questions - Drug therapy for Addison’s and Cushing’s disease

Which of the following components control the secretion of hormones into the bloodstream from the adrenal cortex?

a) Thyroid gland

b) Hypothalamus; anterior pituitary

c) Pancreas

d) Kidneys

Rationale:

(b) Hypothalamus; anterior pituitary is correct because these structures regulate adrenocortical function through the release of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH).

(a) Thyroid gland is incorrect because it regulates metabolism through the secretion of thyroid hormones and does not directly control adrenal function.

(c) Pancreas is incorrect because it primarily regulates blood sugar levels through the secretion of insulin and glucagon.

(d) Kidneys are incorrect because they primarily regulate electrolyte balance and blood pressure through the renin-angiotensin-aldosterone system, not adrenocortical function.

Which condition results from inadequate or excessive secretion of hormones produced by the adrenal cortex?

a) Cushing's syndrome

b) Diabetes insipidus

c) Addison’s disease

d) Hyperthyroidism

Rationale:

(c) Addison’s disease is correct because it is characterized by adrenocortical insufficiency due to inadequate secretion of adrenal hormones.

(a) Cushing's syndrome is incorrect because it results from excessive secretion of cortisol, not inadequate secretion.

(b) Diabetes insipidus is incorrect because it is caused by insufficient production of or response to antidiuretic hormone (ADH), not adrenal hormones.

(d) Hyperthyroidism is incorrect because it results from excessive secretion of thyroid hormones, not adrenal hormones.

Which clinical manifestations are commonly associated with Addison’s disease?

a) Hypertension and tachycardia

b) Hyperglycemia and polyuria

c) Dehydration and weakness

d) Weight gain and edema

Rationale:

(c) Dehydration and weakness are correct because Addison’s disease leads to loss of sodium, water, and chloride, resulting in dehydration and weakness.

(a) Hypertension and tachycardia are incorrect because Addison’s disease often leads to hypotension and decreased cardiac output.

(b) Hyperglycemia and polyuria are incorrect because Addison’s disease primarily affects electrolyte balance and does not directly cause glucose dysregulation.

(d) Weight gain and edema are incorrect because Addison’s disease typically causes weight loss and dehydration rather than weight gain and edema.

Which term describes a life-threatening condition that occurs when Addison’s disease is the underlying problem and the patient is exposed to minor illness or increased stress?

a) Hypertensive crisis

b) Addisonian crisis

c) Hyperglycemic crisis

d) Thyroid storm

Rationale:

(b) Addisonian crisis is correct because it refers to an acute adrenal crisis resulting from insufficient adrenal hormone production during times of stress.

(a) Hypertensive crisis is incorrect because it typically involves severely elevated blood pressure, which is not a characteristic of Addisonian crisis.

(c) Hyperglycemic crisis is incorrect because it involves severe hyperglycemia and is associated with conditions like diabetic ketoacidosis or hyperosmolar hyperglycemic state, not Addison’s disease.

(d) Thyroid storm is incorrect because it refers to a life-threatening exacerbation of symptoms in individuals with hyperthyroidism, not Addison’s disease.

Which medication is commonly used for the treatment of Addison’s disease to replace both mineralocorticoids and glucocorticoids?

a) Metformin

b) Levothyroxine

c) Solu-Cortef

d) Lisinopril

Rationale:

(c) Solu-Cortef is correct because it is a synthetic glucocorticoid used to replace cortisol and also has some mineralocorticoid activity.

(a) Metformin is incorrect because it is an oral medication used to treat type 2 diabetes by decreasing hepatic glucose production and increasing peripheral insulin sensitivity, unrelated to adrenal hormone replacement.

(b) Levothyroxine is incorrect because it is a synthetic thyroid hormone used to treat hypothyroidism, unrelated to adrenal hormone replacement.

(d) Lisinopril is incorrect because it is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure, unrelated to adrenal hormone replacement.

Which physiological system primarily produces corticosteroids?

a) Thyroid gland

b) Adrenal cortex

c) Pancreas

d) Pituitary gland

Rationale:

(b) Adrenal cortex is correct because it is the primary site of corticosteroid production in the body.

(a) Thyroid gland is incorrect because it produces thyroid hormones, not corticosteroids.

(c) Pancreas is incorrect because it produces insulin and glucagon, not corticosteroids.

(d) Pituitary gland is incorrect because it produces hormones such as growth hormone and ACTH, which stimulate the adrenal cortex to produce corticosteroids.

Which of the following conditions is NOT commonly treated with corticosteroids?

a) Arthritis

b) Hypertension

c) Allergic reactions

d) Lupus erythematosus

Rationale:

(b) Hypertension is correct because corticosteroids are not typically used as a first-line treatment for hypertension.

