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A 55-year-old woman comes to the physician because of hot flashes. She first noted them about 9 months ago, and since then they have been worsening. She states that the flashes come on at various times throughout the day, but that they are especially intense at night. She had her last menstrual period approximately 5 months ago. Her medical history is significant for a pulmonary embolus at the age of 36 and severe depression. She takes fluoxetine for depression and has no allergies to medications but smokes one pack of cigarettes per day. Physical examination is unremarkable, including a normal pelvic examination. Which of the following is the most appropriate pharmacotherapy for this patient?
A. Clonidine
B. Estrogen and progesterone
C. Estrogen only
D. Glucophage
E. Tamoxifen
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Not right. She had a history of a pulmonary embolus at the age of 36
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Thats what I thot. But why is D a choice here?
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Why D is one of the option? I don't know man! It was not me who created this Q. I don't know what it is.
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What I mean is what relation does it have to the questions stem?
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The correct answer is A. This patient has a presentation that is most consistent with perimenopausal hot flashes (or hot flushes as they are sometimes called). The exact pathophysiology that underlies the hot flash is not known. However, it is known that women at the menopause and men that undergo orchiectomies experience these symptoms. Therefore, it is assumed that it is the removal of normal levels of sex steroids from the circulation that results in the hot flash. These hot feelings are experienced as a flushing that can last from several seconds to many minutes. The first-line treatment for most women is with hormone replacement therapy. However, estrogen is contraindicated in this patient given her history of pulmonary embolus. The fact that she is a current smoker also places her at greater risk of developing a thrombus if she were to take hormones. Progestins alone have also been shown to relieve hot flashes; however, they may worsen depression and cause other mood changes in patients. Therefore an alternative treatment is needed for her. Clonidine has been used with some success by many women for relief from hot flashes. It is a blood pressure medication, but it has been shown to be effective against hot flashes when used in low doses.
Estrogen and progesterone (choice B) should not be used in this patient because of her history of a pulmonary embolus. Combined hormone replacement therapy has been shown to increase the risk of clot formation in patients. With her history and current smoking, this patient would be at a particularly increased risk.
Estrogen only (choice C) would be contraindicated in this patient for two reasons. First, her uterus is still in place, and unopposed estrogen would place her at greater risk for endometrial hyperplasia and cancer. Second, estrogen would increase this patient's risk of thrombus formation.
Glucophage (choice D) is an oral hypoglycemic medication used in patients with diabetes. It is not known to be effective for the treatment of hot flashes.
Tamoxifen (choice E) actually causes hot flashes in many patients and is not used to treat them.
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amygdala, that's called a distractor.
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:-)) There is no way one could be distracted by this choice fadd. Thanks.
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Then call it a badly constructed Q. Some of the Qs are silly like this.
