Phar 754 S2006 (LEID) Name
Exam 1, Page 1ID Number
4.Pancreatic transplants are usually unhelpful in the treatment of type 1 diabetes mellitus (T1DM) because:
A.T1DM patients are frequently obese and, therefore, at risk for development of T2DM
B.T1DM patients are high-risk, surgery patients
C.It is difficult to find a donor who matches the tissue type of patients with T1DM
D.T1DM is an autoimmune disorder and the recipient of the transplant will likely destroy the transplanted pancreas
E.The pancreas is a fragile organ that does not transplant well
5.Dr. Dunno Toomuch calls to seek your advice on initiating therapy for T2DM in a 58 year-old white female, who has elevated blood glucose despite normal to high levels of circulating insulin. Dr. Toomuch's only requirements are that whatever agent you choose must:
- not cause hypoglycemia at therapeutic doses
- improve insulin sensitivity
- be administered orally
Based on this information, which class of therapeutic agent would be your best choice?
A. Sulfonylureas
B. Meglitinides
C. Biguanides
D. Thiazolidinediones
E. Alpha-glucosidase Inhibitors
6.Which of the following most likely represents the mechanism of action of nateglinide in the treatment of type 2 diabetes mellitus (T2DM)?
A.Nateglinide slows GI emptying time
B.Nateglinide decreases glucose absorption from GI tract
C.Nateglinide increases insulin release from pancreas
D.Nateglinide increases somatostatin release from pancreas
E.Nateglinide inhibits gluconeogenesis in liver
7.Acarbose may be useful in the treatment of T2DM because this agent:
A.Slows GI emptying time
B.Decreases glucose absorption from GI tract
C.Increases insulin release from pancreas
D.Increases somatostatin release from pancreas
E.Inhibits gluconeogenesis in liver
8.What underlies the usefulness of glimepiride in the treatment of T2DM?
A.Glimepiride slows GI emptying time
B.Glimepiride decreases glucose absorption from GI tract
C.Glimepiride increases insulin release from pancreas
D.Glimepiride increases somatostatin release from pancreas
E.Glimepiride inhibits gluconeogenesis in liver
9.Which of the following most likely underlies the usefulness of metformin in the treatment of T2DM?
A.Metformin slows GI emptying time
B.Metformin decreases glucose absorption from GI tract
C.Metformin increases insulin release from pancreas
D.Metformin increases somatostatin release from pancreas
E.Metformin inhibits gluconeogenesis in liver
10.You friend, Bob, suffers from T1DM. Bob, like many patients with T1DM, is highly motivated and monitors his blood glucose levels about 14 times per day. However, while snooping through Bob's backpack one day you notice that Bob carries around vial of lyophyilzed white powder in a small pouch along with a separate vial of clear, sterile liquid, and a syringe. You have never pegged Bob as an IV drug abuser, but he does act strangely on occasion and now you are suspicious. What is the most likely explanation for your finding?
A.Bob is mainlining heroin and you should get him into drug rehab immediately
B.The liquid is a decoy, Bob is likely freebasing cocaine
C.You have found Bob's spare insulin supply
D.You have found Bob's exenatide supply
E.You have found Bob's glucagon emergency kit
11.Your other friend and co-worker, Mary, suffers from T2DM and was recently started on an oral agent to reduce blood glucose. Subsequently, Mary developed an extremely severe case of flatulence, which she claims is related to the drug therapy. This is highly embarrassing for Mary and unpleasant for everyone around her, including you. Which of the following agents is Mary most likely taking?
A.Pioglitazone
B.Rosiglitazone
C.Glyburide
D.Acarbose
E.Rapaglinide
12.Which of the following forms of insulin has a duration of action shorter than that of lente insulin?
A.Regular Insulin
B.Ultra-lente insulin
C.Insulin glargine
D.Protamine zinc insulin
E.NPH insulin
13.Which of the following most likely underlies the pharmacological basis for the use of exenatide in the treatment of T2DM?
A.Exenatide is an insulin receptor agonist
B.Exenatide is an glucagon receptor antagonist
C.Exenatide is an glucagon-like peptide 1 (GLP1) receptor agonist
D.Exenatide is an glucagon-like peptide 1 (GLP1) receptor antagonist
E.Exenatide is a leptin receptor agonist
14.An increasingly popular "off-label" use of exenatide is in the treatment of:
A.T1DM
B.Obesity
C.Anorexia
D.Coronary artery disease
E.Erectile dysfunction
15.The effect of vildagliptin, an inhibitor of dipeptidyl peptidase IV, on insulin secretion would be most similar to that of:
A.Pramlintide acetate
B.Exenatide
C.A synthetic, GLP1 receptor antagonist
D.Exendin (9-39)
E.Acarbose
16.Which of the following agents would be most likely to enhance insulin secretion and stimulate production of new cells in pancreas?
A.Glyburide
B.Nateglinide
C.Metformin
D.Exenatide
E.Metformin
17.Ruboxistaurin shows promise in preventing some of the long-term complications of T1DM and T2DM, particularly diabetes-related retinopathy and kidney disease (glomerulosclerosis). Which of the following most likely underlies the usefulness of ruboxistaurin in this regard?
A.Ruboxistaurin is an orally administered, GLP1 receptor agonist
B.Ruboxistaurin is an orally administered, GLP1 receptor antagonist
C.Ruboxistaurin inhibits protein kinase C
D.Ruboxistaurin inhibits aldose reductase
E.Ruboxistaurin inhibits glycosylation (glucosylation, if you like) of key cellular proteins, such as hemoglobin.
18.MD is a Type I diabetic patient who is very concerned about preventing hypoglycemia after meals. His doctor suggests switching him to a rapid acting, short duration insulin that is injected right before meals. The doctor determined that MD is a very compliant patient who can handle the responsibility of frequent insulin injections and wrote him a prescription. Based on this information, which one of the following insulin formulations did the doctor prescribe?
A. Lispro Insulin
B.Lente Insulin
C. Ultralente Insulin
D.Insulin Glargine
E. Protamine zinc insulin
19.Which of the following patients would be unlikely to respond favorably to exogenously administered growth hormone (GH), in terms of reversing short stature?
I.A pediatric patient with a GH deficiency and a functional insulin-like growth factor 1 (IGF1) signaling pathway
II.A pediatric patient with normal levels of GH and a functional IGF1 signaling pathway
III.A pediatric patient with a GH deficiency and a non-functional IGF1 signaling pathway
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III
20.Some adults are also candidates for GH therapy. In which of the following adult patients would GH be used appropriately?
A. Adults of short stature
B.Adults with T1DM
C. Adults with T2DM
D.Adults with GH deficiency
E. Adults with gestational diabetes
21.Untreated acromegaly in children would most likely lead to:
A. Short stature
B.Gigantism
C. Cretinism
D.Graves' disease
E. Hashimoto's disease
22.The most appropriate medical treatment for acromegaly in adults would be:
A. Therapy with GH
B.Therapy with leuprolide
C. Therapy with clomiphene
D.Therapy with octreotide
E. Therapy with [131I]
23.What is the most likely outcome of giving pegvisomant to an adult patient suffering from acromegaly?
A. Suppression of GH levels
B.Suppression of somatostatin levels
C. Suppression of IGF1 levels
D.Suppression of prolactin levels
E. Regression of the GH-secreting tumor
24.Adult females suffering from hyperprolactinemia are often amenorrheic (i.e., they are not cycling properly and not menstruating). Which of the following therapeutic agents would be most likely to reverse amenorrhea in a female who is hyperprolactinemic?
A. Haloperidol
B.Bromocriptine
C. Octreotide
D.Pegvisomant
E. Methyltestosterone together with an estrogen
25.Human chorionic somatomammotropin (HCS) has been implicated in gestational diabetes by virtue of what pharmacological activity?
A. HCS is a glucagon receptor agonist
B.HCS is a glucagon-like peptide -1 (GLP1) receptor agonist
C. HCS is a GLP2 receptor agonist
D.HCS is a GH receptor agonist
E. HCS is a glucocorticoid receptor agonist
26.What is the basis for testicular regression in males who abuse anabolic steroids?
A.Androgens directly reduce testicular size and volume
B.Androgens suppress secretion of LH, which positively regulates testicular size and volume
C.Androgens suppress secretion of FSH, which positively regulates testicular size and volume
D.Androgens suppress secretion of GnRH, which positively regulates testicular size and volume
E.Androgens induce secretion of inhibin, which negatively regulates testicular size and volume
27.How might testicular regression in males who abuse anabolic steroids most logically be reversed pharmacologically?
A.Administration of finasteride
B.Administration of HCG
C.Administration of FSH
D.Administration of GnRH by continuous infusion
E.Administration of activin
28.What is the relationship between FSH and inhibin in the male?
A.FSH stimulates secretion of inhibin from Sertoli cells; inhibin inhibits release of FSH from gonadotropes
B.FSH inhibits secretion of inhibin from Sertoli cells; the lack of inhibin stimulates release of FSH from gonadotropes
C.FSH stimulates secretion of inhibin from Sertoli cells; inhibin cooperates with testosterone in the initiation of spermatogenesis
D.FSH inhibits secretion of inhibin from Sertoli cells; relieving the inhibition of spermatogenesis that is mediated by inhibin
E.FSH stimulates secretion of inhibin from Sertoli cells; inhibin inhibits release of synthesis and release of testosterone from Leydig cells
29.What is primary role of FSH in the female?
A.FSH stimulates LH release from anterior pituitary
B.FSH stimulates follicular maturation in the ovary
C.FSH directly stimulates endometrial proliferation
D.FSH directly stimulates endometrial cell secretion
E.FSH directly prepares the breasts for lactation
30.What is the primary rationale for giving authentic GnRH (gonadorelin) in a pulsatile fashion to a female patient?
