Thyroid, Adrenal, And Miscellaneous Endocrine Drugs
(263).webp "Thyroid, Adrenal, And Miscellaneous Endocrine Drugs - Quiz")
- 1.
Chronic administration of Winstrol may produce all of the following complications EXCEPT:
- A.
Prostate enlargement
- B.
Increased testicular size
- C.
Gynecomastia in men
- D.
Accelerated atherosclerosis
- E.
Decreased menses in women
Correct Answer
B. Increased testicular sizeExplanation
Stanozolol (Winstrol) is an androgen that would be expected to promote growth and development of male sex organs. However, chronic administration leads to feedback inhibition of testosterone secretion which leads to testicular atrophy.Rate this question:
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- 2.
The patient in Profile #2 is discharged on a new prescription for Deltasone 40 mg qd for 7 days. He should be instructed to:
- A.
Check feet closely for wounds
- B.
Take ibuprofen for musculoskeletal pain
- C.
Take on an empty stomach
- D.
Take at bedtime
- E.
Wear identification for steroid therapy
Correct Answer
A. Check feet closely for woundsExplanation
The patient has a history of diabetes and will be given prednisone (Deltasone), which would be expected to increase blood glucose. When diabetes is poorly controlled, infections are more likely to occur. For this reason, he should monitor more closely for wounds that may become infected. He will not be taking prednisone long enough to develop adrenal insufficiency, so there is no need for him to wear identification for steroid therapy.Rate this question:
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- 3.
J. T. is a 23-year-old male who presents to your outpatient pharmacy and asks to speak to the pharmacist. He inquires about natural remedies for breast enlargement. He also purchases benzoyl peroxide cream and facial cleanser, asking if these are the best products for acne. Which of the following drugs is he likely to be using?
- A.
Depo-Medrol (methylprednisolone)
- B.
Solu-Cortef (hydrocortisone)
- C.
Cytomel (liothyronine)
- D.
Anadrol-50 (oxymetholone)
- E.
Lugol’s iodine solution
Correct Answer
D. Anadrol-50 (oxymetholone)Explanation
Gynecomastia and acne are both adverse effects commonly associated with androgens and anabolic steroids.Rate this question:
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- 4.
Which of the following drugs is used to treat Cushing's disease? I. ketoconazole II. aminoglutethimide III. mitotane
- A.
I only
- B.
III only
- C.
I and II only
- D.
II and III only
- E.
I, II, and III
Correct Answer
E. I, II, and IIIExplanation
Ketoconazole, aminoglutethimide, and mitotane are all used to treat Cushing's disease. Ketoconazole is most commonly known as an antifungal agent, but it inhibits cortisol synthesis at high doses (800-1200 mg daily).Rate this question:
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- 5.
S. M. is a 62-year-old male with COPD who presents to the emergency department for an acute exacerbation of his COPD. The emergency department physician administers methylprednisolone 125 mg IV × one dose prior to admission to the hospital’s general medical floor. S. M. remains on methylprednisolone 80 mg IV every 6 hours for 8 days before he experiences significant improvement. On day 9, although he is improving otherwise, he complains of significant heartburn. Which of the following is the best treatment plan for S. M.’s corticosteroid therapy in the long term?
- A.
Continue S. M. on methylprednisolone 80 mg IV every 6 hours indefinitely because it is useful for COPD and has minimal side effects.
- B.
Change S. M.’s corticosteroid to the equivalent dose of prednisone po, and keep him on it indefinitely because it is useful for COPD and has minimal side effects.
- C.
Change S. M.’s corticosteroid to the equivalent dose of prednisone po and gradually taper over the course of 2 weeks until discontinued.
- D.
Discontinue the methylprednisolone immediately because it is no longer needed.
- E.
Discontinue the methylprednisolone immediately because he is experiencing unacceptable side effects.
