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Endocrine and Reproductive Pharmacology- Part 1
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1.A 55-year-old male patient with a 20-year history of type 2 diabetes mellitus comes to your cl inic for his regular check-up. He looks good, feels However, over the last year his HbA1c levels hovered around 9.5% (equivalent to an average plasma glucose of around 225 mg/dL). Current diabetes medications are metformin and glyburide. The patient says he i s doing “the best he can” with recommended diet and exercise plans. He has other personal and familial ri sk factors for coronary heart disease. He takes a statin and metformin to control his l ipids, but his LDL and triglyceride levels are far too high. He i s taking verapamil for Stage 1 hypertension, but his pressure i s sti l l higher than you’d l ike i t to be. Two years ago, he had severe angina from atherosclerotic coronary disease and underwent angioplasty and placement of a stent. He has had no i schemic episodes s ince.
You’re thinking about adding niacin to get further control of triglyceride levels, adding another antihypertensive drug, and adjusting his diabetes treatment by adding another hypoglycemic drug (perhaps insulin). Which comorbidity or other factor would weigh against your selection of an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) as the add-on antihypertensive drug for this patient?
- Bilateral renal artery stenosis and albuminuria
- Had two episodes of hyperosmolar hyperglycemic nonketotic syndrome in past 2 years
- Has heart failure
- Niacin will indeed be prescribed
2. A patient has an inoperable pancreatic i s let cell carcinoma and i s chronically Which drug would be most l ikely chosen for relatively long-term oral therapy that attempts to raise blood glucose levels into a more acceptable range?
- Atenolol (or metoprolol)
- Octreotide (somatostatin analog)
3. A patient with type 2 diabetes mellitus i s notoriously noncompliant with medication and diet However, he thinks he’s smart enough to fool the physician into thinking otherwise: he takes his medication and eliminates nearly all carbohydrate intake for a few days before each cl inic vis i t, knowing he will get a finger stick for a spot check of plasma glucose levels. What would be the s implest, most cost- effective, and most informative way for the physician to assess for past drug and diet compliance and long-term glycemic control?
- Glucose concentration in venous blood sample
- Glucose tolerance test (oral)
- Plasma levels of the antidiabetic drug
- Urine ketone levels (in a sample donated at the time of cl inic vis i t)
- Urine glucose levels
4. A 70-year-old man complains of progressive difficulty starting his urine stream, and having to get up several times during each night to Rectal examination reveals a generally enlarged, smooth-surfaced prostate. Prostate-specific antigen (PSA) ti ters are s ignificantly elevated. You decide to start finasteride treatment. Eventually urine flow increases, nocturesis episodes decrease, and overall prostate s i ze decreases. Which phrase best summarizes the most l ikely mechanism by which finasteride caused symptom relief?
- Blocks α-adrenergic receptors
- Blocks testosterone receptors
- Inhibits dihydrotestosterone synthesis
- Inhibits testosterone synthesis
- Lowers plasma testosterone levels by increasing i ts renal clearance
5. A 38-year-old woman presents in the endocrinology and metabolism cl inic One of the drugs she i s taking i s classified as a dipeptidyl peptidase-4 (DPP-4) inhibitor. Which statement best describes the main actions of this drug?
- Activates hydroxylases required for cortisol and aldosterone synthesis
- Cleaves active insulin from the proinsulin molecule
- Enzymatically splits levothyroxine from thyroglobulin
- Helps normalize physiologic release of estrogen and progesterone
- Inhibits inactivation of incretins, raises glucagon-like peptide levels
6. A 54-year-old woman who has not seen a physician for several years presents with a previously undiagnosed thyroid cancer and One drug that i s administered as part of early management, and may be l i fesaving, i s propranolol. Which of the following best summarizes the objective for administering this drug?
- Block parenchymal cell receptors for thyroid hormones
- Block thyroid hormone release by a direct effect on the gland
- Inhibit thyroid hormone synthesis
- Lessen dangerous cardiovascular s igns and symptoms of thyroid hormone excess
- Lower TSH levels
7. A woman deemed at high ri sk of postmenopausal osteoporosis i s started on What i s this representative bisphosphonate’s main mechanism of action?
