South University, Savannah NSG 6005 FINAL STUDY GUIDE ALL EXAM INFO: INCLUDES Final exam pharm QUESTION & ANSWERS
NSG 6005 FINAL STUDY GUIDE ALL EXAM INFO: INCLUDES Final exam pharm QUESTION & ANSWERS Guanfacine- used to treat HTN or ADHD, non stimulant. Alpha 2 adrenergic agonist. Antiarrhythmics start on p. 322 Class I: sodium channel blockers Class Ia: lengthens action potential (quinidine, procainamide [requires freq. dosing], disopyramide) Class Ib: shortens action potential (lidocaine, phenytoin) treats ventricular arrhythmias Class Ic: minimal or no effect on action potential; severe ventricular tachycardias- where no other drugs have worked Class II: beta blockers (propranolol, metoprolol, atenolol)- indirectly reduces slope by blocking chronotropic impact of norepinephrine Atenolol has longer half-life than metoprolol Class III: agents that lengthen action potential (potassium channel blockers) – (amiodarone, bretyllium) effective in treating re-entry problems, inhibits v-fib due to myocardial ischemia, improves contractility Class IV: Calcium channel blockers (verapamil, diltiazem, bepridil) & (amlodipine, felodipine) 2 types of CCB: type I- non-hydropyridines-affect conduction through AV node, have neg chronotropic effect (verapamil, diltiazem) type II: hydorphyridines-do not affect conduction through AV node (nifedipine, amlodipine, felodipine) Class IA & IC -what is similar? Lidocaine- Amiodaraone effective against supraventricular rhythms BPH & HTN med Doxazosin- used to treat BPH & HTN Mexiletine- only available orally Valerian has no adverse reactions when used at the recommended level; however, overdosage at 2.5 g or more can cause cardiac disturbance, excitability, headache, insomnia, and nausea. It can potentiate alcohol and other CNS depressants if taken in large amounts. (p. 139) Ayurvedic medicine- Although all three doshas exist together, often plants and people are classified by the one that is most dominant in them, referred to as the person’s “Prakruti,” and specific to them as an individual. (p. 132) Glaucoma meds: Longer eyelashes-lanasoprost or bimatoprost – prostaglandin drugs Glaucoma med cause blurriness after instilled into eyes for few minutes Procainamide-short acting; need dose reduction in CHF and renal impairment (p. 325) VLDL- synthesized in the liver (p. 1130) Drugs that inhibit VLDL synthesis in the liver (niacin, fibric acid derivatives) also reduce LDLs via the endogenous pathway (p.1130). Cholesterol meds: -acted on sterols? Inhibitor Hmgcoa- statins Bile from liver-bile sequestrins Cost benefit analysis Cardiotonic Digoxin with renal failure- contradicted in renal impairment; Digoxin can also be problematic when treating older adults and patients with renal insufficiency. Renal function may decrease during heart failure treatment and the drug may not be adequately excreted, allowing it to increase to toxic levels. Digoxin levels should be closely monitored in these patients. (p. 1072) Because digoxin is excreted essentially unchanged by the kidneys, severe renal impairment effectively contraindicates its use. (p. 318) Treatment with hepatitis C- antiviral meds, NS5A inhibitors Tacrine- Timolol- The nurse concludes that a client newly diagnosed with glaucoma knows the purpose for the prescribed timolol (Timoptic) blocker when the clients makes which statement: Cromolyn-allergic David presents to clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eyedrops. The education regarding using cromolyn eyedrops includes which one of the following tips PNA & hypothyroidism- what med don’t give?? -epi inhaler Which class antiarrhythmic meds treat SVT or VT? HSV med- answer to do with applying to oral lesion at the first sign of outbreak Protozoal infection- which type of med antifungal, antimalarial or antiviral plus one other I can’t remember Erectile dysfunction- sildenafil or something It must be noted that phosphodiesterase-5 inhibitors (sildenafil, Viagra; vardenafil, Levitra; tadalafil, Cialis) used to treat erectile dysfunction, when taken in combination with nitrates used for chest pain, can cause severe vasodilation resulting in hypotension and syncope. (p. 892) Patients with Wolff–Parkinson–White (WPW) syndrome can have ventricular responses that are dangerously rapid. Drugs commonly used to control ventricular response such as diltiazem, verapamil, and digoxin are ineffective in this situation and can facilitate conduction through the accessory pathway, increasing the risk for ventricular fibrillation (p. 315) Final exam pharm 1. Lauren is a 13 year old child who comes to the clinic with a 4 day history of cough, low grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish yellow. The appropriate antibiotic to prescribe would be 2. Pong-tai is a 12month old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to 3. There is often a cross sensitivity and cross resistance between pcn and cephalosporins because 4. Sara is a 25 year old female who is 8 weeks pregnant and has a uti. What would be the appropriate antibiotic to prescribe - 5. Jonathon has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had pcn he developed a red blotchy rash. An appropriate antibiotic to prescribe