Pharmacology

  • Endocrinology

  • What class of drug does metformin belong to?

  • Biguanide

  • What is the mechanism of action of metformin?

  • Increases insulin sensitivity

  • What is the onset of action of insulin detemir: short-, medium- or long-acting?

  • Long-acting

  • What is the onset of action of insulin glargine: short-, medium- or long-acting?

  • Long-acting

  • What is the onset of action of insulin Humalog®: short-, medium- or long-acting?

  • Short-acting

  • What is the onset of action of insulin NovoRapid®: short-, medium- or long-acting?

  • Short-acting

  • What is a bone side-effect of glitazones?

  • Fractures

  • What is an important bone side-effect of corticosteroids?

  • Osteoporosis

  • What is the duration of action of (systemic) prednisolone?

  • 18-36 hours

  • How long does it take for prednisolone to reach peak plasma concentration?

  • 1-2 hours

  • How does food affect time taken for prednisolone to reach peak plasma concentration?

  • Prolonged

  • Which organ is the main site of metabolism of prednisolone?

  • Liver

  • Is prednisolone present in breast milk?

  • Yes

  • What is the mechanism of action of bisphosphonates?

  • Inhibition of osteoclast activity preventing bone resorption

  • Should oral bisphosphonates be taken on a full or empty stomach?

  • Empty stomach

  • How long after an oral bisphosphonate is taken should an upright sitting position be maintained?

  • 30 minutes before moving or eating

  • What is the frequency of administration of alendronate?

  • Once weekly

  • What is the frequency of administration of risedronate?

  • Once weekly

  • In osteoporosis treatment what is the frequency of administration of zoledronic acid?

  • Once yearly

  • What is the route of administration of zoledronic acid?

  • Intravenous

  • What is the route of administration of alendronate?

  • Oral

  • What is the route of administration of risedronate?

  • Oral

  • List 2 gastrointestinal side-effects of bisphosphonates

  • 1) Reflux

    2) Oesophageal erosions

  • What side-effect of the hip can bisphosphonates cause?

  • Atypical femoral fractures

  • What side-effect of the jaw can bisphosphonates cause?

  • Osteonecrosis of the jaw

  • What side-effect of the ear can bisphosphonates cause?

  • Osteonecrosis of the external auditory canal

  • List 3 thyroid complications of amiodarone use

  • 1) Hyperthyroidism

    2) Hypothyroidism

    3) Painless thyroiditis

  • What effect does androgen treatment have on thyroxine-binding globulin (TBG)?

  • Lower thyroxine-binding globulin (TBG) levels – increased T4 levels

  • What effect does oestrogen treatment have on thyroxine-binding globulin (TBG)?

  • Increased thyroxine-binding globulin (TBG) levels – reduced T4 levels

  • What effect does glucocorticoid treatment have on thyroxine-binding globulin (TBG)?

  • Lower thyroxine-binding globulin (TBG) levels – increased T4 levels

  • How is the clearance of anticoagulant drugs affected in hypothyroidism?

  • Reduced clearance – therefore dose reduction may be required to avoid drug toxicity

  • How is the clearance of anti-epileptic drugs affected in hypothyroidism?

  • Reduced clearance – therefore dose reduction may be required to avoid drug toxicity

  • How is levothyroxine requirement for hypothyroidism affected in pregnancy?

  • Increased requirement – dose increase usually required during pregnancy with reduction to pre-pregnancy dose post-partum

  • How is levothyroxine requirement for hypothyroidism affected by weight gain?

  • Increased requirement with increase in more than 10% of body weight

  • How is levothyroxine requirement for hypothyroidism affected by normal aging?

  • Reduced requirement and therefore possible dose reduction

  • How is levothyroxine requirement for hypothyroidism affected by weight loss?

  • Reduced requirement and therefore possible dose reduction with decrease of more than 10% of body weight

  • What is the frequency of administration for levothyroxine treatment?

  • Once daily

  • What is the plasma half-life of levothyroxine?

  • 7 days

  • Ideally how should levothyroxine treatment be taken in relation to food?

  • On an empty stomach with water, 30-60 minutes before breakfast – proximity to food intake is more important than the time of day

  • Approximately how long after levothyroxine treatment does it take for a steady-state TSH concentration?

  • At least 6 weeks

  • How soon after initiation of levothyroxine treatment should serum TSH be repeated?

  • 4 to 6 weeks

  • Approximately how soon after a dose change in levothyroxine treatment should serum TSH be repeated?

  • 6 weeks

  • List 2 common causes for increasing requirements for levothyroxine treatment

  • 1) Levothyroxine malabsorption

    2) Poor adherence to levothyroxine treatment

  • What effect can cholestyramine have on levothyroxine?

  • Reduced absorption of levothyroxine

  • What effect can aluminium hydroxide (antacids) have on levothyroxine?

  • Reduced absorption of levothyroxine

  • What effect can ferrous sulphate have on levothyroxine?

  • Reduced absorption of levothyroxine

  • What effect can omeprazole / lansoprazole have on levothyroxine?

  • Reduced absorption of levothyroxine

  • What are the 2 main purposes of levothyroxine treatment in patients who have undergone thyroidectomy for thyroid cancer?

  • 1) Treatment of hypothyroidism

    2) Prevention of thyroid cancer recurrence

  • What side-effect can lithium have on serum calcium levels?

  • Elevation – hypercalcaemia

  • What is the mechanism of action of pegvisomant?

  • Growth hormone receptor antagonist

  • What is the route of administration of pegvisomant?

  • Subcutaneous

  • What is the mechanism of action of tolvaptan?

  • Vasopressin (ADH) receptor antagonist

  • What is the mechanism of action of statins?

  • Competitive inhibitors of HMG (hydroxymethylglutaryl) CoA reductase

  • Which lipoprotein is the main target of fenofibrate?

  • Triglycerides

  • What effect does gemfibrozil have on cytochrome P450 metabolism?

  • Inhibitor

  • What is the mechanism of action of octreotide?

  • Somatostatin analogue

  • What is the mechanism of action of bromocriptine?

  • Dopamine D2 receptor agonist

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