Correct Answer
C. Change S. M.’s corticosteroid to the equivalent dose of prednisone po and gradually taper over the course of 2 weeks until discontinued.Explanation
The best treatment plan for S. M.'s corticosteroid therapy in the long term is to change his corticosteroid to the equivalent dose of prednisone po and gradually taper it over the course of 2 weeks until discontinued. This is because S. M. is experiencing significant heartburn, which is a common side effect of corticosteroid therapy. Tapering the dose of prednisone gradually helps to prevent withdrawal symptoms and allows the body to adjust to lower levels of the medication. This approach ensures that S. M. can safely discontinue the corticosteroid without experiencing any adverse effects.Rate this question:
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- 6.
Decreased urine production is an effect of:
- A.
Carmustine
- B.
Propylthiouracil
- C.
ACTH
- D.
Desmopressin
- E.
SSKI
Correct Answer
D. DesmopressinExplanation
esmopressin (DDAVP) is a synthetic analog of vasopressin, or antidiuretic hormone. Thus it decreases urine production by increasing water resorption.Rate this question:
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- 7.
Which of the following drugs may be used to diagnose adrenal insufficiency?
- A.
Desmopressin
- B.
Clemastine
- C.
Captopril
- D.
Cosyntropin
- E.
Aminoglutethimide
Correct Answer
D. CosyntropinExplanation
Cosyntropin (Cortrosyn) is a synthetic analog of ACTH that is used to diagnose adrenal insufficiency. It works by stimulating the adrenal cortex to secrete cortisol. If cosyntropin administration does not result in an appropriate increase in cortisol release, adrenal insufficiency is present.Rate this question:
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- 8.
Androderm is administered:
- A.
Once daily
- B.
Three times per week
- C.
Once weekly
- D.
Monthly
- E.
Every 2 weeks
Correct Answer
A. Once dailyExplanation
Testosterone transdermal systems (Androderm, Testoderm) are both applied once daily for 24 hours. Longer acting androgens are available, such as nandrolone decanoate (Deca-Durabolin), for once weekly administration.Rate this question:
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- 9.
Which of the following hormones is secreted by the pituitary gland?
- A.
Adrenocorticotropic hormone
- B.
Testosterone
- C.
Cortisol
- D.
Thyroxine
- E.
Corticotropin-releasing hormone
Correct Answer
A. Adrenocorticotropic hormoneExplanation
Adrenocorticotropic hormone, or ACTH, is released by the pituitary and acts on the adrenal glands to increase cortisol release. Corticotropin-releasing hormone is released by the hypothalamus and acts on the pituitary to stimulate ACTH release.Rate this question:
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- 10.
A patient with atrial fibrillation may require a decreased warfarin dosage when the following drug is initiated:
- A.
Liothyronine
- B.
Rifampin
- C.
Methimazole
- D.
Phenytoin
- E.
Diphenhydramine
Correct Answer
A. LiothyronineExplanation
Liothyronine (Cytomel) is T3, a potent thyroid hormone. In states of hypothyroidism, metabolism is decreased. However, if thyroid hormone is supplemented, blood clotting factors will be metabolized more quickly, leading to decreased warfarin requirements.Rate this question:
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- 11.
The Synthroid prescription dispensed to Mrs. Ricardo on 3/21 requires advising her to:
- A.
Take 4 hours before or 4 hours after Questran
- B.
Take with food
- C.
Watch for signs of infection
- D.
Take as needed to keep desired level of energy
- E.
Discontinue if you experience nausea
Correct Answer
A. Take 4 hours before or 4 hours after QuestranExplanation
Bile acid sequestrants reduce levothyroxine absorption and must be separated from levothyroxine administration by at least 4 hours. Levothyroxine should be administered before a meal on an empty stomach in order to maximize absorption.Rate this question:
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- 12.
Which of the following drugs works by decreasing cortisol synthesis?
- A.
Cortrosyn
- B.
ACTH
- C.
Oxandrolone
- D.
Prednisone
- E.
Metyrapone
Correct Answer
E. MetyraponeExplanation
Metyrapone (Metopirone) inhibits 11-hydroxylase activity, and thus decreases cortisol synthesis.Rate this question:
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- 13.