would be 6. Treatment for herpes simplex 1 7. A girl is prescribed fluconazole after being treated with an antibiotic for uti. What is the purpose of the fluconazole 8. What do glaucoma eye drop timilol, lantoprost have in common - - 9. What antibiotic is used to treat MRSA - 10. What medication to avoid for someone with open angle glaucoma and kidney stones 11. What medications to avoid with closed angle glaucoma - 12. Otitis media 13. ADR of isoniazid 14. What analysis would a managed care organization use to improve health outcomes 15. What analysis would be used if a managed care organization wanted to compare two drugs with different benefits 16. You are prescribing drugs using step therapies to cut costs what drug would you prescribe 17. Which analysis is expressed in terms of life years 18. What do 1A's treat? 19. Mexiletine 20. 1b (lidocaine, mexiletine, phenytoin) 21. 1c (propadenone) 22. Class 2 (BB’S) - Tx: 23. Class 3 (amio, sotalol) 24. Class 4 (verapamil, diltiazem) 25. I. Sodium channel blockers- 1A, 1B, 1C II. β-adrenergic antagonists 26. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy 30. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. Handing out drug samples to poor patients 4. Prescribing all generic medications to cut costs 31. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health-care reform 4. The ability to shift accountability for Medicaid to the state level 32. . According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: 1. The belief among African Americans that prayer is more powerful than drugs 2. Poor compliance on the part of the African American patient 3. The genetic predisposition for illness found among African Americans 4. Discrimination, cultural barriers, and lack of access to health care 33. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: 1. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs 2. Largely unknown due to lack of studies of this population 3. Rapid metabolism of alcohol, leading to increased tolerance 4. Decreased elimination of opioids, leading to increased risk for addiction 34. Hispanic native healers (curanderas): 1. Are not heavily utilized by Hispanics who immigrate to the United States 2. Use herbs and teas in their treatment of illness 3. Provide unsafe advice to Hispanics and should not be trusted 4. Need to be licensed in their home country in order to practice in the United States 35. Pharmacoeconomics is: 1. The study of the part of the U.S. economy devoted to drug use 2. The study of the impact of prescription drug costs on the overall economy 3. The analysis of the costs and consequences of any health-care-related treatment or service 4. The analysis of the clinical efficacy of the drug 36. Indirect costs associated with drug therapy include: 1. The cost of diagnostic tests to monitor therapeutic levels 2. Health-care provider time to prescribe and educate the patient 3. Child-care expenses incurred while receiving therapy 4. Loss of wages while undergoing drug therapy 37. The intangible costs of drug therapy include: 1. Loss of wages while undergoing therapy 2. Inconvenience, pain, and suffering incurred with therapy 3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels 4. Cost of prescription drug coverage, such as Medicare Part D 38. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 39. When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 40. Mary has a two-tiered prescription benefit plan, which means: 1. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not. 2. She is eligible for the new Medicare Part D “donut hole” reduction of costs program. 3. She pays a higher copay for brand-name drugs than for generic drugs. 4. She must always choose to be treated with generic drugs first. 41. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: 1. Order cognitive testing to determine the source of his confusion. 2. Sit down with him and explain the whole Medicare Part D process. 3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him. 4. Request his son come to the next appointment so you can explain the benefit to him. 42. . Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they: 1. Ask for extra refills of medication to get them through the months of no coverage 2. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin 3. Fill their critical medications, but hold off on filling less-critical medications 4. Demonstrate no change in their prescription filling pattern Infectious Disease Gonococcal conjunctivitis: IM ceftriaxone Chlamydial conjunctivitis in newborn: systemic erythromycin for 2-3 weeks CAP in health adult? Amoxicillin CAP in high risk pt? Augmentin CAP in pt with co morbidity? fluoroquinolones (Levaquin) Otitis Media? Amoxicillin Bacterial vaginosis in not pregnant: metronidazole Trichomonas: metronidazole UTI’s 1. Karina is a 28-year-old pregnant woman at 38 weeks' gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: 2. Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? 