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Pharmacology 2 - Final Exam > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Name the (4) types of diabetes?

A
  1. Type 1
  2. Type 2
  3. Gestational
  4. Diabetes from other causes
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2
Q

All of the following statements about DM are true except?

A. Type 2 is known as NIDDM
B. Lack or decrease in insulin production
C. Results in a carbohydrate metabolism problem
D. Type 2 DM is also called Juvenile Diabetes
E. All are true

A

(D) type 2 DM is also called ADULT ONSET

Type 1 DM is referred to as Juvenile Onset or IDDM

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3
Q

Which DM Tx usually requires exogenous insulin administration?

A

Type 1 DM

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4
Q

True or False - Type 2 DM can sometimes be controlled by diet alone?

A

True

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5
Q

Which of the following statements is FALSE?

A. Gestational diabetes symptoms typically vanish after child delivery
B. Type 1 DM represents 5% of all diabetic patients
C. Diabetic ketoacidosis (DKA) is common in Type 1 DM
D. Type 1 DM may be a type of autoimmune response in which immune system attacks virus infected cells and pancreatic beta cells
E. CV disease is not a complication of DM

A

(E) - Cardiovascular disease IS a complication of DM.

In addition, hyperglycemia, DKA, retinopathy, nephropathy, atherosclerotic coronary and PAD, and peripheral and autonomic neuropathies are all considered complications of DM

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6
Q

What (4) symptoms of hyperglycemia would new diabetic patient that hasn’t been diagnosed with DM experience?

A
  1. polyuria
  2. polydipsia
  3. weight loss
  4. increase ketones in urine and blood
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7
Q

True or False - DKA predominantly occurs in patients with type 1 DM?

A

True - however it can occur in patients with type 2 DM

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8
Q

All of the following can precipitate DKA except?

A. lapse in insulin Tx
B. acute infection
C. HTN
D. trauma
E. stress
A

(C) HTN is NOT implicated in precipitating DKA in DM patients

Infarction can also precipitate DKA

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9
Q

Name the (5) symptoms of DKA and indicate which one is the main concern?

A
  1. polyuria
  2. N & V
  3. abdominal pain (children)
  4. fatigue
  5. somnolence possibly coma (MAIN CONCERN)
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10
Q

True or False - minimizing the fluctuations in blood sugar is the key factor in treating DM?

A

True

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11
Q

All the following statements regarding insulin are true except?

A. Prevents DKA
B. Produced by pancreatic beta cells of Islet of Langerhans
C. Human insulin is the same as horse insulin
D. Must be agitated to properly mix insulin in vial
E. There are only two types of human insulin available

A

(C) human insulin is DIFFERENT than horse insulin

Although very similar, each species has their own insulin

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12
Q

Cleavage of proinsulin forms what two products?

A
  1. insulin
  2. C-peptide

Initial problem with beef insulin products was some proinsulin left in vial and caused SE

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13
Q

Name the two human insulin products on the market today? Indicate which one is biosynthetic and which one is semi-synthetic

A
  1. Humulin ® (biosynthetic - 100% biotechnology)
  2. Novolin ® (semi-synthetic - starts with pork insulin then modified by biotechnology)

Since Novolin ® contains some pork products, there is still a small risk of allergies from the presence of proinsulin

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14
Q

All of the following statements are true, except?

A. Regular insulin is immediate acting
B. NPH insulin is intermediate acting
C. Humalog ® onset of action is faster than Humulin R ®
D. NPH insulin is also known as isophane insulin
E. Novolog has a longer onset and DOA than Humalog

A

(E) Novolog ® has a SHORTER onset and DOA than Humalog ®

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15
Q

What is another name for regular insulin?

A

Zinc insulin

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16
Q

Which of the following regarding regular insulin are true?

A. administered SQ
B. administered IV
C. Delayed onset
D. both A & B
E. All of the above
A

(D) both A & B

Regular insulin can be administered SQ or IV and has an immediate onset

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17
Q

Which of the following statements is incorrect?

A. regular insulin in combo with D50 can be used to treat hyperkalemia
B. Novolin R U-500 is commercially available
C. Protamine prolongs DOA of regular insulin
D. NPH insulin administered SQ only BID
E. Humulin N DOA is longer than Humulin R DOA

A

(B) Novolin R U-500 (concentrated regular insulin) is NOT manufactured. The only concentrated injection/solution available is Humulin R U-500

NPH = neutral PROTAMINE hagedorn - since it has protamine, it has a longer onset and DOA. Therefore, dosing regimen is BID supplementing with regular insulin around meal times

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18
Q

True or False - regular human insulin comes as 100 u/ml and concentrated product is 500 u/ml?

