NSG533 / NSG 533 Exam 1 (Latest 2024 / 2025): Advanced Pharmacology | Complete Guide with Questions and Verified Answers | 100% Correct - Wilkes

Exam 1: NSG533 / NSG 533 (Latest 2024 / 2025 Update) Advanced Pharmacology Exam Review | Complete Guide with Questions and Verified Answers | 100% Correct - Wilkes Q: What are the goals set by ACE /ACCE and are they written in stone for all patients? Answer: Primary target for glycemic control is HbA1C Individualize HbA1C goal - based on...Duration of DM Age /life expectancy Comorbid conditions Known CVD or advanced comorbid conditionsHypoglycemic unawareness Individual patient considerations Q: Please note when transitioning from oral therapy for type II DM to insulin, metformin is retained! Secretagogues are discontinued possibly when basal insulin is initiated, but definitely when prandial (fast/rapid) insulin is to be added Answer: Options to add to basal insulin for prandial coverage... Fast-acting insulin DPP-4 inhibitors Incretin mimetics Glinides Alpha-glucosidase inhibitors Colesevelam Q: What are the various types of oral and non-insulin medications and what represents a rational combination of medications? Answer: Combinations should have different mechanism of action Combinations should avoid overlapping ADRs Combinations should ideally be selected based on need for better basal vs post-prandial control Selection should account for patient specific concerns (eg. weight, CVD risk, etc) Q: What antidiabetic medications have compelling indications: Answer: for those with underlying ASCVD or at high risk for CVD for those with CKD for those with a compelling need to avoid hypoglycemia for those where weight is an important consideration (ie which are associated with weight loss, gain or are weight neutral) Q: What are the various insulins and describe the pharmacokinetics (onset, peak, duration)and how are they used (eg basal, basal-bolus, split-mixed, sliding scale (..Ask if you don't understand)). Answer: Basal-bolus (long acting basal + rapid/fast acting bolus) provides the greatest flexibility and control of all regimens Sliding Scale Should NOT be used Difficult to do in home setting, requires education and understanding of patient and caregiver Allows patient to become hyperglycemic, better to schedule dosing and prevent rises in BG Requires frequent blood glucose monitoring, $$$ and compliance issues Q: Can be used as monotherapy or as add-on therapy for T2DM .. Presenting A1C of 9 + symptoms or failure to achieve goal A1C on adequate trial of 2-3 agents at maximally tolerated doses Answer: Often starting with a long acting insulin When glycemic goals aren't reached despite basal insulin (Good FBG and pre-prandial BG, but elevated HbA1C), Consider prandial therapy with fast-acting insulin. Begin fast-acting insulin before largest meal.Variation exists between ADA and ACCE in their recommendations If HbA1C still elevated, add fast-acting to another mealSulfonylurea can continue up until the point where prandial (rapid) insulin is addedMetformin can / should continue !! Q: What agents are used to treat hypothyroid disease? What makes the medications different and what do the guidelines recommend for use Answer: Recommendation 22.1: Patients with hypothyroidism should be treated with Levothyroxine monotherapy. Grade Aother forms of thyroid replacement may be associated with necessary cost, lack of therapeutic rationale, increase adverse effects and allergenicity (animal based products) Starting therapyNormal adult dose: 1.6 mcg/kg/day (~100-125 mcg/day) based on IBW (LBW)Titration by 25-50 mcg every 4-6 weeks until TSH normalizesEXCEPTIONS include elderly, chronically ill patients or history of cardiovascular disease . Initially 12.5-25 mcg/day, then titrate to maintenance dose until TSH normalizesExpect higher requirements during pregnancyThyroid hormone demandIncreases in TBGDestruction of T4 by placental deiodinases Q: How is treatment monitored and how should results be interpreted as far as therapy changes (the relationship between TSH and T3-4) Answer: Monitoring should be every 6-8 weeks after starting or dose/product change. If TSH is not in target range (0.5-2.5 mIU/L) alter dose in 10% to 20% increments. .. levothyroxine has a T 1/2 of 6-10 days (and NTI .. see below). How does this relate to the fact that after initiating or changing a does or changing a product (IE brand to generic, generic to brand or one generic brand to another), TSH should be checked in about 6 weeks? Q: Why are thyroid replacement drugs considered to have a narrow therapeutic index ( NTI )and what does that mean clinically? Answer: The therapeutic index (TI) is the range of doses at which a medication is effective without unacceptable adverse events. Drugs with a narrow TI (NTIs) have a narrow window between their effective doses and those at which they produce adverse toxic effects. Oral Bioavailability: (erratic) 40-80%brand vs generic Highly protein bound (99%)Half-lifeEuthyroid = 6-7 daysHypothyroid = 9-10 daysSteady State: @ 6 weeks or 4-5 t1/2 's ... this is the bases for monitoring @ six weeks from start or changes! Consider changes such as brand to generic, different generics manufactures, different pharmacies, etcAny such change will require repeat lab monitoring @ ~ 6 weeks to confirm the same clinical response Q: What are some drug-drug, drug-food interactions associated with thyroid replacement Answer: drug binding interactions, di-valent cations, amiodarone, certain antibiotics Q: RECOMMENDATION 13 Methimazole should be used in virtually every patient who chooses antithyroid drug therapy for GD, except during the first trimester of pregnancy when propylthiouracil is preferred, in the treatment of thyroid storm (inhibition of peripheral conversion), and in patients with minor reactions to methimazole who refuse radioactive iodine therapy or surgeryDelayed onset Answer: Q: Beta-blockers role in therapy? Answer: So .. beta blockers are used for Symptomatic relief of hyperthyroidism until more definative therapy is instituted and thyroid levels retun to normal or near normal.. Reduction of peripheral manifestations Tachycardia, sweating, severe tremor, nervousness Inhibition of peripheral conversion of thyroid hormones at higher doses (propranolol ONLY) Small therapeutic effect in magnitude thyrotoxicosis Q: Why does amiodarone pose a unique concern to thyroid disorders Answer: