Endocrine Pharmacology Practice Questions

Q: Denosumab, a monoclonal antibody against the RANKL receptor, is used in the treatment of which of the following conditions?

Osteoporosis. **Explanation:** **Denosumab** is a human monoclonal antibody that targets and binds to **RANKL** (Receptor Activator of Nuclear Factor kappa-B Ligand). Under normal physiological conditions, RANKL is secreted by osteoblasts and binds to RANK receptors on osteoclast precursors, leading to their maturation and activation. By inhibiting RANKL, Denosumab prevents osteoclast formation and activity, thereby decreasing bone resorption and increasing bone mineral density. * **Why Option B is correct:** Because it effectively inhibits bone resorption, Denosumab is FDA-approved for the treatment of **postmenopausal osteoporosis**, osteoporosis in men, and bone loss induced by hormone ablation therapy (e.g., in prostate or breast cancer). * **Why Options A, C, and D are incorrect:** * **Rheumatoid Arthritis (A) and SLE (D)** are systemic autoimmune inflammatory diseases. While these conditions can lead to secondary osteoporosis, Denosumab does not treat the underlying inflammatory pathology. * **Osteoarthritis (C)** is a degenerative joint disease involving cartilage breakdown, not a primary disorder of systemic bone resorption. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** It mimics the action of **Osteoprotegerin (OPG)**, the body's natural RANKL decoy receptor. * **Administration:** It is administered as a **subcutaneous injection** once every 6 months. * **Adverse Effects:** The most significant side effects include **hypocalcemia** (must check calcium levels before dosing) and, rarely, **Osteonecrosis of the Jaw (ONJ)** or atypical femur fractures. * **Other Use:** In higher doses (Xgeva), it is used for **Giant Cell Tumor of Bone** and bone metastases.

Q: All the following are pharmacologic therapies for androgen excess except?

Fludrocortisone. ### Explanation The management of androgen excess (hyperandrogenism) focuses on either suppressing the production of androgens or blocking their action at the receptor level. **Why Fludrocortisone is the Correct Answer:** **Fludrocortisone** is a potent **mineralocorticoid** analog used primarily as replacement therapy in adrenal insufficiency (Addison’s disease) or salt-wasting forms of Congenital Adrenal Hyperplasia (CAH). It has no anti-androgenic properties; in fact, its role is to maintain fluid and electrolyte balance. It does not inhibit androgen synthesis or block androgen receptors. **Analysis of Incorrect Options:** * **Glucocorticoids (e.g., Dexamethasone):** These are used in cases of androgen excess caused by CAH. By providing negative feedback to the pituitary, they decrease ACTH secretion, which in turn reduces the overproduction of adrenal androgens. * **Spironolactone:** This is a potassium-sparing diuretic that also acts as a **competitive androgen receptor antagonist** and inhibits 17α-hydroxylase. It is a mainstay treatment for hirsutism in Polycystic Ovary Syndrome (PCOS). * **Oral Contraceptive Pills (OCPs):** OCPs treat androgen excess by multiple mechanisms: they suppress LH secretion (reducing ovarian androgen production), and the estrogen component increases **Sex Hormone-Binding Globulin (SHBG)**, which lowers the levels of free, biologically active testosterone. **Clinical Pearls for NEET-PG:** * **Finasteride:** A 5α-reductase inhibitor often used for hirsutism; it prevents the conversion of Testosterone to the more potent Dihydrotestosterone (DHT). * **Cyproterone Acetate:** A progestin with significant anti-androgenic activity, often found in specific OCP formulations (e.g., Diane-35) used for acne and hirsutism. * **Flutamide:** A pure non-steroidal anti-androgen; however, its use is limited by potential hepatotoxicity.

Q: Which of the following is an anti-androgenic drug?