Which of the following drugs may produce hypothyroidism? I. amitriptyline II. lithium III. amiodarone
- A.
I only
- B.
III only
- C.
I and II only
- D.
II and III only
- E.
I, II and III
Correct Answer
D. II and III onlyExplanation
Lithium and amiodarone have both been associated with hypothyroidism. Amiodarone contains iodine, and may cause hypo- or hyperthyroidism.Rate this question:
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- 14.
K. R. is a 54-year-old male taking methyltestosterone for AIDS-related wasting disease. Which of the following should be used to monitor him for adverse effects from this drug?
- A.
Digital rectal exam
- B.
Hemoglobin A1c
- C.
Serum creatinine
- D.
Urinalysis
- E.
Serum calcium
Correct Answer
A. Digital rectal examExplanation
A digital rectal exam should be used to monitor the patient for adverse effects from methyltestosterone. Methyltestosterone is a medication used to treat AIDS-related wasting disease, and it can have side effects on the prostate gland. By performing a digital rectal exam, the healthcare provider can assess the size, shape, and texture of the prostate gland and check for any abnormalities or signs of prostate-related adverse effects. This monitoring is important to ensure the patient's safety and to detect any potential complications early on.Rate this question:
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- 15.
Which of the following drugs is best for rapid control of thyroid storm?
- A.
Propylthiouracil
- B.
Lugol’s iodine solution
- C.
Methimazole
- D.
Liothyronine
- E.
Liotrix
Correct Answer
B. Lugol’s iodine solutionExplanation
Iodine preparations work more rapidly than propylthiouracil or methimazole in thyroid storm and are preferred for acute control of this condition.Rate this question:
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- 16.
Which of the following drugs is indicated for use in sepsis to augment the effects of vasopressor therapy?
- A.
Pitressin (vasopressin)
- B.
DDAVP (desmopressin)
- C.
Cortrosyn (cosyntropin)
- D.
Tapazole (methimazole)
- E.
Triostat (liothyronine)
Correct Answer
A. Pitressin (vasopressin)Explanation
Vasopressin has antidiuretic and vasoconstrictive properties that may enhance the effects of vasopressors and decrease the required doses of vasopressors in sepsis.Rate this question:
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- 17.
Chronic administration of glucocorticoids predisposes patients to:
- A.
Arthritis
- B.
Obesity
- C.
Alzheimer's disease
- D.
Osteoporosis
- E.
Hepatitis
Correct Answer
D. OsteoporosisExplanation
Glucocorticoids have catabolic effects on a number of tissues, including muscle, fat, skin, and bone. Chronic administration leads to osteopenia and osteoporosis.Rate this question:
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- 18.
A patient is taking prednisone 40 mg daily for 6 months. Upon abrupt cessation, which of the following may occur?
- A.
Myopathy
- B.
Diabetes
- C.
Infection
- D.
Adrenal crisis
- E.
Psychosis
Correct Answer
D. Adrenal crisisExplanation
Chronic administration of glucocorticoids such as prednisone will lead to feedback inhibition of pituitary ACTH release, and atrophy of the adrenal cortex. When prednisone is abruptly stopped, the adrenals will not be able to meet the body's demand for cortisol during severe stress and adrenal crisis may occur.Rate this question:
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- 19.
V. R. is a 76-year-old female with a history of rheumatoid arthritis. Her medications for this condition include etanercept 50 mg subcutaneously once weekly and prednisone 5 mg po daily. She is admitted to the general medical ward of her local hospital for a deep venous thrombosis, and her physician asks for recommendations regarding her home medications. After 3 days in the hospital, V. R. experiences shortness of breath and hemodynamic instability. She is diagnosed with a pulmonary embolism, she is intubated, and she is sent to the ICU. Her physician then specifies she is to have nothing by mouth. Which of the following is the most appropriate plan regarding her prednisone therapy?
- A.
Discontinue prednisone immediately upon transfer to the ICU.
- B.
Taper prednisone over the course of 3 days after transfer to the ICU.
- C.
Continue prednisone by mouth at the same dose she was previously receiving.
