER - Phytoestrogens are not as potent as
estradiol, but they carry some of the same risks. Women should not use phytoestrogens if they
have a history of thromboembolic events or a personal or family history of breast, uterine, or
ovarian cancer.
Selective estrogen receptor modulators (SERMs) uses - CORRECT ANSWER - are drugs
that activate ERs in some tissues and block them in others. These drugs were developed in an
effort to provide the benefits of estrogen (e.g., protection against osteoporosis, maintenance of
the urogenital tract, reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion
of breast cancer, uterine cancer, and thromboembolism). None of these offers all of the benefits
of estrogen, and none avoids all of the drawbacks.
SERMs available - CORRECT ANSWER - Four SERMs are available in the United
States: tamoxifen (Nolvadex-D), toremifene (Fareston), raloxifene (Evista), and bazedoxifene
(Duavee).
Tamoxifen - CORRECT ANSWER - the first SERM to be widely used. By blocking ERs,
tamoxifen (and its active metabolite, endoxifen) can inhibit cell growth in the breast. As a result,
the drug is used extensively to prevent and treat breast cancer. Unfortunately, blockade of ERs
, also produces hot flashes. By activating ERs, tamoxifen protects against osteoporosis and has a
favorable effect on serum lipids. However, receptor activation also increases the risk for
endometrial cancer and thromboembolism.
toremifene - CORRECT ANSWER - (a close relative of tamoxifen) is only used for
chemotherapy.
Raloxifene vs tamoxifen - CORRECT ANSWER - very similar to tamoxifen. The
principal difference is that raloxifene does not activate ERs in the endometrium and hence does
not pose a risk for uterine cancer. Like tamoxifen, raloxifene protects against breast cancer and
osteoporosis, increases the risk for thromboembolism, and induces hot flashes.
Raloxifene uses - CORRECT ANSWER - is approved only for prevention and treatment
of osteoporosis and for prevention of breast cancer in high-risk women.
Duavee uses - CORRECT ANSWER - In 2013 the FDA approved Duavee (conjugated
estrogens/bazedoxifene) for prevention of vasomotor symptoms and osteoporosis in
postmenopausal women with a uterus. Duavee is the first drug to combine estrogen with an
estrogen agonist/antagonist (bazedoxifene). The bazedoxifene component of Duavee reduces the
risk for excessive growth of the lining of the uterus that can occur with the estrogen component.
Duavee contraindications - CORRECT ANSWER - Contraindications to taking Duavee
are the same as for other estrogen-containing products. Should not be taken by patients with a
history of deep vein thrombosis (DVT), pulmonary embolus, or conditions such as stroke or
myocardial infarction (MI) that occurred secondary to a thromboembolic event. They should not
beprescribed to women who are pregnant or who have vaginal bleeding without a known cause.
Patients with a history of liver disease, estrogen-dependent tumors, or breast cancer (except
when indicated for management) also should not take estrogens.
progesterone function - CORRECT ANSWER - If implantation of a fertilized ovum does
not occur, progesterone production by the corpus luteum ceases and menstrual flow begins.
However, if implantation does take place, the developing trophoblast will produce its own
luteotropic hormone—human chorionic gonadotropin (hCG)—that will stimulate the corpus
luteum to continue making progesterone. For the first 7 weeks of gestation, the placenta depends
entirely on progesterone from the corpus luteum. However, between weeks 7 and 10, production
of progesterone is shared between the corpus luteum and placenta. After 10 weeks of gestation,
ACTUAL Exam Questions and CORRECT
Answers
Estrogen Systemic Effects - CORRECT ANSWER - Estrogen also have an important
roles glucose homeostasis. Estrogens have a positive effect on bone by blocking bone resorption.
Estrogens also promote mineral deposition in bone. Estrogens lower CV risk by decreasing
vasoconstriction by activating vascular smooth muscle and they lower LDL and raise HDL. They
promote blood coagulation. Estrogens have a neuroprotective effect by defending neurons from
the effects of oxidative stress and injury. Estrogens preserve cognitive function, enhance short-
term memory and regulate mood. Estrogens have an active role in maintaining glucose levels.
Therapeutic uses of estrogens - CORRECT ANSWER - menopausal hormone therapy
(HT)
female hypgonadism
acne (oral contraceptives)
cancer palliation
gender affirmation therapy for transgender women
Estrogen AE - CORRECT ANSWER - endometrial hyperplasia, endometrial cancer
;breast cancer; CV thromboembolic events/ gallbladder disease, jaundice, headache; nausea,
fluid retention, and chloasma.
Estrogen Contraindications - CORRECT ANSWER - Estrogens should not be taken by
patients with a history of deep vein thrombosis (DVT), pulmonary embolus, or conditions such
as stroke or myocardial infarction (MI) that occurred secondary to a thromboembolic event. They
should not be prescribed to women who are pregnant or who have vaginal bleeding without a
known cause. Patients with a history of liver disease, estrogen-dependent tumors, or breast
cancer (except when indicated for management) also should not take estrogens.
