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WorksheetsPharm Final Quiz 2 (Endocrine: DM+GH)
Total questions: 100
Worksheet time: 51mins
What is the normal blood glucose range?
60-100 mg/dL
70-110 mg/dL
80-120 mg/dL
90-130 mg/dL
What are the S/S (signs and symptoms) of hyperglycemia?
Sweating, trembling, dizziness
Dry mouth, extreme thirst, frequent urge to urinate
Mood changes, hunger, headaches
Blurred vision, extreme fatigue, paleness
What are the S/S (signs and symptoms) of hypoglycemia?
Sweating, trembling, dizziness, extreme fatigue and paleness
Dry mouth, extreme thirst, frequent urge to urinate
Stomach pain, coma in extreme cases
None of the above
List one benefit of administering high doses of glucocorticoids.
Benefit as an anti-inflammatory agent
Causes increased bone density
Promotes rapid wound healing
Enhances insulin sensitivity
SATA: Select all of the following endocrine disorders.
Addison’s disease
Diabetes insipidus
Diabetes mellitus
Growth hormone excess/deficiency
Hyper/hypothyroidism
Which gland secretes growth hormone (GH)?
Anterior pituitary gland
Thyroid gland
Adrenal gland
Pineal gland
Posterior pituitary gland
What does the hypothalamus regulate the release of?
Growth and somatotropin hormones
Digestive enzymes
Red blood cells
Insulin
What is the first step in therapeutic management of growth hormone deficiency if the cause is known?
Treat the cause first
Start growth hormone therapy immediately
Monitor the patient without intervention
Refer to a nutritionist
What must be done if tumors are present in growth hormone deficiency?
Tumors must be removed
Increase growth hormone dosage
No treatment is necessary
Monitor only with imaging
What is used to replace growth hormone in cases of deficiency?
Biosynthetic growth hormone
Insulin
Thyroxine
Cortisol
What percentage of cases is GH replacement successful in?
80%
50%
30%
95%
Which of the following factors does the response to GH treatment depend on?
Age
Length of treatment
Frequency of treatment
Dosage
All of the above
In non-GH deficient children, what is the typical growth after FDA approved treatment in 2003?
Most will grow an extra 1-3 inches over 4-6 years of time at 6-7 injections a week
Most will grow an extra 6-8 inches in the first year alone
There is no significant growth observed after treatment
Most will grow an extra 10-12 inches over 2 years
When is GH normally administered?
At night
In the morning
In the afternoon
After meals
GH release increases during sleeping hours.
True
False
Why can't GH be given PO (orally)?
Due to inactivation in the GI tract
Because it causes severe gastric irritation
Because it is too rapidly absorbed
Because it interacts with dietary fats
How many injections per week are usually given for GH therapy?
6-7 injections per week
1 injection per week
2-3 injections per week
10 injections per week
What should be assessed annually before administering GH to ensure growth plates have not closed?
Epiphyseal status
Blood glucose level
Liver function tests
Thyroid hormone levels
Fontanel status
Prolonged GH administration can antagonize which hormone and lead to which disease?
Insulin; Diabetes Mellitus
Cortisol; Addison's Disease
Thyroxine; Myxedema
Aldosterone; Conn's Syndrome
Which of the following relates to growth hormone?
Somatropin/Humatrope
Insulin/Novolog
Levothyroxine/Synthroid
Metformin/Glucophage
What are two adverse effects and monitoring parameters for GH agent therapy?
Pancreatitis, diabetogenic;
Lab monitoring: BG, A1C
Hypertension, hyperkalemia;
Lab monitoring: serum sodium, potassium
Nephrotoxicity, ototoxicity;
Lab monitoring: BUN, creatinine
Bradycardia, hypotension;
Lab monitoring: ECG, heart rate
SATA: What conditions below are associated with growth hormone excess?
Gigantism
Dwarfism
Hypothyroidism
Addison's disease
Acromegaly
What condition occurs if there is an excess of growth hormone (GH) during childhood?
Acromegaly
Gigantism
Dwarfism
Diabetes Mellitus
If excess growth hormone (GH) occurs after puberty, what condition develops?
Gigantism
Acromegaly
Dwarfism
Hyperthyroidism
Name two physical features that may enlarge in acromegaly.
Large hands and skull
Small ears and nose
Short fingers and toes
Thin lips and narrow jaw
Both gigantism and acromegaly are caused by ______ tumors.
pituitary
thyroid
adrenal
pancreatic
Excess growth hormone (GH) will antagonize insulin and lead to ______ and DM.
hyperglycemia
hypoglycemia
anemia
leukopenia
Which of the following is NOT a treatment for excess growth hormone (GH)?
Surgery to remove tumor
Radiation therapy
Insulin therapy
Pharmacotherapy
If the entire pituitary is removed, what will the patient need for life?
Hormonal replacement
Antibiotic therapy
Physical therapy only
PT and OT
Which medication is described as the most effective drug for acromegaly?
Octreotide
Lanreotide
Pegvisomant
Insulin
Which of the following is the problem in Type 1 Diabetes Mellitus?
