Endocrine Pharmacology Practice Questions

Q: Ulipristal acetate (progesterone receptor modulator) should not be prescribed as emergency contraceptive in women with

liver dysfunction. ***Correct: liver dysfunction*** - **Ulipristal acetate** is extensively metabolized in the **liver** by the CYP450 enzyme system, predominantly CYP3A4. - In individuals with **severe hepatic impairment**, the metabolism of ulipristal acetate can be impaired, leading to increased plasma concentrations and potential adverse effects. - **Severe liver dysfunction** is a documented contraindication in product labeling. *Incorrect: glaucoma* - There is **no known contraindication** for ulipristal acetate use in individuals with **glaucoma**. - Its mechanism of action primarily involves progesterone receptors and does not directly impact intraocular pressure. *Incorrect: coagulopathy* - Ulipristal acetate does **not significantly affect blood coagulation** parameters or platelet function. - It is not contraindicated in individuals with **coagulopathy**, unlike some estrogen-containing contraceptives. *Incorrect: kidney failure* - While urinary excretion of ulipristal acetate metabolites occurs, the **primary elimination pathway is fecal** (approximately 90%). - **Kidney failure** is not considered a contraindication, and dose adjustments are generally not required.

Q: All of the following are correct regarding drospirenone EXCEPT:

It is safe in renal failure patients.. ***4. It is safe in renal failure patients*** - **Drospirenone** has **antimineralocorticoid activity**, which can lead to **hyperkalemia**, especially in patients with **renal impairment**. - Therefore, it is **contraindicated** and not safe in patients with **renal failure** due to the increased risk of potentially life-threatening **hyperkalemia**. *3. It has antimineralocorticoid action* - Drospirenone is a unique progestin derived from **spironolactone**, giving it a distinct **antimineralocorticoid effect**. - This effect helps to reduce symptoms like **bloating** and **fluid retention**, which are often associated with other hormonal contraceptives. *2. It has antiandrogenic property* - Drospirenone possesses significant **antiandrogenic properties**, which are beneficial in treating conditions like **acne** and **hirsutism**. - This action helps to counteract the androgenic side effects some other progestins might exhibit, making it a favorable choice for women who experience these issues. *1. It is a fourth generation progestin* - Drospirenone is classified as a **fourth-generation progestin**, developed to offer an improved side effect profile compared to older progestins. - These newer progestins often have more selective receptor binding and distinct pharmacological properties like **antiandrogenic** and **antimineralocorticoid** effects.

Q: Which of the following drugs should be avoided in labouring women with bronchial asthma?

Prostaglandin F2α. ***Prostaglandin F2α*** - **Prostaglandin F2α** (e.g., **carboprost**) is a potent **bronchoconstrictor** and can exacerbate asthma, leading to severe respiratory distress in susceptible individuals. - Its use for **uterine atony** in labouring women with a history of asthma is generally contraindicated due to the risk of inducing an **asthma attack**. *Ergometrine* - **Ergometrine** is an **ergot alkaloid** used to prevent or treat **postpartum hemorrhage** by causing sustained uterine contractions. - While it can cause some adverse effects like nausea or hypertension, it is **not generally contraindicated** in asthma and does not directly cause bronchoconstriction. *Prostaglandin E1* - **Prostaglandin E1** (e.g., **misoprostol**) is used for cervical ripening and induction of labour, or for preventing postpartum hemorrhage. - It generally has **bronchodilating** properties and is therefore considered safe for use in patients with asthma. *Opioid analgesics* - **Opioid analgesics** (e.g., **pethidine**, **morphine**) are commonly used for pain relief during labour. - While they can cause respiratory depression at high doses, they do **not directly induce bronchoconstriction** and are generally safe for use in asthmatic patients when carefully monitored.

Q: What is the content of ethinyl estradiol in very low dose oral contraceptives ?

20 µg. ***20 µg*** - Very low-dose oral contraceptives typically contain **20 µg of ethinyl estradiol**. This dosage is chosen to minimize estrogen-related side effects while maintaining contraceptive efficacy. - While it offers fewer side effects, its **contraceptive reliability** might be slightly lower than standard doses, and it could lead to more **breakthrough bleeding**. *15 µg* - Oral contraceptives with **15 µg of ethinyl estradiol** are considered ultra-low dose and are less common. - This dosage carries a higher risk of **breakthrough bleeding** and potentially reduced efficacy compared to 20 µg. *25 µg* - An oral contraceptive containing **25 µg of ethinyl estradiol** falls within the low-dose range, but it is not classified as "very low dose" given that 20 µg is the typical threshold for that designation. - While still generally well-tolerated, it contains slightly more estrogen than the very low-dose options. *30 µg* - This concentration of ethinyl estradiol is characteristic of **low-dose oral contraceptives**, but not "very low dose." - It offers good contraceptive efficacy with a relatively low incidence of estrogen-related side effects.

Q: Consider the following list of cancers: 1. Ovarian cancer 2. Colon cancer 3. Endometrial cancer 4. Breast cancer What is the effect of combined oral contraceptive pills on the above?