(a) Arthritis, (c) Allergic reactions, and (d) Lupus erythematosus are incorrect because these are common conditions treated with corticosteroids due to their anti-inflammatory and immunosuppressive effects.

What are the metabolic effects of glucocorticoids when used to treat nonendocrine disorders?

a) Decreased blood glucose levels and increased protein synthesis

b) Increased blood glucose levels and suppressed protein synthesis

c) Decreased fat breakdown and fat redistribution

d) Increased muscle mass and thickening of the skin

Rationale:

(b) Increased blood glucose levels and suppressed protein synthesis is correct because glucocorticoids elevate blood glucose levels and suppress protein synthesis, leading to metabolic effects such as muscle wasting and thinning of the skin.

(a) Decreased blood glucose levels and increased protein synthesis is incorrect because glucocorticoids typically elevate blood glucose levels and suppress protein synthesis.

(c) Decreased fat breakdown and fat redistribution is incorrect because glucocorticoids stimulate fat breakdown and redistribution, leading to features such as a potbelly, moon face, and buffalo hump.

(d) Increased muscle mass and thickening of the skin is incorrect because glucocorticoids typically lead to muscle wasting and thinning of the skin.

What cardiovascular effects are associated with glucocorticoid use?

a) Increased circulating red blood cells and leukocytes

b) Decreased circulating red blood cells and leukocytes

c) Decreased potassium excretion and sodium retention

d) Increased potassium excretion and sodium retention

Rationale:

(b) Decreased circulating red blood cells and leukocytes is correct because glucocorticoids can decrease the number of circulating red blood cells and various types of leukocytes.

(a) Increased circulating red blood cells and leukocytes is incorrect because glucocorticoids typically decrease these cell counts.

(c) Decreased potassium excretion and sodium retention is incorrect because glucocorticoids promote retention of sodium and water but increase excretion of potassium, leading to hypokalemia.

(d) Increased potassium excretion and sodium retention is incorrect because it is the opposite of the effects of glucocorticoids on electrolyte balance.

Which of the following describes a potential side effect of glucocorticoid therapy on water and electrolyte balance?

a) Hypokalemia and dehydration

b) Hypernatremia and hypokalemia

c) Hyperkalemia and hyponatremia

d) Hypokalemia and edema

Rationale:

(b) Hypernatremia and hypokalemia is correct because glucocorticoids promote retention of sodium and water while increasing excretion of potassium, leading to hypernatremia and hypokalemia.

(a) Hypokalemia and dehydration is incorrect because glucocorticoids typically lead to hypokalemia but may cause fluid retention rather than dehydration.

(c) Hyperkalemia and hyponatremia is incorrect because glucocorticoids promote sodium retention and potassium excretion.

(d) Hypokalemia and edema is incorrect because while glucocorticoids can lead to hypokalemia, they typically promote sodium retention and fluid retention rather than causing edema.

What is the primary pharmacodynamic action of hydrocortisone in the treatment of inflammatory conditions?

a) Binds to receptors on the cell membrane to inhibit prostaglandin synthesis

b) Enters the cell and binds to receptors in the cytoplasm to decrease inflammation

c) Inhibits the release of histamine from mast cells

d) Blocks the action of leukotrienes in the inflammatory cascade

Rationale:

(b) Enters the cell and binds to receptors in the cytoplasm to decrease inflammation is correct because hydrocortisone acts intracellularly to suppress inflammation by binding to cytoplasmic receptors.

(a) Binds to receptors on the cell membrane to inhibit prostaglandin synthesis is incorrect because hydrocortisone primarily acts intracellularly, not on the cell membrane.

(c) Inhibits the release of histamine from mast cells is incorrect because this action is typically associated with antihistamines, not corticosteroids like hydrocortisone.

(d) Blocks the action of leukotrienes in the inflammatory cascade is incorrect because leukotriene inhibitors are a separate class of medications used in the treatment of asthma and allergic rhinitis.

Which of the following conditions is NOT an indication for the use of hydrocortisone?

a) Addison’s disease

b) Primary hypoaldosteronism

c) Hypothyroidism

d) Congenital adrenal hyperplasia

Rationale:

(c) Hypothyroidism is correct because hydrocortisone is not indicated for the treatment of hypothyroidism. It is primarily used in conditions affecting the adrenal gland such as Addison’s disease, primary hypoaldosteronism, and congenital adrenal hyperplasia.

(a) Addison’s disease, (b) Primary hypoaldosteronism, and (d) Congenital adrenal hyperplasia are incorrect because these are all conditions where hydrocortisone may be used to supplement deficient adrenal hormone production.