Pancreas is unable to make any insulin
Pancreas can only make a small amount of insulin
Body is sensitive to its own insulin
Body is insensitive to it's own insulin
What is the priority problem in Diabetes Mellitus, for both T1 and T2?
Low blood pressure
High blood glucose levels
High insulin levels
Low endocrine levels
A glycated hemoglobin/A1C test result of 6.5% or higher (on 2 separate tests) indicates _______.
diabetes
acromegaly
increased serum insulin levels
hypertension
A glycated hemoglobin/A1C test result between 5.7-6.4% indicates _______.
prediabetes
normal pancreatic function
type 1 diabetes
gestational diabetes
type 2 diabetes
Which of the following is NOT a function of insulin?
Moves glucose from bloodstream to muscle, liver, and fat cells
Stimulates storage of glucose in liver and muscle
Enhances storage of dietary fats in adipose tissue
Inhibits transport of amino acids into cells
T1DM (Type 1 Diabetes Mellitus) is due to _______.
Excess insulin secretion
Lack of insulin secretion
Insulin resistance
High blood pressure
In T2DM (Type 2 Diabetes Mellitus), insulin receptors have become _______ or resistant to the hormone.
insensitive
hyperactive
overstimulated
deficient
Which of the following is NOT a symptom of Diabetes Mellitus (DM)?
Feeling hungry/thirsty
Tingling limbs
Blurry vision
Sudden weight gain
Frequent urination
Over time, high blood glucose (BG) levels can damage blood vessels, which can in turn lead to _________
multi-organ complications
vascular complications only
neuromuscular degeneration only
hepatic insufficiency only
What is the goal for Hgb A1C in antidiabetic therapy?
Less than 5%
Less than 6%
Less than 7%
Less than 8%
Fasting glucose should be maintained at less than ______ mg/dL according to antidiabetic therapy goals.
110
90
130
150
Postprandial glucose should be less than ______ mg/dL as a goal of antidiabetic therapy.
140
180
200
160
Which of the following antidiabetic drugs CANNOT be used for Type 1 Diabetes Mellitus (T1DM)?
Insulin
Other antidiabetics (PO or SQ)
Regular insulin can be administered by which route(s)?
Only SQ
Only IV
Both SQ and IV
Only PO
Both PO and IV
Why is insulin not given orally?
It would be destroyed by gastric enzymes.
It is too expensive to be taken orally.
It causes severe tooth decay if taken orally.
It is absorbed too quickly in the mouth.
All modern insulin is produced using ______ technology.
DNA
RNA
Protein
Lipid
Human insulin analogs are ______ variations of human insulin.
synthetic
natural
herbal
bacterial
Which of the following is NOT a characteristic of genetically altered insulin?
Can be fast acting or long acting
Designed to mimic normal insulin as closely as possible
Can be engineered to produce effects instantly after administration
Genetically altered to change how they act in the body
Which of the following is NOT a type of insulin?
Rapid acting
Short acting
Intermediate acting
Ultra long acting
List the types of insulin mentioned in the notes.
Rapid acting, Short acting, Intermediate acting, Long acting
Only Rapid acting and Long acting
Short acting, Long acting, Ultra-long acting
Intermediate acting, Ultra-short acting, Long acting
Which of the following is a rapid acting insulin?
A) lispro/Humalog
B) Humulin R
C) Novolin R
D) NPH
Rapid acting insulin is administered _______.
SQ (subcutaneously)
IV (intravenously)
IM (intramuscularly)
PO (orally)
What is the onset time for rapid acting insulin?
Within 15 minutes
30-60 minutes
2-4 hours
6-8 hours
Short acting insulin includes which of the following?
lispro/Humalog
Humulin R
glulisine/Apidra
aspart/Novolog
Short acting insulin is available in U 100 and U 500 strength.
True
False
Which type of insulin is reserved for patients with insulin resistance?
U 100
U 200
U 500
U 300
U 500 insulin is NEVER given IV.
True
False
When regular insulin is given subcutaneously (SQ), what is the typical onset time?
5-10 mins
30-60 mins
2-4 hrs
10-16 hrs
Fill in the blank: The peak time for regular insulin given SQ is _________.
2-4 hrs
30-60 min
6-8 hrs
10-12 hrs
What is the duration of action for regular insulin given SQ?
2-4 hrs
4-10 hrs
5-7 hrs
10-16 hrs
Which of the following is an intermediate acting insulin?
Insulin glargine
NPH/Humulin N
Regular insulin
Insulin lispro
Intermediate acting insulin is a cloudy solution.
True
False
Fill in the blank: The only insulin that can be mixed with short acting or rapid acting insulin in the same syringe is _________
Intermediate acting insulin (NPH)
Long acting insulin (glargine)
Ultra-long acting insulin (degludec)
Premixed insulin
When mixing regular insulin with NPH human insulin, which insulin should be drawn into the syringe first?
Regular insulin (clear before cloudy)
NPH insulin (cloudy before clear)
Both insulins at the same time
It does not matter which is drawn first
What is the recommended time for administering long acting insulin such as glargine or Toujeo?