- D.
Convert her current prednisone dose to the equivalent dose of methylprednisolone IV.
- E.
Change prednisone to methylprednisolone IV at a dose that is higher than the equivalent of her previous prednisone dose.
Correct Answer
E. Change prednisone to methylprednisolone IV at a dose that is higher than the equivalent of her previous prednisone dose.Explanation
At this point, V. R. has become critically ill and is also not to take anything by mouth. She will require an IV formulation of corticosteroids and will require a higher dose than her usual home dose because of the increased physiologic stress her body is under and her presumed lack of ability to mount additional adrenal response because of her long-term corticosteroid use.Rate this question:
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- 20.
Which of the following drugs can be used to treat Cushing’s disease?
- A.
Itraconazole
- B.
Fluconazole
- C.
Amphotericin B
- D.
Terbinafine
- E.
Ketoconazole
Correct Answer
E. KetoconazoleExplanation
Ketoconazole is effective for treatment of Cushing’s disease at high doses. The other antifungals listed have not been shown to be effective.Rate this question:
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- 21.
Close monitoring of adrenal hormone secretion may be required when administering:
- A.
Methyltestosterone
- B.
Mitotane
- C.
Desmopressin
- D.
Iodides
- E.
Propylthiouracil
Correct Answer
B. MitotaneExplanation
Mitotane is cytotoxic to adrenal cells and thus reduces cortisol synthesis and release. ACTH increases cortisol release. Close monitoring of cortisol levels is important when this drug is used.Rate this question:
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- 22.
Which of the following drugs can be used to prevent or decrease surgery-related bleeding in patients with von Willebrand’s disease?
- A.
Acthar Gel (corticotropin)
- B.
Stimate (desmopressin)
- C.
Florinef (fludrocortisone)
- D.
Lysodren (mitotane)
- E.
SSKI (saturated solution of potassium iodide)
Correct Answer
B. Stimate (desmopressin)Explanation
Desmopressin increases clotting factors and circulating platelets and may be used to control bleeding in surgical or other conditions.Rate this question:
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- 23.
Which of the following tests should be done frequently in patients taking desmopressin chronically?
- A.
Serum potassium
- B.
Urine ketones
- C.
Serum sodium
- D.
Serum calcium
- E.
B-natriuretic peptide (BNP)
Correct Answer
C. Serum sodiumExplanation
Desmopressin therapy is associated with hyponatremia, which may be severe and cause neurologic abnormalities.Rate this question:
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- 24.
An increased risk of peptic ulcer disease occurs when NSAIDs are combined with:
- A.
Ranitidine
- B.
Ferrous sulfate
- C.
Dexamethasone
- D.
Carbamazepine
- E.
Acetaminophen
Correct Answer
C. DexamethasoneExplanation
Corticosteroids such as dexamethasone (Decadron) are known to increase the risk of peptic ulcers when used in combination with NSAIDs.Rate this question:
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- 25.
H. P. is a 42-year-old male who presents to his physician. His complaints include increased hair growth on his back and chest; easy bruising; anxiety; fluid retention; and weight gain concentrated in his face, neck, and upper back. Which of the following disorders is H. P. most likely exhibiting?
- A.
Cushing’s disease
- B.
Addison’s disease
- C.
Graves’ disease
- D.
Hyperthyroidism
- E.
Hypothyroidism
Correct Answer
A. Cushing’s diseaseExplanation
The listed symptoms are all associated with Cushing’s disease (adrenal hyperactivity). Addison’s disease represents the opposite to Cushing’s disease (hypoadrenal state), whereas the other three options refer to diseases of the thyroid.Rate this question:
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- 26.
Cosyntropin can be used for which of the following purposes?
- A.
Diagnosis of diabetes insipidus
- B.
Treatment of diabetes insipidus
- C.
Diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH)
- D.
Treatment of adrenal insufficiency
- E.