A

True

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19
Q

Which of the two human insulin products on the market is the only one that is latex free?

A

Novolin products

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20
Q

Humulin 70/30 and Novolin 70/30 consist of what two insulin products?

A
  1. NPH insulin 70% (intermediate-acting)

2. regular insulin 30% (short-acting)

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21
Q

Which of the following statements is incorrect?

A. Lispro + Protamine is equivalent to NPH insulin
B. Humalog mimics prandial release of insulin
C. Humalog mixture products include 50/50 and 75/25
D. Novolog must be administered 30 min prior to or after a meal
E. 70/30 is the only Novolog mixture product available

A

(D) Aspart (Novolog ®) is administered 15 MIN PRIOR TO or 20 min after meal

C* the mixture products contain insulin lispro protamine (intermediate acting) + insulin lispro (rapid acting)

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22
Q

Match the following generic semi-synthetic human insulin products with their brand name:

Lispro
Aspart
Glulisine
Detemir
Glargine
A 
Lispro - Humalog ®
Aspart - Novolog ®
Glulisine - Apidra ®
Detemir - Levemir ®
Glargine - Lantus ®
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23
Q

Which of the following semi-synthetic insulin products have new combination products with protamine available?

A. Glulisine
B. Lispro
C. Lantus ®
D. Novolog ®
E. Both B & D
A

(E) Both B & D

Lispro (Humalog ®) and Aspart (Novolog ®) both have combination products with protamine available

Human Insulin Lispro Protamine
Human Insulin Aspart Protamine

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24
Q

All of the following statements regarding Lispro (Humalog) are true, except?

A. produced via recombinant DNA technology (E. coli)
B. must be administered 30 min prior to or post meal
C. equipotent as regular insulin
D. faster acting and shorter DOA compared with regular insulin
E. Can be mixed with Humulin N

A

(B) must be administered 15 MIN prior to or post meal. Regular insulin is the one that must be administered 30 min before meal.

  • Equipotent as regular insulin - meaning one unit of Humalog has a comparable glucose-lowering effect as one unit of regular insulin
  • Lispro (Humalog ®) can be mixed with Humulin N but may change rate of absorption
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25
Q

What is another name for Lispro (Humalog ®)?

A

Zinc insulin lispro

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26
Q

True or False - due to Humalog’s short DOA, its best when used in combo with an intermediate or long-acting insulin?

A

True

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27
Q

Which of the following are made via recombinant DNA technology?

A. Novolog ®
B. Levemir ®
C. Apidra ®
D. Only A & C
E. All of the above
A

(D) Only Novolog and Glulisine (Apidra ®) are made from recombinant DNA technology. Levemir is NOT

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28
Q

Which insulin product contains cresol which is an excipient that can lead to generalized myalgia and local reactions?

A

Novolog ® (Human Insulin Aspart)

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29
Q

Which of the following statements is incorrect?

A. Human insulin glulisine can be mixed with NPH
B. Detemir brand name is Levemir ®
C. Lente is insulin for dogs
D. Glargine can be mixed with NPH
E. Levemir ® is a clear solution with no particles

A

(D) Glargine should NOT be mixed with any other insulin products

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30
Q

Which of the following are intermediate acting insulins?

A. Levemir ®
B. NPH insulin
C. Lantus ®
D. Both A & B
E All of the above
A

(D) both Levemir and NPH insulin are intermediate acting insulins

*Glargine (Lantus ®) is a LONG ACTING insulin

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31
Q

The intermediate action of Levemir is mostly due to:

A. Its ability to be mixed with NPH
B. Coadministration with a basal insulin
C. Slow dissociation from albumin
D. Fatty acid side chain
E. Both C & D
A

(E) - Detemir (Levemir ®) has a fatty acid side chain that enhances its association to albumin. The slow dissociation from albumin leads to longer acting properties

*Its DOA is somewhere between NPH and glargine

32
Q

Which insulin product is given only once daily SQ?

A

Glargine (Lantus ®)

33
Q

True or False - Lantus ® requires basal insulin for coverage of continuous need?

A

True - although Lantus is given once daily, patients still need basal insulin to cover meals

34
Q

Which of the following insulin products are available as a prefilled syringe or pen?

A. Apidra ®
B. Levemir ®
C. Humalog ®
D. Novolog ®
E. All of the above
A

(E) all of the above

35
Q

True or False - patients that don’t like needles have the option of injecting insulin via jet injectors?

A

True - insulin is injected by air pressure

36
Q

True or False - intranasal insulin products were unsuccessful in humans but worked in dogs?

