endocrine Flashcards
A 23-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Fiasp® FlexTouch 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Fiasp®?
A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin
E) Ultra-long-acting insulin
A
RATIONALE: FIASP® IS A RAPID-ACTING INSULIN ANALOG
MANUFACTURED BY NOVO NORDISK. IT IS DESIGNED TO
PROVIDE FASTER ONSET AND SHORTER DURATION OF ACTION
THAN REGULAR HUMAN INSULIN. THE ONSET OF ACTION OF
FIASP® IS APPROXIMATELY 5-10 MINUTES, WHICH IS FASTER
THAN OTHER RAPID-ACTING INSULIN ANALOGS LIKE
NOVORAPID® AND HUMALOG®
A 53-year-old patient with type 2 diabetes mellitus has commenced on a new medication for his diabetes. He is advised by his general practitioner that there is a rare risk of diabetic ketoacidosis associated with this new medication. Which of the following medications is he likely to have been prescribed?
A) Linagliptin
B) Canagliflozin
C) Gilbenclamide
D) Metformin
E) Pioglitazone
B
RATIONALE: CANAGLIFLOZIN IS THE MEDICATION ASSOCIATED
WITH A RARE RISK OF DIABETIC KETOACIDOSIS. IT IS AN
SGLT2 INHIBITOR USED TO TREAT TYPE 2 DIABETES AND
WORKS BY REMOVING SUGAR FROM THE BODY THROUGH THE
URINE.
A 54-year-old patient with type 2 diabetes mellitus walks into your community pharmacy with a prescription for a new medication for her diabetes. She is concerned as she has read a news article about this new medication stating it increases the risk of bladder cancer. Which of the following medications is she likely to have been prescribed?
A) Gliclazide
B) Metformin
C) Canagliflozin
D) Pioglitazone
E) Saxagliptin
D
RATIONALE:
THE 54-YEAR-OLD PATIENT IS LIKELY PRESCRIBED
PIOGLITAZONE, A DIABETES DRUG LINKED TO AN INCREASED
RISK OF BLADDER CANCER IN SOME STUDIES.
A 57-year-old patient with type 2 diabetes mellitus has commenced on a new medication. He is informed by the general practitioner that he may experience gastrointestinal disturbances, however these are usually transient and will resolve over time. Which of the following medications is he likely to have been prescribed?
A) Gliclazide
B) Metformin
C) Canagliflozin
D) Sitagliptin
E) Pioglitazone
B
RATIONALE: THE MEDICATION MOST LIKELY ASSOCIATED WITH
TRANSIENT GASTROINTESTINAL DISTURBANCES IS
METFORMIN. METFORMIN IS COMMONLY USED TO TREAT
TYPE 2 DIABETES AND IS KNOWN FOR POTENTIAL SIDE
EFFECTS LIKE STOMACH UPSET, DIARRHEA, AND NAUSEA,
WHICH OFTEN RESOLVE OVER TIME AS THE BODY ADJUSTS
TO THE MEDICATION.
A patient on an acute admissions ward is commenced on dexamethasone for severe COVID-19. Which of the following is not likely to be a side effect associated with glucocorticoids?
A) Diabetes mellitus
B) Osteoporosis
C) Muscle wastage
D) Hypernatremia
E) Peptic ulceration
D
RATIONALE: HYPERNATRAEMIA IS GENERALLY NOT
CONSIDERED A TYPICAL SIDE EFFECT ASSOCIATED WITH THE
USE OF GLUCOCORTICOIDS LIKE DEXAMETHASONE.
GLUCOCORTICOIDS ARE MORE COMMONLY ASSOCIATED WITH
SIDE EFFECTS LIKE DIABETES MELLITUS, OSTEOPOROSIS,
MUSCLE WASTAGE, AND PEPTIC ULCERATION.
A patient is commenced on a new medication for hyperthyroidism. The patient walks into your community pharmacy with a sore throat and is concerned this is a side effect of the new medication, as the general practitioner informed him to report a sore throat to a healthcare professional immediately. Which of the following medications is he likely to have been prescribed?
A) Amlodipine
B) Levothyroxine
C) Liothyronine
D) Carbimazole
E) Prednisolone
D
RATIONALE: THE PATIENT IS LIKELY TO HAVE BEEN
PRESCRIBED CARBIMAZOLE. CARBIMAZOLE IS AN ANTITHYROID
MEDICATION USED TO TREAT HYPERTHYROIDISM, AND A SORE
THROAT COULD BE AN EARLY SIGN OF AGRANULOCYTOSIS—A
RARE BUT SERIOUS SIDE EFFECT. PATIENTS ON THIS
MEDICATION ARE USUALLY ADVISED TO REPORT SYMPTOMS
LIKE A SORE THROAT TO A HEALTHCARE PROFESSIONAL
IMMEDIATELY FOR FURTHER EVALUATION.