Bicalutamide. ### Explanation **Correct Option: A. Bicalutamide** Bicalutamide is a potent, non-steroidal **androgen receptor antagonist** [1]. It works by competitively inhibiting the binding of dihydrotestosterone (DHT) and testosterone to their receptors [1]. In clinical practice, it is primarily used in the management of metastatic prostate cancer, often combined with GnRH analogues to prevent the "testosterone flare" phenomenon. **Analysis of Incorrect Options:** * **B. Oxymetholone:** This is a synthetic **androgen/anabolic steroid** [2]. Instead of blocking androgens, it mimics them. It is clinically used to treat certain types of anemia (by stimulating erythropoietin) and muscle-wasting conditions [2]. * **C. Raloxifene:** This is a **Selective Estrogen Receptor Modulator (SERM)**. It acts as an estrogen agonist in the bone (preventing osteoporosis) and an antagonist in the breast and uterus. It has no direct activity on androgen receptors. * **D. Stanozolol:** Similar to oxymetholone, this is an **anabolic steroid** (derived from DHT) [2]. It is often discussed in the context of performance-enhancing drug abuse and the treatment of hereditary angioedema. **NEET-PG High-Yield Pearls:** * **Classification of Anti-androgens:** 1. **Receptor Antagonists:** Flutamide, Bicalutamide (longer half-life, less hepatotoxic), Enzalutamide, and Spironolactone [1]. 2. **5-alpha Reductase Inhibitors:** Finasteride, Dutasteride (used in BPH and male pattern baldness). 3. **Synthesis Inhibitors:** Ketoconazole, Abiraterone. * **Clinical Note:** Bicalutamide is preferred over Flutamide due to its once-daily dosing and significantly lower risk of hepatotoxicity [1]. * **Side Effects:** Common side effects of anti-androgens include gynecomastia, hot flashes, and decreased libido.

Q: Medical adrenalectomy is seen with:

Mitotane. **Explanation:** **Correct Answer: C. Mitotane** **Medical Adrenalectomy** refers to the pharmacological destruction or functional suppression of the adrenal cortex, mimicking a surgical removal. * **Mitotane** is a cytotoxic drug specifically targeted at the adrenal cortex. It is a derivative of the insecticide DDT. * **Mechanism:** It acts as an adrenolytic agent by causing selective atrophy of the *zona fasciculata* and *zona reticularis*, leading to a rapid decrease in adrenocortical hormone production. * **Clinical Use:** It is primarily used in the treatment of inoperable **Adrenocortical Carcinoma** and occasionally in refractory Cushing’s syndrome. **Why other options are incorrect:** * **Vincristine & Vinblastine (Options A & B):** These are Vinca alkaloids that inhibit microtubule polymerization (acting on the M-phase of the cell cycle). Their primary toxicities are neurological (Vincristine) and bone marrow suppression (Vinblastine), with no specific destructive effect on the adrenal glands. * **Methotrexate (Option D):** An antimetabolite that inhibits Dihydrofolate Reductase (DHFR). It is used for various cancers and autoimmune conditions but does not cause adrenal necrosis. **High-Yield Clinical Pearls for NEET-PG:** * **Other drugs causing "Medical Adrenalectomy" or suppression:** Ketoconazole (inhibits 17α-hydroxylase), Metyrapone (inhibits 11β-hydroxylase), and Aminoglutethimide. * **Mitotane Side Effect:** It is highly lipid-soluble and can cause significant GI distress and neurological symptoms (ataxia, dizziness). * **Note:** Patients on Mitotane often require lifelong glucocorticoid and mineralocorticoid replacement therapy due to the permanent destruction of the adrenal tissue.

Q: Which of the following drugs is an antiandrogen?

