Endocrine Pharmacology Practice Questions

Q: A woman with which of the following health problems should avoid centchroman?

Woman with dysfunctional uterine bleeding. ***Woman with dysfunctional uterine bleeding*** *(Marked as official answer, but medically questionable)* - **Important Note:** Centchroman (Ormeloxifene) is actually **approved for treating DUB** in India and is commonly used for this indication. - Its **anti-estrogenic effect on the endometrium** helps reduce abnormal bleeding by preventing excessive proliferation. - This PYQ answer may reflect specific exam context or outdated understanding, but current medical practice uses centchroman **as a treatment for DUB**, not as a contraindication. - Students should be aware this contradicts standard therapeutic use. *Polycystic ovarian syndrome* - Centchroman is **not contraindicated** in PCOS and is sometimes used for contraception in PCOS patients. - It doesn't worsen insulin resistance and may help manage endometrial effects of unopposed estrogen. - Its anti-estrogenic effects can be beneficial in preventing endometrial hyperplasia. *Endometriosis* - Centchroman is **not contraindicated** in endometriosis. - Its **anti-estrogenic action** could theoretically reduce estrogen-dependent growth of endometrial implants. - However, progestins and GnRH agonists are preferred first-line treatments. *Endometrial hyperplasia* - Centchroman has **anti-estrogenic effects on the endometrium**, making it potentially **beneficial** rather than contraindicated. - It inhibits estrogenic stimulation and promotes endometrial shedding. - May actually be used to prevent or treat endometrial hyperplasia. **Clinical Note:** None of the listed options represent absolute contraindications to centchroman. True contraindications include pregnancy, breastfeeding, hormone-dependent cancers, and severe hepatic/renal disease.

Q: An overweight, hirsute woman of 30 years, with one live child presented to the family planning clinic for advice for contraception. The best suited oral contraceptive will contain the following:

Cyproterone acetate. ***Cyproterone acetate*** - Cyproterone acetate is a **progestin with anti-androgenic properties**, making it ideal for women with hirsutism and features of hyperandrogenism, like the patient described. - It effectively reduces **androgen-related symptoms** such as hirsutism and acne, while also providing contraception. *Norgestrel* - Norgestrel is a **second-generation progestin** with some androgenic activity, which would be counterproductive for a patient with hirsutism. - It might worsen androgen-related symptoms rather than improving them. *Norethisterone* - Norethisterone (or norethindrone) is a **first-generation progestin** that also has some androgenic effects. - It is not preferred for women with hirsutism as it could exacerbate symptoms. *Medroxyprogesterone acetate* - Medroxyprogesterone acetate (MPA) is a **progestin** used in injectable contraceptives (DMPA) and oral forms, but does not possess significant anti-androgenic properties. - While it provides effective contraception, it would not address the patient's hirsutism directly.

Q: The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:

30–35 mcg. ***30–35 mcg*** - **Third-generation combined oral contraceptive pills (COCs)** typically contain **30-35 mcg of Ethinyl Estradiol**. - Third generation is defined by the type of **progestin used** (desogestrel, gestodene, or norgestimate), not the estrogen dose. - This dosage provides effective contraception while minimizing estrogen-related side effects compared to first-generation pills. - Common formulations include **30 mcg or 35 mcg** of ethinyl estradiol. *20–30 mcg* - While some third-generation formulations may contain doses at the lower end (20 mcg), this range overlaps with **ultra-low dose formulations**. - The typical and most common dosage for third-generation COCs is **30-35 mcg**, not this lower range. *10–20 mcg* - This represents **ultra-low dose COCs**, which aim to further reduce estrogen exposure. - These formulations may be associated with **breakthrough bleeding** and reduced cycle control. - Not the standard dose for third-generation COCs. *35–50 mcg* - These higher doses are characteristic of **first-generation COCs** from the 1960s-1970s. - Associated with higher rates of **thromboembolic events** and estrogen-related side effects. - Modern COCs use lower doses for improved safety profiles.

Q: Consider the following in respect of Ormeloxifene : 1. It is a research product of Central Drug Research Institute, Lucknow 2. It is a steroidal compound 3. It is a potent antiestrogen with weak estrogenic properties 4. It does not inhibit ovulation Which of the above are correct ?