Diagnosis of adrenal insufficiency
Correct Answer
E. Diagnosis of adrenal insufficiencyExplanation
Cosyntropin (synthetic adrenocorticotropic hormone) should stimulate release of cortisol when administered. Adrenal response to cosyntropin administration is a diagnostic indicator of adrenal insufficiency.Rate this question:
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- 27.
Which of the following drugs is indicated for bedwetting in children?
- A.
Vasopressin
- B.
Desmopressin
- C.
Cosyntropin
- D.
Oxymetholone
- E.
Methimazole
Correct Answer
B. DesmopressinExplanation
Desmopressin, an antidiuretic hormone analog, may be used to control nocturnal enuresisRate this question:
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- 28.
V. R. is a 76-year-old female with a history of rheumatoid arthritis. Her medications for this condition include etanercept 50 mg subcutaneously once weekly and prednisone 5 mg po daily. She is admitted to the general medical ward of her local hospital for a deep venous thrombosis, and her physician asks for recommendations regarding her home medications. Which of the following is the best recommendation for her regarding her prednisone therapy?
- A.
Discontinue prednisone therapy while V. R. is in the hospital.
- B.
Change the dose to prednisone 2.5 mg po daily while V. R. is in the hospital
- C.
Continue the prednisone at the current dose of 5 mg po daily while V. R. is in the hospital.
- D.
Increase the dose of prednisone to 20 mg po daily while V. R. is in the hospital.
- E.
Convert prednisone po to prednisone 10 mg IV daily while V. R. is in the hospital.
Correct Answer
C. Continue the prednisone at the current dose of 5 mg po daily while V. R. is in the hospital.Explanation
Discontinuation or decrease of the prednisone V. R. takes at home may precipitate withdrawal symptoms caused by HPA axis suppression. Increasing the dose to four times the home dose or converting to an IV formulation is not necessary according to the clinical situation of V. R.Rate this question:
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- 29.
Which of the following is a well-recognized adverse effect associated with corticosteroids?
- A.
Renal failure
- B.
QTc prolongation
- C.
Urticaria
- D.
Hyperglycemia
- E.
Weight loss
Correct Answer
D. HyperglycemiaExplanation
Corticosteroids are well known to cause hyperglycemia and should be used in caution in patients with diabetes mellitus.Rate this question:
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- 30.
Which of the following is used to treat adrenal crisis?
- A.
Cosyntropin
- B.
Aminoglutethimide
- C.
Fluoxymesterone
- D.
Vasopressin
- E.
Hydrocortisone
Correct Answer
E. HydrocortisoneExplanation
Hydrocortisone is the drug of choice for adrenal crisis since it possesses both mineralocorticoid and glucocorticoid properties. Although cosyntropin increases cortisol release, patients with adrenal crisis may not have enough adrenal reserve to meet their increased demand.Rate this question:
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- 31.
Decreased ketoconazole absorption may occur if it is administered concomitantly with:
- A.
Antacids
- B.
Food
- C.
Warfarin
- D.
Cyclosporine
- E.
CYP450 3A4 inhibitors
Correct Answer
A. AntacidsExplanation
Ketoconazole requires the presence of stomach acid in order to be absorbed. Any drug that decreases gastric acidity will decrease the extent of ketoconazole absorption. Food increases ketoconazole absorption since food stimulates release of gastric acid.Rate this question:
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- 32.
Which of the following is NOT an acceptable indication for testosterone?
- A.
Anemia
- B.
Hypogonadism
- C.
Delayed puberty
- D.
Body building
- E.
Metastatic breast cancer
Correct Answer
D. Body buildingExplanation
Anabolic steroids may be abused by those who are seeking enhanced muscular development and endurance, such as athletes. For this reason, all of these agents are subject to the Controlled Substances Act.Rate this question:
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- 33.
Which of the following androgen preparations requires the least frequent dosing?
- A.
Methyltestosterone (Methitest)
- B.
Testosterone buccal tablet (Striant)
- C.
Testosterone transdermal system (Androderm)
- D.
Testosterone topical gel (AndroGel)
- E.