Estrogen D/I - CORRECT ANSWER - major substrates of CYP1A2 and CYP3A4.
Inducers of these isoenzymes may lower estrogen levels, whereas drugs that are inhibitors may
raise estrogen levels. In addition, they may decrease the effectiveness of some antidiabetic drugs
,and thyroid preparations. Estrogens can also interact with anticoagulants and other drugs that
affect clotting.
Estrogen type of forms - CORRECT ANSWER - Estrogen is available in conjugated and
esterified forms. Esterified estrogens are plant based; conjugated estrogens are natural
preparations derived from the urine of pregnant horses. Until mid-2016, synthetic conjugated
estrogens A (Cenestin) and B (Enjuvia) were available; however, the manufacturer has
withdrawn them from the market.
Phytoestrogens and types - CORRECT ANSWER - plant-based compounds that have
weak estrogenic activity. There are three types: isoflavones, lignins, and coumestans.
Phytoestrogens uses - CORRECT ANSWER - Phytoestrogens are commonly used by
women as a "natural" way to manage symptoms associated with menopause.
Phytoestrogens risks - CORRECT ANSWER - Phytoestrogens are not as potent as
estradiol, but they carry some of the same risks. Women should not use phytoestrogens if they
have a history of thromboembolic events or a personal or family history of breast, uterine, or
ovarian cancer.
Selective estrogen receptor modulators (SERMs) uses - CORRECT ANSWER - are drugs
that activate ERs in some tissues and block them in others. These drugs were developed in an
effort to provide the benefits of estrogen (e.g., protection against osteoporosis, maintenance of
the urogenital tract, reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion
of breast cancer, uterine cancer, and thromboembolism). None of these offers all of the benefits
of estrogen, and none avoids all of the drawbacks.
SERMs available - CORRECT ANSWER - Four SERMs are available in the United
States: tamoxifen (Nolvadex-D), toremifene (Fareston), raloxifene (Evista), and bazedoxifene
(Duavee).
Tamoxifen - CORRECT ANSWER - the first SERM to be widely used. By blocking ERs,
tamoxifen (and its active metabolite, endoxifen) can inhibit cell growth in the breast. As a result,
the drug is used extensively to prevent and treat breast cancer. Unfortunately, blockade of ERs
, also produces hot flashes. By activating ERs, tamoxifen protects against osteoporosis and has a
favorable effect on serum lipids. However, receptor activation also increases the risk for
endometrial cancer and thromboembolism.
toremifene - CORRECT ANSWER - (a close relative of tamoxifen) is only used for
chemotherapy.
Raloxifene vs tamoxifen - CORRECT ANSWER - very similar to tamoxifen. The
principal difference is that raloxifene does not activate ERs in the endometrium and hence does
not pose a risk for uterine cancer. Like tamoxifen, raloxifene protects against breast cancer and
osteoporosis, increases the risk for thromboembolism, and induces hot flashes.
Raloxifene uses - CORRECT ANSWER - is approved only for prevention and treatment
of osteoporosis and for prevention of breast cancer in high-risk women.
Duavee uses - CORRECT ANSWER - In 2013 the FDA approved Duavee (conjugated
estrogens/bazedoxifene) for prevention of vasomotor symptoms and osteoporosis in
postmenopausal women with a uterus. Duavee is the first drug to combine estrogen with an
estrogen agonist/antagonist (bazedoxifene). The bazedoxifene component of Duavee reduces the
risk for excessive growth of the lining of the uterus that can occur with the estrogen component.
Duavee contraindications - CORRECT ANSWER - Contraindications to taking Duavee
are the same as for other estrogen-containing products. Should not be taken by patients with a
history of deep vein thrombosis (DVT), pulmonary embolus, or conditions such as stroke or
myocardial infarction (MI) that occurred secondary to a thromboembolic event. They should not
beprescribed to women who are pregnant or who have vaginal bleeding without a known cause.
Patients with a history of liver disease, estrogen-dependent tumors, or breast cancer (except
when indicated for management) also should not take estrogens.
progesterone function - CORRECT ANSWER - If implantation of a fertilized ovum does
not occur, progesterone production by the corpus luteum ceases and menstrual flow begins.
However, if implantation does take place, the developing trophoblast will produce its own
luteotropic hormone—human chorionic gonadotropin (hCG)—that will stimulate the corpus
luteum to continue making progesterone. For the first 7 weeks of gestation, the placenta depends
entirely on progesterone from the corpus luteum. However, between weeks 7 and 10, production
of progesterone is shared between the corpus luteum and placenta. After 10 weeks of gestation,
