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PHRM 825 Therapeutics > Random Exam 2 Info > Flashcards

Random Exam 2 Info Flashcards

1
Q

which of the following is NOT a physiological effect of testosterone?

a. stimulation of erythrocyte production
b. deepening of the voice
c. increase in lean body mass
d. increase in HDL levels
e. growth of beard hair

A

d. increase in HDL levels

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2
Q

which of the following is NOT an indication for antiandrogens?

a. benign prostatic hyperplasia
b. endometriosis
c. prostatic carcinoma
d. excessive sexual drive in men

A

b. endometriosis

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3
Q

The inhibition of the first step of the steroid synthesis by a drug will decrease the levels of all steroid hormones. Which of the following enzymes catalyzes this step?

a. 17,20-lyase
b. P450scc
c. 17a-hydroxylase
b. 21B-hydroxylase

A

b. P450scc

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4
Q

Which of the following enzymes converts testosterone to a more potent androgen in the target tissues?

a. 21-hydroxylase
b. 17a-hydroxylase
c. aromatase
d. 5a-reductase

A

d. 5a-reductase

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5
Q

select an incorrect pair of a drug and its property

a. methyltestosterone: orally active androgen
b. testosterone cypionate: androgen for intramuscular injection
c. flutamide: non-steroidal antiandrogen
d. finasteride: 5a-reductase inhibitor
e. spironolactone: anabolic steroid

A

e. spironolactone: anabolic steroid

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6
Q

Which of the following modes of cell-cell communication has the shortest signal duration?

a. endocrine
b. juxtacrine
c. paracrine
d. autocrine
e. neuronal

A

e. neuronal

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7
Q

which of the following is NOT an adverse effect of androgens in women?

a. amenorrhea
b. hirsutism
c. gynecomastia
d. acne

A

c. gynecomastia

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8
Q

What is the effect of the 17a-ethinyl group on the property of Ethinyl estradiol?

a. prevention of conversion of estrone
b. gaining of SERM activity
c. decrease in oral bioavailability
d. gaining of antiestrogenic activity

A

a. prevention of conversion of estrone

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9
Q

Which of the following statements is INCORRECT regarding the menstrual cycle?

a. in the early follicular phase, estrogen suppresses production of FSH
b. in the late follicular phase, estrogen stimulates the surge of LH and FSH
c. If pregnancy does not occur, production of estrogen and progesterone by corpus luteum declines
d. in the luteal phase, both estrogen and progesterone stimulate the production of LH and FSH

A

d. in the luteal phase, both estrogen and progesterone stimulate the production of LH and FSH

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10
Q

Which of the following is NOT a physiological effect of estrogens?

a. stromal development and ductal growth in breast
b. enhancement of coagulability of blood
c. increase rate of resorption of bone
d. development of endometrial lining during menstrual cycle

A

c. increase rate of resorption of bone

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11
Q

Which of the following estrogens can be used for depot injection due to its slow absorption?

a. mestranol
b. quinestrol
c. estradiol valerate
d. ethinyl estradiol

A

c. estradiol valerate

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12
Q

which of the following is NOT a side effect of estrogens?

a. hot flashes
b. endometrial carcinoma
c. uterine bleeding
d. breast cancer

A

a. hot flashes

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13
Q

_________ is a selective estrogen receptor modulator (SERM) used to treat breast cancer

a. ethinyl estradiol
b. tamoxifen
c. diethyl stilbesterol
d. clomiphene

A

b. tamoxifen

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14
Q

Which of the following is a conjugated estrogen existing in a mixture of estrogens in Premarin?

a. ethinyl estradiol
b. equilin sulfate
c. metranol
d. estradiol cypionate

A

b. equilin sulfate

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15
Q

Which of the following SERMs is used to stimulate ovulation?

a. clomiphene
b. raloxifene
c. toremifene
d. tamoxifen

A

a. clomiphene

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16
Q

which of the following is NOT an aromatase inhibitor?