- Activates vi tamin D and so facilitates absorption of dietary calcium
- Contains lots of calcium, which supplements dietary calcium intake
- Directly forms hydroxyapatite crystals in bone
- Provides supplemental phosphate, which indirectly elevates plasma Ca 2+
- Reduces the number and activity of osteoclasts in bone
8. Some patients who are taking high doses of a bisphosphonate for Paget disease of the bone develop an endocrine-metabolic What disorder would that be?
- Cushing disease (cushingoid symptoms)
- Diabetes insipidus
- Diabetes mellitus
9. Metyrapone i s useful in testing hyper- or hypo-function of certain endocrine conditions or biological processes those glands normally When we administer this drug for diagnostic purposes, which structure or function are we most l ikely assessing?
- α cells of pancreatic i s lets
- β cells of pancreatic i s lets
- Leydig cells of the testes
- Pituitary-adrenal axis
- Thyroid gland’s response to TSH
10. A 60-year-old man on long-term therapy with a drug develops hypertension, hyperglycemia, and decreased bone Blood tests indicate anemia. Some of his stool samples initially were positive for occult blood, and then the stool developed a “coffee-grounds” appearance. Which drug i s most l ikely responsible for the patient’s symptoms?
11. A woman with atrial fibrillation i s being treated long-term with amiodarone (and warfarin). This antiarrhythmic can cause biochemical changes and cl inical s igns and symptoms that resemble those associated with which endocrine disease/disorder?
- Addisonian cris i s
- Cushing syndrome
- Diabetes insipidus
- Diabetes mellitus Hypothyroidism
- Ovarian hyperstimulation syndrome
12. A 22-year-old woman has been sexually assaulted and she wishes to have the pregnancy terminated by pharmacologic What i s generally the most appropriate drug, assuming no contraindications?
- Ergonovine (or methylergonovine)
13. A patient has hyperthyroidism from a thyroid cancer, and the medical team concludes that oral radioiodine (sodium iodide 131 [131I]) i s the preferred treatment. The dosage i s calculated correctly, and the drug i s What statement about this approach i s also correct?
- A β-adrenergic blocker should not be used for symptom control i f or when 131I i s used
- Hyperthyroidism symptoms resolve almost completely within 24 to 48 hours after dosing with 131I
- Many patients treated with 131I develop metastatic nonthyroid cancers in response to the drug
- Oral antithyroid drugs should be administered up to and including the day of 131I administration
- There i s a high incidence of delayed hypothyroidism after using 131I for eradication of a thyroid tumor, and so thyroid hormone supplements may be needed later on
14. A 20-year-old woman, otherwise healthy, presents with i rregular and occasionally missed menstrual periods, oily facial skin and acne, and s l ight She was a competitive runner during high school and now i s in training for a triathlon. She i s not taking any medications other than an estrogen-progesterone oral contraceptive. A pelvic ultrasound evaluation reveals numerous immature ovarian follicles (generally but incorrectly referred to as cysts). The diagnosis i s polycystic ovarian syndrome (PCOS). Which drug would be the most rational initial therapy to prescribe to help provide symptom relief without compromising the woman’s ability to conceive?
- Estrogen (dose higher than in her oral contraceptive)
- Prednisone (or a s imilar oral glucocorticoid)
15. A 50-year-old woman with a high ri sk of breast cancer i s started on tamoxifen for What i s the main mechanism of action of this drug?
- Blocks estrogen receptors in breast ti ssue
- Blocks estrogen receptors in the endometrium
- Increases the ri sk of osteoporosis
- Raises plasma LDL cholesterol and total cholesterol, lowers HDL
- Reduces the ri sk of thromboembolic disorders
16. A 50-year-old woman i s recently diagnosed with type 2 diabetes Exercise and diet do not provide adequate glycemic control, so drug therapy needs to start. The physician contemplates prescribing metformin. Which statement about this drug i s correct?
