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NR 566 Week 4 Midterm Review Questions-Answers

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• Professor question:Why are statins recommended in the evening instead of morning? (pg 561)After starting John on insulin, he calls the office saying he feels bad. He said when he checked his blood sugar before calling it was 52 mg/dl. What instructions should he be given? • Professor question: What diabetic medications would be contraindicated in patients with heart failure? Which diabetic drug(s) may have beneficial effects in heart failure?(text has info on this but ADA 2020 guidelines has even more up to date info on this topic, so here is the page. See Recommendation 9.9 and 9.10) • Professor question:What lab do we need to check prior to starting metformin? (hint: which organ function needs to be evaluated?) • What other potential adverse effects are there associated with metformin? (Micromedex in the library is a good source for this info) • Professor question: The GLP1RA class drugs end with "-tide". They are highly recommended as a second agent after metformin by both ADA and AACE/ACE guidelines. Per ADA guidelines:…… continue…. According to the text, what effect does carbamazepine have on thyroid function tests? What is the difference b/w total and free T4? • Professor question: Can you review in our text the sulfonylurea class? What is the MOA, what are some examples? What are the adverse effects? Thanks!! • Professor question: If our patient had HF and Afib, he might be on digoxin. What medication for DM can decrease digoxin levels? (class and examples) • Professor question: Jason- glad you recognized that contrast dye can be an issue for patients on metformin. • Can you read this (older, I know) article that explains why it is a concern rather than binding with contrast dye? • Professor question: Can you review for us what the ADA criteria for diagnosis of T2DM are? • Professor question: If John’s A1C remains elevated and he does not have any indicators or at high-risk for ASCVD, CKD, or HF, a thiazolidinedione (TZD) could be prescribed (American Diabetes Association, 2020). How do thiazolidinediones help control blood sugar? Why is it important that there is little to no risk indicators for cardiovascular involvement when prescribing TZDs? • Professor question: One class of diabetic drugs sometimes used is meglitinides. What is an important teaching point about this drug for patients to make sure the drug is most effective? • Professor question: What side effects are most common for GLP-1 receptor agonists? What diseases would be contraindicated to have with the administration of GLP-1 receptor agonists? • Professor question: If John is started on insulin and he still struggles to meet A1C goals, a sodium–glucose cotransporter 2 (SGLT2) inhibitor to insulin therapy has shown the ability to improve A1C levels while also aiding in decreasing body weight when compared with insulin therapy alone (American Diabetic Association, 2020). How do SFLT2 drugs work and what are some examples of drugs in that class? Pg 589 Week 2 • Professor FACTS: The current IDSA guidelines (2019) recommend the following 3 options when treating CAP in a previously healthy patient:……. • Professor question: Can you tell us (from the text), what is the definition of drug-resistant TB? • Professor question: From our text can you tell us the findings of the SMART trial regaring salmeterol use? • Professor question: According to our text, what is the advantage of using transdermal nicotine over nicotine gum? • Professor question: Theophylline is not used very often anymore but we may see it used by a specialist when inhaled therapy is insufficient. The reason is that this is a drug with a narrow therapeutic window- it is associated with toxicities including seizures. It is a drug that requires monitoring of drug levels. • According to our text, are there any considerations regarding theophylline and type of diet? • Professor question: If a woman is pregnant and taking INH, what supplement do we need to advise? (see text) • Professor question: What type of medication is Spiriva? What is the generic name? Week 3 • Professor question: As we discuss medications for HTN this week let's consider a pregnant women and women of childbearing age who might become pregnant. What classes are contraindicated for pregnant woman? • Professor question: One of our reading topics this week is reduction of lipids. Can you tell us about fenofibric acid? What is it used for and how does it work? At what level of hypertriglyceridemia should it be considered to reduce the risk of pancreatitis? • Professor question: Thanks! To help with our topic of lipid management this week, what lab test should we order if a patient on a statin develops muscle pain? • Professor question: To help with our review of lipid therapies this week, will you tell us about ezetimibe (Zetia)?What is it MOA and is it a first line agent? • Professor question: If a patient has heart failure why would we need to be cautious about prescribing calcium channel blockers? Which CCB have the strongest neg inotropic effect? • Professor question: Can you review the discussion of angina which discusses imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs affect MOS? Which affect MOD? • professor question: What antihypertensive class is indicated in a patient with DM who has microalbuminuria?According to the text, what are conditions would this class be indicated for? • Professor question: What is the dosing schedule for long acting isosorbide mononitrate and why? • Professor question: According to our text, what lipid abnormality is most likely to benefit from omega 3 FA supplementation? • Professor question: To help with this week's study can you review from the text the causes of systolic heart failure? • Professor question: What is the dosing schedule for ACEIs? (how many times per day are they taken?) • Professor question: According to the text, what labs should be checked in a week after initiating an ACEI? Why? • Professor question: What anti-arrhythmic medication in the reading this week requires pulmonary and thyroid function monitoring every 6 months? • Professor question: Can you review the classes of angina from our text? • Professor question: From our text, can you review the statin strength from weakest to highest?

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NR 566 Week 4 MidTerm Review Questions


Please give all credit to these responses to my classmates in Professor Halls
class!!! Hope this helps in reviewing for our midterm!! Sorry for the late
submission! Good luck everyone


Week 1
Professor question: Why are statins recommended in the evening instead of
morning? (pg 561)
After starting John on insulin, he calls the office saying he feels bad. He said when he
checked his blood sugar before calling it was 52 mg/dl. What instructions should he be
given?


Answer from classmate: Statins are recommended to be taken in the evening.
Cholesterol synthesis is highest through the night and first thing in the morning. The
biosyntheses of cholesterol follows a normal circadian rhythm. Administration at night
allows for the medication to be at peak levels in the body during the time of high
cholesterol synthesis (Korani et al., 2019).
A blood glucose level <70mg/dL is considered to be hypoglycemia. John called the
office with a sugar of 52mg/dL. He would be given instructions that follow "the rule of
15". This means that when symptoms occur, he should consume 15 g of a fast-acting
carbohydrate. After 15 minutes, he should recheck his blood glucose. John should also
be educated on the best options of carbohydrates to consume. Examples would be 4
oz of juice, four-five hard candies, honey, or half a can of regular soft drink. Another
education point is that John needs to have a meal within a few hours after the low blood
glucose. He may also need to see his doctor for adjustments to be made on insulin
dosage as well as meal patterns to help prevent another low blood glucose episode
from occurring (Woo & Robinson, 2016).



Professor question: What diabetic medications would be contraindicated in patients
with heart failure?
Which diabetic drug(s) may have beneficial effects in heart failure?
(text has info on this but ADA 2020 guidelines has even more up to date info on this
topic, so here is the page. See Recommendation 9.9 and 9.10)

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