Which adverse effect is NOT commonly associated with the use of hydrocortisone?

a) Hypertension

b) Hypokalemia

c) Hyperkalemia

d) Peptic ulcer

Rationale:

(c) Hyperkalemia is correct because hydrocortisone typically promotes potassium excretion, leading to hypokalemia, not hyperkalemia.

(a) Hypertension, (b) Hypokalemia, and (d) Peptic ulcer are incorrect because these are all known adverse effects of corticosteroid therapy, including hydrocortisone.

What is a recommended administration instruction for patients prescribed oral hydrocortisone?

a) Take on an empty stomach to maximize absorption

b) Consume grapefruit juice with the medication to enhance its effects

c) Take once a day in the evening for better efficacy

d) Take with a meal or snack to decrease intestinal tract upset

Rationale:

(d) Take with a meal or snack to decrease intestinal tract upset is correct because oral corticosteroids like hydrocortisone can irritate the gastrointestinal tract, so taking them with food can help minimize this side effect.

(a) Take on an empty stomach to maximize absorption is incorrect because taking corticosteroids on an empty stomach can increase the risk of gastrointestinal irritation.

(b) Consume grapefruit juice with the medication to enhance its effects is incorrect because grapefruit juice can actually inhibit the metabolism of certain medications, leading to increased systemic concentrations and potentially adverse effects.

(c) Take once a day in the evening for better efficacy is incorrect because corticosteroids are typically dosed in the morning to mimic the body's natural cortisol secretion pattern.

Why is it important for patients on long-term hydrocortisone therapy to consider taking the medication every other day in the morning?

a) To maximize its anti-inflammatory effects

b) To avoid potential adrenal suppression

c) To minimize the risk of hypertension

d) To prevent electrolyte imbalances

Rationale:

(b) To avoid potential adrenal suppression is correct because long-term corticosteroid therapy can suppress the body's natural production of cortisol, so taking the medication every other day can help prevent adrenal insufficiency.

(a) To maximize its anti-inflammatory effects is incorrect because the primary concern with long-term corticosteroid therapy is adrenal suppression, not the efficacy of its anti-inflammatory effects.

(c) To minimize the risk of hypertension is incorrect because hypertension can occur with long-term corticosteroid use regardless of dosing frequency.

(d) To prevent electrolyte imbalances is incorrect because electrolyte imbalances are a potential side effect of corticosteroid therapy but are not specifically addressed by adjusting dosing frequency.

What is the primary pharmacodynamic action of fludrocortisone in the treatment of conditions like Addison’s disease?

a) Potassium retention and sodium excretion

b) Sodium retention and potassium excretion

c) Sodium excretion and potassium retention

d) Water retention and potassium excretion

Rationale:

(b) Sodium retention and potassium excretion is correct because fludrocortisone acts primarily as a mineralocorticoid, promoting sodium retention and potassium excretion to help maintain electrolyte balance.

(a) Potassium retention and sodium excretion is incorrect because fludrocortisone primarily promotes sodium retention and potassium excretion.

(c) Sodium excretion and potassium retention is incorrect because it is the opposite of the pharmacodynamic action of fludrocortisone.

(d) Water retention and potassium excretion is incorrect because fludrocortisone primarily affects sodium and potassium balance, not water retention.

Which adverse effect is NOT commonly associated with the use of fludrocortisone?

a) Hypertension

b) Hypokalemia

c) Hypercalcemia

d) Edema

Rationale:

(c) Hypercalcemia is correct because fludrocortisone does not typically cause hypercalcemia. It primarily leads to sodium retention, potassium excretion, and fluid retention, resulting in hypertension, hypokalemia, and edema.

(a) Hypertension, (b) Hypokalemia, and (d) Edema are incorrect because these are common adverse effects of fludrocortisone therapy.

What is a potential sign of electrolyte imbalance associated with fludrocortisone therapy?

a) Increased serum sodium and decreased serum potassium levels

b) Decreased serum sodium and increased serum potassium levels

c) Increased serum sodium and increased serum potassium levels

d) Decreased serum sodium and decreased serum potassium levels

Rationale:

(a) Increased serum sodium and decreased serum potassium levels is correct because fludrocortisone promotes sodium retention and potassium excretion, leading to hypernatremia and hypokalemia.

(b) Decreased serum sodium and increased serum potassium levels is incorrect because the opposite electrolyte imbalance would be expected with fludrocortisone therapy.

(c) Increased serum sodium and increased serum potassium levels is incorrect because fludrocortisone primarily leads to sodium retention and potassium excretion.