a. letrozole
b. exemestane
c. anastrazole
d. fulvestrant

A

d. fulvestrant

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17
Q

Which of the following is an antiestrogenic activity of raloxifene?

a. decreases LDL levels in blood
b. decrease risk for breast cancer
c. increases risk for blood clots
d. prevent osteoporosis in postmenopausal women

A

b. decrease risk for breast cancer

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18
Q

Which of the following is NOT an adverse effect of androgen-like progestins

a. acne
b. hirsutism
c. venous thromboembolic disease
d. weight gain

A

c. venous thromboembolic disease

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19
Q

Which is INCORRECT about the physiologic effects of progesterone?

a. decreases basal insulin levels & insulin response to glucose
b. causes maturation of endometrium following ovulation
c. causes a decrease in Na+ reabsorption
d. promotes glycogen storage in liver

A

a. decreases basal insulin levels & insulin response to glucose

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20
Q

What is the benefit of use of progestins in combination with estrogens?

a. Prevents acne
b. Increases efficacy of estrogens
c. Prevents breast cancer
d. Prevents uterine bleeding & endometrial carcinoma

A

d. Prevents uterine bleeding & endometrial carcinoma

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21
Q

what is the active component of Plan B?

a. mifepristone
b. ulipristal acetate
c. levonorgestrel
d. ethinyl estradiol

A

c. levonorgestrel

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22
Q

Which of the following is CORRECT about the physiological effects of glucocorticoids?

a. Inhibit the production of eicosanoids
b. Promote synthesis of cytokines
c. Increase protein synthesis in muscle
d. Suppress lipolysis in adipose tissues

A

a. Inhibit the production of eicosanoids

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23
Q

Which of the following is NOT a symptom of Cushing’s disease?

a. Opportunistic infections
b. Osteoporosis
c. Extreme weakness
d. Easy bruising

A

c. Extreme weakness

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24
Q

A patient has abnormally high levels of ACTH due to pituitary carcinoma. What would be the corresponding effect on the patient’s corticosteroid levels?

a. Increase in cortisol and increase in aldosterone
b. Decrease in cortisol and increase in aldosterone
c. Increase in cortisol and no change in aldosterone
d. Decrease in cortisol and no change in aldosterone

A

c. Increase in cortisol and no change in aldosterone

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25
Q

Cessation of long-term systemic glucocorticoid therapy can lead to ____.

a. Cushing’s symptoms
b. Ectopic production of ACTH
c. Tumors in the adrenal cortex
d. Addisonian symptoms

A

d. Addisonian symptoms

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26
Q

Which of the following glucocorticoids is a long-acting glucocorticoid?

a. Prednisone
b. Cortisol
c. Dexamethasone

A

c. Dexamethasone

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27
Q

Which of the following corticosteroids is used in the minerlocorticoid replacement therapy?

a. Betamethasone
b. Prednisone
c. Triamcinolone acetonide
d. Fludrocortisone

A

d. Fludrocortisone

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28
Q

Which of the following glucocorticoids is NOT used as an inhaled glucocorticoid?

a. Flunisolide
b. Prednisone
c. Triamcinolone acetonide
d. Fluticasone propionate

A

b. Prednisone

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29
Q

Which of the following is NOT an adverse effect of glucocorticoids?

a. Hypoglycemia
b. Steroid myopathy
c. Moon face
d. Cataract

A

a. hypoglycemia

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30
Q

which of the following is a hypothalamic hormone?

a. ACTH
b. growth hormone
c. FSH
d. somatostatin

A

d. somatostatin

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31
Q

Which of the following is a clinical use of non-pulsatile continuous administration of GnRH?

a. Induction of ovulation
b. Stimulation of gonadotropin release
c. Suppression of LH surge
d. Stimulation of androgen synthesis

A

c. Suppression of LH surge

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32
Q

Which of the following is an GnRH receptor antagonist?

a. Desmopressin
b. Degarelix
c. Leuprolide
d. Nafarelin

A

b. Degarelix

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33
Q

Which of the following statements is INCORRECT about hCG?

a. It is extracted and purified from the urine of pregnant women
b. It is produced during pregnancy
c. It is a pituitary hormone
d. Its activity is nearly identical to that of LH

A

c. it is a pituitary hormone

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34
Q

Which of the following is NOT a symptom of growth hormone deficiency?

a. Acromegaly
b. Short stature
c. Adiposity in childhood
d. Hypoglycemia

A

a. Acromegaly

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35
Q

which of the following is a posterior pituitary hormone?

a. LH
b. TSH
c. Prolactin
d. Vasopressin

A

d. Vasopressin

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36
Q

hyperprolactinemia can be treated with __________

a. dopamine agonists
b. GnRH antagonists
c. SERMs
d. Antiandrogens

A

a. dopamine agonists

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37
Q

which of the following hormones can be used for labor induction?

a. GnRH
b. hCG
c. oxytocin
d. prolactin

A

c. oxytocin

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38
Q

Which of the following is INCORRECT about desmopressin?

a. It has a much higher vasopressor to antidiuretic activity than that of vasopressin
b. It is a synthetic analog of vasopressin
c. It can be used to treat pituitary diabetes insipidus
d. It has a longer half-life than vasopressin

A

a. It has a much higher vasopressor to antidiuretic activity than that of vasopressin

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39
Q

Which of the following is a mixture of FSH and LH?
a. Lutropin a
b. Urofollitropin
c. hCG
d. Menotropin

A

d. Menotropin

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40
Q

Which of the following statements is INCORRECT on the action of the eicosanoids?

a. PGE2 dilates blood vessels
b. PGF2a dilates bronchi
c. PGI2 inhibits platelet aggregation
d. TXA2 promotes platelet aggregation

A

b. PGF2a dilates bronchi

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41
Q

Aspirin use before surgery or tooth extraction is contraindicated bc aspirin increases the risk of bleeding by inhibition of ___ synthesis in ___.

a. PGI2, platelets
b. PGI2; vascular endothelia
c. TXA2; platelets
d. TXA2; vascular endothelia

A

c. TXA2; platelets

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42
Q

Which of the following drugs can be used together w/ NSAIDs to prevent gastric ulcers?

a. Alprostadil
b. Misoprostol
c. Latanoprost
d. Prostacyclin

A

b. Misoprostol

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43
Q

Which of the following statements is INCORRECT about NSAIDs?

a. Most NSAIDs inhibit both COX1 and COX2
b. NSAIDs reduce synthesis of prostaglandins
c. NSAIDs reduce synthesis of leukotrienes
d. NSAIDs reduce pain, fever, inflammation

A

c. NSAIDs reduce synthesis of leukotrienes

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44
Q

Which of the following NSAIDs is suitable for a long-term use to treat chronic inflammation due to less GI side effects?

a. Sulindac
b. Indomethacin
c. Aspirin
d. Ketorolac

A

a. Sulindac

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45
Q

Select the most potent NSAID out of the following drugs

a. Aspirin
b. Ibuprofen
c. Indomethacin
d. Naproxen

A

c. Indomethacin

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46
Q

Select the NSAID that is suitable only for a short-term management of moderate to severe pain

a. Sulindac
b. Naproxen
c. Diclofenac
d. Ketorolac

A

a. Ketorolac

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47
Q

which of the following NSAIDs is a selective COX2 inhibitor?

a. aspirin
b. celecoxib
c. indomethacin
d. ketorolac

A

b. celecoxib

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48
Q

Which of the following statements is CORRECT about acetaminophen?

a. It is an NSAID
b. Overdosing may cause liver damage
c. It is associated with Reye’s disease
d. It suppresses blood coagulation

A

b. Overdosing may cause liver damage

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49
Q

A 17a-hydroxylase deficiency will most likely lead to increased levels of which steroid hormone?

a. aldosterone
b. cortisol
c. testosterone
d. estradiol

A

a. aldosterone

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50
Q

you would expect an increase in __________ and a decrease in __________ with 21a-hydroxylase deficiency?

