Endocrine Pharmacology Practice Questions

Q: Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

To make it long acting. ***To make it long acting*** - **Zinc** is added to insulin formulations, particularly **neutral protamine Hagedorn (NPH) insulin**, to create larger crystal complexes [1]. - These larger complexes **slow down the absorption** of insulin from the subcutaneous injection site, thereby prolonging its duration of action [2]. *To make it short acting* - **Short-acting insulins** like regular insulin are not formulated with zinc, as their purpose is rapid onset and a shorter duration. - Adding zinc would counteract the desired rapid-acting pharmacokinetic profile. *To make it fast acting* - **Fast-acting insulins** (insulin analogs) have specific amino acid modifications that alter their self-association properties to ensure rapid absorption, not the addition of zinc [2]. - Zinc actually works against the goal of fast action by promoting aggregation. *Addition of zinc makes the insulin effective orally* - Insulin is a **peptide hormone** and is generally destroyed by digestive enzymes in the gastrointestinal tract, making oral administration ineffective regardless of zinc presence [3]. - Efforts to create oral insulin involve complex delivery systems, not simple zinc addition.

Q: Which drug is used as a spermicidal cream in contraceptives?

Nonoxynol-9. **Nonoxynol-9** - **Nonoxynol-9** is a common **spermicide** used in many contraceptive products like creams, foams, and gels. - It works by damaging the **sperm cell membrane**, effectively immobilizing and killing sperm. *Gossypol* - **Gossypol** is a natural compound found in cotton plants that has been studied for its potential as a **male contraceptive**. - It works by inhibiting **spermatogenesis** but has not been approved for widespread use due to toxicity concerns like **hypokalemia**. *Clomiphene* - **Clomiphene** is a **selective estrogen receptor modulator (SERM)** used to induce ovulation in women who are infertile due to anovulation. - It stimulates the release of **gonadotropins** (FSH and LH) from the pituitary gland, leading to follicular development. *Centchroman* - **Centchroman** (also known as Ormeloxifene) is a **non-steroidal oral contraceptive** used in India. - It acts as a **selective estrogen receptor modulator** in the uterus, disrupting the implantation process.

Q: Which of the following anti-diabetic drugs is associated with weight gain?

Pioglitazone. ***Pioglitazone*** - **Pioglitazone**, a **thiazolidinedione**, primarily works by improving insulin sensitivity in peripheral tissues. - Its mechanism of action can lead to **fluid retention** and **increased subcutaneous fat storage**, both contributing to weight gain. *Acarbose* - **Acarbose** is an **alpha-glucosidase inhibitor** that delays carbohydrate absorption in the gut. - This mechanism typically leads to a **neutral effect or slight weight loss**, as fewer calories are rapidly absorbed. *Metformin* - **Metformin**, a **biguanide**, reduces hepatic glucose production and improves insulin sensitivity. - It is often associated with **weight neutrality or modest weight loss**, and is not known to cause weight gain. *Sitagliptin* - **Sitagliptin** is a **dipeptidyl peptidase-4 (DPP-4) inhibitor** that enhances incretin effects. - This class of drugs is generally considered **weight-neutral** and rarely causes weight gain.

Q: Insulin of choice for the treatment of diabetic ketoacidosis is:

Regular Insulin. ***Regular Insulin*** - **Regular insulin** is the insulin of choice for treating **diabetic ketoacidosis (DKA)** because it can be administered intravenously. - Its **short onset of action** and predictable duration allow for rapid and precise titration in a critical care setting. *Insulin lispro* - **Insulin lispro** is a **rapid-acting insulin analog** typically used for mealtime coverage, which has a very quick onset and short duration. - While it acts quickly, its primary use is not for the continuous intravenous infusion required in DKA management. *Insulin glargine* - **Insulin glargine** is a **long-acting insulin analog** designed to provide basal insulin replacement. - It has a prolonged duration of action and a slow, sustained release profile, making it unsuitable for the rapid correction needed in DKA. *NPH insulin* - **NPH insulin** is an **intermediate-acting insulin** that has a delayed onset and peak effect. - Its insoluble nature and variable absorption make it inappropriate for the acute, immediate intravenous insulin therapy required in DKA.

Q: In the management of diabetes mellitus, lactic acidosis is caused by which of the following?

