NURS 565
NURS 565 Advanced Pharmacology
Comprehensive Final Exam Study
Guide uploaded Exam 2026
Glycemic Goals in DM2 - Blood glucose of 80-130 before meals, 180 or less 1-2 hrs.
post meals, A1C under 7. Long-term goals are to manage BG and preveny long term
complications.
Preventing Diabetic Nephropathy - ACE inhibitors, such as lisinopril. Or ARBs such as
losartan if patient cannot tolerate ACEs
ADAs Stepped Care Approach to DM Treatment –
1. Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient characteristics. For
example, add SGLT2 inhibitor for patients with cardiovascular or renal disease.
Biguanides - Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces glucose absorption
in gut. Sensitized fat and skeletal muscle receptors to insulin (increased uptake of
insulin). Safe in pregnancy. GI side effects so take with meals. Excreted by kidneys so
increased toxicity (lactic acidosis) if renal impairment. Low risk of hypoglycemia.
1st vs. 2nd Generation Sulfonylurea - All 1st generation have been discontinued. 2nd
generation (Glipizide) have shorter duration of action and increased potency.
Sulfonylureas - glipizide, glyburide, glimepiride. Promote insulin release by beta cells.
Block potassium channels of pancreatic islets to let calcium in, which stimulates insulin
release. Do not take with ETOH (disulfiram reaction includes flushing, palpitations,
nausea). Hypoglycemia and weight gain are also common side effects. Do not take if
pregnant or breastfeeding. Increased risk of toxicity if liver or kidneys are impaired.
Meglitinides MOA - Stimulate a rapid/ short-lived release of insulin from the pancreas.
Meglitinides (Glinides) - Repaglinide (Prandin)
Nateglinide (Starlix)
Meglitinides patient teaching - Tell patient to eat within 30 minutes.
Meglitinides (Glinides) precautions - Hypoglycemia increased in patients with liver
dysfunction 2/2 slower metabolism of the drug.
NURS 565
, NURS 565
Meglitinides vs. Sulfonylureas - -meglitinides are rapid acting and will have its effect on
a single meal-decreasing post prandial hyperglycemia. Taken with each meal.
-sulfonylureas continuously stimulate insulin release- having most of its effect on fasting
glucose levels.
Both stimulate pancreatic insulin release.
Thiazolidinediones (TZDs) - Pioglitazone (Actos)
Rosiglitazone (Avandia)
Thiazolidinediones (TZDs) MOA - Peroxisome proliferator-activated receptor gamma
agonists (PPAR𝜸 agonists) that increase peripheral insulin sensitivity. Promotes
increased glucose uptake by skeletal and adipose cells.
Thiazolidinediones (TZDs) adverse effects - Renal retention of fluid- so not for patients
with stage 3 or 4 heart failure. May also cause upper respiratory infections, headache,
and myalgia. Hepatotoxic. Monitor liver function.
Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin (Januvia), gliptins
Dipeptidyl Peptidase-4 Inhibitors MOA - DDP-4 is an enzyme that inactivate incretin
hormones. So, by inhibiting this enzyme, sitagliptin enhances the activity of incretins,
stimulate release of insulin from pancreatic B cells, decrease hepatic glucose
production
Dipeptidyl Peptidase-4 Inhibitors Adverse effects - -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors - Canagliflozin
Dapagliflozin
Empagliflozin
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors - - SGLT2 is expressed in the
proximal renal tubules which is responsible for the majority of the reabsorption of filtered
glucose from the tubular lumen. By inhibiting SGLT2, these agents reduce reabsorption
of filtered glucose, which increase urinary glucose excretion.
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors adverse effects - UTI, genitalia
fungal infections, increased urination, weight loss. Hypotension and dizziness when
used concurrently with diuretics.
Which diabetic medication(s) is beneficial for patients with heart failure? - SGLT-2
inhibitors 2/2 diuretic effect.