a. testosterone/estrogen, aldosterone/cortisol
b. progesterone, aldosterone/cortisol
c. aldosterone/cortisol, testosterone/estrogen
d. all steroid hormone synthesis would decrease

A

c. aldosterone/cortisol, testosterone/estrogen

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51
Q

progesterone function in menstrual cycle

A

maintains the uterine lining

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52
Q

describe the difference in the mechanism of action of acetaminophen from that of NSAIDs

A

acetaminophen blocks productions of prostaglandins in the CNS; NSAIDs block the activity of COX enzymes, which are responsible for the production of prostaglandins

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53
Q

describe the difference in the mechanism of action of acetaminophen from that of NSAIDs

A

acetaminophen blocks productions of prostaglandins in the CNS; NSAIDs block the activity of COX enzymes, which are responsible for the production of prostaglandins, in both the CNS and throughout the body

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54
Q

what enzyme would we inhibit to treat gynecomastia?

A

aromatase

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55
Q

function of 5a-reductase

A

converts testosterone to DHT, a more potent androgen

56
Q

why are estrogens often given in combination with progestins?

a. progesterone helps limit endometrial carcinomas
b. progesterone protects from breast cancer development
c. progesterone limits nausea experienced from estrogens
d. both A and B

A

a. progesterone helps limit endometrial carcinomas

(progestins do not protect from breast cancer or reduce water retention (usually) from estrogens)

57
Q

true or false: tamoxifen increases risk of osteoporosis

A

false

58
Q

why might a male be given an aromatase inhibitor?

a. excess testosterone is converted into estrogen in some forms of cancer
b. males do not possess aromatase and therefore are never given aromatase inhibitors
c. aromatase inhibitors help reduce testosterone, since testosterone is removed from the body more rapidly than estrogen

A

a. excess testosterone is converted into estrogen in some forms of cancer

59
Q

what is a clinical use of testosterone?

a. hirsutism
b. acne
c. endometriosis
d. overactive sex drive
e. benign prostatic hyperplasia

A

c. endometriosis

60
Q

will a more lipophilic molecule have a shorter or longer half life than a less lipophilic molecule?

A

longer

61
Q

inhibiting the 5a-reductase enzyme is necessary for what diseases?

A

male pattern baldness, polycystic ovary syndrome (PCOS)

62
Q

which of the following is not one of the primary uses of progestins?

a. hormonal contraception
b. endometriosis
c. dysmenorrhea
d. hormone replacement (monotherapy)

A

d. hormone replacement (monotherapy)

(progestins can be given as monotherapy for birth control, but are not given solely for hormonal replacement)

63
Q

what hormone increases androgen production in men? What is required for spermatogenesis?

A

-LH stimulates androgen production
-FSH and LH are both required for spermatogenesis

64
Q

what hormone does hCG resemble?

A

LH

(both are heterodimeric proteins with the same alpha chain)

65
Q

what are the steps of the inflammatory response?

A

damaged cells release histamine, which inc blood flow to the area and causes capillary leakage. Phagocytes enter the area and engulf debris. Platelets leave the capillary to seal the wound

66
Q

which of the following two eicosanoids have an effect on platelets? (2 of them)

a. PGI2
b. PGE2
c. PGF2a
d. TXA2

A

a and d

67
Q

describe how NSAIDs increase the risk of gastric bleeding

A

many NSAIDs are acidic, which upsets the lining of the stomach. NSAIDs block the production of PGEs (protect stomach lining). If a bleed does occur, the platelet aggregation inhibition makes it harder to stop

68
Q

JT is a 67 yowm who takes an aspirin 81 mg tablet daily following his recent heart attack. This morning, JT wakes up with shoulder pain and wants to take 400 mg ibuprofen in addition to the aspirin. What would you tell JT?

a. the aspirin dose will cover the pain
b. take the drugs at the same time on an empty stomach
c. take the aspirin 30 minutes before the ibuprofen
d. don’t take the drugs together

A

c. take the aspirin 30 minutes before the ibuprofen

69
Q

which of the following drugs are prodrugs?