Metformin. ***Metformin*** - Metformin can cause **lactic acidosis**, especially in patients with **renal impairment**, as it inhibits hepatic gluconeogenesis and lactate clearance [1]. - The risk is increased in conditions leading to **tissue hypoperfusion** or **hypoxemia**, where lactate production is elevated. *Pioglitazone* - **Pioglitazone** is a thiazolidinedione that improves insulin sensitivity but is not associated with lactic acidosis [1]. - Its main risks include **fluid retention**, **heart failure**, and increased risk of **bladder cancer**. *Glipizide* - **Glipizide** is a sulfonylurea that stimulates insulin secretion from beta cells but does not cause lactic acidosis [2]. - The primary adverse effect is **hypoglycemia** [2]. *Tolbutamide* - **Tolbutamide** is an older generation sulfonylurea, similar to glipizide, and also acts by stimulating insulin release [2]. - Its main risk is **hypoglycemia**, and it is not associated with lactic acidosis [2].

Q: Exenatide is a new drug used in diabetes mellitus. Mechanism of action of this drug is:-

Release of insulin acting as agonist of GLP-1 receptors. ***Release of insulin acting as agonist of GLP-1 receptors*** - **Exenatide** is a **glucagon-like peptide-1 (GLP-1) receptor agonist**, mimicking the action of endogenous GLP-1. - This leads to glucose-dependent **insulin release**, suppression of **glucagon secretion**, delayed **gastric emptying**, and increased **satiety**, all contributing to improved glycemic control. *Inhibition of DPP-4* - This mechanism describes the action of **DPP-4 inhibitors** (e.g., sitagliptin, saxagliptin), which prevent the breakdown of endogenous GLP-1 and other **incretin hormones**. - While both GLP-1 agonists and DPP-4 inhibitors target the incretin system, exenatide directly acts as an agonist, rather than preventing breakdown. *Inhibiting intestinal absorption of carbohydrates* - This mechanism describes drugs like **alpha-glucosidase inhibitors** (e.g., acarbose, miglitol), which delay carbohydrate absorption from the gut. - Exenatide's primary action is not on carbohydrate absorption but rather on pancreatic hormone secretion and gastric emptying. *Stimulation of PPAR-gamma* - This mechanism describes **thiazolidinediones** (TZDs) like pioglitazone and rosiglitazone, which enhance **insulin sensitivity** by acting on **peroxisome proliferator-activated receptor-gamma (PPAR-gamma)** in adipose tissue. - Exenatide belongs to a different class of antidiabetic drugs with a distinct mechanism of action.

Q: The success of estrogen and estrogen-like drugs in combating osteoporosis in postmenopausal women may indicate that estrogen:

Decreases the activity of bone-resorbing cells. ***Decreases the activity of bone-resorbing cells*** - **Estrogen** plays a crucial role in maintaining **bone density** by inhibiting the activity of **osteoclasts**, which are the cells responsible for **bone resorption**. - In postmenopausal women, the decline in estrogen levels leads to increased osteoclast activity and accelerated **bone loss**, hence the effectiveness of estrogen therapy. *Increases the activity of bone-resorbing cells* - An increase in **bone-resorbing cell** (osteoclast) activity would lead to further **bone loss** and exacerbate osteoporosis, contrary to the observed therapeutic effect of estrogen. - Estrogen's protective role in **bone health** is primarily through its inhibitory effect on osteoclasts. *Prevents the mineralization of bone during turnover* - This option describes a process that would lead to **osteomalacia** or **rickets**, where new bone matrix fails to mineralize adequately. - Estrogen's action is not primarily on mineralization but on the **balance between bone formation and resorption**. *Reduces the activity of bone-forming cells* - Reducing the activity of **bone-forming cells** (osteoblasts) would also lead to reduced bone density and worsen osteoporosis. - While estrogen has complex effects, its main therapeutic benefit in osteoporosis is to **slow down bone breakdown**, not to reduce bone formation.