(d) Decreased serum sodium and decreased serum potassium levels is incorrect because fludrocortisone typically leads to sodium retention and potassium excretion.

Why is growth retardation a concern in children receiving long-term fludrocortisone therapy?

a) Due to decreased appetite and malnutrition

b) Due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis

c) Due to increased secretion of growth hormone

d) Due to enhanced calcium absorption

Rationale:

(b) Due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis is correct because long-term corticosteroid therapy, including fludrocortisone, can suppress the body's natural production of cortisol, leading to growth retardation in children.

(a) Due to decreased appetite and malnutrition is incorrect because while decreased appetite and malnutrition may contribute to growth retardation, the primary mechanism is suppression of the HPA axis.

(c) Due to increased secretion of growth hormone is incorrect because corticosteroids typically suppress the secretion of growth hormone.

(d) Due to enhanced calcium absorption is incorrect because calcium absorption is not directly related to growth retardation in children receiving corticosteroid therapy.

Which adverse effect is NOT commonly associated with long-term fludrocortisone therapy?

a) Osteoporosis

b) Glucose intolerance

c) Hypotension

d) Myopathy

Rationale:

(c) Hypotension is correct because fludrocortisone therapy typically leads to hypertension due to sodium retention, not hypotension.

(a) Osteoporosis, (b) Glucose intolerance, and (d) Myopathy are incorrect because these are all known adverse effects of long-term corticosteroid therapy, including fludrocortisone.

What is a contraindication for the use of glucocorticoids?

a) Systemic fungal infections

b) Hypertension

c) Osteoporosis

d) Diabetes mellitus

Rationale:

(a) Systemic fungal infections is correct because glucocorticoids are contraindicated in these infections due to their immunosuppressive effects, which can exacerbate fungal growth.

(b) Hypertension, (c) Osteoporosis, and (d) Diabetes mellitus are incorrect because while these conditions warrant cautious use of glucocorticoids, they are not absolute contraindications.

Why is it important to administer glucocorticoids before 9 am?

a) To enhance their anti-inflammatory effects

b) To minimize the risk of adrenal insufficiency

c) To prevent glucose intolerance

d) To reduce the risk of osteoporosis

Rationale:

(b) To minimize the risk of adrenal insufficiency is correct because administering glucocorticoids in the morning mimics the body's natural cortisol secretion pattern, helping to prevent adrenal suppression and insufficiency.

(a) To enhance their anti-inflammatory effects is incorrect because the timing of administration primarily affects adrenal function rather than the efficacy of anti-inflammatory effects.

(c) To prevent glucose intolerance is incorrect because glucose intolerance is a potential adverse effect of glucocorticoid therapy, not related to timing of administration.

(d) To reduce the risk of osteoporosis is incorrect because while glucocorticoids can contribute to osteoporosis, the timing of administration does not directly affect this risk.

What withdrawal syndrome symptoms might occur if glucocorticoids are abruptly discontinued?

a) Hypertension and hyperglycemia

b) Hypotension and hypoglycemia

c) Muscle weakness and fatigue

d) Hyperkalemia and hyponatremia

Rationale:

(c) Muscle weakness and fatigue is correct because abrupt withdrawal of glucocorticoids can lead to adrenal insufficiency, resulting in symptoms such as hypotension, hypoglycemia, myalgia, arthralgia, and fatigue.

(a) Hypertension and hyperglycemia is incorrect because these symptoms are more commonly associated with chronic glucocorticoid therapy rather than withdrawal.

(b) Hypotension and hypoglycemia is incorrect because these are symptoms of adrenal insufficiency that can occur with withdrawal of glucocorticoids.

(d) Hyperkalemia and hyponatremia is incorrect because these electrolyte imbalances are not typically associated with glucocorticoid withdrawal.

What clinical manifestation is characteristic of Cushing’s disease?

a) Hypertension and bradycardia

b) Moon-faced appearance and buffalo hump

c) Weight loss and muscle wasting

d) Thin hair and fragile skin

Rationale:

(b) Moon-faced appearance and buffalo hump is correct because these are characteristic physical features of Cushing’s disease, caused by excessive cortisol secretion.

(a) Hypertension and bradycardia is incorrect because hypertension is common in Cushing’s disease but bradycardia is not typically associated with it.

(c) Weight loss and muscle wasting is incorrect because weight gain and central adiposity are more common in Cushing’s disease.

(d) Thin hair and fragile skin is incorrect because thinning of the hair and fragile skin are also characteristic features of Cushing’s disease, but not as specific as the moon-faced appearance and buffalo hump.