a. nabumetone
b. ibuprofen
c. sulindac
d. meloxicam

A

a and c

70
Q

misoprostol is sometimes used in patients who require long-term NSAID usage. Which purposes does this prostaglandin analog serve? (2 answers)

a. reduce acid secretion
b. increase absorption of the NSAID
c. increase platelet aggregation potential
d. increase gastric mucus secretion potential

A

a and d

(Misoprostol is a PGE1 analog. PGE1 has a protective effect on the stomach by decreasing acid secretion and increasing mucus secretion)

71
Q

which symptom would a patient with osteoarthritis typically not complain of?

a. joint stiffness in the morning
b. crepitus
c. muscle atrophy
d. involvement of bilateral joints

A

d. involvement of bilateral joints

72
Q

JO is a 50 yof who comes to the pharmacy complaining of right knee pain that is not controlled on 4 g of tylenol per day. She states the pain has really limited her at work and she doesn’t know what other options she has. In the past, she has had GI bleeds on ibuprofen. What would you recommend to JO?

a. naproxen 250 mg bid
b. diclofenac 1% gel (4 mg) to knee qid
c. tramadol 50 mg qd
d. intra-articular triamcinolone 10 mg injection today

A

b. diclofenac 1% gel (4 mg) to knee qid

(topical NSAID would bypass stomach problems, which would likely rule out naproxen. Injections are usually later choices after topical therapy)

73
Q

PB is a 60 yom who calls your clinic complaining of bothersome joint pain in his right hand. The pain subsides after about 25 minutes upon waking but comes back and makes typing at work difficult. PB has a PMH of liver cirrhosis and eczema. He hasn’t tried any medication. What do you recommend?

a. tylenol 500 mg q6h
b. ibuprofen 200 mg q8h
c. accupuncture once per week
d. capsaicin 0.15% cream to hands 3-4 times per day

A

b. ibuprofen 200 mg q8h

(hand osteoarthritis, eczema might make us stay away from topicals)

74
Q

Which of the following statements is true?

a. Molecules involved in juxtacrine signaling are released into the bloodstream
b. Molecules involved in endocrine signaling associate with high affinity receptors
c. Molecules involved in paracrine signaling travel long distance through the blood
d. molecules involved in synaptic signaling are present in low local concentration and dissociate rapidly

A

b. Molecules involved in endocrine signaling associate with high affinity receptors

75
Q

_____ receptors involve molecules that are _____, which activate downstream molecules for cell signaling

a. cell-surface; hydrophobic
b. cell-surface; lipophilic
c. intracellular; hydrophilic
d. intracellular; hydrophobic

A

d. intracellular; hydrophobic

76
Q

AA is recently diagnosed with 17α-hydroxylase deficiency. Which of the following would be most likely to be observed in this patient?

a. mutation in CYP21A2
b. deficiency of aldosterone
c. deficiency of sex hormone
d. overproduction of cortisol

A

c. deficiency of sex hormone

(17a-hydroxylase makes sex hormones)

77
Q

CD is diagnosed with 21-hydroxylase deficiency. Which of the following statements is FALSE?

a. it is caused by CYP21A2 mutation
b. adrenal glands are enlarged due to hypocortisolism
c. deficiency of aldosterone
d. deficiency of sex hormones

A

d. deficiency of sex hormones

78
Q

Which of the following enzymes is reversible (work both ways)?

a. 17 β-hydroxysteroid dehydrogenase
b. Aromatase
c. 21-hydroxylase
d. 17,20-lyase

A

a. 17 β-hydroxysteroid dehydrogenase

79
Q

Which of the following enzymes is NOT inhibited by ketoconazole?

a. P450scc
b. 11 β-hydroxylase
c. Aromatase
d. 17α-hydroxylase

A

c. Aromatase

80
Q

Which of the following statements is FALSE regarding testosterone?