1, 3 and 4. ***1, 3 and 4*** - Ormeloxifene, also known as **Centchroman**, was developed by the **Central Drug Research Institute (CDRI), Lucknow**, making statement 1 **correct**. - It is a **selective estrogen receptor modulator (SERM)** that acts as a **potent antiestrogen** in the uterus and breast, with **weak estrogenic activity** in other tissues like bone, thus statement 3 is **correct**. - Ormeloxifene has a **unique mechanism** among contraceptives: it **does not inhibit ovulation**. Instead, it works by **preventing implantation** through endometrial changes and altering cervical mucus, making statement 4 **correct**. - Statement 2 is **incorrect** because Ormeloxifene is a **non-steroidal compound**, not a steroidal one. *1, 2 and 3* - This option is incorrect because statement 2, claiming Ormeloxifene is a **steroidal compound**, is false. Ormeloxifene is a **non-steroidal SERM**. - While statements 1 and 3 are correct, the inclusion of incorrect statement 2 makes this option wrong. *1 and 3 only* - While statements 1 and 3 are indeed correct, this option is **incomplete** as it excludes statement 4. - Statement 4 is also correct—Ormeloxifene **does not inhibit ovulation**, which is a key distinguishing feature of this contraceptive. *2, 3 and 4* - This option is incorrect because statement 2 is false—Ormeloxifene is **non-steroidal**, not steroidal. - Although statements 3 and 4 are correct, the inclusion of the false statement 2 makes this entire option incorrect.

Q: A female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?

Canagliflozin. ***Canagliflozin*** - Canagliflozin is a **sodium-glucose co-transporter 2 (SGLT2) inhibitor**. These drugs work by increasing **urinary glucose excretion**. - The increased glucose in the urine (glycosuria) creates a favorable environment for fungal and bacterial growth, leading to common side effects such as **vulvovaginal candidiasis** (yeast infections) and urinary tract infections, which manifest as pruritus. *Metformin* - Metformin is a **biguanide** that primarily reduces hepatic glucose production and increases insulin sensitivity. - Its common side effects are gastrointestinal, such as **diarrhea, nausea, and abdominal discomfort**, but it does not typically cause genitourinary infections or pruritus. *Linagliptin* - Linagliptin is a **dipeptidyl peptidase-4 (DPP-4) inhibitor** that increases endogenous GLP-1 and GIP levels, enhancing glucose-dependent insulin secretion. - Common side effects include **nasopharyngitis** and **headache**, but it is not associated with vulvovaginal pruritus. *Liraglutide* - Liraglutide is a **glucagon-like peptide-1 (GLP-1) receptor agonist** that increases glucose-dependent insulin secretion, suppresses glucagon secretion, and slows gastric emptying. - Its most common side effects are **gastrointestinal (nausea, vomiting), decreased appetite, and pancreatitis (rare)**, but it generally does not cause vulvovaginal pruritus.

Q: Which of the following is not used to treat PCOD?

Tamoxifen. ***Tamoxifen*** - **Tamoxifen** is a selective estrogen receptor modulator (SERM) primarily used in the treatment of **estrogen receptor-positive breast cancer**. - While other SERMs like clomiphene citrate are used in PCOD for ovulation induction, tamoxifen is not a standard treatment for **PCOD** itself. *OCP* - **Oral contraceptive pills (OCPs)** are a common first-line treatment for managing various symptoms of PCOD, such as **menstrual irregularities** and **hirsutism**. - They work by suppressing ovarian androgen production and providing regular withdrawal bleeds. *Metformin* - **Metformin** is an insulin-sensitizing agent often used in PCOD, especially in women with **insulin resistance** or impaired glucose tolerance. - It helps improve **menstrual regularity** and can facilitate ovulation in some patients by reducing insulin levels. *Clomiphene citrate* - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) commonly used as an **ovulation induction agent** in women with PCOD who are trying to conceive. - It works by blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins** (FSH and LH).

Q: A 63-year-old man comes to the physician because of a 4-month history of urinary hesitancy and poor urinary stream. Digital rectal examination shows a symmetrically enlarged, nontender prostate. Serum studies show a prostate-specific antigen concentration of 2 ng/mL (N < 4). Pharmacotherapy with finasteride is initiated. Which of the following is the most likely effect of this drug?