3. Carmin is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: 4. Janis is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: 5. Laurel is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: 6. When sam used clotrimazole he developed a red itchy rash, he know has athletes foot again, what medication should he use - Terbinafine Sinusitis not high risk? Amoxicillin Eczema- topical corticosteroids Contact dermatitis Fungal infections- Topical immunomodulators 1. topical immunomodulators such as pimecrolimus Elidel or tacrolimus Protopic are used for 1. Josie has severe cystic acne and is requesting tx with Accutane. the appropriate tx for her would be Migraines/ headaches - Simple: naproxen (alieve) - James has been dx with cluster HA. Appropriate acute therapy includes o 100% of oxygen 15-30minutes - Alternate study guide * The clinical characteristics of medication-overuse headaches When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. The clinical characteristics of medication-overuse headaches include ________. - * Pain Management Contract A. Patients with a history of chemical dependency or possible inappropriate use of pain medications * One of the main drug classes used to treat acute pain is NSAIDs. They are used because * goal of treatment of acute pain Which of the following is the goal of treatment of acute pain? * early sign of aspirin toxicity * FDA Black Box Warning of NSAIDS All nonsteroidal anti-inflammatory drugs (NSAIDs) have an FDA Black Box Warning regarding potential for causing life-threatening GI bleeds new: cardiovascular * education and monitoring for chronic long-term corticosteroid therapy * bisphosphonates in osteoporosis -inhibit osteoclastic activity The drug recommended as primary prevention of osteoporosis in women over seventy years old is: * Selective estrogen receptor modifiers (SERMs) Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively: * Education for a woman considering hormone replacement * Premarin dosage changes interval Dosage changes of conjugated equine estrogen (Premarin) are made at ____ intervals. C. six to eight week * goals of therapy when prescribing hormone replacement therapy (HRT) * ongoing monitoring for sildenafil Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: Patients should also be screened for the use of nitrates * monitoring for medroxyprogesterone injection * Education for oral contraceptives. * transdermal testosterone gel - do not come in contact with pregnant woman * education for patient who has hypothyroidism on thyroid replacement hormones * treatment of hyperthyroidism with propylthiouracil A woman who is pregnant and has hyperthyroidism is best managed by a specialty team that will most likely treat her with: * Prophylactic use of bisphosphonates is recommended for patients with early osteopenia The drugs recommended for older adults with Type 2 diabetes include: * rules in total daily insulin dose When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? * Treatment with insulin for Type 1 diabetics Establishing glycemic targets is the first step in treatment of both types of diabetes. For Type 1 diabetes: * most reliable indicator of poor nutritional status in older adults Unlike most Type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: * advantages of Dipeptidyl peptidase-4 inhibitors (gliptins) Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: * reason why Sulfonylureas have been moved to Step 2 therapy Sulfonylureas may be added to a treatment regimen for Type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they * insulin preparations has the shortest onset and duration of action 1. Insulin preps are divided into categories based on onset, duration, and intensity of action following sq injection. which of the following insulin preparations has the shortest onset and duration of action * Signs and symptoms of hypoglycemia 1. Jim presents with a fungal infxn of 2 of his toenails-onychomycosis. tx for fungal infxn of the nail includes * Long-term treatment of moderate atopic dermatitis includes 1. long term tx of moderate atopic dermatitis includes * Mild acne may be initially treated with 1. mild acne may be treated initially with * Patients with tinea pedis may be treated with Topical Azoles, miconazole, clotrimazole * Topical immunomodulators are used for 1. topical immunomodulators such as pimecrolimus Elidel or tacrolimus Protopic are used for * the ideal medication topical corticosteroid cream to treat diaper dermatitis 1. when choosing a topical corticosteroid cream to tx diaper dermatitis, the ideal medication would be * Instructions regarding home removal of hard cerumen includes . Janie presents to clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen includes:- * Oral beta blockers should be avoided in patients who use ophthalmic beta blockers due to: * * Anticholinergic agents * Monitoring for phenytoin * Prescribing precautions for an anorexiant * Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes: * Ciprofloxacin otic drops- Warm bottle in hands before instilling * Oral beta blockers should be avoided in patients who use ophthalmic beta blockers due to: * Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:- * gonococcal conjunctivitis treatment * instruction regarding the use of topical diphenhydramine * Instructions for using topical corticosteroids in children * Impetigo treatment 2. Erik present with one golden-crusted