I. Start the exam by click the “Start” button
Endocrine and Reproductive Pharmacology- Part 1
See all quizzes of the Endocrine and Reproductive Pharmacology at here:
II. Preview all questions below
1.The attending in the endocrine/metabolic diseases cl inic prescribes colesevelam as add-on therapy for a 58-year-old male with type 2 diabetes who i s not getting adequate glycemic control (based on high levels of HbA1c measured twice in the last 12 months) from his current medications: metformin and The man has been a pack-a-day cigarette smoker for 40 years and says he “can’t seem to quit.” In addition to the diabetes and nicotine addiction he has several other comorbidities that are not optimally managed with his current medications for each, or recommended l i festyle modifications (he largely ignores them). The attending states that the cole-sevelam might just help one of those comorbidities in addition to possibly lowering HbA1c levels after a few months on the drug. What is the “other condition” that i s most l ikely to be favorably and rather directly influenced by the colesevelam?
- Chronic bronchitis (or emphysema)
- Hyperuricemia, gout
- Nicotine addiction
- Prostatism (ie, benign prostatic hypertrophy)
2. Your patient, who is taking an oral contraceptive, has heard about and asks about the risk of thromboembolism as a result of taking these To reduce the ri sk of this potentially severe adverse hematologic response, but sti l l provide reasonably effective contraception, what would you prescribe?
- A combination product with a higher estrogen dose
- A combination product with a higher progestin dose
- A combination product with a lower estrogen dose
- A combination product with a lower progestin dose
- A product that contains only estrogen
3. A 27-year-old woman i s diagnosed with hypercortism. To determine whether cortisol production i s independent of pituitary gland control, you decide to suppress ACTH production by giving a high-potency Which drug would be the best choice for this purpose?
4. A patient with Cushing syndrome i s being treated by X-irradiation of the It may take several months of this therapy for adequate symptomatic and metabolic improvement. Until that time, which drug would be administered to suppress glucocorticoid synthesis?
- Cortisol (massive doses)
5. A woman who has been taking an oral contraceptive (estrogen plus progestin) for several years i s diagnosed with epilepsy and started on What i s the most l ikely consequence of adding the phenytoin?
- Agranulocytosis or aplastic anemia, requiring stopping both drugs immediately
- Breakthrough seizures from increased phenytoin clearance
- Phenytoin toxicity, s ignificant and of fast onset
- Profoundly increased ri sk of craniofacial abnormalities in the fetus Reduced contraceptive efficacy
- Thromboembolism from the estrogen component of the contraceptive
6. A woman wants a prescription for an oral contraceptive, and your choice i s between an estrogen-progestin combination and a “minipill” (progestin only). Compared with a hormone combination product, what i s the main difference that would occur when a progestin-only approach i s used?
- Better contraceptive efficacy
- Direct spermicidal effects
- Higher ri sk of thromboembolism
- More menstrual i rregularities (i rregular cycle length, amenorrhea, spotting, etc)
- Poorer compliance due to taking the drug on an i rregular cycle, rather than daily
7. A woman i s taking a combination estrogen-progestin combination oral She experiences a multitude of s ide effects. Which s ide effect i s most l ikely due to what can be described as an “estrogen excess,” and not l ikely due to the progestin content of the medication?
- Increased appetite
- Weight gain
8. A comatose patient with an endocrine disorder undergoes a computed tomography (CT) diagnostic procedure that involves contrast media that has a tendency to induce lactic He i s also taking a drug that, in i ts own right, may cause lactic acidosis. Normally the drug would be stopped, at least temporarily, two days before the CT, but due to the patient’s acute and serious i l lness that could not be done. Lactic acidosis indeed develops and the patient nearly dies. Which drug was the most l ikely cause of this severe and potentially fatal metabolic derangement?
- Insulin glargine, prescribed for type 1 diabetes mellitus
- Levothyroxine, prescribed to maintain euthyroid status following thyroidectomy
- Metformin, prescribed for type 2 diabetes mellitus
- Propylthiouracil, prescribed for hyperthyroidism
- Spironolactone, prescribed for an adrenal cortical tumor
9. A patient with type 2 diabetes mellitus begins gaining weight after several months of therapy with an oral antidiabetic A complete work-up indicates edema and other s igns and symptoms of heart failure. Which antidiabetic drug or group was the most l ikely cause?
- Sulfonylureas, both fi rst- and second-generation agents (eg, tolbutamide, chlorpropamide, glyburide, gl ipizide)
10. A woman goes into premature labor early enough that there are great concerns about inadequate fetal lung development and the ri sk of fetal respiratory distress Suitable uterine-relaxing drug therapy i s started to s low labor, but parturition seems imminent. What other adjunct should be administered prepartum, specifically for the purpose of reducing the ri sks and complications of the newborn’s immature respiratory system development?
- Albuterol (β2 agonist)
- Ergonovine (or methylergonovine)
- Magnesium sulfate
11. We prescribe etidronate for a postmenopausal woman who i s at great ri sk for developing for Which s ide effect or adverse response to this drug i s the patient most l ikely to experience?