Testosterone cypionate in oil (Depo-Testosterone)
Correct Answer
E. Testosterone cypionate in oil (Depo-Testosterone)Explanation
Testosterone cypionate in oil is a depot injection and is recommended to be given every 2–4 weeks. Topical formulations are applied daily, and oral formulations are taken every 12–24 hours.Rate this question:
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- 34.
All of the following may decrease the effect of thyroid hormone supplementation EXCEPT:
- A.
Antacids
- B.
Bile acid sequestrants
- C.
Estrogens
- D.
Sucralfate
- E.
Theophylline
Correct Answer
E. TheopHyllineExplanation
Numerous drugs are known to decrease thyroid hormone absorption, including antacids that contain divalent and trivalent cations, calcium salts, magnesium, sucralfate, and bile-acid sequestrants. Estrogens and enzyme-inducing drugs may decrease circulating thyroid hormone levels and necessitate a dose increase of thyroxine.Rate this question:
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- 35.
Which of the following is NOT an effect of glucocorticoids?
- A.
Immunosuppression
- B.
Decreased prostaglandin synthesis
- C.
Inhibit glycogenolysis
- D.
Decreased neutrophils at site of infection
- E.
Inhibition of macrophages
Correct Answer
C. Inhibit glycogenolysisExplanation
Glucocorticoids have potent effects on glucose and carbohydrate metabolism. They promote glycogen breakdown, rather than inhibit it.Rate this question:
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- 36.
Which of the following corticosteroid agents has the highest ratio of mineralocorticoid to glucocorticoid activity?
- A.
Hydrocortisone
- B.
Fludrocortisone
- C.
Prednisone
- D.
Methylprednisolone
- E.
Dexamethasone
Correct Answer
B. FludrocortisoneExplanation
Fludrocortisone is almost purely mineralocorticoid and is used for increasing blood pressure rather than for anti-inflammatory effects.Rate this question:
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- 37.
Which of the following is LEAST likely to contribute to the increased blood glucose seen in this patient?
- A.
Dextrose 5%/NaCl 0.9% solution
- B.
Captopril
- C.
Epinephrine
- D.
Methylprednisolone
- E.
Anaphylaxis
Correct Answer
B. CaptoprilExplanation
Captopril increases insulin sensitivity and would not be expected to contribute to increased blood glucose. This patient's blood glucose began rising shortly after admission. His IV fluids contain glucose, epinephrine increases blood glucose by increasing glycogen breakdown, methylprednisolone (Solu-Medrol) promotes glycogenolysis, and anaphylaxis would be expected to increase stress response leading to increased epinephrine release and increased blood glucose.
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- 38.
A patient who is suffering from heat intolerance, weight loss, tachycardia, tremor, and anxiety may be treated with:
- A.
Acetaminophen
- B.
Mitotane
- C.
Cyproheptadine
- D.
Propylthiouracil
- E.
Diazepam
Correct Answer
D. PropylthiouracilExplanation
Heat intolerance, weight loss, tachycardia, tremor and anxiety are cardinal features of hyperthyroidism. Propylthiouracil is effective at reducing the excessive thyroxine level.Rate this question:
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- 39.
Excessive doses of levothyroxine may cause:
- A.
Weight gain
- B.
Osteoporosis
- C.
Cold intolerance
- D.
Bradycardia
- E.
Sedation
Correct Answer
B. OsteoporosisExplanation
Levothyroxine decreases bone mineral density and when given in supratherapeutic doses may cause osteoporosis. For this reason, the lowest possible replacement dose should be administered.Rate this question:
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- 40.
Which of the following of Mrs. Ricardo's conditions could the Synthroid exacerbate?
- A.
Hypercholesterolemia
- B.
Anemia
- C.
Coronary artery disease
- D.
Hypertension
- E.
Constipation
Correct Answer
C. Coronary artery diseaseExplanation
Thyroid hormones enhance oxygen consumption and increase the oxygen demand. Mrs. Ricardo has a past medical history of coronary artery disease (CAD), and is elderly. Thyroid supplementation would actually lower her cholesterol in the long run, but may precipitate angina acutely.Rate this question:
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