Endocrine - Pharmacology

Question 1

What is the basis of treatment of diabetes mellitus type 1?

Answer 1

Low-sugar diet and insulin replacement

Question 2

What is the basis of treatment for diabetes mellitus type 2?

Answer 2

Dietary modification and exercise for weight loss, oral hypoglycemics, insulin replacement (late)

Question 3

Name three short-acting insulins.

Answer 3

Lispro, aspart, regular

Question 4

Is neutral protamine Hagedorn (NPH) insulin considered a short-, intermediate-, or long-acting insulin?

Answer 4

Intermediate-acting insulin

Question 5

Name two long-acting insulins.

Answer 5

Glargine, detemir

Question 6

Insulin binds insulin receptors which have ______ _____ signaling pathways.

Answer 6

Tyrosine kinase

Question 7

For what electrolyte disturbance can insulin be used as a treatment?

Answer 7

Hyperkalemia

Question 8

A patient is in the intensive care unit and noted to have a blood glucose of 225 mg/dL; what medication is appropriate for this condition?

Answer 8

Insulin is effective in treating stress-induced hyperglycemia

Question 9

What is the most common adverse effect of insulin treatment?

Answer 9

Hypoglycemia; very rarely, one may see a hypersensitivity reaction

Question 10

Name two first generation sulfonylureas.

Answer 10

Tolbutamide, chlorpropamide

Question 11

Name three second generation sulfonylureas.

Answer 11

Glyburide, glimepiride, glipizide

Question 12

Which diabetes drugs can cause a disulfiram-like reaction?

Answer 12

First-generation sulfonylureas

Question 13

To which class of diabetes drugs does metformin belong?

Answer 13

Biguanides

Question 14

To which class of diabetes drugs do pioglitazone and rosiglitazone belong?

Answer 14

Glitazones

Question 15

Name two -glucosidase inhibitors.

Answer 15

Acarbose, miglitol

Question 16

Describe the mechanism of action of sulfonylureas.

Answer 16

Sulfonylureas close the K⁺ channel on the -cell membrane leading to cell depolarization and causing insulin release by increased calcium influx

Question 17

Will sulfonylureas work in type 1 diabetes mellitus?

Answer 17

No; these drugs require islet cell function and the ability to secrete endogenous insulin (defective in type 1 diabetes)

Question 18

What is an adverse effect of second-generation sulfonylureas?

Answer 18

Hypoglycemia

Question 19

What is the mechanism of action of metformin?

Answer 19

Unknown; may decrease gluconeogenesis, increase glycolysis, thereby decreasing serum glucose levels; overall, it acts as an insulin sensitizer

Question 20

True or False: Metformin can be used in patients without islet function.

Answer 20

TRUE

Question 21

Before prescribing metformin, it is important to assess the function of what organ?

Answer 21

Kidney; if metformin cannot be excreted it may build up leading to lactic acidosis

Question 22

How do glitazones work?

Answer 22

They increase target cell response to insulin via the peroxisome proliferator-activated receptor-γ pathway

Question 23

What are the side effects of glitazones?

Answer 23

Glitazones can cause weight gain, edema, hepatotoxicity, and cardiovascular toxicity

Question 24

Acarbose and miglitol work by inhibiting what enzyme?

Answer 24

-Glucosidase, an intestinal brush border enzyme; this results in decreased postprandial hyperglycemia

Question 25

What is the principal toxicity of -glucosidase inhibitors?

Answer 25

Gastrointestinal disturbances

Question 26

What is the mechanism of action of pramlintide?

Answer 26

Pramlintide is a mimetic of an endogenous hormone and acts by inhibiting glucagon

Question 27

What are some toxicities of pramlintide?

Answer 27

Hypoglycemia, nausea, diarrhea

Question 28

Give an example of a glucagon-like peptide-1 mimetic drug.

Answer 28

Exenatide; this drug was discovered in the saliva of the gila monster

Question 29

What is the mechanism of action of the GLP-1 mimetics?

Answer 29

Increases insulin and decreases glucagon

Question 30

What are toxicities of exenatide use?

Answer 30

Nausea, vomiting and possibly pancreatitis

Question 31

Orlistat works by inhibiting _____ \_\_\_\_\_.

Answer 31

Pancreatic lipases

Question 32

Orlistat is properly used for the long-term management of obesity in conjunction with what other therapy?

Answer 32

A modified diet (remember: orlis**tat** gets rid of **fat**)

Question 33

What adverse effects are associated with the use of orlistat?

Answer 33

Steatorrhea, gastrointestinal discomfort, reduced fat-soluble vitamin absorption, and headache

Question 34

Which drug used in the treatment of obesity may result in vitamin A, D, E, and K deficiency?

Answer 34

Orlistat, which can reduce the absorption of fat-soluble vitamins

Question 35

Sibutramine works by inhibiting what processes?

Answer 35

The reuptake of serotonin and norepinephrine

Question 36

What are side effects of sibutramine?

