Endocrine

Question 1

The adrenal medulla is responsible for secreting ____ and ____.

Answer 1

Epinephrine and Norepinephrine

Question 2

The adrenal cortex secretes ______ and _____.

Answer 2

Corticosteroids and androgens

Question 3

What effect does cortisol have on glucose levels?

Answer 3

Increases glucose levels

Question 4

What are the cardiovascular effects of cortisol?

Answer 4

Increased CO and vasoconstriction

Question 5

What is the effect that cortisol has on the fetus?

Answer 5

Induced fetal lung surfactant secretion

Question 6

What are some of the physical findings of excess cortisol?

Answer 6

Buffalo hump, muscle wasting, moon face, striae, poor wound healing

Question 7

What are some of the physical findings of too little cortisol?

Answer 7

Bronze pigmentation of the skin, changes in body hair distribution, GI disturbances, weakness, weight loss

Question 8

What type of receptor is activated via glucticocorticoids?

Answer 8

intracellular nuclear transcription factor receptors

Question 9

What is the response of glucocorticoid receptor activation?

Answer 9

Up or down regulation of specific genes

Question 10

How is the metabolism of glucocorticoids slowed down?

Answer 10

Increasing oral effectiveness, increase the potency, increase the duration of action

Question 11

What drug is used in endocrine replacement therapy?

Answer 11

Hydrocortisone

Question 12

What receptors does hydrocortisone active?

Answer 12

GC and MC

Question 13

What is the duration of hydrocortisone?

Answer 13

8-12 hrs (short acting)

Question 14

How is prednisone different than hydrocortisone?

Answer 14

Intermediate acting (18-36 hrs), partially GC selective, slower metabolism

Question 15

Which glucocorticoid is the longest acting?

Answer 15

Dexamethasone

Question 16

Which GC drug is MC selective?

Answer 16

Fludrocortisone

Question 17

What properties make dexamethasone long acting (36-54 hrs)?

Answer 17

Low protein binding (higher free drug concentration); slower metabolism

Question 18

When would fludrocortisone be used?

Answer 18

adrenal failure, 21-hydroxylase deficiency

Question 19

Which drug is a MC antagonist?

Answer 19

Spironolactone

Question 20

What is the MOA for decreasing redness and swelling of GC?

Answer 20

Vasoconstriction, decrease vascular permeability, decrease histamine release

Question 21

What is the MOA of how GC decrease fever and pain?

Answer 21

Inhibition of arachidonic acid metabolism which decreases prostaglandins and leukotrienes

Question 22

What is the cause of the poor wound healing of excess GCs?

Answer 22

Decreased fibrin and collagen formation

Question 23

Why is risk of infection a side effect of GC use?

Answer 23

suppression of the immune system via decreased leukocytes and inhibition of the neutrophils

Question 24

Describe the proper ways to dose GCs?

Answer 24

Short term –> high dose or Long term–> low dose

Question 25

Describe the feedback regulation effects of GC?

Answer 25

Suppression of the HPA axis which suppresses ACTH release

Question 26

How are the GCs excreted?

Answer 26

Via the kidney

Question 27

Side effects of MC receptor activation?

Answer 27

Hypernatremia, hypokalemia, edema, hypertension

Question 28

What is the rate limiting step in TH synthesis?

Answer 28

The conversion of iodide to iodine via perioxidase

Question 29

Long duration of action of levothyroxine (T4) is due to which factor?

Answer 29

highly protein bound

Question 30

Slow onset of levothyroxine is due to what?

Answer 30

Conversion to T3 in the body

Question 31

Why is liothyroine rapid onset?

Answer 31

less protein-bound and more potent

Question 32

When should liothyroine be considered?

Answer 32

prior and following radioiodine treatment, TSH suppression

Question 33

Why is there a slow onset with thyroid drugs?

Answer 33

it takes time to empty the plasma binding sites since the effects are mediated by protein synthesis and resetting metabolism

Question 34

What drug interactions are present with thyroid drugs?

Answer 34

degradation of vitamin K dependent clotting factors (interfere with warfarin); Increase cardiac responsiveness to catecholamines

Question 35

What drug is used to treat the sympathetic stimulation of hyperthryoidism?

Answer 35

propranolol

Question 36

Methimazole and Propylthiouracil belong to which drug class?

Answer 36

Thioamides

Question 37

What enzyme is inhibited by the thioamides?

Answer 37

Perioxidase

Question 38

How do PTU and methimazole work to control TH?

Answer 38

decrease the synthesis by interfering with iodination and the coupling steps

Question 39

What is a major adverse effects of the hyperthyroid drugs?

Answer 39

Agranulocytosis

Question 40

Which is the more potent of the thioamides?

Answer 40

Methimazole

Question 41

Why is methimazole preferred over PTU?

Answer 41

longer plasma half life and duration and no liver toxicity

Question 42

When is PTU used over methamazole?

Answer 42

First trimester of pregnancy and thyroid storms

Question 43

How does potassium iodide differ from PTU and methimazole in controlling TH?

Answer 43

Inhibits synthesis and release of TH

Question 44

What is PTU mechanism of action in regards to T4 and T3?

Answer 44

Inhibition of T4 conversion to T3

Question 45

When is potassium iodide used most often?

Answer 45

decrease size and vascularity of the thyroid gland prior to a thyroidectomy

Question 46

When shouldn't potassium iodide be used?