lesion at the site of an insect bite consistent with impetigo. his parents have limited finances and request the least expensive tx. which med would be the best choice for him 3. metformin is a primary choice of drug to treat hyperglycemia in type 2 dm pt b/c 4. Infants with congenital hypothyroidism are tx with 5. If prescribing bupropion ZYBAN for tobacco cessation, the instructions to the pt include 6. pts who choose the nicotine lozenge to assist in quitting tobacco should be instructed 7. When starting a pt with hypothyroidism on thyroid replacement hormones, pt education would include 8. ADA has recommended which of the following tests for ongoing management of DM 9. Lipro is na insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true 10. Nonselective beta blockers and alcohol create serious drug reactions with insulin because they 11. Prior to prescribing metformin the provider should 12. Insulin is used to treat both types of DM. it acts by 13. elderly pts who are started on levothyroxine for thyroid replacement should be monitored for 14. action of "gliptin" is different from other antidiabetic agents because they 15. the Beers Criteria is used to 16. In addition to methimazole, a symptomatic pt with hyperthyroidism may need a prescription for 17. prophylactic use of bisphosphonates is recommended for pts with early osteopenia related to long term use of which drug 18. a women who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely tx her with 19. GLP-1 agonist 20. the drugs recommended by American academy of pediatrics for use in children with dm, depending on type, are 21. type 2 dm is a complex disorder involving 22. administration of exenatide is by subcutaneous injection 23. Insulin preps are divided into categories based on onset, duration, and intensity of action following sq injection. which of the following insulin preparations has the shortest onset and duration of action 24. according to beers criteria, the elderly should be cautiously prescribed fluoxetine Prozac due to 25. when giving SQ NPH, insulin begins to take effect onset of action - 60-90 min after administration 26. both men and women experience bone loss with aging. the bones most likely to demonstrate significant loss are 27. the beers criteria recommend which muscle relaxant for use in the elderly 28. When using the step up approach in caring for pts with GERD, the step up from OTC antacid use is 29. Metoclopramide improves GERD by 30. Isoniazid INH may induce a deficiency of which vitamin 31. grapefruit juice contains furanocoumarins that have been found to 32. cruciferous vegetables may alter drug pharmocokinetics by 33. Patrick is a 10yr old who presents with constipation. along with diet changes, a laxative is ordered to provide a more rapid relief. appropriate choice of med for a 10yr old would be - PEG 3350 Miralax 34. Tetracycline needs to be given on an empty stomach because it chelates with 35. GERD may be aggrevated by the following medication that effects lower esophageal sphincter (LES) tone 36. Glen is an 82 yr old who needs to be prescribed a new drug. what changes in elimination should be taken into consideration when rxing for Glen 37. when using the step up approach in caring for pts with GERD the step up from once daily ppi use is 38. tx failure in pts with PUD associated with H pylori may be due to 39. Sadis is a 90 y/o pt who requires a new RX. what changes in drug distribution with aging would influence rxing for Sadie 40. Antacids tx GERD by 41. Phenytoin decreases folic acid absorption by 42. Josie is a 5yr old presenting with 48hr n/v/d. unable to keep fluids down and wt is 4 lbs less than last recorded wt. besides IV fluids, her exam warrants use of anti nausea med. which is appropriate 43. which of the following vitamin or mineral supplements may be teratogenic if a pregnant woman takes more then recommended 44. many pts self medicate with antacid. which pts should be counseld to not take calcium carbonate antacids without discussing with their provider 1st 45. robert is c/o poor sleep. medications that may contribute to sleep problems in the elderly are 46. fasting for an extended period can 47. food in the gastrointestinal tract affects drug absorption by 48. infants with reflux are initially tx with 49. Sadie is a 72 yr old who takes omeprazole for chronic GERD. chronic long term omeprazole use places her at risk for 50. when using a step up approach for GERD the next step up when a pt has been on PPI for 12 wks is 51. Delta is 88 with low back pain. what guidelines should be followed when rxing pain management for Delta 52. Food can alter pH of stomach leading to 53. most frequent type of drug-food interaction is 54. After H pylori tx is completed, the next step in peptic ulcer disease is 55. a pt with new onset of systolic ejection murmur should be assessed for which nutritional deficiency 56. Acceptable 1st line tx for PUD with positive H pylori test is 57. pts who are on chronic long term PPI therapy require monitoring for 58. antacids such as calcium carbonate TUMs, can reduce the absorption of which of the following nutrients 59. if a pt with H pylori positive PUD fails 1st line therapy the 