Post13 Hormones/Osteo

Which of the following drugs would INCREASE the cardiovascular adverse effects of thyroid hormones?
A. acetominophen
B. beta blockers
C. parasympathomimetic drugs
D. sympathomimetic drugs

F.H. is a 42 year old type 1 diabetic who has been receiving insulin for a long time. He needs a very high dose of insulin to maintain his blood glucose within the target range. Which of the following drugs might be added to his medications to help control his blood glucose?
A. glucagon.
B. bromocriptine.
C. growth hormone.
D. metformin (GLUCOPHAGE).

Which of the following are adverse effects of metformin (GLUCOPHAGE)?
A. hypotension
B. headache
C. blurred vision
D. hyperglycemia

Which of the following would you predict as an effect of insulin administration?
A. Increased blood glucose
B. Decreased white blood cell count
C. Increased serum sodium
*D. Decreased serum potassium

After subcutaneous administration of regular insulin, the peak effect is seen:
A. within 5-10 minutes
B. in 2-4 hours
C. in 8-12 hours
D. after 2 weeks of therapy

Match the drug to its MAJOR mechanism of aciton.

glipizide (GLUCOTROL)     Increases insulin release
acarbose (PRECOSE)     Delays absorption of carbohydrate
repaglinide (PRANDIN)     Increases insulin release
NPH insulin     Replaces insulin

For many years, women have been prescribed estrogen with or without progesterone at menopause to reduce hotflashes and protect the bones and blood vessels. In 2002 the Women's Health Initiative published findings (JAMA 2002 Jul 17;288(3):366-8) substantiated by other reviews (JAMA 2002 Aug 21;288(7):872-81) that showed the effect of postmenopausal hormone replacement therapy (HRT) to include:
A. It increases the risk of breast cancer.
B. It reduces the risk of blood clots, heart attack and stroke.
C. It increases the risk of colon cancer.
D. It increases the risk of osteoporotic bone fractures.

A patient is to receive 12 units of regular insulin AND sliding scale insulin as follows: for BS (blood sugar) less than 80: give sugar, for BS 81-140: give no insulin, for BS 141-200 give 2 units regular insulin, for BS 201-250 give 4 units regular insulin, for BS 251-300 give 6 units regular insulin, for BS 301-350 give 8 units regular insulin. For BS over 350 give 10 units regular insulin. This morning the blood sugar was 40. What should you do?
A. Give 12 units Humalog insulin with sugar.
B. Give 12 units Humulin-R with sugar.
C. Give 12 units Humulin-N with sugar.
D. Give sugar.

LC is a 33 year old who has been taking oral contraceptives. She reports a recent weight gain and says her right foot is so swollen she can barely get her shoe on. Her left foot is normal. What is the significance of these complaints?
A. These symptoms may eventually require a trip to the doctor, but they are not related to the BCPs.
B. She is probably pregnant, and should pick up an over-the counter kit to check before she takes any more BCPs.
C. She has probably developed a blood clot in her right leg (thrombophlebitis), and should go to the hospital to have it checked.
D. She is showing signs of menopause and could probably safely stop taking the BCPs without getting pregnant.

Pregnancy may cause swelling but the unilateral nature of her leg swelling is classically related to a major clot in the vien that prevents fluid from returning to the heart. Pieces of the clot could break off and travel to her lungs. These emboli can result in death, so she should go to the hospital to be tested for blood clots and be put on anticoagulants as needed. Women who get thrombophlebitis are 3-4 times more likely to have been taking BCP than those who do not get such clots. The risk of thrombophlebitis is not related to lenght of therapy and this risk dissappears when the pills are stopped.

Which of the following is the least expensive prevention for osteoporosis?
A. Forteo
B. Evista
C. Calcium supplements with vitamin D
D. Flomax

Altough not the most effective strategy, calcium supplements are the least expensive. Vitamin D improve efficacy without significant increase in cost. Thsi therapy costs about $12/month. Flomax is for benign prostatic hypertrophy. (Fosamax is for osteoporosis prevention, but at $70/30 days, costs more than Ca/vitD.) Forteo costs about $500/month and between cost and a black box warning from the FDA regarding osteosarcoma, it is reserved for those at greatest risk for fracture. Evista is about $70/month. (figures from rxlist 8-2004)

Which of the following are adverse effects of glipizide (GLUCOTROL)?
A. hypertension
B. headache
C. chest pain
D. muscle pain

After subcutaneous administration of regular insulin, the peak effect is seen:
A. within 5-10 minutes
B. in 2-4 hours
C. in 8-12 hours
D. after 2 weeks of therapy


LC is a 33 year old who has been taking oral contraceptives for the past 8 years. To assess her risk of having adverse effects from this medication, the most important question you should ask is:
A. "Are you allergic to eggs?"
B. "Do you smoke?"
C. "Have any family members been diagnosed with osteoporosis?"
D. "Has anyone in your family died of colon cancer?"