Cyproterone acetate. **Explanation:** **Cyproterone acetate** is a potent **androgen receptor antagonist** and a progestational agent. It works by competitively inhibiting the binding of dihydrotestosterone (DHT) to its specific receptors in target organs. Additionally, it exerts a negative feedback effect on the hypothalamus and pituitary, reducing the secretion of gonadotropins (LH and FSH), which further lowers testosterone levels. **Analysis of Options:** * **Cyproterone acetate (Correct):** Used clinically in the management of hirsutism in women, precocious puberty in boys, and as palliative treatment for advanced prostatic carcinoma. * **Clomiphene citrate (Incorrect):** This is a **Selective Estrogen Receptor Modulator (SERM)**. It acts as an antagonist at the hypothalamus, blocking the negative feedback of estrogen, which leads to increased FSH/LH secretion. It is primarily used for ovulation induction in infertility. * **Letrozole (Incorrect):** This is a **Third-generation Aromatase Inhibitor**. It prevents the conversion of androgens to estrogens. It is used as a first-line treatment for postmenopausal breast cancer and for ovulation induction. **High-Yield Clinical Pearls for NEET-PG:** * **Flutamide & Bicalutamide:** Pure non-steroidal antiandrogens used primarily for prostatic carcinoma to prevent the "testosterone flare" caused by GnRH agonists. * **Finasteride:** A 5-alpha reductase inhibitor (blocks conversion of Testosterone to DHT); used for Benign Prostatic Hyperplasia (BPH) and male pattern baldness. * **Spironolactone:** A diuretic that also possesses significant antiandrogenic activity, often used off-label for female acne and hirsutism. * **Side Effect:** A common side effect of antiandrogens in males is **gynecomastia**.

Q: Which of the following antidiabetic drugs causes weight loss?

Metformin. **Explanation:** The effect of antidiabetic medications on body weight is a high-yield topic for NEET-PG. **Correct Option: A (Metformin)** Metformin, a Biguanide, is considered **weight-neutral or weight-reducing**. It causes weight loss primarily through: 1. **Decreased Appetite:** It increases the release of Glucagon-like peptide-1 (GLP-1) and lactate, which suppress the hunger centers in the hypothalamus. 2. **Gastrointestinal Side Effects:** Common adverse effects like nausea and abdominal discomfort often lead to reduced caloric intake. 3. **Metabolic Effects:** It improves insulin sensitivity and reduces hepatic gluconeogenesis without stimulating insulin secretion (avoiding the anabolic effects of insulin). **Incorrect Options:** * **B. Sulfonylureas (e.g., Glipizide):** These are "insulin secretagogues." By increasing endogenous insulin levels, they promote lipogenesis and glucose uptake into adipose tissue, leading to significant **weight gain**. * **C. Insulin:** Insulin is a potent anabolic hormone. It promotes fat storage and inhibits lipolysis, consistently causing **weight gain** in patients with diabetes. * **D. Nateglinide:** As a Meglitinide analog, it also stimulates insulin secretion (though with a shorter duration than sulfonylureas). Consequently, it is associated with **weight gain**. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Loss Drugs:** Metformin, GLP-1 agonists (Liraglutide, Semaglutide), and SGLT-2 inhibitors (Dapagliflozin). * **Weight Gain Drugs:** Insulin, Sulfonylureas, Thiazolidinediones (Pioglitazone - due to fluid retention and adipogenesis), and Meglitinides. * **Metformin** is the first-line drug for Type 2 Diabetes, especially in obese patients, due to its weight-favorable profile and euglycemic nature (low risk of hypoglycemia).

Q: Which antidiabetic medication is known to cause pancreatitis as an adverse drug reaction?

Vildagliptin. **Explanation:** **Vildagliptin** is a **Dipeptidyl Peptidase-4 (DPP-4) inhibitor** (Gliptin). The association between DPP-4 inhibitors and **acute pancreatitis** is a well-documented adverse drug reaction (ADR). The underlying mechanism is thought to involve the chronic stimulation of pancreatic ductal synthesis and hyperplasia induced by increased GLP-1 levels, which can lead to ductal occlusion and subsequent inflammation. Patients starting on "gliptins" should be monitored for persistent, severe abdominal pain. **Analysis of Incorrect Options:** * **Metformin (Biguanide):** Its most notorious life-threatening ADR is **lactic acidosis**. Common side effects are gastrointestinal (diarrhea, abdominal cramps) and Vitamin B12 deficiency. It does not cause pancreatitis. * **Glibenclamide (Sulfonylurea):** The primary adverse effects are **hypoglycemia** and weight gain. It works by stimulating insulin release from pancreatic beta cells but is not associated with pancreatic inflammation. * **Insulin:** The most common ADR is **hypoglycemia**. Other effects include lipodystrophy at the injection site and weight gain. It is actually used in the management of diabetic ketoacidosis, which can sometimes coexist with pancreatitis, but it does not cause the condition. **High-Yield Clinical Pearls for NEET-PG:** 1. **Incretin-based therapies:** Both **DPP-4 inhibitors** (e.g., Vildagliptin, Sitagliptin) and **GLP-1 agonists** (e.g., Exenatide, Liraglutide) are associated with a risk of acute pancreatitis. 2. **Vildagliptin specific:** Unlike Sitagliptin, Vildagliptin has also been associated with **hepatotoxicity**; hence, LFTs should be monitored. 3. **DPP-4 Inhibitor Safety:** **Linagliptin** is the "gliptin" of choice in patients with renal failure as it is primarily excreted via the bile.

