21: Drugs affecting the Endocrine system

Question 1

1. Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:
2. Cortical bones
3. Femoral neck bones
4. Cervical vertebrae
5. Pelvic bones

Answer 1

2. Femoral neck bones

Question 2

2. Bisphosphonates treat or prevent osteoporosis by:
3. Inhibiting osteoclastic activity
4. Fostering bone resorption
5. Enhancing calcium uptake in the bone
6. Strengthening the osteoclastic proton pump

Answer 2

1. Inhibiting osteoclastic activity

Question 3

3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?
4. Selective estrogen receptor modulators
5. Aspirin
6. Glucocorticoids
7. Calcium supplements

Answer 3

3. Glucocorticoids

Question 4

4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of:
5. Lipase
6. Protease
7. Amylase
8. Pancreatin

Answer 4

1. Lipase

Question 5

5. Brands of pancreatic enzyme replacement drugs are:
6. Bioequivalent
7. About the same in cost per unit of lipase across brands
8. Able to be interchanged between generic and brand-name products to reduce cost
9. None of the above

Answer 5

2. About the same in cost per unit of lipase across brands

Question 6

6. When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?
7. 15 to 30 minutes
8. 60 to 90 minutes
9. 3 to 4 hours
10. 6 to 8 hours

Answer 6

2. 60 to 90 minutes

Question 7

7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:
8. “Fruity” breath odor and rapid respiration
9. Diarrhea, abdominal pain, weight loss, and hypertension
10. Dizziness, confusion, diaphoresis, and tachycardia
11. Easy bruising, palpitations, cardiac dysrhythmias, and coma

Answer 7

3. Dizziness, confusion, diaphoresis, and tachycardia

Question 8

8. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:
9. Increase blood glucose levels
10. Produce unexplained diaphoresis
11. Interfere with the ability of the body to metabolize glucose
12. Mask the signs and symptoms of altered glucose levels

Answer 8

4. Mask the signs and symptoms of altered glucose levels

Question 9

9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?
10. Optimal time of preprandial injection is 15 minutes.
11. Duration of action is increased when the dose is increased.
12. It is compatible with neutral protamine Hagedorn insulin.
13. It has no pronounced peak.

Answer 9

2. Duration of action is increased when the dose is increased.

Question 10

10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
11. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
12. The initial dose of glargine is 2 to 10 units per day.
13. Patients who have been on high doses of NPH will need tests for insulin antibodies.
14. Obese patients may require more than 100 units per day.

Answer 10

1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.

Question 11

11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
12. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
13. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
14. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
15. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.

Answer 11

3. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.

Question 12

12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:
13. Substitutes for insulin usually secreted by the pancreas
14. Decreases glycogenolysis by the liver
15. Increases the release of insulin from beta cells
16. Decreases peripheral glucose utilization

Answer 12

2. Decreases glycogenolysis by the liver

Question 13

13. Prior to prescribing metformin, the provider should:
14. Draw a serum creatinine to assess renal function
15. Try the patient on insulin
16. Tell the patient to increase iodine intake
17. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions

Answer 13

1. Draw a serum creatinine to assess renal function

Question 14

14. The action of “gliptins” is different from other antidiabetic agents because they:
15. Have a low risk for hypoglycemia
16. Are not associated with weight gain
17. Close ATP-dependent potassium channels in the beta cell
18. Act on the incretin system to indirectly increase insulin production

Answer 14

4. Act on the incretin system to indirectly increase insulin production

Question 15

15. Sitagliptin has been approved for:
16. Monotherapy in once-daily doses
17. Combination therapy with metformin
18. Both 1 and 2
19. Neither 1 nor 2

Answer 15

3. Both 1 and 2

Question 16

16. GLP-1 agonists:
17. Directly bind to a receptor in the pancreatic beta cell
18. Have been approved for monotherapy
19. Speed gastric emptying to decrease appetite
20. Can be given orally once daily

Answer 16

1. Directly bind to a receptor in the pancreatic beta cell

Question 17

17. Avoid concurrent administration of exenatide with which of the following drugs?
18. Digoxin
19. Warfarin
20. Lovastatin
21. All of the above

Answer 17

4. All of the above

Question 18

18. Administration of exenatide is by subcutaneous injection:
19. 30 minutes prior to the morning meal
20. 60 minutes prior to the morning and evening meal
21. 15 minutes after the evening meal
22. 60 minutes before each meal daily

Answer 18

2. 60 minutes prior to the morning and evening meal

Question 19

19. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:
20. Tinnitus and decreased salivation
21. Fever and sore throat
22. Hypocalcemia and osteoporosis
23. Laryngeal edema and difficulty swallowing

Answer 19

2. Fever and sore throat

Question 20

20. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:
21. Excessive sedation
22. Tachycardia and angina
23. Weight gain
24. Cold intolerance

Answer 20

2. Tachycardia and angina

Question 21

21. Which of the following is not an indication that growth hormone supplements should be discontinued?
22. Imaging indication of epiphyseal closure
23. Growth curve increases have plateaued
24. Complaints of mild bone pain
25. Achievement of anticipated height goals

Answer 21

3. Complaints of mild bone pain

Question 22

22. Besides osteoporosis, IV bisphosphonates are also indicated for:
23. Paget’s Disease
24. Early osteopenia
25. Renal cancer
26. Early closure of cranial sutures

Answer 22

1. Paget’s Disease

Question 23

23. What is the role of calcium supplements when patients take bisphosphonates?
24. They must be restricted to allow the medication to work.
25. They must be taken in sufficient amounts to provide foundational elements for bone growth.
26. They must be taken at the same time as the bisphosphonates.
27. They only work with bisphosphonates if daily intake is restricted.

Answer 23

2. They must be taken in sufficient amounts to provide foundational elements for bone growth.

Question 24

24. Which of the following statements about pancreatic enzymes is true?
25. Dosing may be titrated according to the decrease of steatorrhea.
26. The amount of carbohydrates in the meal drives the amount of enzyme used.
27. The amount of medication used is increased with a cystic fibrosis pulmonary flare.
28. The FDA and Internet-available formulations are bioequivalent.

Answer 24

1. Dosing may be titrated according to the decrease of steatorrhea.

Question 25

25. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?
26. Paget’s disease
27. Pulmonary cancers
28. Gallbladder surgery
29. Some bariatric surgeries

Answer 25

4. Some bariatric surgeries