Pharm Adrenocortigoids And Antag Part 1

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Pharm Adrenocortigoids And Antag Part 1 - Quiz

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Questions and Answers
  • 1. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A glucocorticoid devoid of salt retaining activity

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    D. Dexamethasone
    Explanation
    Dexamethasone is a glucocorticoid that does not have salt retaining activity.

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  • 2. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A mineralocorticoid antagonist

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    J. Spironolactone
    Explanation
    Spironolactone is a mineralocorticoid antagonist. It blocks the effects of aldosterone, a hormone that regulates sodium and water balance in the body. By inhibiting aldosterone, spironolactone helps to reduce fluid retention and lower blood pressure. It is commonly used to treat conditions such as hypertension, heart failure, and edema.

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  • 3. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A drug that inhibits several steps of steroidogenesis requiring cytochrome P450 enzymes

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    G. Ketoconazole
    Explanation
    Ketoconazole is a drug that inhibits several steps of steroidogenesis requiring cytochrome P450 enzymes.

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  • 4. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A mineralocorticoid used to treat adrenal insufficiency

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    E. Fludrocortisone
    Explanation
    Fludrocortisone is a mineralocorticoid that is used to treat adrenal insufficiency. It helps to replace or supplement the body's natural mineralocorticoids, which are hormones that regulate salt and water balance in the body. By taking fludrocortisone, it can help to prevent low blood pressure, electrolyte imbalances, and other symptoms associated with adrenal insufficiency.

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  • 5. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A drug that blocks of the conversion of cholesterol to pregnenolone

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    A. Aminoglutethimide
    Explanation
    Aminoglutethimide is a drug that blocks the conversion of cholesterol to pregnenolone.

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  • 6. 

    DIRECTIONS 1-6 Match each corticosteroid or antagonist with the appropriate description (each lettered option can be selected only once): A drug that blocks the cytoplasmic glucocorticoid receptors

    • A.

      Aminoglutethimide

    • B.

      Aldosterone

    • C.

      Desoxycorticosterone

    • D.

      Dexamethasone

    • E.

      Fludrocortisone

    • F.

      Hydrocortisone

    • G.

      Ketoconazole

    • H.

      Mifepristone

    • I.

      Prednisone

    • J.

      Spironolactone

    Correct Answer
    H. Mifepristone
    Explanation
    Mifepristone is a drug that blocks the cytoplasmic glucocorticoid receptors.

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  • 7. 

    Most of the known effects of corticosteroids are mediated by actions on which of the following molecular targets?

    • A.

      G-protein coupled receptors

    • B.

      Tyrosine kinase receptors

    • C.

      Specific nucleotide sequences of the DNA

    • D.

      Ion channel coupled receptors

    • E.

      Specific nucleotide sequences of RNA

    • F.

      Specific nucleotide sequences of ribosomes

    Correct Answer
    C. Specific nucleotide sequences of the DNA
    Explanation
    Answer: C
    (Katzung, pp 636, Brunton, pp 1596)
    Corticosteroids are sufficiently lipid soluble to cross the membrane of the target cells. In the
    cytoplasm they bind to a corticosteroid receptor-heat-shock protein complex and this binding
    releases the heat-shock protein. The hormone-receptor complex is then transported into the
    nucleus where it binds to specific nucleotide sequences along the DNA, called glucocorticoid (or
    mineralocorticoid) response elements. This binding alters the transcription so modulating the
    expression of specific genes.
    A, B, D, E, F) (see explanation above)

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  • 8. 

    Which of the following actions most likely contributes to the antiinflammatory effects of glucocorticoids?

    • A.

      Inhibition of ACTH release

    • B.

      Increased catabolism of prostaglandins

    • C.

      Increased capillary permeability

    • D.

      Increased release of interleukin-1

    • E.

      Induction of lipocortin synthesis

    Correct Answer
    E. Induction of lipocortin synthesis
    Explanation
    Answer: E
    (Katzung, pp 302, Brunton, pp 657)
    The antiinflammatory effects of glucocorticoids is mediated by a vast array of actions including
    the induction of the synthesis of lipocortins. These enzymes act as inhibitors of phospholipase
    A2, the enzyme that catalyzes the release of arachidonic acid from membrane phospholipids.
    Since arachidonic acid is the precursor of eicosanoids, the corticosteroid induced induction of
    lipocortins leads to an inhibition of phospholipase A2 and in turn to an inhibition of biosynthesis
    of all eicosanoids, which are proinflammatory compounds.
    A) Glucocorticoids inhibit ACTH release but this contributes very little to the antiinflammatory
    effect.
    B, C D) Glucocorticoids do not influence the catabolism of prostaglandins and decrease, not
    increase capillary permeability and the release of interleukin 1.

