Question 1

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

Accepted Answer

The potentially fatal granulocytopenia associated with propylthiouracil treatment can result in infection. Fever and sore throat are common symptoms of infection and should be reported immediately to prevent further complications. Tinnitus and decreased salivation are not associated with granulocytopenia or propylthiouracil treatment. Hypocalcemia and osteoporosis are potential complications of hyperthyroidism, but not specifically related to propylthiouracil treatment. Laryngeal edema and difficulty swallowing are not common symptoms of granulocytopenia, but may indicate a serious allergic reaction to the medication.

Question 2

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

Accepted Answer

Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of glucocorticoids. Selective estrogen receptor modulators (SERMs) are not associated with osteopenia, and calcium supplements and aspirin are not likely to cause early osteopenia.

Question 3

Prior to prescribing metformin, the provider should:

Accepted Answer

Metformin is contraindicated in patients with renal impairment due to the risk of lactic acidosis. Therefore, it is important to assess renal function prior to metformin initiation.

Question 4

Bisphosphonates treat or prevent osteoporosis by:

Accepted Answer

Bisphosphonates work by inhibiting osteoclastic activity, which reduces the amount of bone resorption and prevents further loss of bone density. This leads to an increase in bone mass and a decrease in the risk of fractures.

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?

Accepted Answer

According to research, newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. Premixed insulin analogues are associated with more weight gain than the oral antidiabetic agents, so choice B is incorrect. Neutral protamine Hagedorn insulin is not the preferred insulin to add for postprandial hyperglycemia, so choice D is incorrect. Choice A is incorrect as there is no conclusive evidence that premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.

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?

Accepted Answer

Duration of action is not increased when the dose is increased, as it is a rapid-acting insulin analogue with a fixed duration of action.

Question 7

Sitagliptin has been approved for:

Accepted Answer

Sitagliptin has been approved for both monotherapy in once-daily doses and combination therapy with metformin.

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:

Accepted Answer

Enzyme replacement therapy for cystic fibrosis patients is prescribed in units of lipase, as this enzyme is typically the most deficient in patients with CF-related pancreatic insufficiency. The lipase component helps the body to break down fats more effectively.

Question 9

GLP-1 agonists:

Accepted Answer

The answer of GLP-1 agonists:
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Question 10

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

Accepted Answer

Femoral neck bones are the bones most likely to demonstrate significant loss of bone mass with aging. This is due to the fact that they are weight-bearing bones and are subjected to more mechanical stress, which can accelerate bone loss. Cortical bones and pelvic bones may also experience some degree of bone loss with aging, but not to the same extent as femoral neck bones. Cervical vertebrae are not typically affected by age-related bone loss.

Question 11

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

Accepted Answer

Nonselective beta blockers can mask the signs and symptoms of altered glucose levels, making it difficult to recognize hypoglycemia, hyperglycemia or ketoacidosis. When combined with alcohol, this effect can be amplified, increasing the risk of serious drug interactions with insulin. Therefore, it is important to monitor blood glucose levels carefully in patients taking these medications, especially those who consume alcohol.

Question 12

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

Accepted Answer

Metformin decreases glycogenolysis by the liver, which reduces the amount of glucose released into the bloodstream. This helps to lower blood glucose levels in individuals with type 2 diabetes. Metformin does not substitute for insulin usually secreted by the pancreas, increase the release of insulin from beta cells, or decrease 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:

Accepted Answer

When switching from NPH insulin to insulin glargine, it is common to reduce the initial dose of glargine by about 20% to minimize the risk of hypoglycemia. This is because glargine has a longer duration of action and a more predictable absorption profile, which can lead to a lower risk of hypoglycemic events, especially nocturnal hypoglycemia.

Question 14

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

Accepted Answer

The signs and symptoms of hypoglycemia include dizziness, confusion, diaphoresis (excessive sweating), and tachycardia (fast heart rate). Fruity breath odor and rapid respiration are signs of ketoacidosis, while diarrhea, abdominal pain, weight loss, and hypertension are symptoms of hyperglycemia. Easy bruising, palpitations, and cardiac dysrhythmias can be signs of other medical conditions but are not specifically associated with hypoglycemia. Coma is a severe complication that can occur in severe cases of hypoglycemia.

Question 15

Administration of exenatide is by subcutaneous injection:

Accepted Answer

Exenatide, when used in its immediate-release formulation, is typically administered by subcutaneous injection 60 minutes prior to the morning and evening meals, not right before or after meals, to ensure proper absorption and efficacy.

Question 16

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

Accepted Answer

Exenatide may delay gastric emptying and may affect the absorption of orally administered drugs. Therefore, concurrent administration of exenatide with drugs that have narrow therapeutic indices, such as digoxin and warfarin, or require absorption, such as lovastatin, should be avoided.

Question 17

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

Accepted Answer

Gliptins, also known as dipeptidyl peptidase-4 (DPP-4) inhibitors, act on the incretin system to indirectly increase insulin production. They inhibit the breakdown of incretin hormones like GLP-1 and GIP, which are released from the gut after a meal and stimulate insulin secretion from the beta cells of the pancreas. This results in a glucose-dependent increase in insulin secretion and a decrease in glucagon secretion, which helps lower blood glucose levels. Gliptins have a low risk for hypoglycemia and are generally weight-neutral, but they do not directly affect ATP-dependent potassium channels in the beta cell.

Question 18

Brands of pancreatic enzyme replacement drugs are:

Accepted Answer

The answer of Brands of pancreatic enzyme replacement drugs are:
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Question 19

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

Accepted Answer

The onset of action of neutral protamine Hagedorn (NPH) insulin after subcutaneous administration is generally 60 to 90 minutes.

Question 20

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

Accepted Answer

Elderly patients started on levothyroxine are at an increased risk of developing tachycardia and angina, especially if the dose is too high. Monitoring their heart rate and symptoms of chest pain is important to ensure they are on the appropriate dose. Excessive sedation, weight gain, and cold intolerance are not common side effects of levothyroxine.

Quiz 21: Drugs Affecting the Endocrine System