2nd line of tx is 60. A pt has been rxd silver sulfadiazine (Silvadene) cream to tx burns to his leg. normal adverse effects of silvadene cream include 61. Jose has had eczema for many years and reports he thinks his corticosteroid cream is not working as well as previously. he may be experiencing tolerance to the corticosteroid. treatment options include 62. Erika has been rxd isotretinoin Accutane by her derm and is presenting to her primary care provider with symptoms of sadness and depression. A becks depression scale indicated she has mild to moderate depression. what would be the best care for her at this point 63. when prescribing griseovulvin V to treat tinea capitis it is critical to instruct the pt or parent to 64. when a pt has contact dermatitis, wet dressings with Domeboro solution are used for 65. pts who are tc with greater than 100 gm/week of topical calcipotriene for psoriasis need to be monitored for 66. Josie has severe cystic acne and is requesting tx with Accutane. the appropriate tx for her would be 67. Rick has male pattern baldness on the vertex of his head and has been using Rogaine for 2 mths. he asks how effective minoxidil Rogaine is 68. when writing a rx of permethrin 5% cream Elimite for scabies, pt ed would include 69. Drew is a 17 yr old competitive runner who presents with c/o pain in his hip that occurred after he fell while running. his only medical problem is severe acne for which he takes Accutane. with this hx what would you be concerned for 70. mild acne may be treated initially with 71. when prescribing tacrolimus Protopic to tx atopic dermatitis pts should be informed that 72. Jim presents with a fungal infxn of 2 of his toenails-onychomycosis. tx for fungal infxn of the nail includes 73. Li is a 6 mth old with eczema. she would benefit from topical corticosteroids. instructions for using corticosteroids in children include 74. topical immunomodulators such as pimecrolimus Elidel or tacrolimus Protopic are used for 75. Juakeem is a nasal MRSA carrier. Tx to erradicate nasal MRSA is mupropion. Pt ed r/g tx nasal MRSA includes 76. Erik present with one golden-crusted lesion at the site of an insect bite consistent with impetigo. his parents have limited finances and request the least expensive tx. which med would be the best choice for him 77. Catherine has head lice and her mother is asking about what products are available that are not neurotoxic. the only non-neurotoxic head lice tx is 78. first-line therapy for treating topical fungal infections such as tinea corporis (ring worm) or tinea pedis (athletes foot) would be 79. when SAM used clotrimazole (Lotrimin AF) for athletes foot, he developed a red itchy rash consitent with a hypersensitivity reaction. he now has athletes foot again. what would be a good choice of anti fungal for Sam 80. Dwayne has classic tinea capitis. tx for tinea on the scalp is 81. long term tx of moderate atopic dermatitis includes 82. when choosing a topical corticosteroid cream to tx diaper dermatitis, the ideal medication would be 83. scabies tx for a 4 yr old child includes a rx for 84. Erik presents with a golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment? 85. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete's foot) would be: 86. Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment 87. Long-term treatment of moderate atopic dermatitis includes: 88. Narcotics are exogenous opiates. They act by ______ 89. A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: - A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his or her leg. Normal adverse effects of silver sulfadiazine cream include: 90. Prior to prescribing metformin, the provider should: 91. Progesterone-only pills are recommended for women who: - A. Are breastfeeding B. Have a history of migraine 92. Sadie is a seventy-two-year-old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: - 93. Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be: 94. Sitagliptin has been approved for: - A. Monotherapy in once-daily doses A sixty-six-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The nurse practitioner managing his primary healthcare needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): - A. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex). B. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce. C. Symptoms of hypertensive crisis (headache, tachycardia, sweating, etc.) require immediate treatment. D. All the above options are correct. D. All the above options are correct. 95. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: 96. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is not true? 97. Studies have shown that control targets that reduce the hemoglobin A1c to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include 98. The type of ADR that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic doses is: - A 99. Unlike most type II diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: 100. Vicky, age fifty-six years, comes to clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over two years for migraine and states one dose usually works to abort her migraine. What is the best care for her? 101. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: What impact does developmental variation in renal function has on prescribing for infants and children? 102. When a patient is on selective-serotonin reuptake inhibitor - No lab monitoring is required 103. When Sam used clotrimazole (Lotrimin AF) for athlete's foot, he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete's foot again. What would be a good choice of antifungal for Sam? 104. Which of the following is the mechanism of action of oral combined contraceptives that prevent pregnancy? - . 107. Since 40% of bone accrual occurs during adolescence, building bone during this time is critical. Ways to improve bone accrual in adolescents include: - Encouraging a daily dietary intake of 1,300 mg of calcium and 400 IU of vitamin D 108. Hot flashes are often a concern during menopause. Which of the following may help in reducing them? 109. Factors common in women that can affect adherence to a treatment regimen include all of the following EXCEPT: 110. Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is: 111. Maternal-to-child transmission of HIV infection during pregnancy may be prevented by: 112. Erroneous information about LGBTQ individuals can lead to failure to give accurate advice to them as patients. Which of the following statements is true about lesbians: 113. Which of the following holds true for the pharmacokinetics of women 4 114. The metabolism of drugs in women is primarily impacted by: 2. 115. The interpretation of DEXA scores in the rare cases of adolescent osteoporosis in teens: 3. Must use special Z-scores developed for this reason 116. The timing of NSAIDS for best control of severe menstrual cramps includes: 1. 117. Which of the following is true concerning lesbian health concerns? 4. 118. The nurse is reconciling the medications with a client who is being discharged. Which of the following indicates there is a "discrepancy? - 119. Clients in a nursing home have been prescribed permethrin shampoo (Nix) for head lice. The nurse will question the order for the client who has a history of: 120. A client uses timolol maleate (Timoptic) eye drops. The expected outcome of this beta-adrenergic blocker is to control glaucoma by: 121. After listening to the nurse explain the use of the PO version of tretinoin (isotretinoin - Accutane) to a 19 year-old female client, the client demonstrates understanding of the most important point by making which statement at the end of the teaching session: 122. A client who is in kidney (renal) failure may have a diminished capacity to excrete medications. It is imperative that this client be assessed for what development? 123. Nurses have a legal and moral responsibility to report medication errors. The steps of reporting these errors include: 124. After a nurse provided instructions about timolol (Timoptic) to a client with a history of chronic heart disease, the client asks, "How can this eye drops affect my heart?" The nurse's best response includes which of the following information? 125. The client should be aware of potential side effects of prostaglandins latanoprost (Xalatan) used in the treatment of glaucoma. The nurse should include which of the following in the teaching plan: 126. A client has been treated for chronic open-angle glaucoma for 5 years asks the nurse, "How does glaucoma damage my eyesight." The nurse's reply should be based on the knowledge that open-angle glaucoma: 127. The nurse should assess clients with chronic open-angle glaucoma for: 128. The nurse observes the client instill eye drops for gluacoma. The client asks, "why should I hold pressure to my lacrimal duct for approximately 2 minutes after I instill the drops?" The nurse explains to the client that this method is the best technique because 129. Mr. Smith was diagnosed with scabies and was prescribed permethrin 5% cream (Elimite). Which is the best instruction by the nurse to ensure the client applies the cream appropriately 130. The nurse is discussing skin care with a teenaged client who has MILD acne. Which medication or treatment should the nurse discuss with the client? 131. A client who was admitted for a pulmonary embolism requires emergency surgery. The client has been receiving intravenous heparin and has a current aPTT level of >150 seconds. What nursing intervention will the nurse anticipate as a priority before surgery? 132. A diabetic client has been diagnosed with hypertension, and the physician has prescribed propranolol, a beta-blocker. When performing discharge teaching, it is important for the client to recognize that the addition of propranolol with a history of diabetes can cause: 133. Hydroxychloroquine sulfate (Plaquenil) has been prescribed for a 24-year-old client for the control of his auto-immune disease. The nurse will teach the client to immediately report: 134. Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and instructs the client to immediately report: 135. A patient calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: 136. The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? 137. Torsades de Pointes, a polymorphic ventricular arrhythmia, is associated with prolongation of Q-T intervals. Which antiarrhythmic agent is most likely to cause this arrhythmia? 