Q: Which of the following is recombinant PTH?

Teriparatide. **Explanation:** **Teriparatide (Option A)** is the correct answer. It is a **recombinant human parathyroid hormone (rhPTH 1-34)**, consisting of the first 34 amino acids of the natural hormone. While continuous high levels of PTH cause bone resorption, **intermittent (once-daily) subcutaneous administration** of Teriparatide stimulates osteoblastic activity more than osteoclastic activity. This leads to a net increase in bone mineral density, making it a potent anabolic agent for treating severe osteoporosis. **Analysis of Incorrect Options:** * **Cinacalcet (Option B):** It is a **calcimimetic** drug. It increases the sensitivity of calcium-sensing receptors (CaSR) in the parathyroid gland to extracellular calcium, thereby inhibiting the secretion of PTH. It is used in secondary hyperparathyroidism and parathyroid carcinoma. * **Carisoprodol (Option C):** It is a centrally acting **skeletal muscle relaxant** used for acute musculoskeletal pain. It acts primarily through its metabolite, meprobamate, at the GABA-A receptor. * **Oxethazaine (Option D):** It is a potent **local anesthetic** used in antacid suspensions (Mucaine gel). It remains ionized in acidic gastric juice, providing symptomatic relief in gastritis and GERD. **High-Yield Clinical Pearls for NEET-PG:** * **Black Box Warning:** Teriparatide carries a risk of **Osteosarcoma** (observed in rat studies); hence, it is contraindicated in patients with Paget’s disease or prior radiation therapy. * **Duration of Use:** Treatment is generally limited to **2 years** in a lifetime. * **Abaloparatide:** A newer recombinant analog of PTH-related protein (PTHrP) used for similar indications. * **Denosumab:** A monoclonal antibody against **RANKL**, often confused with PTH analogs in exams; it is an antiresorptive agent, not an anabolic one.

Q: Which of the following drugs is commonly administered by the intranasal route?

Desmopressin. **Explanation:** **Desmopressin (Option B)** is the correct answer. It is a synthetic analogue of the antidiuretic hormone (Vasopressin). The intranasal route is a preferred non-invasive method for administering peptide drugs like Desmopressin because the nasal mucosa is highly vascularized, allowing for rapid absorption and bypassing first-pass metabolism. It is commonly used intranasally for the treatment of **Central Diabetes Insipidus** and was historically used for nocturnal enuresis (though oral forms are now preferred for the latter to reduce the risk of hyponatremia). **Analysis of Incorrect Options:** * **Adrenaline (Option A):** Typically administered Intramuscularly (IM) for anaphylaxis or Intravenously (IV) during cardiac arrest. While it can be used topically (e.g., to control epistaxis), it is not a standard "intranasal drug" for systemic effect. * **Ganirelix (Option C):** A GnRH antagonist used in assisted reproduction to prevent premature LH surges. It is administered via **Subcutaneous (SC)** injection. * **Insulin (Option D):** Primarily administered **Subcutaneously**. While an inhaled form (Afrezza) exists for pulmonary delivery, it is not administered via the intranasal route. **High-Yield Clinical Pearls for NEET-PG:** * **Other Intranasal Drugs:** Calcitonin (for osteoporosis), Midazolam (for acute seizures), Sumatriptan (for migraines), and Naloxone (for opioid overdose). * **Desmopressin Specifics:** It acts selectively on **V2 receptors**. Unlike natural Vasopressin, it lacks significant V1 activity, meaning it does not cause vasoconstriction (pressor effect). * **Drug of Choice:** Desmopressin is the DOC for Central Diabetes Insipidus and von Willebrand Disease (Type 1).