Protection against 1, 2 and 3. **Protection against 1, 2, and 3** - Combined oral contraceptive (COC) pills are known to **reduce the risk of ovarian and endometrial cancer**, effects that can persist for decades after discontinuation. This is primarily due to the suppression of ovulation and the direct effect of progestin on the endometrium. - COC use also offers some **protection against colorectal cancer**, with studies showing a modest reduction in risk, potentially related to changes in bile acid metabolism or other hormonal effects. *Increased risk of 3 and 4 only* - While COCs **decrease the risk of endometrial cancer (3)**, they are associated with a **modest, temporary increase in the risk of breast cancer (4)**, which typically returns to baseline 10 years after cessation. - This option incorrectly states an increased risk for endometrial cancer and doesn't account for the protective effects on ovarian and colon cancer. *Decreased risk of 1 and 2 only* - COCs do **decrease the risk of ovarian cancer (1) and colon cancer (2)**. - However, this option is incomplete as it overlooks the significant protective effect on **endometrial cancer (3)**. *Increased risk of 2 and 3 only* - COCs actually **decrease the risk of both colon cancer (2) and endometrial cancer (3)**. - This statement directly contradicts the established protective effects of COCs on these cancer types.

Q: Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?

Levonorgestrel. ***Levonorgestrel*** - **Levonorgestrel** is a **second-generation progestogen** commonly used in combined oral contraceptive pills and emergency contraception. - While effective, it tends to have higher androgenic activity compared to third-generation progestogens. *Norgestimate* - **Norgestimate** is a **third-generation progestogen** known for its lower androgenic activity. - It is often favored in combined oral contraceptives to minimize androgenic side effects like acne and hirsutism. *Gestodene* - **Gestodene** is a **third-generation progestogen** that has minimal androgenic activity and high progestational potency. - It is frequently included in modern combined oral contraceptives to improve cycle control and reduce side effects. *Desogestrel* - **Desogestrel** is also a **third-generation progestogen** and is an active metabolite of etonogestrel. - It is characterized by its low androgenic effects and is used in various combined oral contraceptive formulations.

Q: Post coital contraception is achieved by all except

High degree of progesterone. ***High degree of progesterone*** - A *high degree of progesterone* is associated with **maintaining pregnancy**, not preventing it. - Progesterone supports the endometrium and maintains the corpus luteum, which are essential for pregnancy continuation. - While synthetic progestins (like levonorgestrel) are used in emergency contraception, they work through different mechanisms (ovulation inhibition, altered cervical mucus) at specific low doses, not as "high degree of progesterone" [2]. - High progesterone levels are NOT used for post-coital contraception. *By administration of RU 486* - **RU 486 (mifepristone)** is a progesterone receptor antagonist effective for post-coital contraception and medical abortion [1]. - It blocks progesterone action, causing decidual necrosis and preventing implantation or terminating early pregnancy [1]. - Commonly used as emergency contraception and for early medical abortion [1]. *Administration of prostaglandins* - **Prostaglandins** (like misoprostol) cause uterine contractions and cervical ripening [1]. - Used in combination with mifepristone for medical abortion [1]. - Can prevent implantation or induce abortion when administered post-coitally [1]. *High dose estrogens* - **High-dose estrogens** were historically used for post-coital contraception (Yuzpe regimen combined estrogen-progestin). - Work by inhibiting or delaying ovulation, interfering with corpus luteum function, and altering the endometrium to prevent implantation. - Effective when administered within 72 hours of unprotected intercourse.

Q: Mifepristone used for inducing abortion acts on :

Progesterone receptors. ***Progesterone receptors*** - **Mifepristone** is a **progesterone receptor antagonist**, meaning it blocks the action of progesterone [1]. - In pregnancy, **progesterone** is crucial for maintaining the uterine lining and preventing contractions, so blocking its action leads to **endometrial shedding** and uterine contractions [1].*Uterine contractility* - While mifepristone ultimately affects **uterine contractility**, this is an **indirect effect** of blocking progesterone [1]. - The direct action is on the **receptors themselves**, not the contractility mechanism.*Hypothalamopituitary ovarian axis* - Mifepristone does **not primarily act** on the **hypothalamic-pituitary-ovarian axis**. - Its main effect is directly on the **uterine tissue** by blocking progesterone's local action.*All of the options* - As mifepristone's primary and direct mechanism is through **progesterone receptor antagonism**, this option is incorrect [1]. - The effects on uterine contractility are secondary to its receptor blockade.