A

True

37
Q

Which of the following statements is incorrect?
A. Sole™ MicroPump allows direct bolus
B. Regular insulin can be mixed with any other insulin in any proportion
C. Patients should use whatever insulin is available at the pharmacy
D. Most insulin products are stable for 12 months at 37C
E. Generalized insulin allergies are rare

A

(C) patients should ALWAYS use the same brand and type of insulin as well as the same brand and type of insulin syringes and pens

38
Q

Which of the following statements is incorrect?

A. Rotating injection sites can help minimize lipodystrophy
B. Generalized insulin allergy is usually caused by stopping then restarting insulin therapy after a lapse of months or years
C. Prednisone is helpful with insulin resistance
D. Local allergic reactions from insulin usually disappear in a few weeks
E. You should never travel with unrefrigerated insulin

A

(E) It is ok to travel with unrefrigerated insulin, but you should try to avoid extreme temperatures

39
Q

This term is defined as the amount of insulin you need to stay alive, not including meals?

A

Basal insulin

40
Q

Name the (5) SE of insulin (even though these are less frequent now that we have human insulin and less proinsulin)?

A
  1. Hypoglycemia
  2. Insulin resistance
  3. Local allergic reactions
  4. Generalized insulin allergy
  5. Local lipodystrophy
41
Q

All of the following can lead to hypoglycemia from insulin, except?

A. Error in dosage
B. Missed meal
C. Unplanned exercise
D. Illness
E. All of the above
A

(E) all of the above

42
Q

Which of the following is NOT a symptom of hypoglycemia?

A. Sweating
B. Palpitations
C. Visual disturbances
D. Faintness
E. Nausea
A

(E) nausea is NOT a symptom of hypoglycemia

43
Q

Why would an increased dose of insulin be necessary to properly treat DM patients with insulin resistance?

A

Patients develop antibodies that breakdown insulin. Therefore, more insulin is needed to achieve a therapeutic effect in these patients

44
Q

Which of the following statements regarding oral hypoglycemic agents is false?

A. Used in the Tx of Type 1 DM
B. Sulfonylureas decrease plasma glucose
C. Patients taking sulfonylureas have an increased risk of CV mortality
D. Patients starting on a “glitazone” drug should continue taking insulin or any other antidiabetic drug they were already taking before
E. None of the above

A

(A) Oral hypoglycemic agents are used to treat Type II DM. They are NOT used to treat Type 1 DM b/c they cannot prevent symptomatic hyperglycemia or DKA

45
Q

Name the (4) types of oral hypoglycemics?

A
  1. Secratogogues
  2. Insulin sensitizers
  3. Alpha-glucoside inhibitors
  4. Dipeptidyl Peptidase IV inhibitors
46
Q

Which of the following drugs are Secretagogues?

A. Sulfonylureas
B. Biguanides
C. Meglitinides
D. Thiazolidinediones
E. Both A & C
A

(E) both Sulfonylureas and Meglitinides are secretagogues oral hypoglycemic agents

*Biguanides and Thiazolidinediones are Insulin Sensitizers

47
Q

Which of the following statements is incorrect?

A. Glyburide can be used to treat gestational diabetes
B. Hepatic function impairment would lead to inadequate release of glucose
C. Decreased hepatic function may be associated with an increase in lactic acidosis SE with Metformin
D. Patients do not usually gain weight on Metformin
E. Glucophage ® has no effect on patient lipid profiles

A

(E) Glucophage ® (Metformin) does a good job of improving lipid profiles, especially in patients whose lipid profile is abnormally elevated

*A - Glyburide (Diabeta ®, Micronase ®, Glynase ®) is the only one indicated for gestational diabetes

48
Q

Increased CV mortality is seen in which (3) types of oral hypoglycemic agents?

A
  1. Sulfonylureas
  2. Meglitinides
  3. Biguanides
49
Q

All of the following statements regarding Sulfonylureas are true, except?

A. Most are primarily metabolized by the liver
B. Suppresses glucagon release
C. Increased CV mortality does NOT apply to patients able to control their type 2 DM (NIDDM)
D. Micronized Glyburide is ER while non-micronized glyburide is IR
E. Patient with impaired renal function will see decreased effect

A

(E) Renal function impairment decreases elimination of sulfonylureas meaning the drug will stay in the blood longer and these patients will see an INCREASED effect

50
Q

All of the following actions are part of Sulfonylureas MOA except?

A. Decreases plasma glucose
B. Stimulates insulin secretion from beta cells of pancreas by blocking ATP sensitive K+ channel
C. Increases peripheral insulin sensitivity
D. Inhibits hepatic glucose synthesis
E. All of the above

A

(E) all of the above contribute to Sulfonylureas MOA

51
Q

Which of the following sulfonylureas is not matched correctly with its brand name?