a. Testosterone binds to an intracellular receptor and alter the rate of transcription
b. Testosterone is mostly produced in the adrenal glands
c. Most of the circulated testosterone is bound to SHBG
d. 5 α-dihydrotestosterone is the more potent structure of testosterone

A

b. Testosterone is mostly produced in the adrenal glands

81
Q

Hypothalamus release GnRH. This signals the _______ pituitary gland to release _____, which signals the _____ to increase ______.

a. Anterior; LH; Sertoli cell; testosterone
b. Anterior; LH; Leydig cell; testosterone
c. Anterior; FSH; Leydig cell; spermatogenesis
d. Posterior; FSH; Sertoli cell; spermatogenesis

A

b. Anterior; LH; Leydig cell; testosterone

82
Q

what are the physiological effects of testosterone?

a. increase HDL levels
b. negative nitrogen balance
c. stimulate erythrocyte production
d. decrease bone resorption rate

A

c. stimulate erythrocyte production

83
Q

Which of the following is NOT a method to increase half-life of a synthetic androgen?

a. Addition of an alkyl group on carbon 17
b. Decreasing solubility
c. Addition of a ketone group on carbon 11
d. Covering the OH group with ester

A

c. Addition of and ketone group on carbon 11

84
Q

Which of the following antiandrogen molecules inhibit 5α-reductase?

a. Finasteride
b. Spironolactone
c. Cyproterone
d. Flutamide

A

a. Finasteride

(dutasteride also inhibits)

85
Q

Which of the following statements is FALSE?

a. Progesterone plays a role in maturation of endometrium
b. The menstrual cycle is divided into follicular phase and luteal phase
c. In early follicular phase, estrogen stimulates FSH production
d. In late follicular phase, estrogen stimulates LH and FSH surge
e. In luteal phase, estrogen and progesterone suppresses LH and FSH production

A

c. In early follicular phase, estrogen stimulates FSH production

86
Q

Which of the following statements is TRUE?

a. Corpus luteum degenerates once pregnancy occurs
b. The endometrium secretes hCG during pregnancy
c. hCG acts like FSH to stimulate corpus luteum during the 1st
trimester
d. Higher progesterone level helps maintain endometrium

A

d. Higher progesterone level helps maintain endometrium

87
Q

Which of the following is NOT a physiologic effect of estrogen?

a. Development of endometrial lining
b. Female maturation
c. Decrease bone resorption
d. Decrease HDL
e. Blood coagulation

A

d. decrease HDL

88
Q

Which of the following is NOT required on a structure of an estrogen for activity?

a. Aromaticity in A ring
b. 17 β OH group
c. 16-OH group
d. Hydroxyl group in carbon 3

A

c. 16-OH group

89
Q

Which of the following is NOT a characteristic of a nonsteroidal estrogen?

a. An OH group for agonist activity
b. Rigid core
c. 4 membered ring
d. Amine substituted side chain for antagonist/SERM activity

A

c. 4 membered ring

90
Q

SH is a patient with breast cancer and osteoporosis. Which of the following would be
most appropriate for this patient?

a. Diethylstilbestrol
b. Tamoxifen
c. Anastrozole
d. Exemestane

A

b. Tamoxifen

91
Q

Which of the following is a SERD?

a. Fulvestrant
b. Clomiphene
c. Raloxifene
d. Exemestane

A

a. Fulvestrant

92
Q

Which of the following is FALSE regarding SERM?

a. Has both agonist and antagonist effects
b. Can block stronger estrogen
c. Increase risk for blood clots
d. Mainly steroidal estrogen

A

d. Mainly steroidal estrogen

93
Q

Which of the following is NOT a pharmacological effect of oral contraceptive?

a. Combination products inhibit pituitary function
b. Progestin-only products do not always inhibit ovulation
c. Combination products inhibit ovarian function
d. Combination products may decrease breast size

A

d. Combination products may decrease breast size

94
Q

Which of the following statements is FALSE regarding emergency contraceptives?

a. It is most effective when taken within 72 hours
b. Ulipristal acetate is a SERM
c. Mifepristone is effective up to 70 days
d. Mifepristone is used in combination with misoprostol