Q: Retention of sodium is a side effect of:

Hydrocortisone. ***Hydrocortisone*** - **Hydrocortisone** possesses some **mineralocorticoid activity**, particularly at higher doses, leading to **sodium retention** and potassium excretion. - This mineralocorticoid effect can cause side effects like **edema** and **hypertension** due to increased fluid volume. *Triamcinolone* - **Triamcinolone** is a synthetic corticosteroid with **negligible mineralocorticoid activity**. - It is often favored when **sodium retention** is undesirable, as it primarily exerts **glucocorticoid effects**. *Corticosterone* - **Corticosterone** is a natural glucocorticoid with less potent **mineralocorticoid activity** than aldosterone but more than most synthetic glucocorticoids. - While it can cause some **sodium retention**, it is not a commonly prescribed medication and its effect is less pronounced than **hydrocortisone** at equipotent doses in clinical settings. *Prednisolone* - **Prednisolone** has minimal **mineralocorticoid activity** compared to hydrocortisone. - It is primarily a **glucocorticoid** used for its anti-inflammatory and immunosuppressive effects with a lower risk of **sodium retention**.

Q: Which is the drug of choice in Paget's disease?

Alendronate. ***Alendronate*** - **Bisphosphonates** like alendronate are the **first-line treatment** for Paget's disease due to their potent antiresorptive inhibitory effect on **osteoclasts**. - They reduce bone turnover, bone pain, and the risk of complications such as **fractures** and **bone deformities**. *Allopurinol* - This drug is used to treat **gout** by inhibiting **xanthine oxidase** and reducing uric acid production. - It has no role in the management of Paget's disease, which is a disorder of abnormal bone remodeling. *Calcitonin* - Historically, calcitonin was used for Paget's disease, but its effectiveness is **less than bisphosphonates** and it is associated with more side effects. - It is now generally reserved for patients who **cannot tolerate bisphosphonates** or have severe renal impairment. *Steroids* - **Corticosteroids** are potent anti-inflammatory and immunosuppressive agents. - They are primarily used in conditions like **autoimmune disorders** or severe inflammatory diseases, and are **not indicated** for the treatment of Paget's disease.

Question 1

Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

Accepted Answer

To make it long acting

Answer

To make it short acting

Answer

To make it fast acting

Answer

Addition of zinc makes the insulin effective orally

Question 2

Mechanism of action of exenatide in diabetes mellitus is

Accepted Answer

It is analogue of GLP released from gut and increases glucose dependent insulin secretion

Answer

It is DPP-4 inhibitor and results in decreased breakdown of GLP

Answer

It is amylin analogue and decreases glucagon

Answer

It inhibits SGLT-2 and causes glucosuria

Question 3

Which drug is used as a spermicidal cream in contraceptives?

Accepted Answer

Nonoxynol-9

Answer

Gossypol

Answer

Clomiphene

Answer

Centchroman

Question 4

Which of the following anti-diabetic drugs is associated with weight gain?

Accepted Answer

Pioglitazone

Answer

Acarbose

Answer

Metformin

Answer

Sitagliptin

Question 5

Insulin of choice for the treatment of diabetic ketoacidosis is:

Accepted Answer

Regular Insulin

Answer

Insulin lispro

Answer

Insulin glargine

Answer

NPH insulin

Question 6

In the management of diabetes mellitus, lactic acidosis is caused by which of the following?

Accepted Answer

Metformin

Answer

Pioglitazone

Answer

Glipizide

Answer

Tolbutamide

Question 7

Exenatide is a new drug used in diabetes mellitus. Mechanism of action of this drug is:-

Accepted Answer

Release of insulin acting as agonist of GLP-1 receptors

Answer

Inhibiting intestinal absorption of carbohydrates

Answer

Stimulation of PPAR-gamma

Answer

Inhibition of DPP-4

Question 8

The success of estrogen and estrogen-like drugs in combating osteoporosis in postmenopausal women may indicate that estrogen:

Accepted Answer

Decreases the activity of bone-resorbing cells

Answer

Increases the activity of bone-resorbing cells

Answer

Prevents the mineralization of bone during turnover

Answer

Reduces the activity of bone-forming cells

Question 9

Retention of sodium is a side effect of:

Accepted Answer

Hydrocortisone

Answer

Triamcinolone

Answer

Corticosterone

Answer

Prednisolone

Question 10

Which is the drug of choice in Paget's disease?

Accepted Answer

Alendronate

Answer

Allopurinol

Answer

Calcitonin

Answer

Steroids

Endocrine Pharmacology — MCQs

Endocrine Pharmacology — MCQs

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