Endocrine Pharmacology Practice Questions

Q: The established benefits of estrogen replacement therapy in menopausal women include a reduction in all of the following EXCEPT

Mood depression. ***Mood depression*** - While some women may experience mood changes during menopause, estrogen replacement therapy does not consistently or significantly reduce **mood depression**. - The relationship between estrogen and mood is complex, and depression in menopausal women often has **multifactorial causes** beyond hormonal changes. *Hot flushes* - Estrogen replacement therapy is highly effective in alleviating **vasomotor symptoms** such as hot flushes and night sweats [1, 2]. - These symptoms are directly linked to declining estrogen levels. *Atrophic vaginitis* - Estrogen therapy effectively treats **genitourinary syndrome of menopause** (GSM), including symptoms of atrophic vaginitis. - It restores the **vaginal epithelium**, increasing lubrication and reducing dryness, itching, and dyspareunia. *Osteoporosis* - Estrogen plays a crucial role in **bone density maintenance** and its decline at menopause contributes to accelerated bone loss. - Estrogen replacement therapy is a known treatment to prevent and manage **postmenopausal osteoporosis** by reducing bone turnover [1].

Q: Which of the following drugs is available as a nasal spray formulation?

Calcitonin. ***Calcitonin*** - **Calcitonin salmon** is available as a nasal spray (Miacalcin®) and is used in the treatment of **postmenopausal osteoporosis**. - Nasal administration provides an alternative to injection for patients who may have difficulty with subcutaneous or intramuscular routes. *Oestrogen* - **Oestrogen** is primarily available in oral, transdermal patch, vaginal cream, or injectable formulations. - While some hormonal therapies are available as nasal sprays (e.g., certain GnRH agonists), **oestrogen itself is not typically administered via this route** for routine indications. *Calcium* - **Calcium** is a mineral supplement predominantly available in oral formulations (e.g., tablets, chewables, liquids). - It is not typically formulated as a nasal spray for systemic absorption or treatment of calcium deficiency. *PTH* - **Teriparatide**, a recombinant form of **parathyroid hormone (PTH)**, is administered via subcutaneous injection. - While it has potent effects on bone, it is not available as a nasal spray due to challenges with absorption and stability.

Q: Tolvaptan is a/an -

Vasopressin antagonist. ***Vasopressin antagonist*** - **Tolvaptan** specifically blocks the action of **vasopressin (antidiuretic hormone)** at the V2 receptor. - This action leads to increased water excretion without affecting electrolyte balance, making it useful in treating conditions like **hyponatremia** and **syndrome of inappropriate antidiuretic hormone secretion (SIADH)**. *ACE inhibitor* - **ACE inhibitors** like captopril or enalapril block the conversion of **angiotensin I to angiotensin II**, reducing vasoconstriction and aldosterone release. - They are primarily used for **hypertension**, **heart failure**, and **diabetic nephropathy**, which is a different mechanism of action than tolvaptan. *Renin inhibitor* - **Renin inhibitors**, such as aliskiren, directly block the **renin enzyme**, preventing the formation of angiotensin I. - This mechanism also targets the **renin-angiotensin-aldosterone system (RAAS)** but at an earlier step than an ACE inhibitor. *Angiotensin antagonist* - **Angiotensin receptor blockers (ARBs)**, such as losartan or valsartan, block the binding of **angiotensin II** to its AT1 receptor. - Similar to ACE inhibitors, they are used for **hypertension** and **heart failure** but do not directly affect vasopressin.

Q: In osteoporosis, bone formation is increased by which drug?

Teriparatide. ***Teriparatide*** - Teriparatide is a recombinant form of **parathyroid hormone (PTH)** that, when administered intermittently, stimulates **osteoblast activity** leading to increased **bone formation**. - It is an **anabolic agent** used in osteoporosis to build new bone rather than just prevent bone loss. *Estrogen* - Estrogen is primarily used to prevent **bone loss** by **inhibiting osteoclast activity** and supporting bone mineralization. - It does not directly **increase bone formation** but rather maintains bone density. *Bisphosphonates* - Bisphosphonates inhibit **osteoclast-mediated bone resorption** by inducing apoptosis in osteoclasts. - They primarily **decrease bone breakdown** and do not directly stimulate new bone formation. *Calcitonin* - Calcitonin is a hormone that **inhibits osteoclast activity** and thus reduces bone resorption. - It is not a bone-forming agent but rather acts to **decrease bone breakdown** and is used for pain relief in vertebral fractures.

Q: Drug not used in SIADH is:

Desmopressin. ***Desmopressin*** - **Desmopressin** is a synthetic analog of **ADH** (antidiuretic hormone), which is **excessive in SIADH**. - Administering desmopressin would worsen SIADH by further increasing water reabsorption and diluting serum sodium. *3% NaCl* - **Hypertonic saline** (like 3% NaCl) is used in SIADH, particularly for severe hyponatremia, to **raise serum sodium levels** rapidly. - It works by increasing the osmotic gradient, drawing water out of cells and into the extracellular space for excretion. *Demeclocycline* - **Demeclocycline** is a **tetracycline antibiotic** that can induce **nephrogenic diabetes insipidus**. - This effect makes the kidneys less responsive to ADH, thus reducing water reabsorption and helping to correct hyponatremia in chronic SIADH. *Tolvaptan* - **Tolvaptan** is an **ADH receptor antagonist** (Aquaretic). - It blocks the action of ADH in the kidneys, leading to increased water excretion without affecting electrolyte excretion, thereby raising serum sodium levels.