A. Tolazamide - Tolinase ®
B. Tolbutamide - Orinase ®
C. Glipizide - Glucotrol ®
D. Glimepiride - Amaryl ®
E. Glyburide - Diabinese ®
A

(E) Glyburide - MICRONASE, DIABETA, OR GLYNASE PRESTABS

*Chlorpropamide - Diabinese (1st generation sulfonylurea)

52
Q

Which of the following oral hypoglycemic agents are IR?

A. Micronase ®
B. Glynase PresTabs ®
C. DiaBeta ®
D. Both A & B
E. Both A & C
A

(E) Micronase and DiaBeta are the non-micronized IR formulations of Glyburide

  • Glynase PresTabs is the micronized ER formulation of Glyburide
53
Q

Which of the following statements regarding Sulfonylureas is correct?

A. Warning of renal function and hepatic impairment
B. Alcohol + sulfonylurea can cause disulfiram-like syndrome
C. All dosing should be individualized
D. B & C
E. All of the above

A

(E) All of the above

54
Q

What is the only sulfonylurea that CANNOT be taken with food?

A

Glipizide (Glucotrol ®) - should be taken 30 min before eating

55
Q

Which sulfonylurea has minimal transfer across the placenta and therefore safer to use in gestational diabetes?

A

Glyburide (Diabeta ®, Micronase ®, Glynase ®)

56
Q

Name the (2) Meglitinides?

A
  1. Repaglinide (Prandin ®)

2. Nateglinide (Starlix ®)

57
Q

Which of the following statements regarding Repaglinide (Prandin ®) is incorrect?

A. Can be used in combo with Metformin
B. Stimulates the release of insulin from pancreas
C. Increased CV mortality SE
D. CYP2D6 inducers will increase Repaglinide metabolism
E. Administer 1-30 minutes prior to meal

A

(D) CYP3A4 inducers will increase metabolism of Repaglinide. 2D6 inducers will not affect it

*All the same facts apply to Nateglinide (Starlix ®) also

58
Q

All of the following oral hypoglycemic agents have increased risk of CV mortality except?

A. Glucophage ®
B. Glucotrol ®
C. Amaryl ®
D. Starlix ®
E. Glyset ®
A

(E) Glyset is an alpha-glucoside inhibitor and does not increase patient risk of CV mortality

59
Q

Which of the following statements regarding Metformin (Glucophage ®) is incorrect?

A. Patients may lose weight instead of typical weight gain
B. Decreases liver production of glucose
C. Fortamet ® is an ER formulation
D. Improves insulin action by increasing peripheral glucose uptake and utilization
E. Safe to drink alcohol while on this med

A

(E) Drinking alcohol while taking Metformin may potentiate the effect of metformin on lactate metabolism increasing patient’s risk of lactic acidosis

60
Q

Which of the following statements about insulin sensitizers is incorrect?

A. Metformin has a rare but fatal (50% fatality) SE of lactic acidosis
B. Metformin contraindicated in men with Scr >1.5 and women >1.4
C. Class consists of Biguanides and Thiazolidinediones
D. Pioglitazone and rosiglitazone can be taken without regard to meals
E. None of the above

A

(E) None of the above are incorrect

61
Q

What is the maximum daily dose of Metformin?

A

2,550 mg (850mg TID)

62
Q

Which group of insulin sensitizers are known as glitazones?

A

Thiazolidinediones

Pioglitazone
Rosiglitazone

63
Q

True or False - insulin must be present for thiazolidinedione action to occur?

A

True - these drugs decrease insulin resistance by improving target responses to insulin

64
Q

Which of the following statements regarding thiazolidinediones is incorrect?

A. Indicated for patients currently on insulin therapy
B. Warnings include CHF, cardiac enlargement, and hepatotoxicity
C. Can be taken without regard to meals
D. If miss a dose, double up on the next day
E. None of the above

A

(D) If dose is missed, take with next meal - do NOT double up on the next day

65
Q

Thiazolidinediones are indicated for all of the following patients except?

A. Tx of Type II DM
B. Currently on insulin therapy
C. Hyperglycemia not controlled by insulin alone
D. Diet control should be included
E. All of the above
A

(E) all of the above

66
Q

Which of the following oral hypoglycemic agents are alpha-glucoside inhibitors?

A. Avandia ®
B. Actos ®
C. Glyset ®
D. Precose ®
E. Both C & D
A

(E) Both C & D are alpha-glucose inhibitors

Miglitol (Glyset ®)
Acarbose (Precose ®)

67
Q

Which of the following statements regarding alpha-glucoside inhibitors is incorrect?

A. Delays digestion of ingested carbohydrates resulting in smaller rise in blood glucose level following meals
B. Digestive enzymes will decrease the drug concentration
C. Take at the first bite of each main meal
D. Common SE is flatulence
E. None of the above

A

(E) none of the above are incorrect

68
Q

Which of the following insulin products is NOT one of the five semi-synthetic human insulins?

A. Humalog ®
B. Novolog ®
C. Apidra ®
D. Levemir ®
E. Glucotrol ®
A

(E) Glucotrol ® (Glipizide) is NOT a semi-synthetic human insulin. It is an oral hypoglycemic agent, specifically a 2nd generation sulfonylurea

69
Q

Which of the following statements about Dipeptidyle Peptidase IV Inhibitors is incorrect?

A. Increases insulin release in response to a meal
B. Reduces inappropriate secretion of glucagon
C. Group consists of “gliptin” drugs
D. Sitagliptin should NOT be used in IDDM
E. Adjust Linagliptin dose in patients with renal impairment

A

(E) - NO dosage adjustment for Linagliptin required in renal impairment

*C - Sitagliptin (Januvia ®), Saxagliptin (Onglyza ®), Linagliptin (Tradjenta ®), Alogliptin (Nesina ®)

70
Q

Which of the following Metformin combination products is matched correctly?

A. Metaglip - Metformin + Glipizide
B. ActosplusMet - Metformin + Pioglitazone
C. Janumet - Metformin + Repaglinide
D. Kombiglyze - Metformin + Saxagliptin
E. Duetact - Glimepiride + Pioglitazone
A

(C) Janumet is Metformin + SITAGLIPTIN (Januvia ®)

71
Q

Which of the following statements is incorrect?

A. Normal thyroid contains much more T4 than T3
B. T4 is more potent than T3
C. Mono-deiodination in bloodstream accounts for 1/3 of T3 production
D. rT3 is inactive and may inhibit calorigenic actions of T3
E. Exogenous thyroid in a euthyroid patient causes a suppression of thyroid secretion in the patient

A

(B) T3 is four times MORE POTENT than T4 and is therefore the primary cause of thyroid effects

72
Q

Which of the following statements is incorrect?

A. Exogenous thyroid increases the body’s basic metabolic rate
B. Hypothyroidism Dx by taking body temp several times during day
C. Potassium iodide can be used to treat some types of hypothyroidism
D. T3 is faster acting and has shorter DOA than T4
E. T4 is not highly protein bound

A

(E) T4 is VERY HIGHLY protein bound in the blood, which is also reversible. Some drugs (salicylates and phenytoin) can disrupt the binding and increase the physiological effects

*B - If temp

73
Q

Which of the following statements is incorrect?

A. PTH regulates both calcium and phosphorous
B. PTH secretion results in increased Ca and decreased P in extracellular fluids
C. Hypoparathyroidism is characterized by hypocalcemia and tetany
D. DiGeorge syndrome - no parathyroid glands at birth
E. Recommended Tx for hypoparathyroidism is administration of PTH

A

(E) Administration of PTH is NOT recommended since it is only effective for about 2 years. Recommended therapy includes administration of large quantities of vitamin D along with calcium carbonate

74
Q

PTH is responsible for which of the following?

A. Increases extracellular Ca
B. Increases gut absorption of Ca
C. Decreases renal excretion of Ca
D. Only A & B
E. All of the above
A

(E) all of the above

75
Q

PTH secretion or administration results in a decrease of phosphorous in the extracellular fluid mainly from?

A. Decrease in P absorption from diet
B. Increase in P excretion
C. Increased Ca absorption
D. B & C
E. None of the above
A

(B) The decrease in extracellular phosphorous is mainly from an increase in P excretion caused by PTH

76
Q

Which of the following statements regarding hyperparathyroidism is incorrect?

A. More common in women
B. May be due to prolonged hypocalcemia in women (pregnancy, lactation)
C. Can cause metastatic calcification
D. Characterized by very low osteoclast activity
E. Hypercalcemia

A

(D) Characterized by EXTREME osteoclast activity leading to hypercalcemia

77
Q

Which of the following is matched correctly?

A. Primary hyperparathyroidism - due to enlarged gland
B. Secondary hyperparathyroidism - response to low calcium
C. Tertiary hyperparathyroidism - continued excessive production of PTH in spite of normal calcium levels
D. B & C
E. All of the above

A

(E) all of the above

Pharmacology 2 - Final Exam (1 decks)

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