Brian K . Irons, Pharm.D., FCCP, BCACP, BC-ADM
Texas Tech University Health Sciences Center
School of Pharmacy
Lubbock, Texas
Learning Objectives
1. Differentiate between the diagnostic and classification
criteria for various endocrine and metabolic
disorders, including type 1 and type 2 diabetes
mellitus, diabetes insipidus, polycystic ovary syndrome,
obesity, and disorders of the thyroid, adrenal,
and pituitary glands.
2. Review the various therapeutic agents used in
treating endocrine and metabolic disorders.
3. Select appropriate treatment and monitoring
options for a given patient presenting with one of
the above endocrine or metabolic disorders.
4. Recommend appropriate therapeutic management
for secondary complications from diabetes or thyroid
disorders.
Self-Assessment Questions
Answers and explanations to these questions can be
found at the end of this chapter.
1. A 66-year-old Hispanic man with a history of myocardial
infarction, dyslipidemia, and hypertension
received a diagnosis of type 2 diabetes mellitus
(DM). After 1 month of exercise and dietary
changes and no diabetes medications, his hemoglobin
A1C and fasting glucose concentration today
are 11.5% and 362 mg/dL, respectively. He weighs
123.8 kg, with a body mass index (BMI) of 42 kg/
m2. Which set of drugs is best to initiate?
A. Metformin and glipizide.
B. Glipizide and insulin glulisine.
C. Pioglitazone and acarbose.
D. Insulin detemir and glulisine.
2. A 21-year-old patient is given a diagnosis of type
1 DM after the discovery of elevated glucose concentrations
(average 326 mg/dL) and is showing
signs and symptoms of hyperglycemia. Her weight
is 80 kg. Which is the most appropriate initial dosage
of rapid-acting insulin before breakfast for this
patient? Assume a total daily insulin (TDI) regimen
of 0.5 unit/kg/day.
A. 2 units.
B. 4 units.
C. 7 units.
D. 14 units.
3. A patient with type 2 DM has a blood pressure
reading of 152/84 mm Hg, a serum creatinine of
1.8 mg/dL, and two recent spot urine albumin/creatinine
concentrations of 420 and 395 mg/g. Which
class of drugs (barring any contraindications) is
best to initiate in this patient?
A. Thiazide diuretic.
B. Dihydropyridine calcium channel blocker.
C. Angiotensin receptor blocker (ARB).
D. Nondihydropyridine calcium channel blocker.
4. Regarding propylthiouracil (PTU) and methimazole
in the treatment of hyperthyroidism, which
statement is most appropriate?
A. PTU is clinically superior to methimazole in
efficacy.
B. PTU may be associated with greater liver toxicity
than methimazole.
C. Both agents are equally efficacious in the
treatment of Hashimoto’s disease.
D. Both medications should be administered
three times daily.
5. Which medication is the most appropriate choice
for a patient with a diagnosis of Cushing’s syndrome
who did not experience adequate symptom
relief after surgical resection for a pituitary
adenoma?
A. Ketoconazole.
B. Spironolactone.
C. Hydrocortisone.
D. Bromocriptine.
6. A physician is asking for a recommendation for
initial therapy for a patient with type 2 DM. The
physician states that metformin is no longer an
option for this patient. An A1C obtained today is
9.4% (personal goal 7%), and the patient’s estimated
glomerular filtration rate (eGFR) is 29 mL/
min. Which of the following agents would be the
best recommendation?
A. Canagliflozin.
B. Alogliptin.
C. Glargine.
D. Exenatide
1. Differentiate between the diagnostic and classification
criteria for various endocrine and metabolic
disorders, including type 1 and type 2 diabetes
mellitus, diabetes insipidus, polycystic ovary syndrome,
obesity, and disorders of the thyroid, adrenal,
and pituitary glands.
2. Review the various therapeutic agents used in
treating endocrine and metabolic disorders.
3. Select appropriate treatment and monitoring
options for a given patient presenting with one of
the above endocrine or metabolic disorders.
4. Recommend appropriate therapeutic management
for secondary complications from diabetes or thyroid
disorders.
Self-Assessment Questions
Answers and explanations to these questions can be
found at the end of this chapter.
1. A 66-year-old Hispanic man with a history of myocardial
infarction, dyslipidemia, and hypertension
received a diagnosis of type 2 diabetes mellitus
(DM). After 1 month of exercise and dietary
changes and no diabetes medications, his hemoglobin
A1C and fasting glucose concentration today
are 11.5% and 362 mg/dL, respectively. He weighs
123.8 kg, with a body mass index (BMI) of 42 kg/
m2. Which set of drugs is best to initiate?
A. Metformin and glipizide.
B. Glipizide and insulin glulisine.
C. Pioglitazone and acarbose.
D. Insulin detemir and glulisine.
2. A 21-year-old patient is given a diagnosis of type
1 DM after the discovery of elevated glucose concentrations
(average 326 mg/dL) and is showing
signs and symptoms of hyperglycemia. Her weight
is 80 kg. Which is the most appropriate initial dosage
of rapid-acting insulin before breakfast for this
patient? Assume a total daily insulin (TDI) regimen
of 0.5 unit/kg/day.
A. 2 units.
B. 4 units.
C. 7 units.
D. 14 units.
3. A patient with type 2 DM has a blood pressure
reading of 152/84 mm Hg, a serum creatinine of
1.8 mg/dL, and two recent spot urine albumin/creatinine
concentrations of 420 and 395 mg/g. Which
class of drugs (barring any contraindications) is
best to initiate in this patient?
A. Thiazide diuretic.
B. Dihydropyridine calcium channel blocker.
C. Angiotensin receptor blocker (ARB).
D. Nondihydropyridine calcium channel blocker.
4. Regarding propylthiouracil (PTU) and methimazole
in the treatment of hyperthyroidism, which
statement is most appropriate?
A. PTU is clinically superior to methimazole in
efficacy.
B. PTU may be associated with greater liver toxicity
than methimazole.
C. Both agents are equally efficacious in the
treatment of Hashimoto’s disease.
D. Both medications should be administered
three times daily.
5. Which medication is the most appropriate choice
for a patient with a diagnosis of Cushing’s syndrome
who did not experience adequate symptom
relief after surgical resection for a pituitary
adenoma?
A. Ketoconazole.
B. Spironolactone.
C. Hydrocortisone.
D. Bromocriptine.
6. A physician is asking for a recommendation for
initial therapy for a patient with type 2 DM. The
physician states that metformin is no longer an
option for this patient. An A1C obtained today is
9.4% (personal goal 7%), and the patient’s estimated
glomerular filtration rate (eGFR) is 29 mL/
min. Which of the following agents would be the
best recommendation?
A. Canagliflozin.
B. Alogliptin.
C. Glargine.
D. Exenatide
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