Renal and Endocrine Jeopardy Review

Question 1

Mr Bourne is having a good response to metformin but needs a 2nd agent. Choose an option and state the benefits and risks and problems this medication poses for Mr Burne.

Answer 1

SGLT2i - cardio protective, secretes excess glucose into urine. Risk = potential yeast infection
Insulin - maximum effect to lowering glucose, risks: hypoglycemia
Sulfonylurea - benefits: cheap, CVD and renal benefits risks: severe hypoglycemia, weight gain
GLP1 - cardio and renal protective, weight loss is a potential benefit, risks = GI upset, pancreatitis

Question 2

What medicine blocks renal glucose reabsorption?

Answer 2

SGLT2i

Question 3

8 weeks after starting levothyroxine 125 mcg, your patient symptoms have only marginally improved. Labs are closer to normal but not nearly at target. Med student wants to up the dose of levothyroxine. Remembering your favorite pharmacology professor – you should check for what?

Answer 3

Check medication list – are they taking any antacids or lithium?

Also check for compliance and verify proper administration

Question 4

Your patient has urosepsis and significantly reduced renal function. Choose antibiotics that are active against likely organisms and discuss their +/-.

Answer 4

Vancomycin can be used but has to be renal adjustment - good for gram positive and MRSA

Cefepime (anti pseudomonal cephalosporin) for gram negative coverage, pip tazo (aka Zosyn) for pseudomonas

Question 5

What is the MOA for glucocorticoid induced osteopenia?

Answer 5

Inhibition of osteoblast activity

Question 6

Discuss the antibiotics that you would use for Mr. Hoffman’s urosepsis and infected artificial knee. What are the likely organisms? Identify the advantages and disadvantages of your choice.

Answer 6

Vancomycin - cover gram + and MRSA (adjust dose for renal function)

Pip tazo - for gram negative and pseudomonas coverage, narrow with culture results

Question 7

This medication reduces hepatic gluconeogenesis, reduces intestinal absorption of glucose, and increases insulin sensitivity

Answer 7

metformin

Question 8

After a careful interview you want to start thyroid replacement therapy in an otherwise healthy woman who is 51. what is the drug and dose. and when do you want to evaluate her for follow up?

Answer 8

levothyroxine 125 mcg per day. Reevaluate in 6 weeks

Question 9

Pharmacologic agent used in patients with hyperkalemia and related EKG changes

Answer 9

Calcium gluconate

Question 10

This treatment for hyperthyroidism blocks conversion of iodide to iodine and is preferentially iodinated by the thyroid over thyroglobulin

Answer 10

Methimazole or propylthiouracil (PTU)

Question 11

A go to antibiotic for enteric gram negative infections

Answer 11

Ceftriaxone

Question 12

Stimulates insulin secretion via blockade of K channels on pancreatic beta cells

Answer 12

Sulfonyurea agents

Question 13

Your patient today is pregnant and has pyelonephritis. Your best choice of antibiotic is:

Answer 13

Ceftriaxone or another 3rd generation cephalosporin

Question 14

A BPH question prompt: How would you manage Mr. Hoawrd?

Answer 14

Tamsulosin +/- finasteride

Question 15

How does kayexalate work? What else needs to happen

Answer 15

GI cation exchanger (sodium exchanged for potassium), K+ is excreted in the stool

Question 16

A go to antibiotic from gram positive infections

Answer 16

Vancomycin

Question 17

This quinolone should not be used for infections of the urinary tract

Answer 17

Not excreted by the kidney – moxifloxacin

Question 18

Facilitates the action of endogenous insulin

Answer 18

Incretin enhancers (GLP1 is an example)

Question 19

Your patient is concerned about osteoporosis as her mother was disabled by this problem. She wants to continue to take calcium supplements. How should she do this while taking thyroid replacement?

Answer 19

Should be taken about 4 hours before or after the dose

Question 20

This disorder acts to narrow the therapeutics window of water soluble medications

Answer 20

Acute or chronic renal failure

Question 21

Useful option for post menopausal women who do not tolerate bisphosphonates like alendronate.

Answer 21

Raloxifene (SERMS)

Question 22

IV glucose + insulin and IV calcium gluconate and albuterol

Answer 22

acute treatment for hyperkalemia

Question 23

How should your patient take the thyroid dose prescribed earlier (125 mcg levothyroxine per day)?

Answer 23

Take 60 minutes prior to or 4 hours after food, or take at bedtime

Question 24

This SERM is not useful in men

Answer 24

SERM = Selective estrogen receptor modulators

Raloxifene - men dont have enough estrogen receptors for this to help

Question 25

The essential component of all osteoporosis of prevention strategies

Answer 25

Calcium