Answer 46

prior to radio-iodine therapy

Question 47

When is radioactive iodine contraindicated?

Answer 47

pregnancy, breast-feeding, young children, salivary adenitis, radiation thyroiditis

Question 48

Explain why thioamides are used with radioactive iodine.

Answer 48

Decreases in TH will cause an increase in TSH which will lead to more thyroid activity so more of the radio-active iodine will be taken up into the thyroid

Question 49

In treating a thyroid storm, what drugs are used and why?

Answer 49

Iodides--decrease release of preformed TH; PTU--decrease synthesis and conversion of T3 from T4; Glucocorticoids--prevent shock and slow conversion; Propanolol--symptomatic relief of sympathetic effects

Question 50

Sex hormones bind to which kind of receptor?

Answer 50

Nuclear transcription factor receptor

Question 51

What effect does estrogen have on cholesterol?

Answer 51

Increase HDL and decrease LDL

Question 52

What effect does estrogen have on the CV system?

Answer 52

Increased clotting factors, decreased fibrinogen, antithrombin, and protein S, plasminogen activator type I

Question 53

What effect does estrogen have on the bones?

Answer 53

Increased bone mineral density, bone maturation, closure of the epiphyseal plates

Question 54

What are the therapeutic uses of estrogen?

Answer 54

Replacement therapy, post menopause or after oophorectomy, suppressive therapy

Question 55

What are the three types of estrogens used in drugs?

Answer 55

Estradiol, Conjugated estrogens, Ethinyl Estradiol

Question 56

When are progestins used?

Answer 56

Replacement therapy and suppressive therapy

Question 57

Which progestin have little to no androgen effects?

Answer 57

Medroxyprogesterone acetate

Question 58

Which progestin is structurally related to testosterone?

Answer 58

Norethindrone

Question 59

What side effects are strictly related to norethindrone?

Answer 59

Acne, weight gain, masculinization, altered libido

Question 60

What symptoms are relieved in HRT for post menopausal women?

Answer 60

vasomotor, urogenital atrophy, psychological

Question 61

What are the risks of long-term HRT?

Answer 61

increased risk of heart disease, strokes, PE, breast cancer, endometrial cancer (E only)

Question 62

How do SERMs work?

Answer 62

Agonist and antagonist effects at estrogen receptors depending on the receptor conformation which will active different response elements

Question 63

What are the two SERM drugs?

Answer 63

Raloxifene and Tamoxifen

Question 64

How do the SERM drugs differ in their effects?

Answer 64

Raloxifene is an antagonist in both the breast and uterus (reducing risk) and Tamoxifen is only antagonizing in breast tissue and agonizing in the endometrial tissues

Question 65

In the combo contraceptives, what is the estrogen component?

Answer 65

Ethinyl estradiol

Question 66

What is the progestin component in COC?

Answer 66

norethinadrone

Question 67

How do COC work to disrupt the cycle?

Answer 67

increase estrogen levels which negatively inhibit the hypothalamus and anterior pituitary to release less FSH and LH = no follicular development

Question 68

What is the primary way that COC work to stop pregnancy from occurring?

Answer 68

Prevent ovulation

Question 69

What are the secondary ways that COC work to inhibit pregnancy?

Answer 69

thickening of the cervical mucus

Question 70

Which progestin components avoid the masculinizing effects?

Answer 70

Norethynodrel, norgestimate, drospirenone

Question 71

Which progestin is anti-androgenic?

Answer 71

drospirenone

Question 72

Which progestins have androgenic side effects?

Answer 72

Norethindrone, levonorgesterol

Question 73

When would you need to consider back up contraceptives when using COCs?

Answer 73

Missed 2 or more consecutive doses

Question 74

When will menses and fertility return after discontinuation of COCs?

Answer 74

30 days and 90 days

Question 75

What lifestyle factors increase risk of thromboembolism in patients using COCs?

Answer 75

over the age of 35 and smoking history

Question 76

Why do COCs have many drug interactions?

Answer 76

they are metabolized by the liver

Question 77

What are absolute contraindications of using COCs?

Answer 77

Pregnancy, estrogen-responsive tumors, tobacco smoking over the age of 35

Question 78

What are the progestin only slow release drugs used?

Answer 78

Levonorgestral, etonogestral, medroxyprogesterone acetate

Question 79

What are the progestin only oral drugs?

Answer 79

Norethindrone, drosperinone

Question 80

When would an progestin only oral drug be used?

Answer 80

when estrogen is contraindicated and greater chance of pregnancy is acceptable

Question 81

How does norethindrone stop pregnancy?

Answer 81

inhibition of fertilization and implantation

Question 82

How does drosperinone stop pregnancy?

Answer 82

inhibition of ovulation

Question 83

What is the MOA of the emergency contraceptive drugs?

Answer 83

inhibition or delay of ovulation; inhibition of fertilization but not implantation (DOESN'T AFFECT AN ESTABLISHED PREGNANCY)

Question 84

What are the two options of emergency contraceptive drugs?

Answer 84

Levonorgestral, ulipristal

Question 85

What is the MOA of ulipristal?

Answer 85

Mixed agonist/antagonist actions at progestin receptors to delay ovulation

Question 86

Which emergency contraceptive is sold over the counter?

Answer 86

Levonorgestral

Question 87

How long after unprotected sex can ulipristal be used to impede ovulation?

Answer 87

up to 5 days