A

b. Ulipristal acetate is a SERM

(it is a SPRM, a selective progesterone receptor modulator)

95
Q

_____ and _____ cause vasodilation. PGI2 _____ platelet aggregation

a. PGE2; PGI2; enhances
b. PGE2; PGF2a; enhances
c. PGE2; PGI2; inhibits
d. PGE2; TXA2; inhibits

A

c. PGE2; PGI2; inhibits

96
Q

Which of the following drug(s) is recommended to be avoided in patients under 12 yo? There may be more than one answer.

a. Acetylsalicylic acid
b. Acetaminophen
c. Salsalate
d. Ibuprofen

A

a. Acetylsalicyclic acid
c. Salsalate

97
Q

Which of the following is most suitable for long term use?

a. Ketorolac
b. Celecoxib
c. Indomethacin
d. Naproxen

A

b. Celecoxib

98
Q

Which of the following is NOT a consequence of COX1 inhibition?

a. Inhibition of uterine motility
b. Platelet aggregation inhibition
c. Stomach ulceration
d. Increased production of PGE production
e. TXA2 inhibition

A

d. increased production of PGE production

(decreases)

99
Q

Which of the following is NOT true regarding the COX2 inhibition?

a. Inhibits production of TXA2 which decreases risk of clotting
b. Increases cardiovascular risk
c. Decreased GI side effect
d. Results in elevated blood pressure

A

a. Inhibits production of TXA2 which decreases risk of clotting

100
Q

RS is a 45 yom presenting to the clinic today with the following lab results: decreased CRH, decreased ACTH, and increased cortisol. Which of the following is the most appropriate diagnosis for this patient?

a. Primary (adrenal defect) adrenal insufficiency
b. Secondary (pituitary defect) adrenal insufficiency
c. Primary (adrenal defect) cushing’s disease
d. Secondary (pituitary defect) cushing’s disease

A

c. Primary (adrenal defect) cushing’s disease

101
Q

RS is a 45 yom presenting to the clinic today with the following lab results: decreased CRH, decreased ACTH, and increased cortisol. Which of the following is the most appropriate diagnosis for this patient?

a. Primary (adrenal defect) adrenal insufficiency
b. Secondary (pituitary defect) adrenal insufficiency
c. Primary (adrenal defect) Cushing’s disease
d. Secondary (pituitary defect) Cushing’s disease

A

Primary (adrenal defect) Cushing’s disease

102
Q

Which of the following is NOT a symptom of adrenal insufficiency?

a. Extreme weakness
b. Anorexia
c. Osteoporosis
d. Depression

A

c. Osteoporosis

103
Q

A patient presents to the ED complaining of intense edema that recently appeared. The patient stated that he/she started a new oral steroid recently but cannot remember what it was. Which of the following steroids is the patient most likely taking?

a. Prednisone
b. Fludrocortisone
c. Triamcinolone
d. Betamethasone

A

b. Fludrocortisone

104
Q

Which of the following is NOT an adverse effect of glucocorticoid?

a. Decreased glucose production
b. Redistribution of fat
c. Immune system suppression
d. Cataracts

A

a. Decreased glucose production

105
Q

What is the preferred corticosteroid dose and duration of treatment?

a. Highest dose and longest duration possible
b. Highest dose and shortest duration possible
c. Lowest dose and longest duration possible
d. Lowest dose and shortest duration possible

A

c. Lowest dose and longest duration possible

106
Q

true or false: corticosteroids are used as immunosuppressant and anti-inflammatory to cure underlying disease

A

false

(they do not cure)

107
Q

Which of the following is a long-acting corticosteroid?

a. Prednisolone
b. Hydrocortisone
c. Betamethasone
d. Triamcinolone
e. All of the above

A

c. Betamethasone

(long-acting; inhaled; not oral)

108
Q

Which of the following is NOT a side effect of corticosteroids?