NURS 565
NURS 565 Advanced Pharmacology
Comprehensive Final Exam Study
Guide uploaded Exam 2026
Glycemic Goals in DM2 - Blood glucose of 80-130 before meals, 180 or less 1-2 hrs.
post meals, A1C under 7. Long-term goals are to manage BG and preveny long term
complications.
Preventing Diabetic Nephropathy - ACE inhibitors, such as lisinopril. Or ARBs such as
losartan if patient cannot tolerate ACEs
ADAs Stepped Care Approach to DM Treatment –
1. Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient characteristics. For
example, add SGLT2 inhibitor for patients with cardiovascular or renal disease.
Biguanides - Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces glucose absorption
in gut. Sensitized fat and skeletal muscle receptors to insulin (increased uptake of
insulin). Safe in pregnancy. GI side effects so take with meals. Excreted by kidneys so
increased toxicity (lactic acidosis) if renal impairment. Low risk of hypoglycemia.
1st vs. 2nd Generation Sulfonylurea - All 1st generation have been discontinued. 2nd
generation (Glipizide) have shorter duration of action and increased potency.
Sulfonylureas - glipizide, glyburide, glimepiride. Promote insulin release by beta cells.
Block potassium channels of pancreatic islets to let calcium in, which stimulates insulin
release. Do not take with ETOH (disulfiram reaction includes flushing, palpitations,
nausea). Hypoglycemia and weight gain are also common side effects. Do not take if
pregnant or breastfeeding. Increased risk of toxicity if liver or kidneys are impaired.
Meglitinides MOA - Stimulate a rapid/ short-lived release of insulin from the pancreas.
Meglitinides (Glinides) - Repaglinide (Prandin)
Nateglinide (Starlix)
Meglitinides patient teaching - Tell patient to eat within 30 minutes.
Meglitinides (Glinides) precautions - Hypoglycemia increased in patients with liver
dysfunction 2/2 slower metabolism of the drug.
NURS 565
, NURS 565
Meglitinides vs. Sulfonylureas - -meglitinides are rapid acting and will have its effect on
a single meal-decreasing post prandial hyperglycemia. Taken with each meal.
-sulfonylureas continuously stimulate insulin release- having most of its effect on fasting
glucose levels.
Both stimulate pancreatic insulin release.
Thiazolidinediones (TZDs) - Pioglitazone (Actos)
Rosiglitazone (Avandia)
Thiazolidinediones (TZDs) MOA - Peroxisome proliferator-activated receptor gamma
agonists (PPAR𝜸 agonists) that increase peripheral insulin sensitivity. Promotes
increased glucose uptake by skeletal and adipose cells.
Thiazolidinediones (TZDs) adverse effects - Renal retention of fluid- so not for patients
with stage 3 or 4 heart failure. May also cause upper respiratory infections, headache,
and myalgia. Hepatotoxic. Monitor liver function.
Dipeptidyl Peptidase-4 Inhibitors - Sitagliptin (Januvia), gliptins
Dipeptidyl Peptidase-4 Inhibitors MOA - DDP-4 is an enzyme that inactivate incretin
hormones. So, by inhibiting this enzyme, sitagliptin enhances the activity of incretins,
stimulate release of insulin from pancreatic B cells, decrease hepatic glucose
production
Dipeptidyl Peptidase-4 Inhibitors Adverse effects - -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors - Canagliflozin
Dapagliflozin
Empagliflozin
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors - - SGLT2 is expressed in the
proximal renal tubules which is responsible for the majority of the reabsorption of filtered
glucose from the tubular lumen. By inhibiting SGLT2, these agents reduce reabsorption
of filtered glucose, which increase urinary glucose excretion.
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors adverse effects - UTI, genitalia
fungal infections, increased urination, weight loss. Hypotension and dizziness when
used concurrently with diuretics.
Which diabetic medication(s) is beneficial for patients with heart failure? - SGLT-2
inhibitors 2/2 diuretic effect.
NURS 565