- Beneficial and unwanted actions are unaffected by l iver function status
- Lactic acidosis occurs frequently, but i t i s seldom serious
- Metformin-induced hypoglycemia seldom occurs
- Useful for type 1 diabetes also
- Weight gain i s a common and unwanted s ide effect
17. Most therapeutic insulins nowadays are modifications of native human insulin, done by substituting some amino acids in the native protein using recombinant DNA For all these genetically modified insulins, what i s the one common result of such changes?
- Changes the onsets, durations of action
- Enables administration by either subcutaneous or intravenous routes
- Prevents cellular K+ uptake as glucose enters cells
- Reactivates endogenous (pancreatic) insulin synthesis
- Selectively affects glucose metabolism, l i ttle/no effects on l ipids
18. You have prescribed an oral agent to help control a patient’s blood glucose He has type 2 diabetes. In explaining how the drug works, you describe i t as a “starch blocker” that inhibits the intestinal uptake of complex carbohydrates in the diet. You advise also that flatus or some cramping or “grumbling sounds” in the belly may develop. Which drug fi ts this description?
- Any thiazolidinedione (“glitazone”)
19. A patient with type 1 diabetes i s being treated with insulin What cl inically important property sets this particular insulin apart, or otherwise differentiates i t, from nearly all the other insulin formulations that might be used instead?
- Blood levels, hypoglycemic effects, following insulin glargine injection are more accurately described as a plateau rather as a definite “spike” or peak
- Disulfiram-like reactions (acetaldehyde accumulation from inhibited EtOH metabolism) more common, severe, with insulin glargine
- Has an extremely fast onset, useful for immediate postprandial control of plasma glucose elevations
- Poses l i ttle or no ri sk of hypoglycemia i f the patient skips several meals in a row
- Sensitizes parenchymal cells to insulin (eg, the administered insulin i tself), not s imply providing or replacing insulin, thereby enhancing glycemic control
20. A patient presents in the emergency department (ED) with a massive overdose of a The most worrisome s igns and symptoms include excessive cardiac stimulation (severe tachycardia, palpitations, angina, etc). The ED physician orders IV administration a β-adrenergic blocker, saying (correctly) i t i s the only drug l ikely to normalize cardiac function quickly and save the patient’s l i fe. What was the most l ikely drug the patient overdosed on?
- A second-generation sulfonylurea (eg, gl ipizide, glyburide)
- Prednisone (oral glucocorticoid)
21. This week finds you accompanying an attending in her outpatient endocrinology cl One patient, a 56-year-old woman, i s taking exena- tide, which i s classified as an incretin mimetic. What phrase best describes exenatide’s actions or main cl inical use?
- Antagonizes testosterone effects, useful for treating hirsutism in men or women
- Is a new adjunct to metformin and/or sulfonylurea therapy of hyperthyroidism
- Often used as an add-on to a bisphosphonate for prophylaxis of postmeno-pausal osteoporosis
- Preferred stimulant of cortisol production for treating Addison disease
- Useful adjunct for some patients with poorly controlled type 2 diabetes mellitus
22. A patient with hypothyroidism following thyroidectomy will require l i felong hormone replacement What drug or formulation generally would be most suitable?
- Levothyroxine (T4)
- Thyroid, desiccated
23. A patient develops marked skeletal muscle tetany soon after a recent The attending confirms the diagnosis, in part, by l ightly tapping the patient’s cheek in front of the ear. Stimulating the facial nerves in this manner leads to spasms of the local (oris) muscle (Chvostek s ign). Which drug i s most l ikely to be chosen to manage this adverse response to surgery?
- Calcium gluconate
- Pl i camycin (mithramycin)
- PTH (parathyroid hormone)
- Vitamin D
24. A 40-year-old man with a symmetrically enlarged thyroid gland associated with elevated levels of T3 and T4 i s treated with propylthiouracil (PTU). Which phrase best summarizes the principal mechanism of action of PTU?
- Blocks iodide transport into the thyroid
- Increases hepatic metabolic inactivation of ci rculating T4 and T3
- Inhibits proteolysis of thyroglobulin
- Inhibits thyroidal peroxidase
- Releases T3 and T4 into the blood