Q: Drug of choice for precocious puberty:

GnRH agonists. ***GnRH agonists*** - **GnRH agonists** are the drug of choice for central precocious puberty as they **downregulate GnRH receptors** on the pituitary. - This downregulation leads to a **reduction in gonadotropin release** (LH and FSH), thereby suppressing sex hormone production and halting pubertal progression. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** primarily used in **breast cancer treatment**. - While it has **antiestrogenic effects** in breast tissue, it has **estrogenic effects** in other tissues and would not be appropriate for treating precocious puberty as it **does not suppress the central hypothalamic-pituitary-gonadal axis** and may have unpredictable effects on pubertal development. *Cyproterone acetate* - **Cyproterone acetate** is an **antiandrogen** with some progestational effects, mainly used to treat conditions caused by excess androgens, such as hirsutism or severe acne. - While it can suppress some aspects of sexual development by blocking androgen receptors, it **does not directly inhibit the central pubertal cascade** in the same way GnRH agonists do. *Medroxyprogesterone* - **Medroxyprogesterone** is a **progestin** that can suppress gonadotropin release in certain contexts, primarily in managing endometrial hyperplasia or contraception. - It is sometimes used in specific forms of precocious puberty (e.g., peripheral) but is **not the first-line treatment for central precocious puberty** as GnRH agonists are more effective at suppressing the entire hypothalamic-pituitary-gonadal axis.

Q: Hypokalemia is seen in therapy with

Corticosteroids. ***Corticosteroids*** - **Corticosteroids** can cause **hypokalemia** due to their mineralocorticoid activity, which promotes renal potassium excretion. - This effect is often dose-dependent and more pronounced with certain corticosteroids like **fludrocortisone** or high doses of prednisolone. *Diazepam* - **Diazepam** is a **benzodiazepine** that acts on GABA receptors in the brain. - It primarily causes central nervous system effects like sedation and anxiolysis, without directly affecting **potassium levels**. *Ibuprofen* - **Ibuprofen** is a **non-steroidal anti-inflammatory drug (NSAID)**. - It can lead to **renal dysfunction** and **fluid retention**, but it does not directly cause **hypokalemia**. *Digitalis* - **Digitalis** (digoxin) is a cardiac glycoside used to treat **heart failure** and **arrhythmias**. - While **hypokalemia** can exacerbate **digitalis toxicity**, digitalis therapy itself does not significantly cause **hypokalemia**; rather, it's a critical electrolyte to monitor.

Q: Corticosteroid which needs least systemic monitoring is:

Budesonide. ***Budesonide*** - This **corticosteroid** has a very high **first-pass metabolism** in the liver, leading to low systemic bioavailability. - Due to its localized action and minimal systemic exposure, it requires the **least systemic monitoring** compared to other corticosteroids. *Dexamethasone* - Has a **long half-life** and potent **glucocorticoid activity**, leading to significant systemic effects. - Requires careful monitoring for side effects like **hyperglycemia**, osteoporosis, and immune suppression. *Prednisolone* - A commonly used oral corticosteroid with **intermediate systemic potency** and half-life. - Requires monitoring for a range of systemic side effects, including **adrenal suppression** and fluid retention. *Hydrocortisone* - This is a short-acting corticosteroid, and its systemic use can lead to **significant mineralocorticoid effects** in addition to glucocorticoid effects. - Requires monitoring for electrolyte imbalances, **hypertension**, and other systemic corticosteroid side effects.

Question 1

Bremelanotide is indicated for:

Accepted Answer

Hypoactive sexual desire disorder (HSDD) in premenopausal women

Answer

LUTS

Answer

Metastatic RCC

Answer

Hormone refractory prostate cancer

Question 2

The established benefits of estrogen replacement therapy in menopausal women include a reduction in all of the following EXCEPT

Accepted Answer

Mood depression

Answer

Hot flushes

Answer

Atrophic vaginitis

Answer

Osteoporosis

Question 3

Which of the following drugs is available as a nasal spray formulation?

Accepted Answer

Calcitonin

Answer

Oestrogen

Answer

Calcium

Answer

PTH

Question 4

Enuresis persists, and the patient is placed on desmopressin acetate (DDAVP). This medication works by which of the following mechanisms?

Accepted Answer

Increase water permeability and reabsorption in collecting tubules

Answer

Decrease detrusor muscle tone

Answer

Increase external sphincter contraction

Answer

Improves alertness of the patient during the sleep cycle

Question 5

Tolvaptan is a/an -

Accepted Answer

Vasopressin antagonist

Answer

ACE inhibitor

Answer

Renin inhibitor

Answer

Angiotensin antagonist

Question 6

In osteoporosis, bone formation is increased by which drug?

Accepted Answer

Teriparatide

Answer

Estrogen

Answer

Bisphosphonates

Answer

Calcitonin

Question 7

Drug not used in SIADH is:

Accepted Answer

Desmopressin

Answer

3% NaCl

Answer

Demeclocycline

Answer

Tolvaptan

Question 8

Drug of choice for precocious puberty:

Accepted Answer

GnRH agonists

Answer

Tamoxifen

Answer

Cyproterone acetate

Answer

Medroxyprogesterone

Question 9

Hypokalemia is seen in therapy with

Accepted Answer

Corticosteroids

Answer

Diazepam

Answer

Ibuprofen

Answer

Digitalis

Question 10

Corticosteroid which needs least systemic monitoring is:

Accepted Answer

Budesonide

Answer

Dexamethasone

Answer

Prednisolone

Answer

Hydrocortisone

Endocrine Pharmacology — MCQs

Endocrine Pharmacology — MCQs

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