A.To treat infertility related to a GnRH deficiency
B.To treat estrogen receptor-positive breast cancer
C.To treat endometriosis in women of child-bearing age
D.To treat uterine fibroids
E.To antagonize HCS in the pregnant female
31.Which of the following hormones most likely regulates progesterone secretion positively by the corpus luteum during the luteal phase of the cycle in a non-pregnant female?
A.LH
B.FSH
C.HCG
D.HCS
E.Estrogen
32.Which of the following most likely underlie(s) the use of RU-486 as an abortifacient agent?
I.Pharmacological antagonism of estrogen receptor
II.Pharmacological antagonism of glucocorticoid receptor
III.Pharmacological antagonism of progesterone receptor
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III
33.Ganirelix is often used for in vitro fertilization procedures to prevent premature LH surges in females. What is the pharmacological basis for this activity?
A.Ganirelix is a GnRH receptor agonist
B.Ganirelix is a GnRH receptor antagonist
C.Ganirelix is a LH receptor agonist
D.Ganirelix is a LH receptor antagonist
E.Ganirelix is a selective estrogen receptor modulator
34.Which of the following would be the most likely acute and direct effect of administering ganirelix, or a drug of this class, to a male patient?
A.Increased secretion of FSH and LH
B.Decreased secretion of FSH and LH
C.Increased secretion of testosterone
D.Increased secretion of inhibin
E.Stimulation of spermatogenesis
35.The pharmacological activity of chrysin is most similar to that of:
A.Saw palmetto
B.Flutamide
C.Leuprolide
D.Letrozole
E.Finasteride
36.What is/are the basis for the use of progestin-only preparations as emergency contraceptives?
I.Creation of an inhospitable endometrial environment for implantation
II.Suppression of LH surge and ovulation
III.Antagonism of progesterone receptor in the endometrium
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III
37.Which of the following would most likely enhance the abortifacient efficacy of RU-486?
A.Oral contraceptives containing estrogen and a progestin
B.Oral contraceptives containing progesterone only
C.Misoprostol
D.HCG
E.HCS
38.Systemic administration of glucocorticoids:
I.Suppresses numbers of circulating T lymphocytes
II.Suppresses numbers of circulating B lymphocytes
III.Suppresses numbers of circulating neutrophils
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III
39.A patient suffering from congenital adrenal hyperplasia requires replacement hormone therapy with the following:
I.Cortisol or other glucocorticoids
II.Aldosterone or other mineralocorticoids
III.ACTH
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III
40.The patient in the previous question, who is suffering from congenital adrenal hyperplasia, would tend to produce excessive levels of which of the following hormones in the adrenal cortex?
A.Cortisol
B.Aldosterone
C.Epinephrine
D.Androgens
E.All of the above
41.What is the rationale for treating a hyperthyroid patient with glucocorticoids?
A.To decrease joint inflammation associated with hyperthyroidism
B.To suppress expression of 5’-deiodinase and reduce the conversion of T4 to T3 in the body
C.To block the effects of excessive thyroid hormone on the heart
D.To induce metabolism of thyroid hormone
E.To repress thyroid peroxidase
42.What is the rationale for treating a hyperthyroid patient with propranolol?
A.To decrease joint inflammation associated with hyperthyroidism
B.To suppress expression of 5’-deiodinase and reduce the conversion of T4 to T3 in the body
C.To block the effects of excessive thyroid hormone on the heart
D.To induce metabolism of thyroid hormone
E.To repress thyroid peroxidase
43.Goiter in the context of hypothyroidism is most likely related to:
A.Persistent stimulation of the thyroid gland by autoimmune antibodies that react against TSH receptor on thyroid follicular cells
B.Persistent stimulation of the thyroid gland by TSH
C.Persistent activation of 5’ deiodinase
D.Addison’s disease
E.Dysfunctional thyrotropes in the anterior pituitary
44.Goiter in the context of hyperthroidism is most likely related to:
A.Persistent stimulation of the thyroid gland by autoimmune antibodies that react against TSH receptor on thyroid follicular cells
B.Persistent stimulation of the thyroid gland by TSH
C.Persistent activation of 5’ deiodinase
D.Addison’s disease
E.Dysfunctional thyrotropes in the anterior pituitary
45.Based on what you know about the hormones involved in spermatogenesis, which of the following would represent the most reasonable (not necessarily the most effective) male contraceptive?
A. An agent that inhibits testosterone synthesis and secretion
B. An agent that mimics the effects of inhibin
C. An agent that stimulates FSH production
D. An agent that stimulates LH production
E. An agent that mimics the effects of testosterone, such as a testosterone receptor agonist
46.Glucocorticoids and NSAIDs both inhibit inflammatory processes but these two classes of agents differ in many important ways with respect to their anti-inflammatory mechanisms of action, such as:
I.Glucocorticoids repress the expression of cyclooxygenase subtypes, whereas NSAIDs inhibit the activity of these enzymes
II.Glucocorticoids inhibit formation of lipoxygenase products, such as leukotrienes, whereas NSAIDs do not.
III.Glucocorticoids induce the expression of the NF-B inhibitor, IB, whereas NSAIDs do not
A.I only
B.III only
C.I and II only
D.II and III only
E.I, II, and III