Increased prostatic apoptosis. Increased prostatic apoptosis - **Finasteride** is a 5α-reductase inhibitor that blocks the conversion of **testosterone to dihydrotestosterone (DHT)**, which is the primary androgen promoting normal and hyperplastic prostatic growth [1]. - By reducing DHT levels, finasteride causes **prostatic gland atrophy** and **apoptosis**, leading to a decrease in prostate size and an improvement in urinary symptoms related to benign prostatic hyperplasia (BPH). Decreased production of urine - Finasteride directly affects prostatic growth and does not influence the **kidney's ability to produce urine** or directly alter overall urine volume. - Decreased urine production would relate to issues such as **renal dysfunction or dehydration**, not BPH treatment. Decreased internal urethral sphincter tone - This effect is typically achieved by **alpha-1 adrenergic blockers** (e.g., tamsulosin), which relax the smooth muscle in the prostate and bladder neck, improving urine flow [2]. - Finasteride's mechanism of action is **hormonal**, focusing on prostate size reduction rather than sphincter tone. Increased penile blood flow - Medications that increase penile blood flow, such as **PDE5 inhibitors** (e.g., sildenafil), are used to treat erectile dysfunction. - Finasteride has no direct effect on **penile blood flow**; in fact, it can sometimes cause or worsen erectile dysfunction as a side effect.

Q: The drug of choice for hyperthyroidism in third trimester of pregnancy is:

Carbimazole. ***Carbimazole*** - **Carbimazole** (metabolized to methimazole) is the **drug of choice in the third trimester** of pregnancy for managing hyperthyroidism. - The teratogenic risk of methimazole/carbimazole is confined to the **first trimester** (embryopathy includes aplasia cutis, choanal atresia, esophageal atresia). By the third trimester, organogenesis is complete and this risk has passed. - **Propylthiouracil (PTU)** is associated with severe **hepatotoxicity**, which is why current guidelines recommend switching from PTU to methimazole/carbimazole after the first trimester. - Both drugs cross the placenta, but in the third trimester, the safety profile favors carbimazole over PTU. *Propylthiouracil* - **PTU** is preferred only in the **first trimester** to avoid methimazole-associated congenital anomalies during the critical period of organogenesis. - After the first trimester, patients should be switched to methimazole/carbimazole due to PTU's risk of severe **hepatotoxicity** (including fulminant hepatic failure requiring transplantation). - PTU is not the drug of choice for the third trimester despite having lower placental transfer. *Sodium iodide* - **Sodium iodide** is used acutely in **thyroid storm** or as preoperative preparation for thyroidectomy, not for chronic management of hyperthyroidism. - Prolonged use can cause the **Wolff-Chaikoff effect** (temporary inhibition of thyroid hormone synthesis) followed by escape phenomenon and worsening hyperthyroidism. - Can cause fetal goiter and hypothyroidism with chronic use, making it unsuitable for long-term pregnancy management. *Radioactive iodine* - **Radioactive iodine** is **absolutely contraindicated** in pregnancy at any stage. - It crosses the placenta after 10-12 weeks of gestation and destroys the fetal thyroid gland, causing permanent **fetal hypothyroidism** and **cretinism**. - Must be avoided in pregnancy; pregnancy should be excluded before radioactive iodine therapy.

Q: Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

To make it long acting. ***To make it long acting*** - **Zinc** is added to insulin formulations, particularly **neutral protamine Hagedorn (NPH) insulin**, to create larger crystal complexes [1]. - These larger complexes **slow down the absorption** of insulin from the subcutaneous injection site, thereby prolonging its duration of action [2]. *To make it short acting* - **Short-acting insulins** like regular insulin are not formulated with zinc, as their purpose is rapid onset and a shorter duration. - Adding zinc would counteract the desired rapid-acting pharmacokinetic profile. *To make it fast acting* - **Fast-acting insulins** (insulin analogs) have specific amino acid modifications that alter their self-association properties to ensure rapid absorption, not the addition of zinc [2]. - Zinc actually works against the goal of fast action by promoting aggregation. *Addition of zinc makes the insulin effective orally* - Insulin is a **peptide hormone** and is generally destroyed by digestive enzymes in the gastrointestinal tract, making oral administration ineffective regardless of zinc presence [3]. - Efforts to create oral insulin involve complex delivery systems, not simple zinc addition.