Morning
Afternoon
Night
Any time, but needs consistency
What is the onset time for long acting insulin?
3-4 hrs
10-20 min
30-60 min
1-2 hrs
What is the peak time for long acting insulin?
None
1-2 hours
4-6 hours
8-10 hours
What is the duration of action for long acting insulin?
24 hrs
4-6 hrs
8-12 hrs
16-18 hrs
Which of the following is NOT a premixed combination of short acting (regular) insulin and intermediate acting (NPH) insulin?
Humulin 70/30
Humulin 50/50
Humalog 75/25
All of the above
What is the intent of using premixed combinations of short acting (regular) insulin and intermediate acting (NPH) insulin?
To give longer insulin coverage and mimic what the pancreas does more efficiently
To increase the risk of hypoglycemia significantly
To eliminate the need for dietary management in diabetes
To provide only rapid correction of high blood sugar levels
Coverage of premixed insulin combinations is up to how many hours?
24 hrs
12 hrs
36 hrs
48 hrs
Which of the following is NOT a method of SQ injection for insulin administration?
Syringe and needle
Pen injectors
Jet injectors
Oral tablets
Which of the following is an oral antidiabetic agent for T2DM?
Biguanides
Sulfonylureas
Thiazolidinediones/Glitazones
All of the above
Which of the following is NOT an oral agent for diabetes management?
Metaglitinides
Alpha-Glucosidase Inhibitors
GLP-1 Agonists
Gliptins
Which class of injectable agents is NOT to be confused with insulin?
GLP-1 Agonists
Incretin Mimetics
SGLT-2 Inhibitors
All of the above
What is the mechanism of action (MoA) of metformin/Glucophage?
Decreases hepatic production of glucose
Stimulates insulin secretion from pancreatic beta cells
Inhibits intestinal absorption of carbohydrates
Increases glucagon secretion
Metformin promotes insulin release from the pancreas.
True
False
Metformin is SAFE to use with patients who occasionally ________.
skip meals
drink alcohol heavily
have severe kidney disease
are pregnant
Which of the following is NOT a major adverse effect of metformin?
Decreased appetite
Nausea and diarrhea
Hypoglycemia
Lactic acidosis
Alcohol intake with metformin can lead to ________.
lactic acidosis
hypoglycemia
hypertension
hyperkalemia
What does the 'V' in the mnemonic VOMIT BAG for metformin stand for?
vitamin B12 deficiency
vomiting
vasculitis
visual disturbance
Which condition is metformin used to treat in women, as indicated by the 'O' in VOMIT BAG?
A) Osteoporosis
B) Ovarian cancer
C) Polycystic Ovary Syndrome (PCOS)
D) Obesity
Metformin is considered the first line agent for which type of diabetes?
Type 2 Diabetes Mellitus (T2DM)
Type 1 Diabetes Mellitus (T1DM)
Gestational Diabetes Mellitus (GDM)
Maturity Onset Diabetes of the Young (MODY)
What is the major adverse effect (AE) associated with Metformin?
Lactic acidosis
Hypoglycemia
Weight gain
Pancreatitis
Complication of lactic acidosis with Metformin is extremely rare if kidneys are well functioning.
True
False
Which of the following increases the risk of lactic acidosis with Metformin use?
Alcohol intake
High protein diet
Exercise
Vitamin supplements
Metformin should be avoided in patients with ________.
renal insufficiency
hypertension
hyperthyroidism
migraine
IV contrast media that contains ______ may lead to lactic acidosis when used with Metformin.
iodine
barium
calcium
magnesium
How long before and after administration of contrast media should Metformin be stopped?
48 hours
12 hours
24 hours
72 hours
Which class of oral antidiabetic drugs stimulates the release of insulin from the pancreas?
Sulfonylureas
Biguanides
Thiazolidinediones
Alpha-glucosidase inhibitors
1st generation sulfonylurea agents have largely been replaced by 2nd generation agents.
True
False
Sulfonylureas can increase cellular sensitivity to insulin.
True
False
Glipizide, a sulfonylurea, cannot induce hypoglycemia.
True
False
Which of the following diabetes medications can increase risk of bladder cancer and is contraindicated in heart failure patients?
Thiazolidinediones
Meglitinides
Alpha-Glucosidase Inhibitors
Injectable T2DM Agents
Which category of diabetic medications can patients safely take after skipping a meal, but carries the risk of hypoglycemia due to it's mechanism of action?
Thiazolidinediones
Meglitinides
Sulfonylureas
Metformin
What is the mechanism of action for Alpha-Glucosidase Inhibitors such as acarbose?
delays absorption of carbohydrates
increases absorption of carbohydrates
increases secretion of insulin from the pancreas
increases bodily sensitivity to insulin
Injectable T2DM agents, such as Victoza, can be used in conjunction with insulin.
True
False
Injectable T2DM agents, such as Byetta, can be used in conjunction with metformin or a sulfonylurea.
True
False
SATA: Select all of the following treatments for moderate to severe hypoglycemia.
IV dextrose
IV sucrose
SQ glucagon
IM glucagon
PO glucagon
Glucagon can cause hypotension.
True
False
