Deck 21: Drugs Affecting the Endocrine System

Question 1

Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:

A) Tinnitus and decreased salivation
B) Fever and sore throat
C) Hypocalcemia and osteoporosis
D) Laryngeal edema and difficulty swallowing

Answer 1

Fever and sore throat

Question 2

Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

A) Selective estrogen receptor modulators
B) Aspirin
C) Glucocorticoids
D) Calcium supplements

Answer 2

Glucocorticoids

Question 3

Prior to prescribing metformin, the provider should:

A) Draw a serum creatinine to assess renal function
B) Try the patient on insulin
C) Tell the patient to increase iodine intake
D) Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions

Answer 3

Draw a serum creatinine to assess renal function

Question 4

Bisphosphonates treat or prevent osteoporosis by:

A) Inhibiting osteoclastic activity
B) Fostering bone resorption
C) Enhancing calcium uptake in the bone
D) Strengthening the osteoclastic proton pump

Question 5

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?

A) Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
B) Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
C) Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
D) Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.

Question 6

Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?

A) Optimal time of preprandial injection is 15 minutes.
B) Duration of action is increased when the dose is increased.
C) It is compatible with neutral protamine Hagedorn insulin.
D) It has no pronounced peak.

Question 7

Sitagliptin has been approved for:

A) Monotherapy in once-daily doses
B) Combination therapy with metformin
C) Both 1 and 2
D) Neither 1 nor 2

Question 8

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:

A) Lipase
B) Protease
C) Amylase
D) Pancreatin

Question 9

GLP-1 agonists:

A) Directly bind to a receptor in the pancreatic beta cell
B) Have been approved for monotherapy
C) Speed gastric emptying to decrease appetite
D) Can be given orally once daily

Question 10

Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:

A) Cortical bones
B) Femoral neck bones
C) Cervical vertebrae
D) Pelvic bones

Question 11

Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:

A) Increase blood glucose levels
B) Produce unexplained diaphoresis
C) Interfere with the ability of the body to metabolize glucose
D) Mask the signs and symptoms of altered glucose levels

Question 12

Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:

A) Substitutes for insulin usually secreted by the pancreas
B) Decreases glycogenolysis by the liver
C) Increases the release of insulin from beta cells
D) Decreases peripheral glucose utilization

Question 13

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:

A) The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
B) The initial dose of glargine is 2 to 10 units per day.
C) Patients who have been on high doses of NPH will need tests for insulin antibodies.
D) Obese patients may require more than 100 units per day.

Question 14

Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:

A) "Fruity" breath odor and rapid respiration
B) Diarrhea, abdominal pain, weight loss, and hypertension
C) Dizziness, confusion, diaphoresis, and tachycardia
D) Easy bruising, palpitations, cardiac dysrhythmias, and coma

Question 15

Administration of exenatide is by subcutaneous injection:

A) 30 minutes prior to the morning meal
B) 60 minutes prior to the morning and evening meal
C) 15 minutes after the evening meal
D) 60 minutes before each meal daily

Question 16

Avoid concurrent administration of exenatide with which of the following drugs?

A) Digoxin
B) Warfarin
C) Lovastatin
D) All of the above

Question 17

The action of "gliptins" is different from other antidiabetic agents because they:

A) Have a low risk for hypoglycemia
B) Are not associated with weight gain
C) Close ATP-dependent potassium channels in the beta cell
D) Act on the incretin system to indirectly increase insulin production

Question 18

Brands of pancreatic enzyme replacement drugs are:

A) Bioequivalent
B) About the same in cost per unit of lipase across brands
C) Able to be interchanged between generic and brand-name products to reduce cost
D) None of the above

Question 19

When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?

A) 15 to 30 minutes
B) 60 to 90 minutes
C) 3 to 4 hours
D) 6 to 8 hours

Question 20

Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:

A) Excessive sedation
B) Tachycardia and angina
C) Weight gain
D) Cold intolerance

Question 21

Which of the following is not an indication that growth hormone supplements should be discontinued?

A) Imaging indication of epiphyseal closure
B) Growth curve increases have plateaued
C) Complaints of mild bone pain
D) Achievement of anticipated height goals

Question 22

Which of the following statements about pancreatic enzymes is true?

A) Dosing may be titrated according to the decrease of steatorrhea.
B) The amount of carbohydrates in the meal drives the amount of enzyme used.
C) The amount of medication used is increased with a cystic fibrosis pulmonary flare.
D) The FDA and Internet-available formulations are bioequivalent.

Question 23

What is the role of calcium supplements when patients take bisphosphonates?

A) They must be restricted to allow the medication to work.
B) They must be taken in sufficient amounts to provide foundational elements for bone growth.
C) They must be taken at the same time as the bisphosphonates.
D) They only work with bisphosphonates if daily intake is restricted.

Question 24

Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?

A) Paget's disease
B) Pulmonary cancers
C) Gallbladder surgery
D) Some bariatric surgeries

Question 25

Besides osteoporosis, IV bisphosphonates are also indicated for:

A) Paget's Disease
B) Early osteopenia
C) Renal cancer
D) Early closure of cranial sutures