Q: Metformin is NOT effective in lowering blood sugar levels in which of the following patients?

Non-diabetics. **Explanation:** Metformin, a biguanide, is unique among oral hypoglycemic agents because it is an **euglycemic** drug rather than a hypoglycemic drug. Its primary mechanism of action is to decrease hepatic glucose production (gluconeogenesis) and improve insulin sensitivity in peripheral tissues. **1. Why "Non-diabetics" is the correct answer:** Metformin does not stimulate insulin release from pancreatic beta cells. In non-diabetic individuals, where hepatic glucose production and peripheral insulin sensitivity are already within physiological limits, Metformin does not further lower blood glucose levels. Therefore, it **does not cause hypoglycemia** in healthy individuals, making it ineffective at lowering sugar levels below the normal baseline. **2. Analysis of Incorrect Options:** * **Obese diabetics:** Metformin is the first-line drug of choice here because it promotes modest weight loss and addresses the core issue of insulin resistance common in obesity. * **Type 2 diabetics:** This is the primary indication for Metformin. It effectively lowers HbA1c by 1–1.5% by suppressing excessive hepatic glucose output. * **Diabetics not responding to sulfonylureas:** Metformin is often added as a second-line agent or used as a substitute when sulfonylureas fail (secondary failure), as it works via a different, insulin-independent mechanism. **High-Yield NEET-PG Pearls:** * **Mechanism:** Activates **AMP-activated protein kinase (AMPK)**. * **Side Effects:** Most common are GI-related (diarrhea, abdominal pain). The most serious but rare side effect is **Lactic Acidosis**. * **Contraindication:** Renal impairment (CrCl <30 ml/min) due to the risk of lactic acid accumulation. * **Vitamin Deficiency:** Long-term use can lead to **Vitamin B12 deficiency** due to interference with its absorption in the ileum.

Question 1

Denosumab, a monoclonal antibody against the RANKL receptor, is used in the treatment of which of the following conditions?

Accepted Answer

Osteoporosis

Answer

Rheumatoid arthritis

Answer

Osteoarthritis

Answer

Systemic lupus erythematosus (SLE)

Question 2

All the following are pharmacologic therapies for androgen excess except?

Accepted Answer

Fludrocortisone

Answer

Glucocorticoids

Answer

Spironolactone

Answer

Oral contraceptives

Question 3

Which of the following is an anti-androgenic drug?

Accepted Answer

Bicalutamide

Answer

Oxymetholone

Answer

Raloxifene

Answer

Stanozolol

Question 4

Medical adrenalectomy is seen with:

Accepted Answer

Mitotane

Answer

Vincristine

Answer

Vinblastine

Answer

Methotrexate

Question 5

Which of the following drugs is an antiandrogen?

Accepted Answer

Cyproterone acetate

Answer

Clomiphene citrate

Answer

Letrozole

Answer

None of the above

Question 6

Which of the following antidiabetic drugs causes weight loss?

Accepted Answer

Metformin

Answer

Sulfonylureas

Answer

Insulin

Answer

Nateglinide

Question 7

Which antidiabetic medication is known to cause pancreatitis as an adverse drug reaction?

Accepted Answer

Vildagliptin

Answer

Metformin

Answer

Glibenclamide

Answer

Insulin

Question 8

Which of the following is recombinant PTH?

Accepted Answer

Teriparatide

Answer

Cinacalcet

Answer

Carisoprodol

Answer

Oxethazaine

Question 9

Which of the following drugs is commonly administered by the intranasal route?

Accepted Answer

Desmopressin

Answer

Adrenaline

Answer

Ganirelix

Answer

Insulin

Question 10

Metformin is NOT effective in lowering blood sugar levels in which of the following patients?

Accepted Answer

Non-diabetics

Answer

Obese diabetics

Answer

Type 2 diabetics

Answer

Diabetics not responding to sulfonylureas

Endocrine Pharmacology — MCQs

Endocrine Pharmacology — MCQs

On this page

Practice by Chapter

Want unlimited practice?