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  • 9. 

    Which of the following actions most likely contributes to the immunosuppressive effect of glucocorticoids ?

    • A.

      Increased plasma levels of free fatty acids

    • B.

      Increased gluconeogenesis

    • C.

      Reduced production of TNF in macrophages

    • D.

      Increased protein synthesis in the liver

    • E.

      Decreased calcium absorption from the intestine

    Correct Answer
    C. Reduced production of TNF in macrophages
    Explanation
    Answer: C
    (Katzung, pp 640, Brunton, pp 1600)
    Glucocorticoids inhibit the synthesis of almost all known cytokines, including the macrophagemediated
    production of tumor necrosis factor (TNF). This cytokine has proinflammatory,
    oncostatic and chemotactic properties which play interacting roles in the function of the immune
    system.
    A, B, D, E) Glucocorticoids can exert all these actions but they do not contribute significantly to
    the immunosuppressive effect of these drugs.

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  • 10. 

    Which of the following statements regarding the pharmacokinetics of corticosteroids are correct? (Check all that apply)

    • A.

      Oral bioavailability is generally very good

    • B.

      Substantial absorption does occur through the skin

    • C.

      They distribute into peripheral tissues but cross the blood-brain barrier with difficulty

    • D.

      Their biological half-lives can be long (up to 72 hours)

    • E.

      They are mainly excreted unchanged by the kidney

    Correct Answer(s)
    A. Oral bioavailability is generally very good
    B. Substantial absorption does occur through the skin
    D. Their biological half-lives can be long (up to 72 hours)
    Explanation
    (Katzung, pp 636, Brunton, pp 1601, Koda-Kimble pp 44-7)
    Corticosteroids are very lipid soluble drugs and therefore they can be easily absorbed by oral
    route and even though the intact skin. Their plasma half lives are short (1-6 hours) but since they
    lives) can be quite long.
    C) Since corticosteroids are very lipid soluble they widely distribute in all tissues, including brain
    E) As a rule a lipid soluble drug is mainly biotransformed by the liver and corticosteroids are not
    exceptions to this rule.

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  • 11. 

    Which of the following are effects of glucocorticoids upon carbohydrate metabolism? (Check all that apply)

    • A.

      Decreased gluconeogenesis in liver

    • B.

      Increased glucose uptake by skeletal muscle

    • C.

      Increased glycogen synthesis in liver

    • D.

      Decreased glucose uptake by adipose tissue

    • E.

      Increased glucose utilization in peripheral tissues

    Correct Answer(s)
    C. Increased glycogen synthesis in liver
    D. Decreased glucose uptake by adipose tissue
    Explanation
    Answer: CD
    (Katzung, pp 640, Brunton, pp 1597)
    Effects of glucocorticoids on intermediary metabolism can be viewed as protecting glucose
    dependent tissue (brain and heart) from starvation. To this end they increase glycogen synthesis
    and storage in liver and diminish glucose utilization in the periphery, therefore decreasing
    glucose uptake by adipose tissue. The net results of all these effect is to increase blood glucose
    levels.
    A, B, E) Actually glucocorticoids have actions opposite to those listed .

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  • 12. 

    Glucocorticoids are used clinically in many disease states. However they are used only rarely to treat which of the following diseases?

    • A.

      Autoimmune diseases

    • B.

      Malignancies

    • C.

      Infectious diseases

    • D.

      Inflammatory bowel diseases

    • E.

      Skin diseases

    Correct Answer
    C. Infectious diseases
    Explanation
    Answer: C
    (Katzung, pp 646, Brunton, pp 1609)
    Because of their antiinflammatory and immunosuppressive actions glucocorticoids are generally
    contraindicated in infectious disease. Few infectious diseases however (i.e. Pneumocystis carinii
    pneumonia and Haemophilus influenzae meningitis in infants) can be effectively treated with
    corticosteroids.
    A, B, D, E) glucocorticoid are use extensively, not rarely, in these diseases.