Answer 36

Hypertension, tachycardia

Question 37

Sibutramine is used to treat what condition?

Answer 37

Sibutramine is used for the short-term and long-term management of obesity

Question 38

Methimazole and propylthiouracil inhibit what process?

Answer 38

Thyroid hormone synthesis (by inhibiting the organification and coupling of thyroid hormone)

Question 39

Propylthiouracil inhibits which biochemical pathway that methimazole does not?

Answer 39

Both affect thyroid hormone synthesis, but propylthiouracil also decreases the peripheral conversion of thyroxine to triiodothyronine

Question 40

What disorder is treated using methimazole or propylthiouracil?

Answer 40

Hyperthyroidism

Question 41

What are the known toxicities of methimazole and propylthiouracil?

Answer 41

Skin rash, aplastic anemia and agranulocytosis (rare)

Question 42

What laboratory test should be ordered to avoid a rare but devastating adverse effect when starting a patient on methimazole or propylthiouracil?

Answer 42

Complete blood count, to monitor for aplastic anemia or agranulocytosis

Question 43

What pharmacotherapies are used as thyroxine replacements in hypothyroidism?

Answer 43

Levothyroxine and triiodothyronine

Question 44

A patient with hypothyroidism and myxedema is started on thyroid replacement therapy; what should you tell him about the prognosis of his myxedematous changes?

Answer 44

Myxedema can be treated by levothyroxine or triiodothyronine therapy

Question 45

What toxicities are associated with thyroid hormone replacement therapy?

Answer 45

Tachycardia, heat intolerance, tremors, arrhythmias (symptoms of hyperthyroidism)

Question 46

What are two medical indications for use of growth hormone?

Answer 46

Growth hormone deficiency, Turners syndrome

Question 47

List four indications for the use of octreotide.

Answer 47

Acromegaly, carcinoid tumor, gastrinoma, and glucagonoma

Question 48

List three processes that can be stimulated with the use of exogenous oxytocin.

Answer 48

Labor, uterine contractions, and milk let-down

Question 49

Following delivery, a woman continues to have uterine bleeding; what normally endogenous substance can be given to stop the blood loss?

Answer 49

Oxytocin (also known as pitocin)

Question 50

Can desmopressin be used in the treatment of nephrogenic diabetes insipidus?

Answer 50

No; desmopressin is an antidiuretic hormone analog that requires renal response and thus is effective only in pituitary diabetes insipidus

Question 51

A patient has hyponatremia with low serum osmolarity and high urine osmolarity; name a drug that works by antagonizing the defective pathway.

Answer 51

This is syndrome of inappropriate antidiuretic hormone secretion and can be treated by demeclocycline, which is an antidiuretic hormone antagonist

Question 52

What are the adverse effects of demeclocycline?

Answer 52

Photosensitivity, abnormalities of bones and teeth (demeclocycline is in the tetracycline family)

Question 53

What is the mechanism of action of glucocorticoids?

Answer 53

Decreases production of leukotrienes and prostaglandins by inhibiting phospholipase A₂ and expression of COX-2

Question 54

List five examples of glucocorticoid drugs.

Answer 54

Hydrocortisone, prednisone, triamcinolone, dexamethasone, and beclomethasone

Question 55

What endocrine disease causes hypotension and skin pigmentation and can be treated with glucocorticoids?

Answer 55

Addisons disease

Question 56

What medication can be injected into a joint to treat the inflammation associated with degenerative arthritis?

Answer 56

Glucocorticoids, which are potent antiinflammatories

Question 57

Give an example of a common pediatric pulmonary disease that can be treated with glucocorticoids.

Answer 57

Asthma

Question 58

A patient with a longstanding history of severe asthma, rheumatoid arthritis, and psoriasis has a buffalo hump and a blood glucose of 230 mg/dL; what is the likely cause of the hyperglycemia?

Answer 58

This patient has iatrogenic diabetes mellitus secondary to long-term glucocorticoid use

Question 59

Glucocorticoids can cause what iatrogenic endocrine disorder?

Answer 59

Cushings syndrome

Question 60

What is the effect of chronic glucocorticoid use on fat distribution?

Answer 60

Patients develop truncal obesity, a buffalo hump, and moon facies

Question 61

What effect does chronic glucocorticoid use have on the musculoskeletal system?

Answer 61

It can cause muscle wasting and lead to osteoporosis

Question 62

What effect can glucocorticoid toxicity have on the skin?

Answer 62

Thin skin and easy bruisability

Question 63

A patient who is on chronic glucocorticoid therapy becomes ill and is found to have very low blood pressure; how might this be related to the medication history?

Answer 63

Long-term glucocorticoid therapy may lead to adrenocortical atrophy and failure to mount a stress response during illness

Question 64

A patient is found to have peptic ulcer disease. His medications include hydrochlorothiazide, oral prednisone, and atenolol; which is most likely to cause his ulcers?

Answer 64

Peptic ulcers are an adverse effect of glucocorticoids