Nurs 615 Exam IV
How will you prescribe lipase, protease, and amylase components? - correct answers-
Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic
secretions each replacement drug has amylase, lipase and protease components,
however the drug is prescribed in units of lipase
What is the medication of choice for hypertensive crisis with pheochromocytoma? -
correct answers-Surgical resection of the tumor is the first treatment of choice either my
open laparotomy or laparoscopy either surgical option requires prior treatment of
nonspecific irreversible adrenergic adraonoreceptor blocker phenoxybenzamine or a
shorter acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly use
phenozibenamine in practice. Doing so promotes the surgery to proceed while
minimizing the likelihood of severe intraoperative hypertension which is likely when the
tumor is manipulated.
What is the onset of action, peak of action, and duration of action of each insulin
preparation? - correct answers-(Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
Peak 2-4 hrs
Duration 6-10 hrs
(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - correct
answers-Hypoglycemia- dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail polish remover or
fruity breath. Also abdominal pain, nausea, vomiting and sob.
When changing from NPH to glargine insulin, how will you adjust the patient's dose? -
correct answers-The initial dose of glargine is reduced by 20% to prevent hypoglycemia.
How does metformin work? - correct answers-Decreases hyperglycemia by decreasing
hepatic glucose production called hepatic gluconeogenesis. The average person with
, type 2 diabetes has three times the rate of gluconeogenesis, metformin treatment
reduces this by over 1/3rd. The molecular mechanism of metformin isn't completely
understood. In addition to suppressing hepatic glucose production, metformin increases
insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorilization
of glu4 enhancer factor, decreases insulin induced suppression of fatty acid oxidation,
and decreases absorption of glucose from the GI tract. Also of note** Metformin helps
reduce LDL cholesterol and triglyceride levels and is not associated with weight gain, in
some people it helps promote weight loss**
What diagnostic testing is required before and throughout therapy with metformin? -
correct answers-Metformin is not metabolized, it is cleared from the body by tubular
secretion and is secreted unchanged in the urine. Metformin is undetectable in blood
plasma within 24 hrs of a single oral dose the average elimination half-life in plasma is
6.2 hrs as it is secreted in the urine you should check a serum crt to assess renal
function.
What is the action of gliptin? - correct answers-The mechanism of DDP-4 inhibitors is to
increase incretin levels incretin are GLP1 and GIP which inhibit glucagon release in
which in turn increases insulin secretion, decreases gastric emptying, and decreases
blood glucose levels
How do GLP agonists work? - correct answers-They bind directly to a receptor in the
pancreatic beta cell. These agents work in the same pathway as the DPP-4 inhibitors as
mentioned above but are generally considered more potent.
When should exenatide be administered? - correct answers-60 minutes prior to the
morning and evening meal
How will you assess for granulocytopenia? - correct answers-Signs of a Cold or flu
including fever and sore throat
What are the adverse effects of propylthiouracil? - correct answers-Agranulocytosis,
thrombocytopenia, and fulminant liver failure as stated above, pt's on PTU when they
develop fever or sore throat, it would be important to check a CBC preferably with a
smear and a diff.
What are the adverse effects of levothyroxine? - correct answers-Tachycardia and
angina in the elderly
A patient develops a toxic goiter. What is the recommended treatment? - correct
answers-Methimazole for one month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? - correct answers-PTU- Fatal
agranulocytopenia look for fever and sore throat and TEMPORARY ALOPECIA
How will you prescribe lipase, protease, and amylase components? - correct answers-
Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic
secretions each replacement drug has amylase, lipase and protease components,
however the drug is prescribed in units of lipase
What is the medication of choice for hypertensive crisis with pheochromocytoma? -
correct answers-Surgical resection of the tumor is the first treatment of choice either my
open laparotomy or laparoscopy either surgical option requires prior treatment of
nonspecific irreversible adrenergic adraonoreceptor blocker phenoxybenzamine or a
shorter acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly use
phenozibenamine in practice. Doing so promotes the surgery to proceed while
minimizing the likelihood of severe intraoperative hypertension which is likely when the
tumor is manipulated.
What is the onset of action, peak of action, and duration of action of each insulin
preparation? - correct answers-(Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
Peak 2-4 hrs
Duration 6-10 hrs
(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - correct
answers-Hypoglycemia- dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail polish remover or
fruity breath. Also abdominal pain, nausea, vomiting and sob.
When changing from NPH to glargine insulin, how will you adjust the patient's dose? -
correct answers-The initial dose of glargine is reduced by 20% to prevent hypoglycemia.
How does metformin work? - correct answers-Decreases hyperglycemia by decreasing
hepatic glucose production called hepatic gluconeogenesis. The average person with
, type 2 diabetes has three times the rate of gluconeogenesis, metformin treatment
reduces this by over 1/3rd. The molecular mechanism of metformin isn't completely
understood. In addition to suppressing hepatic glucose production, metformin increases
insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorilization
of glu4 enhancer factor, decreases insulin induced suppression of fatty acid oxidation,
and decreases absorption of glucose from the GI tract. Also of note** Metformin helps
reduce LDL cholesterol and triglyceride levels and is not associated with weight gain, in
some people it helps promote weight loss**
What diagnostic testing is required before and throughout therapy with metformin? -
correct answers-Metformin is not metabolized, it is cleared from the body by tubular
secretion and is secreted unchanged in the urine. Metformin is undetectable in blood
plasma within 24 hrs of a single oral dose the average elimination half-life in plasma is
6.2 hrs as it is secreted in the urine you should check a serum crt to assess renal
function.
What is the action of gliptin? - correct answers-The mechanism of DDP-4 inhibitors is to
increase incretin levels incretin are GLP1 and GIP which inhibit glucagon release in
which in turn increases insulin secretion, decreases gastric emptying, and decreases
blood glucose levels
How do GLP agonists work? - correct answers-They bind directly to a receptor in the
pancreatic beta cell. These agents work in the same pathway as the DPP-4 inhibitors as
mentioned above but are generally considered more potent.
When should exenatide be administered? - correct answers-60 minutes prior to the
morning and evening meal
How will you assess for granulocytopenia? - correct answers-Signs of a Cold or flu
including fever and sore throat
What are the adverse effects of propylthiouracil? - correct answers-Agranulocytosis,
thrombocytopenia, and fulminant liver failure as stated above, pt's on PTU when they
develop fever or sore throat, it would be important to check a CBC preferably with a
smear and a diff.
What are the adverse effects of levothyroxine? - correct answers-Tachycardia and
angina in the elderly
A patient develops a toxic goiter. What is the recommended treatment? - correct
answers-Methimazole for one month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? - correct answers-PTU- Fatal
agranulocytopenia look for fever and sore throat and TEMPORARY ALOPECIA
