NSG-533 Advanced Pharmacology Questions
with Verified Correct Answers
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able to control
her diet although she continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day of the week. She
states compliance with all medications. She denies any history of hypoglycemia despite
being able to identify signs and symptoms and describe appropriate treatment
strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN 16 mg/dL,
SCr 0.89 mg/dL, glucose 128 mg/dL; A1C 7.8%
Based on EP's profile above, which of the agents would be able to obtain an A1C goal of
less than 7% and would be appropriate in the patient? Please provide an explanation of
appropriateness or lack thereof.
Exenatide - Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and
decrease A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to
the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia
, which could be made worse by this drug. The package insert does not indicate a specific
potassium concentration cut off to no longer use this medication; however, there are better
choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
clinical trials and currently the patient does not have any cautionary objective measures to not
use this medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be used in
patients taking sulfonylureas; however, it may be recommended to reduce or stop the
sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is associated
with significant GI side effects. More information would be needed regarding fasting and
post-prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best
and therefore would not achieve the desired A1C goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol
panel, and normal renal/hepatic function were noted with today's laboratory test
results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y
ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
with Verified Correct Answers
EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able to control
her diet although she continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day of the week. She
states compliance with all medications. She denies any history of hypoglycemia despite
being able to identify signs and symptoms and describe appropriate treatment
strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN 16 mg/dL,
SCr 0.89 mg/dL, glucose 128 mg/dL; A1C 7.8%
Based on EP's profile above, which of the agents would be able to obtain an A1C goal of
less than 7% and would be appropriate in the patient? Please provide an explanation of
appropriateness or lack thereof.
Exenatide - Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and
decrease A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicated for EP due to
the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia
, which could be made worse by this drug. The package insert does not indicate a specific
potassium concentration cut off to no longer use this medication; however, there are better
choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
clinical trials and currently the patient does not have any cautionary objective measures to not
use this medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be used in
patients taking sulfonylureas; however, it may be recommended to reduce or stop the
sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is associated
with significant GI side effects. More information would be needed regarding fasting and
post-prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at best
and therefore would not achieve the desired A1C goal of <7%
JR is a 68-year-old African American man with a new diagnosis of T2DM. He was
classified as having prediabetes (at risk for developing diabetes) 5 years before the
diagnosis and has a strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol
panel, and normal renal/hepatic function were noted with today's laboratory test
results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagnosed 2 y
ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 in
Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