A 31-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Tresiba® FlexTouch 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Tresiba®?
A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin
E) Ultra-long-acting insulin
E
RATIONALE: TRESIBA® (INSULIN DEGLUDEC) IS AN ULTRA-
LONG-ACTING INSULIN PREPARATION. IT IS DESIGNED TO
PROVIDE A STABLE AND PROLONGED DURATION OF ACTION,
OFTEN LASTING BEYOND 42 HOURS.
A 49-year-old patient is admitted to hospital with severe persistent abdominal pain. He is diagnosed with acute pancreatitis and this is likely to be associated with a medication he was prescribed for type 2 diabetes mellitus. Which of the following medications is he likely to have been prescribed?
A) Metformin
B) Pioglitazone
C) Gilbenclamide
D) Acarbose
E) Sitagliptin
E
RATIONALE: ACUTE PANCREATITIS HAS BEEN REPORTED AS A
RARE SIDE EFFECT ASSOCIATED WITH SITAGLIPTIN, WHICH IS
A DPP-4 INHIBITOR USED IN THE TREATMENT OF TYPE 2
DIABETES. IF A PATIENT IS ADMITTED WITH SYMPTOMS OF
ACUTE PANCREATITIS, HEALTHCARE PROVIDERS MAY
CONSIDER EVALUATING THE MEDICATION LIST FOR POTENTIAL
CAUSES, INCLUDING SITAGLIPTIN.
A patient is commenced on fludrocortisone acetate alongside other medication for the treatment of adrenocortical insufficiency resulting from septic shock. Which of the following is not likely to be a side effect associated with mineralocorticoids?
A) Hypertension
B) Hypokalaemia
C) Hypernatraemia
D) Hyperglycaemia
E) Water retention
D
RATIONALE: HYPERGLYCEMIA IS NOT A SIDE EFFECT
ASSOCIATED WITH MINERALOCORTICOIDS SUCH AS
FLUDROCORTISONE ACETATE, WHICH ARE USED TO REGULATE
SALT AND WATER BALANCE IN THE BODY. HOWEVER,
MINERALOCORTICOIDS CAN CAUSE HYPERTENSION,
HYPOKALEMIA, HYPERNATREMIA, AND WATER RETENTION.
A 36-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Humalog® KwikPen 100units/ml solution for injection 3ml prefilled pens. Which type of insulin preparation is Humalog®?
A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin
E) Ultra-long-acting insulin
A
RATIONALE: RAPID-ACTING INSULIN. HUMALOG® (INSULIN
LISPRO) IS A FAST-ACTING INSULIN USED TO HELP CONTROL
BLOOD SUGAR LEVELS AFTER MEALS IN PEOPLE WITH TYPE 1
AND TYPE 2 DIABETES.
A 47-year-old patient with type 2 diabetes mellitus is prescribed a new medication to be taken alongside his insulin to improve his diabetes control. The general practitioner informs him that he will be closely monitored for signs of heart failure. Which of the following medications is he likely to have been prescribed?
A) Gliclazide
B) Pioglitazone
C) Acarbose
D) Sitagliptin
E) Metformin
B
RATIONALE: PIOGLITAZONE IS THE MEDICATION MOST
COMMONLY ASSOCIATED WITH AN INCREASED RISK OF HEART
FAILURE. WHICH IS KNOWN TO IMPROVE INSULIN SENSITIVITY
AND GLYCEMIC CONTROL BUT ALSO HAS THE POTENTIAL TO
CAUSE FLUID RETENTION AND HEART FAILURE.
A 35-year-old is commenced on a basal bolus regimen to manage his type 1 diabetes mellitus. Which of the following insulins is not an example of a basal insulin?
A) Insulin glargine
B) Insulin detemir
C) Insulin degludec
D) Insulin gluisine
E) Insulin isophane
D
RATIONALE: INSULIN GLULISINE IS NOT AN EXAMPLE OF A
BASAL INSULIN. IT IS A RAPID-ACTING INSULIN USED TO
CONTROL BLOOD SUGAR LEVELS DURING MEALS OR PERIODS
OF HIGH SUGAR INTAKE.
A 23-year-old patient with type 1 diabetes mellitus is commenced on an insulin to be taken for meals. She is informed to inject her insulin 15-30 minutes before food. Which of the following insulin preparations is she likely to have been prescribed?