- Fluid/electrolyte loss from profuse diarrhea
- Hepatic necrosis
- Renal damage from calcium stone formation
12. A 75-year-old man had surgery for prostate carcinoma, and local metastases were found intraoperatively. What i s the most appropriate follow-up drug aimed at treating the metastases?
13. A 53-year-old woman with type 2 diabetes mellitus i s started on Diet, exercise, and usually effective doses of metformin have not provided adequate glycemic control based on periodic measurements of HbA1c. What i s the primary mechanism by which the glyburide i s l ikely to provide better glycemic control?
- Decrease insulin resistance by lowering body weight
- Enhance renal excretion of glucose
- Increase insulin synthesis
- Promote glucose uptake by muscle, l iver, and adipose ti ssue via an insulin-independent process
- Release insulin from the pancreas
14. A 75-year-old woman with type 2 diabetes i s taking an oral anti-diabetic One day she goes without eating for 18 hours, but takes her drug nonetheless. She i s transported to the emergency after passing out. Her plasma glucose concentration i s 48 mg/dL (hypoglycemic) upon arrival at the ED, and she i s in very serious condition. Which drug, that most l ikely aggravated this fasting hypoglycemia, did she take?
15. A man with type 2 diabetes i s receiving a combination of oral drugs to maintain glycemic He becomes hypoglycemic one afternoon and ingests some orange juice and two chocolate bars—all containing abundant amounts of complex carbohydrates. Despite his ingestion of orange juice and several chocolate bars, his blood glucose levels remain low, his symptoms persist. Which antidiabetic that he was taking accounted for the failure of oral sugars to restore his plasma glucose?
16. A 35-year-old woman has Graves disease, a small goiter, and symptoms that are deemed “mild-to-moderate.” Propylthiouracil i s What i s the most serious adverse response to this drug, for which close monitoring i s required?
- Cholestatic jaundice
- Renal tubular necrosis Rhabdomyolysis
- Thyroid cancer
17. A 60-year-old man with type 2 diabetes mellitus i s treated with pioglitazone (in addition to a proper diet and exercise). Which phrase summarizes best this drug’s main mechanism of action?
- Blocks intestinal carbohydrate absorption
- Causes glycosuria (increased renal glucose excretion)
- Increases hepatic gluconeogenesis
- Increases release of endogenous insulin
- Increases target ti ssue sensitivity to insulin
18. A patient with a history of type 2 diabetes mellitus presents in the ED. His complaints include nonspecific gastrointestinal symptoms, including nausea and He states he i s bloated and has abdominal pain. His appetite has been suppressed for several days. He has malaise and difficulty breathing. His l iver i s enlarged and tender; l iver function tests indicate hepatic damage. Plasma bicarbonate i s low and lactate levels are high. Kidney function i s falling rapidly.
The diagnosis i s lactic acidosis, and the suspicion i s that i t was caused by an antidiabetic drug. Which of the following drugs i s this patient most l ikely to be taking?
19. A patient i s transported to the ED shortly after taking a massive overdose of her levothyroxine in an apparent suicide Which of the following drugs should be administered for prompt control of the hormone-related effects that are most l ikely to lead to her death i f not correctly managed?
- Radioiodine (131I)
20. There are two main formulations of oral contraceptives: those that are estrogen-progestin combinations, and those that contain only progestin (“minipill”). What i s the main mechanism by which these drugs exert their desired contraceptive effects?
- Acidify the cervical mucus, thereby making the mucus spermicidal
- Displace/detach a fertilized egg from the endometrium
- Inhibit nidation (implantation of a fertilized ovum)
- Inhibit ovulation
- Reduce uterine blood flow such that the fertilized ovum becomes hypoxic and dies
21. A 55-year-old postmenopausal woman develops weakness, polyuria, polydipsia, and s ignificant increases of plasma creatinine A computed tomogram (CT scan) indicates nephrocalcinosis. A drug i s considered to be the cause. Which drug was most l ikely responsible?
- Vitamin D
22. A patient has severe Cushing Surgery cannot be scheduled for several months, so the physician plans to treat the patient in the interim with a drug that she describes as a “potent inhibitor of corticosteroid synthesis.” Which drug best fi ts that description?
23. You prescribe bromocriptine for a woman with primary Normal menstruation returns about a month after starting therapy. Which statement best describes the mechanism by which bromocriptine caused i ts desired effects?
- Blocked estrogen receptors, enhanced gonadotropin release
- Increased follicle-stimulating hormone (FSH) synthesis
- Inhibited prolactin release
- Stimulated ovarian estrogen and progestin synthesis
- Stimulated gonadotropin-releasing hormone (GnRH) release
24. A patient has had his parathyroid glands excised during a total In addition to requiring supplemental thyroid hormone, interventions aimed at correcting hypoparathyroidism will be necessary. What i s the main physiologic action or role of parathyroid hormone—one that necessitates suitable therapy?
- Decreases active absorption of Ca from the small intestine
- Decreases excretion of phosphate
- Decreases renal tubular reabsorption of calcium
- Decreases resorption of phosphate from bone
- Increases mobilization of calcium from bone