a. Muscle weakness
b. Osteoporosis
c. Hypoglycemia
d. Cataract
e. Increase bp

A

c. hypoglycemia

109
Q

Which of the following is a clinical presentation of Cushing’s syndrome? Select all that applies.

a. Moon face
b. Fast growth
c. Buffalo hump
d. Easy bruising
e. All of the above

A

a. Moon face
c. Buffalo hump
d. Easy bruising

110
Q

Which of the following are clinical presentations of primary chronic adrenal insufficiency? Select all that applies.

a. Tachycardia
b. Hyponatremia
c. Salt craving
d. Hyperpigmentation of skin and mucous membranes
e. All of the above

A

b. hyponatremia
c. salt craving
d. hyperpigmentation of skin and mucous membranes

111
Q

Which of the following should be avoided to prevent hypercortisolism?

a. Phenytoin
b. Rifampin
c. Carbamazepine
d. All of the above

A

d. All of the above

112
Q

3 drugs that are 17a-alkylated estrogens

A

-ethinyl estradiol
-mestranol
-quinestrol

113
Q

2 drugs that are estrogenic esters

A

-estradiol valerate
-estradiol cypionate

(these have low solubility, so you don’t need to inject them as often)

114
Q

conjugated estrogens are made of 50-60% __________ and 20-30% __________

A

estrone sulfate, equilin sulfate

(think of Premarin)

115
Q

2 drugs that are non-steroidal estrogens

A

-diethylstilbesterol (DES)
-chlorotrianisene (Tace)

116
Q

use for diethyl stilbesterol (DES)

A

advanced prostate cancer

117
Q

SERMs are _____ estrogen _____

a. selective; antagonists
b. partial; antagonists
c. selective agonists
d. partial; agonists

A

d. partial agonists

118
Q

5 SERM drugs to know

A

-Tamoxifen (Novaldex)
-Toremifene (Fareston)
-Ospemifene (Osphena)
-Raloxifene (Evista)
-Clomiphene

119
Q

one SERD drug to know

A

Fulvestrant

(it is an estrogen receptor antagonist)

120
Q

3 aromatase inhibitors to know

A

-anastrozole
-letrozole
-exemestane

121
Q

what is the mechanism of immunosuppression by glucocorticoids?

A

activated glucocorticoid receptor (GR) binds to NFkB (NF kappa beta) and prevents binding of NFkB to its response element; transcription of cytokine genes are repressed

122
Q

2 short-acting systemic corticosteroid drugs

A

-hydrocortisone
-cortisone

123
Q

4 intermediate-acting systemic corticosteroid drugs

A

-prednisone
-prednisolone
-methylprednisolone
-triamcinolone

124
Q

2 long-acting systemic corticosteroids drugs

A

-dexamethasone
-betamethasone

125
Q

is methyltestosterone taken orally or intramuscularly?

A

orally

126
Q

5a-reductase inhibitors (2 of them)

A

-finasteride
-dutasteride

127
Q

2 clinical uses for spironolactone

A

-hirsutism in women
-acne

(testosterone can cause oily skin, so spironolactone blocking that can help with acne)

128
Q

2 clinical uses of cyproterone

A

-hirsutism in women
-excessive sex drive in men

129
Q

2 main clinical uses of finasteride and dutasteride

A

-benign prostatic hyperplasia
-male pattern baldness

130
Q

steroidal androgen receptor inhibitor drugs (2 of them)

A

-cyproterone/cyproterone ester
-spironolactone

131
Q

non-steroidal androgen receptor inhibitors (2 of them)

A

-flutamide
-enzalutamide

132
Q

main use of flutamide and enzalutamide

A

prostate cancer

133
Q

if pregnancy occurs, the fertilized egg/embryo secretes what?

a. FSH
b. LH
c. hCG
d. GnRH

A

c. hCG

134
Q

most potent estrogen

A

17B-estradiol

135
Q

SAR for estrogen (3 things)

A

-hydroxyl at C3 is essential
-17B-OH is required for activity
-17a-ethynyl allows for oral bioavailability

PHRM 825 Therapeutics (25 decks)

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