situational endo meds

A 7-year-old with Turner syndrome presents with short stature and delayed growth. The physician prescribes recombinant GH. What drug is this?

Somatropin

A middle-aged man with acromegaly develops gallstones after starting therapy. Which drug most likely caused this?

Octreotide

A patient with Parkinson-like tremors is also being treated for hyperprolactinemia. Which dopamine agonist is being used?

Bromocriptine

A patient with uncontrolled acromegaly despite surgery is prescribed a GH receptor blocker. What drug is this?

Pegvisomant

A man with prostate cancer is started on a GnRH agonist to suppress testosterone. Name one possible drug.

Leuprolide

A woman with infertility is prescribed a GnRH antagonist during IVF. Which drug could this be?

Cetrorelix

A man with advanced prostate cancer develops hot flashes and decreased libido while on therapy. Which drug class is responsible?

GnRH agonists

A 10-year-old boy presents with polyuria and polydipsia. Labs confirm central diabetes insipidus. What is the drug of choice?

Desmopressin

A patient with SIADH is given a vasopressin antagonist. What complication should be monitored?

Polyuria and hypernatremia

A patient on desmopressin for nocturnal enuresis develops hyponatremia. What is the cause?

Water intoxication due to excessive ADH activity

A man with Addison’s disease is prescribed a mineralocorticoid to retain sodium. Which drug is this?

Fludrocortisone

A patient with adrenal insufficiency is rushed to the ER in shock. What IV drug is immediately given?

Hydrocortisone

A patient on long-term prednisone develops osteoporosis. What is the mechanism?

Glucocorticoids increase bone resorption and reduce bone formation

A woman on corticosteroid therapy reports black tarry stools. What condition is suspected?

Peptic ulcer disease

A patient on dexamethasone shows improvement in cerebral edema. Why is dexamethasone preferred?

It penetrates CNS and reduces swelling

A patient with Cushing’s syndrome undergoes a dexamethasone suppression test. What does the test measure?

Cortisol suppression to confirm hypercortisolism

A patient abruptly stops taking prednisone. What life-threatening complication may occur?

Adrenal crisis due to HPA axis suppression

A patient on long-term glucocorticoid therapy presents with moon face and truncal obesity. What condition is this?

Iatrogenic Cushing’s syndrome

A patient receiving fludrocortisone presents with high blood pressure and low potassium. What adverse effect is occurring?

Sodium retention with hypokalemia

A patient on chronic steroids develops recurrent infections. What is the mechanism?

Immunosuppression from glucocorticoids

A newborn with cretinism is started on thyroid replacement. Which drug is prescribed?

Levothyroxine

A patient with hypothyroidism is prescribed levothyroxine. When should it be taken for best absorption?

In the morning on an empty stomach

A patient on liothyronine experiences tachycardia. What is the cause?

Excess T3 causing hyperthyroidism-like effects

A woman with Graves’ disease is treated with methimazole. What is the most serious adverse effect to monitor?

Agranulocytosis

A pregnant woman in her first trimester is prescribed an antithyroid drug. Which is preferred?

Propylthiouracil (PTU)

A patient on PTU develops jaundice and dark urine. What adverse effect is suspected?

Hepatotoxicity

A man taking strong iodine solution for hyperthyroidism complains of metallic taste and sore gums. What condition is this?

Iodism

A patient with thyroid cancer receives radioactive iodine. Who should avoid contact with this patient?

Pregnant women and children

A patient with myxedema coma is admitted. What is the drug of choice?

IV levothyroxine

A patient with thyroid storm is treated with PTU and beta-blockers and iodine. What is the rationale?

To block hormone synthesis and control symptoms and prevent release of hormones

A dialysis patient with hypocalcemia is given calcitriol. What is the mechanism?

Increases calcium absorption and bone formation

A patient on calcitriol develops confusion and constipation. What lab abnormality is suspected?

Hypercalcemia

A patient with osteoporosis is prescribed alendronate. What administration teaching is essential?

Take with full water and remain upright for 30 minutes

A patient develops jaw pain after long-term bisphosphonate therapy. What condition is suspected?

Osteonecrosis of the jaw

A patient with Paget’s disease is prescribed calcitonin. What is its action?

Inhibits osteoclasts and increases calcium excretion

A patient allergic to fish develops a reaction after injection of a bone-protective drug. Which drug likely caused this?

Calcitonin salmon

A woman with osteoporosis is given teriparatide. What is the black-box warning?

Osteosarcoma risk with prolonged use

A man with uncontrolled type 1 diabetes is admitted with DKA. Which insulin is given IV?

Regular insulin

A patient on insulin lispro should take it at what time?

Within 15 minutes of meals

A patient is prescribed insulin glargine. What is its main property?

Long-acting insulin with no peak

A patient on NPH insulin notices cloudy suspension. What type of insulin is this?

Intermediate-acting insulin

A diabetic patient has recurrent hypoglycemia at night. What condition may explain morning hyperglycemia?