A) Fiasp®
B) Tresiba®
C) Apidra®
D) Actrapid®
E) Humalog®
D
RATIONALE: THE PATIENT IS LIKELY TO HAVE BEEN
PRESCRIBED ACTRAPID®, WHICH IS A SHORT-
ACTING/SOLUBLE INSULIN TYPICALLY INJECTED 15-30
MINUTES BEFORE MEALS TO CONTROL BLOOD SUGAR
LEVELS.
A 45-year-old patient visits his general practitioner as he is concerned about the fact that he has noticed inflammation of the foreskin and glans penis since starting a new medication for type 2 diabetes mellitus. Which of the following medications is he likely to have been prescribed?
A) Pioglitazone
B) Empaglifozin
C) Acarbose
D) Gliclazide
E) Metformin
B
RATIONALE: THE MEDICATION MOST LIKELY ASSOCIATED WITH
THE SYMPTOM OF INFLAMMATION OF THE FORESKIN AND
GLANS PENIS (ALSO KNOWN AS BALANITIS) IN THIS CONTEXT
IS EMPAGLIFLOZIN. EMPAGLIFLOZIN IS A SODIUM-GLUCOSE
CO-TRANSPORTER 2 (SGLT2) INHIBITOR USED TO TREAT TYPE
2 DIABETES.
A 44-year-old patient walks into your community pharmacy with a prescription for prednisolone. The trainee pharmacist in your pharmacy is learning about glucocorticoid activity and wants to know which of the following corticosteroids has the highest glucocorticoid activity. Which of the following corticosteroids has the highest glucocorticoid activity?
A) Prednisolone
B) Dexamethasone
C) Fludrocortisone
D) Hydrocortisone
E) Deflazacort
B
RATIONALE: AMONG THE CORTICOSTEROIDS LISTED,
DEXAMETHASONE HAS THE HIGHEST GLUCOCORTICOID
ACTIVITY. DEXAMETHASONE IS A POTENT GLUCOCORTICOID
WITH MINIMAL MINERALOCORTICOID ACTIVITY, AND IT IS
USED FOR A WIDE RANGE OF INFLAMMATORY AND
AUTOIMMUNE CONDITIONS.
A 79-year-old patient is admitted into hospital due to a fall. You are the ward pharmacist and are asked by the junior doctor to review his medication to identify whether a medication the patient was taking may have increased their risk of falls. Which of the following medications is likely to have increased the patient’s risk of a fall?
A) Metformin
B) Acarbose
C) Gilbenclamide
D) Empagliflozin
E) Pioglitazone
C
RATIONALE: AMONG THE MEDICATIONS LISTED,
GILBENCLAMIDE IS THE ONE MOST LIKELY ASSOCIATED WITH
AN INCREASED RISK OF FALLS IN OLDER ADULTS.
GILBENCLAMIDE IS A SULFONYLUREA USED TO LOWER BLOOD
GLUCOSE LEVELS IN TYPE 2 DIABETES.
patient is diagnosed with type 1 diabetes mellitus and is initiated on a basal bolus regimen to control their diabetes mellitus. Which of the following insulins is not an example of a bolus insulin?
A) Insulin lispro
B) Insulin aspart
C) Insulin degludec
D) Insulin glulisine
E) Insulin soluble
C
RATIONALE: INSULIN DEGLUDEC IS NOT AN EXAMPLE OF A
BOLUS INSULIN; IT IS A LONG-ACTING INSULIN USED FOR
BASAL CONTROL.
A patient is due to be prescribed 30mg prednisolone on a cardiorespiratory admissions unit for suppression of an inflammatory disorder, however the medical team on the ward are also considering using methylprednisolone. What is the equivalent anti-inflammatory dose of methylprednisolone?
A) 20mg
B) 22mg
C) 24mg
D) 26mg
E) 30mg
C
RATIONALE: THE EQUIVALENT ANTI-INFLAMMATORY DOSE
OF METHYLPREDNISOLONE TO 30MG PREDNISOLONE IS
24MG. .
You are working on an acute admissions ward and the medical student on the ward is learning about corticosteroids and wants to ask you a question in relation to glucocorticoid activity. Which of the following corticosteroids has the lowest glucocorticoid activity?
A) Dexamethasone
B) Prednisolone
C) Betamethasone
D) Hydrocortisone
E) Deflazacort
D
RATIONALE: HYDROCORTISONE HAS THE LOWEST
GLUCOCORTICOID ACTIVITY. HYDROCORTISONE IS OFTEN
CONSIDERED THE STANDARD AGAINST WHICH OTHER
CORTICOSTEROIDS ARE COMPARED IN TERMS OF
GLUCOCORTICOID POTENCY.
A 38-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Actrapid® 100units/ml solution for injection 10ml vials. Which type of insulin preparation is Actrapid®?
A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin
E) Ultra-long-acting insulin
B
RATIONALE: ACTRAPID® IS A TYPE OF SHORT-ACTING
INSULIN. IT IS ALSO KNOWN AS REGULAR INSULIN AND
TYPICALLY HAS AN ONSET OF ACTION OF 30 MINUTES, A
PEAK OF ACTION AT 2-4 HOURS, AND A DURATION OF ACTION
OF UP TO 8 HOURS.
Gradual withdrawal of systemic corticosteroids may need to be considered in some cases to prevent adverse effects, such as adrenal insufficiency. Which of the following scenarios does not require gradual withdrawal?
A) Received more than three weeks of treatment
B) Recent received repeated courses
C) Been given repeat doses in the evening
D) Received 30mg prednisolone daily for 1 week
E) Taken a short course within 1 year of stopping long-term therapy
D
RATIONALE: AMONG THE SCENARIOS LISTED,
“RECEIVED 30MG
PREDNISOLONE DAILY FOR 1 WEEK” WOULD BE THE LEAST
LIKELY TO REQUIRE GRADUAL WITHDRAWAL TO PREVENT
ADRENAL INSUFFICIENCY.
A 47-year-old patient with type 2 diabetes mellitus has commenced on a new medication for his diabetes. He is advised by his general practitioner that there is a rare risk of lactic acidosis. Which of the following medications is he likely to have been prescribed?
A) Pioglitazone
B) Gliclazide
C) Sitagliptin
D) Metformin
E) Empagliflozin
D
RATIONALE: THE MEDICATION MOST LIKELY ASSOCIATED WITH
A RARE RISK OF LACTIC ACIDOSIS IS METFORMIN.
A 32-year-old patient is commenced on a medication for hypothyroidism. The general practitioner explains the importance of remaining on the same brand, as other brands of the medication may not be bioequivalent. Which of the following medications is he likely to have been prescribed?
A) Carbimazole
B) Ramipril
C) Propylthiouracil
D) Atenolol
E) Liothyronine
E
RATIONALE: THE MEDICATION LIKELY TO HAVE BEEN
PRESCRIBED FOR TREATING HYPOTHYROIDISM IN THIS
SCENARIO IS LIOTHYRONINE. LIOTHYRONINE ALSO REQUIRES
CAREFUL DOSING AND MONITORING. THE BIOEQUIVALENCE
OF DIFFERENT BRANDS CAN VARY
A 24-year-old is newly diagnosed with type 1 diabetes mellitus and has been informed that he needs to ensure he tests his blood-glucose concentration no more than 2 hours before driving. What should the blood-glucose concentration be prior to driving according to the Driver and Vehicle Licensing Agency (DVLA)?
A) At least 4 mmol/litre
B) At least 5 mmol/litre
C) At least 6 mmol/litre
D) At least 8 mmol/litre
E) At least 10 mmol/litre
B
RATIONALE: THE DRIVER AND VEHICLE LICENSING AGENCY
(DVLA) IN THE UK RECOMMENDS THAT BLOOD-GLUCOSE
CONCENTRATION SHOULD BE AT LEAST 5 MMOL/LITRE
BEFORE DRIVING FOR PEOPLE WITH DIABETES, INCLUDING
THOSE WITH TYPE 1 DIABETES MELLITUS.
A 37-year-old patient with type 1 diabetes mellitus walks into your community pharmacy with a prescription for Insuman Basal® 100units/ml suspension for injection 3ml prefilled SoloStar pens. Which type of insulin preparation is Insuman Basal®?
A) Rapid-acting insulin
B) Short-acting insulin
C) Intermediate-acting insulin
D) Long-acting insulin
E) Ultra-long-acting insulin
C
RATIONALE: INSUMAN BASAL® IS AN INTERMEDIATE-ACTING
INSULIN. IT IS OFTEN USED AS A BASAL INSULIN TO PROVIDE
A STEADY LEVEL OF BACKGROUND INSULIN OVER AN
EXTENDED PERIOD, USUALLY LASTING AROUND 10 TO 16
HOURS. INTERMEDIATE-ACTING INSULINS LIKE INSUMAN
BASAL® HELP CONTROL BLOOD SUGAR LEVELS BETWEEN
MEALS AND DURING THE NIGHT.