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  • 13. 

    A 54-year-old man, recently diagnosed with immunologic thrombocytopenic purpura started a treatment with a large dose of a drug. The molecular mechanism of action of that drug involved binding to a receptor-heat-shock protein complex in the cytoplasm. Which of the following drugs was most likely prescribed?

    • A.

      Fludrocortisone

    • B.

      Azathioprine

    • C.

      Norethindrone

    • D.

      Prednisone

    • E.

      Calcitriol

    • F.

      Ethinyl estradiol

    Correct Answer
    D. Prednisone
    Explanation
    Answer: D
    (Katzung, pp 644, Brunton, pp 1595)
    Immunologic thrombocytopenic purpura is, in most adults, a chronic disorder that results from
    development of an antibody directed against a structural platelet antigen. Treatment in the adult
    is usually begun with a large dose of an oral glucocorticoid, like prednisone. The mechanism of
    action of all steroid drugs involves binding to a receptor-heat-shock protein complex in the
    cytoplasm.
    A, C, E, F) The mechanism of action of these drugs also involves binding to a receptor-heatshock
    protein complex in the cytoplasm, but these drugs are not used in autoimmune diseases.
    B) Azathioprine is an immunosuppressant drug sometimes used in immunologic
    thrombocytopenic purpura, but its mechanism of action is different from the one described
    above.

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  • 14. 

    A 44-year-old woman suffering from Crohn’ disease had been receiving high doses of oral prednisone to treat an acute stage of the disease. Which of the following actions most likely contributed to the therapeutic effect of the drug in this patient?

    • A.

      Increased catabolism of prostaglandins

    • B.

      Decreased number of circulating neutrophils

    • C.

      Increased proliferation of T cells

    • D.

      Increased activation of complement system

    • E.

      Inhibition of lymphocyte-mediated production of interleukin-2

    Correct Answer
    E. Inhibition of lymphocyte-mediated production of interleukin-2
    Explanation
    Answer: E
    (Katzung, pp 1032, Brunton, pp 1600)
    Crohn disease is a chronic inflammatory bowel disease of unknown origin. The antiinflammatory
    effect of glucocorticoids, which may dramatically reduce fever diarrhea and abdominal pain in
    the acute stage of the disease, is due to many actions, including inhibition of lymphocytemediated
    production of interleukin-2. This cytokine induces proliferation of B and T cells (including cytotoxic T cells) and activation of natural killer cells and lymphokine-activated killer
    cells, an therefore it plays a main role in inflammatory processes.
    A) Glucocorticoids have no effect on the metabolism of prostaglandins
    B, C, D) Glucocorticoids have effect opposite to those listed.

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  • 15. 

    A 55-year-old man with Addison’s disease presented to the hospital complaining of episodic weakness, paresthesias, and constipation. He had been taking cortisol and fludrocortisone for several months. On admission his blood pressure was 160/98 mm Hg and an ECG showed prolongation of Q-T interval. Lab results revealed a plasma K+ level of 2.5 mEq/L. Which of the following events best explains the patient syndrome?

    • A.

      Cortisol induced hyperglycemia

    • B.

      Fludrocortisone excess

    • C.

      Inadequate therapy of adrenal insufficiency

    • D.

      Cortisol induced myopathy

    • E.

      Essential hypertension

    Correct Answer
    B. Fludrocortisone excess
    Explanation
    Answer: B
    (Katzung, pp 647, Brunton, pp 1603)
    In a person under treatment for adrenal insufficiency the high blood pressure, the low K+ levels
    and the ECG data suggest that the symptoms and signs of the patient are due to an excessive
    dose of fludrocortisone, a mineralocorticoid currently used to treat Addison disease.
    A, D) Hyperglycemia or myopathy induced by cortisol excess would not cause the patient’
    symptoms and signs.
    C) An inadequate therapy of adrenal insufficiency would have caused symptoms opposite to
    those exhibited by the patient.
    E) The patient has a high blood pressure, but in a person with adrenal insufficiency essential
    hypertension is unlikely. The high blood pressure is more likely due to an excessive dose of the
    mineralocorticoid used for treatment.

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