Somogyi effect

A diabetic patient has elevated fasting glucose due to early morning hormone surge. What phenomenon is this?

Dawn phenomenon

A hypoglycemic patient is found unconscious at home. What emergency drug should be administered?

Glucagon injection

A patient with type 2 diabetes is started on metformin. What rare but serious adverse effect must be monitored?

Lactic acidosis

A patient on metformin is scheduled for a CT scan with contrast dye. What should be done?

Hold metformin to prevent lactic acidosis

A diabetic patient on sulfonylureas experiences hypoglycemia. What is the mechanism?

Increased insulin secretion independent of glucose

A patient taking glipizide develops weight gain and hypoglycemia. What class of drug is this?

Second-generation sulfonylurea

A diabetic patient with heart failure is prescribed pioglitazone. What adverse effect is possible?

Fluid retention worsening heart failure

A patient on acarbose reports bloating and diarrhea. What is the mechanism of the drug?

Delays carbohydrate absorption in the gut

A patient with type 2 diabetes is given sitagliptin. What serious adverse effect should be monitored?

Pancreatitis

A diabetic patient on exenatide reports nausea and weight loss. What is the mechanism of the drug?

GLP-1 agonist increasing insulin and slowing gastric emptying

A patient on dapagliflozin develops recurrent UTIs. What drug class is responsible?

SGLT2 inhibitor

A diabetic patient using insulin is also prescribed pramlintide. What is the risk?

Severe hypoglycemia if insulin is not adjusted

A patient on long-term insulin develops lipoatrophy at injection sites. What is the prevention?

Rotate injection sites

A patient using beta-blockers is also diabetic. What complication can occur?

Masked symptoms of hypoglycemia

A diabetic patient has fruity breath and polyuria and dehydration. What condition is this?

Diabetic ketoacidosis

A woman on prednisone presents with mood swings and depression. What is the likely cause?

Steroid-induced psychiatric effects

A patient on levothyroxine develops palpitations and weight loss. What is the cause?

Overdose causing hyperthyroid symptoms

A patient taking methimazole for hyperthyroidism has fever and sore throat. What is the immediate action?

Stop drug and check WBC count

A patient with Addison’s disease requires lifelong therapy. What combination is used?

Glucocorticoids and mineralocorticoids

A patient with adrenal insufficiency is stressed by surgery. What adjustment is needed?

Increase glucocorticoid dose

A man on hydrocortisone develops truncal obesity and thin extremities. What syndrome is this?

Cushingoid appearance

A patient is prescribed nafarelin nasal spray. What condition is being treated?

Endometriosis

A patient on ganirelix is undergoing assisted reproduction. What is the purpose of this drug?

Prevent premature ovulation

A patient on tesamorelin reports reduced abdominal fat. What is the indication of this therapy?

HIV-associated lipodystrophy

A patient on lanreotide shows improvement in acromegaly symptoms. What is the drug’s mechanism?

Somatostatin analog inhibiting GH

A patient with hypertension and hypokalemia is suspected of primary aldosteronism. Which hormone is in excess?

Mineralocorticoids (aldosterone)

A man with pheochromocytoma is given steroids pre-op. What is the rationale?

Prevent adrenal crisis from stress

A patient on oxytocin infusion shows uterine hyperstimulation. What is the priority nursing action?

Stop infusion immediately

A patient on bromocriptine reports orthostatic hypotension. What is the cause?

Dopamine agonist effect lowering BP

A patient treated with degarelix reports decreased libido. What is the mechanism?

GnRH antagonist blocking sex hormone release

A man with thyroid storm is sweating and tachycardic and restless. What immediate drug reduces sympathetic symptoms?

Propranolol

A patient with Addison’s disease is not taking fludrocortisone properly. What complication may develop?

Hypotension and electrolyte imbalance

A patient on methimazole has improved symptoms but continues weight loss. What should be assessed?

T3 and T4 levels for dosing adjustment

A diabetic patient on insulin reports hypoglycemia after exercise. What is the cause?

Increased glucose utilization during activity

A patient on prednisone requires surgery. What is the perioperative concern?

Increased risk of infection and poor healing

A patient on levothyroxine also takes calcium supplements. What interaction occurs?

Calcium reduces levothyroxine absorption

A patient with SIADH has severe hyponatremia. What drug is indicated?

Vasopressin antagonist

A patient on calcitriol presents with kidney stones. What is the cause?

Hypercalcemia from excess vitamin D activity

A patient on pramlintide reports early satiety and delayed digestion. What is the mechanism?

Amylin analog delaying gastric emptying

A diabetic patient on insulin glargine develops nocturnal hypoglycemia. What is the likely error?

Incorrect mixing with other insulins

A patient with hyperthyroidism develops exophthalmos. What underlying disease is this?

Graves’ disease

A woman with Hashimoto’s thyroiditis presents with fatigue and cold intolerance. What lab confirms the diagnosis?

High TSH and low T4

A patient with Addison’s disease develops sudden hypotension and vomiting and shock. What emergency condition is this?

Adrenal crisis