Chapter 21: Drugs Affecting the Endocrine System
Identify the choice that best completes the statement or answers the question.
____ 1. Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:
A. Cortical bone
B. Femoral neck
C. Cervical vertebrae
D. Pelvic bones
____ 2. Bisphosphonates treat or prevent osteoporosis by:
A. Inhibiting osteoclastic activity
B. Fostering bone resorption
C. Enhancing calcium uptake in bone
D. Strengthening the osteoclastic proton pump
____ 3. 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
D. Calcium supplements
____ 4. 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:
____ 5. Brands of pancreatic enzyme replacement drugs are:
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
____ 6. When given subcutaneously, NPH insulin begins to take effect (onset of action):
A. 15 to 30 minutes after administration
B. 60 to 90 minutes after administration
C. 3 to 4 hours after administration
D. 6 to 8 hours after administration
____ 7. 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
____ 8. 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
____ 9. Lipro 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 NPH insulin.
D. It has no pronounced peak.
____ 10. The decision may be made to switch from BID 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
____ 11. 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 complications risks. Which of the following statements are 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 post-prandial glucose levels than are long-acting insulins.
D. Patients who are not controlled on oral agents and have post-prandial hyperglycemia can have NPH insulin added at bedtime.
____ 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
____ 13. 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
____ 14. 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
____ 15. Sitagliptin has been approved for:
A. Monotherapy in once daily doses
B. Combination therapy with metformin
C. Both A and B
D. Neither A nor B
____ 16. 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
____ 17. Avoid concurrent administration of exenatide with which of the following drugs?
D. All of the above
____ 18. 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
____ 19. 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
____ 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