Q: Mechanism of action of exenatide in diabetes mellitus is

It is analogue of GLP released from gut and increases glucose dependent insulin secretion. ***It is analogue of GLP released from gut and increase glucose dependant insulin secretion*** - **Exenatide** is a **glucagon-like peptide-1 (GLP-1) receptor agonist**, mimicking the action of naturally occurring GLP-1 [1]. - It stimulates **glucose-dependent insulin secretion**, suppresses glucagon release, slows gastric emptying, and promotes satiety, all contributing to improved glycemic control [2]. *It inhibits SGLT-2 and cause glucosuria* - This describes the mechanism of **sodium-glucose co-transporter 2 (SGLT-2) inhibitors**, such as empagliflozin or canagliflozin, which promote glucose excretion in urine. - **Exenatide** does not directly affect renal glucose reabsorption. *It is DPP-4 inhibitor and result in decreased breakdown of GLP* - This mechanism belongs to **dipeptidyl peptidase-4 (DPP-4) inhibitors** (e.g., sitagliptin, saxagliptin), which prevent the rapid degradation of endogenous GLP-1, thus prolonging its action [1]. - **Exenatide** directly activates GLP-1 receptors rather than modulating the enzyme that breaks down endogenous GLP-1 [1]. *It is amylin analogue and decrease glucagon* - This describes **pramlintide**, an amylin analogue used in diabetes management, which primarily suppresses postprandial glucagon secretion, slows gastric emptying, and promotes satiety. - While **exenatide** also decreases glucagon, its primary mechanism is via GLP-1 receptor agonism [2].

Question 1

A woman with which of the following health problems should avoid centchroman?

Accepted Answer

Woman with dysfunctional uterine bleeding

Answer

Polycystic ovarian syndrome

Answer

Endometriosis

Answer

Endometrial hyperplasia

Question 2

An overweight, hirsute woman of 30 years, with one live child presented to the family planning clinic for advice for contraception. The best suited oral contraceptive will contain the following:

Accepted Answer

Cyproterone acetate

Answer

Norgestrel

Answer

Medroxyprogesterone acetate

Answer

Norethisterone

Question 3

The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:

Accepted Answer

30–35 mcg

Answer

35–50 mcg

Answer

10–20 mcg

Answer

20–30 mcg

Question 4

Consider the following in respect of Ormeloxifene :

1. It is a research product of Central Drug Research Institute, Lucknow
2. It is a steroidal compound
3. It is a potent antiestrogen with weak estrogenic properties
4. It does not inhibit ovulation Which of the above are correct ?

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1 and 3 only

Question 5

A female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?

Accepted Answer

Canagliflozin

Answer

Metformin

Answer

Linagliptin

Answer

Liraglutide

Question 6

Which of the following is not used to treat PCOD?

Accepted Answer

Tamoxifen

Answer

OCP

Answer

Metformin

Answer

Clomiphene citrate

Question 7

A 63-year-old man comes to the physician because of a 4-month history of urinary hesitancy and poor urinary stream. Digital rectal examination shows a symmetrically enlarged, nontender prostate. Serum studies show a prostate-specific antigen concentration of 2 ng/mL (N < 4). Pharmacotherapy with finasteride is initiated. Which of the following is the most likely effect of this drug?

Accepted Answer

Increased prostatic apoptosis

Answer

Decreased production of urine

Answer

Decreased internal urethral sphincter tone

Answer

Increased penile blood flow

Question 8

The drug of choice for hyperthyroidism in third trimester of pregnancy is:

Accepted Answer

Carbimazole

Answer

Sodium iodide

Answer

Radioactive iodine

Answer

Propylthiouracil

Question 9

Purpose of adding zinc to insulin in commercial preparations for treatment of diabetes mellitus is:-

Accepted Answer

To make it long acting

Answer

To make it short acting

Answer

To make it fast acting

Answer

Addition of zinc makes the insulin effective orally

Question 10

Mechanism of action of exenatide in diabetes mellitus is

Accepted Answer

It is analogue of GLP released from gut and increases glucose dependent insulin secretion

Answer

It is DPP-4 inhibitor and results in decreased breakdown of GLP

Answer

It is amylin analogue and decreases glucagon

Answer

It inhibits SGLT-2 and causes glucosuria

Endocrine Pharmacology — MCQs

Endocrine Pharmacology — MCQs

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