Q: The following drugs can cause osteoporosis, except

mifepristone. ***Mifepristone***- **Mifepristone** is the **least commonly associated** with osteoporosis among these options in typical clinical practice, making it the best answer to this "EXCEPT" question.- While mifepristone is an anti-progestin and anti-glucocorticoid used for conditions like Cushing's syndrome, its osteoporosis risk is **less direct and less well-established** compared to the other drugs listed.- In chronic use, mifepristone can paradoxically increase cortisol levels through negative feedback disruption, which theoretically could affect bone, but this is **not a primary clinical concern** in its typical therapeutic applications.*Corticosteroid*- **Corticosteroids** are the **most common cause** of drug-induced osteoporosis (glucocorticoid-induced osteoporosis - GIOP) [1, 2].- They increase bone resorption by stimulating osteoclast activity and decrease bone formation by inhibiting osteoblast function [2].- Even short-term use can lead to rapid bone loss, with fracture risk increasing within 3-6 months of therapy.*Danazol*- **Danazol** is a synthetic androgen that causes a **hypoestrogenic state** by suppressing ovarian function.- This reduction in estrogen levels leads to **accelerated bone loss and osteoporosis**, particularly in women [1, 2].- Prolonged use requires bone density monitoring.*GnRH analogue*- **GnRH analogues** suppress sex hormone production (estrogen and testosterone) by pituitary desensitization.- The resulting **hypogonadism** directly causes **rapid bone loss** and significantly increased osteoporosis risk [1, 2].- Bone loss can occur within 6 months of therapy, often requiring prophylactic bone-protective agents.

Q: The mechanism of action by which clomiphene citrate induces ovulation is

through its anti-estrogenic effect. ***Correct: Through its anti-estrogenic effect*** - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) that acts as an **estrogen antagonist** at the hypothalamus and pituitary gland - By blocking estrogen receptors, it prevents the hypothalamus from sensing circulating estrogen, thereby removing the **negative feedback** normally exerted by estrogen - This perceived low estrogen state triggers increased **GnRH secretion**, leading to elevated **FSH and LH release**, which stimulates follicular development and ovulation *Incorrect: Through the hypothalamic estrogenic effect* - Clomiphene citrate is an **anti-estrogen**, not an estrogen agonist at the hypothalamic level - An estrogenic effect would **enhance negative feedback**, inhibiting GnRH and gonadotropin release, thereby **suppressing** rather than inducing ovulation *Incorrect: Through negative feedback on gonadotrophins* - This is the opposite of clomiphene's mechanism - Clomiphene works by **blocking negative feedback**, not establishing it - By antagonizing estrogen receptors, it tricks the hypothalamus into perceiving low estrogen levels, leading to **increased** (not decreased) gonadotropin release *Incorrect: Through positive feedback on gonadotrophins* - While clomiphene ultimately results in increased gonadotropin release, it does so by **disrupting negative feedback**, not by directly creating positive feedback - True positive feedback occurs naturally during the late follicular phase when sustained high estrogen levels trigger the LH surge - Clomiphene's mechanism is distinct—it removes the brake (negative feedback) rather than adding an accelerator (positive feedback)

Question 1

Ulipristal acetate (progesterone receptor modulator) should not be prescribed as emergency contraceptive in women with

Accepted Answer

liver dysfunction

Answer

glaucoma

Answer

coagulopathy

Answer

kidney failure

Question 2

All of the following are correct regarding drospirenone EXCEPT:

Accepted Answer

It is safe in renal failure patients.

Answer

It has antimineralocorticoid action.

Answer

It is a fourth generation progestin.

Answer

It has antiandrogenic property.

Question 3

Which of the following drugs should be avoided in labouring women with bronchial asthma?

Accepted Answer

Prostaglandin F2α

Answer

Ergometrine

Answer

Prostaglandin E1

Answer

Opioid analgesics

Question 4

What is the content of ethinyl estradiol in very low dose oral contraceptives ?

Accepted Answer

20 µg

Answer

15 µg

Answer

25 µg

Answer

30 µg

Question 5

Consider the following list of cancers:

1. Ovarian cancer
2. Colon cancer
3. Endometrial cancer
4. Breast cancer

What is the effect of combined oral contraceptive pills on the above?

Accepted Answer

Protection against 1, 2 and 3

Answer

Increased risk of 3 and 4 only

Answer

Decreased risk of 1 and 2 only

Answer

Increased risk of 2 and 3 only

Question 6

Which one of the following is not a third generation progestogen used in combined oral contraceptive pills ?

Accepted Answer

Levonorgestrel

Answer

Norgestimate

Answer

Gestodene

Answer

Desogestrel

Question 7

Post coital contraception is achieved by all except

Accepted Answer

High degree of progesterone

Answer

By administration of RU 486

Answer

Administration of prostaglandins

Answer

High dose estrogens

Question 8

Mifepristone used for inducing abortion acts on :

Accepted Answer

Progesterone receptors

Answer

Uterine contractility

Answer

Hypothalamopituitary ovarian axis

Answer

All of the options

Question 9

The following drugs can cause osteoporosis, except

Accepted Answer

mifepristone

Answer

corticosteroid

Answer

danazol

Answer

GnRH analogue

Question 10

The mechanism of action by which clomiphene citrate induces ovulation is

Accepted Answer

through its anti-estrogenic effect

Answer

through the hypothalamic estrogenic effect

Answer

through negative feedback on gonadotrophins

Answer

through positive feedback on gonadotrophins

Endocrine Pharmacology — MCQs

Endocrine Pharmacology — MCQs

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