Which precaution is important for patients with Cushing’s disease to prevent complications?

a) Increasing glucocorticoid dose gradually

b) Administering live virus vaccines

c) Avoiding physical activity

d) Monitoring blood pressure regularly

Rationale:

(d) Monitoring blood pressure regularly is correct because hypertension is a common complication of Cushing’s disease and requires close monitoring to prevent cardiovascular complications.

(a) Increasing glucocorticoid dose gradually is incorrect because it is not relevant to the management of Cushing’s disease, which involves reducing cortisol levels rather than increasing them.

(b) Administering live virus vaccines is incorrect because patients with Cushing’s disease should avoid live virus vaccines due to their immunosuppressive state.

(c) Avoiding physical activity is incorrect because while patients with Cushing’s disease may experience muscle weakness, physical activity is important for overall health and should be encouraged within the limits of their condition.

What is the primary goal of drug therapy in Cushing’s Disease?

a) To increase cortisol secretion

b) To inhibit enzymes involved in cortisol synthesis

c) To stimulate adrenal cortex function

d) To promote conversion of deoxycortisol to cortisol

Rationale:

(b) To inhibit enzymes involved in cortisol synthesis is correct because drugs used to treat Cushing’s Disease, such as deoxycortisol inhibitors like ketoconazole, aim to reduce cortisol levels by inhibiting enzymes involved in its synthesis.

(a) To increase cortisol secretion is incorrect because the goal in Cushing’s Disease is to decrease excessive cortisol production.

(c) To stimulate adrenal cortex function is incorrect because the goal is to suppress adrenal cortex function to reduce cortisol secretion.

(d) To promote conversion of deoxycortisol to cortisol is incorrect because deoxycortisol inhibitors work by preventing the conversion of precursor molecules to cortisol.

What is the pharmacodynamic action of ketoconazole in the treatment of Cushing’s Disease?

a) Stimulation of cortisol synthesis

b) Inhibition of enzymes involved in cortisol production

c) Promotion of adrenal cortex function

d) Enhancement of cortisol receptor binding

Rationale:

(b) Inhibition of enzymes involved in cortisol production is correct because ketoconazole, as a deoxycortisol inhibitor, works by inhibiting an enzyme used in the production of cortisol, thereby reducing cortisol secretion.

(a) Stimulation of cortisol synthesis is incorrect because ketoconazole does not stimulate cortisol synthesis but rather inhibits it.

(c) Promotion of adrenal cortex function is incorrect because the goal is to suppress adrenal cortex function in Cushing’s Disease.

(d) Enhancement of cortisol receptor binding is incorrect because ketoconazole does not affect cortisol receptor binding but rather reduces cortisol levels.

Which adverse effect is a Black Box warning associated with the use of ketoconazole?

a) Headache and sedation

b) Hepatotoxicity

c) Nausea and vomiting

d) Hypokalemia

Rationale:

(b) Hepatotoxicity is correct because ketoconazole carries a Black Box warning for hepatotoxicity, which can manifest as liver damage and failure.

(a) Headache and sedation, (c) Nausea and vomiting, and (d) Hypokalemia are incorrect because while these are adverse effects associated with ketoconazole, hepatotoxicity is the most severe and carries a Black Box warning.

What is an important patient teaching point regarding the use of ketoconazole for Cushing’s Disease?

a) Report any signs of adrenal insufficiency promptly

b) Avoid consuming grapefruit juice while taking the medication

c) Take the medication with a meal to minimize gastrointestinal upset

d) Discontinue the medication immediately if experiencing headache or sedation

Rationale:

(b) Avoid consuming grapefruit juice while taking the medication is correct because grapefruit juice can inhibit the metabolism of ketoconazole, leading to increased systemic concentrations and potential toxicity.

(a) Report any signs of adrenal insufficiency promptly is incorrect because ketoconazole does not typically cause adrenal insufficiency.

(c) Take the medication with a meal to minimize gastrointestinal upset is incorrect because while this may be a helpful tip for some medications, it is not specific to ketoconazole.

(d) Discontinue the medication immediately if experiencing headache or sedation is incorrect because sudden discontinuation of ketoconazole can lead to adverse effects and should be done under medical supervision.

Which clinical condition is ketoconazole used to treat?

a) Addison’s Disease

b) Cushing’s Disease

c) Hypothyroidism

d) Hyperparathyroidism

Rationale:

(b) Cushing’s Disease is correct because ketoconazole is used to control cortisol secretion in conditions of cortisol excess, such as Cushing’s Disease.

(a) Addison’s Disease, (c) Hypothyroidism, and (d) Hyperparathyroidism are incorrect because ketoconazole is not indicated for the treatment of these conditions.