138. Which diagnosis in your patient's history would make you question the order for procainamide? - 139. CONJUNCTIVITIS IN A CHILD THAT IS ACCOMPANIED BY ACUTE 140. When you prescribe BB eye drops in conjunction with oral BB it can cause 141. What is rx to prevent swimmers ears - Isopropyl ear drops earSol 142. Chapter 27: Anemia - vitamin B12 2. Premature infants require iron supplementation with: A. 10 mg/day of iron B. 2 mg/kg per day until age 12 months C. 7 mg/day in diet D. 1 mg/kg per day until adequate intake of iron from foods 3. Breastfed infants should receive iron supplementation of: A. 3 mg/kg per day B. 6 mg/kg per day C. 1 mg/kg per day D. Breastfed babies do not need iron supplementation 4. Valerie presents to clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of iron supplementation C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID 5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of elemental iron C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID 6. Monitoring for a patient taking iron to treat iron deficiency anemia is: A. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started B. Complete blood count every 4 weeks throughout treatment C. Annual complete blood count D. Reticulocyte count in 4 weeks ____ 7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: A. Take the iron with milk if it upsets her stomach B. Antacids may help with the nausea and GI upset caused by iron C. Increase fluids and fiber to treat constipation D. Iron is best tolerated if it is taken at the same time as her other medications ____ 8. Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? A. 40 mcg/day B. 400 mcg/day C. 800 mcg/day D. 2 gm/day ____ 9. Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: A. Oral folic acid 1 to 2 mg per day B. Oral folic acid 1 gram per day C. IM folate weekly for at least 6 months D. Oral folic acid 400 mcg daily ____ 10. Patients who are being treated for folate deficiency require monitoring of: A. Complete blood count every 4 weeks B. Hematocrit and hemoglobin at 1 week and then at 8 weeks C. Reticulocyte count at 1 week D. Folate levels every 4 weeks until hemoglobin stabilizes ____ 11. The treatment of vitamin B12 deficiency is: A. 1,000 mcg daily of oral cobalamin B. 2 gm per day of oral cobalamin C. 100 mcg/day Vitamin B12 IM D. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week ____ 12. The dosage of Vitamin B12 to initially treat pernicious anemia is: A. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month B. Vitamin B12 IM monthly C. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg weekly for a month D. Oral cobalamin 1,000 mcg daily ____ 13. Before beginning IM Vitamin B12 therapy, which laboratory values should be obtained? A. Reticulocyte count, hemoglobin, and hematocrit B. Iron C. Vitamin B12 D. All of the above ____ 14. ____ should be monitored when Vitamin B12 therapy is started. A. Serum calcium B. Serum potassium C. Ferritin D. C-reactive protein ____ 15. Anemia due to chronic renal failure is treated with: A. Epoetin alfa (Epogen) B. Ferrous sulfate C. Vitamin B12 D. Hydroxyurea Chapter 28: Chronic Stable Angina and Low-Risk Unstable Angina Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Angina is produced by an imbalance between oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? A. Calcium channel blockers B. Beta blockers C. ACE inhibitors D. Aspirin ____ 2. Not all chest pain is caused by myocardial ischemia. Non-cardiac causes of chest pain include: A. Pulmonary embolism B. Pneumonia C. Gastroesophageal reflux D. All of the above ____ 3. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is: A. Class I B. Class II C. Class III D. Class IV ____ 4. Patients at high risk for developing significant coronary heart disease are those with: A. LDL values between 100 and 130 B. Systolic blood pressure between 120 and 130 C. Class III angina D. Obesity Chapter 1. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be Buspirone/Buspar 2. Common mistakes practitioners make in treating anxiety disorders include Thinking a partial response to medication is acceptable 3. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be 4. An appropriate drug to initially treat panic disorder is: 5. Prior to starting antidepressants, patients should have laboratory testing to rule out: 6. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. 7. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: Appetite and concentration improve in the first 1 to 2 weeks. 8. An appropriate drug for the treatment of depression with anxiety would be ) 9. An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: 10. The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is: 11. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting 12. 13. The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the 14. What "onset of action" symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor? . 15. Which of the following should not be taken with a selective serotonin reuptake inhibitor? 16. Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? 17. The patient shares with the provider that he is taking his Prozac at night before going to bed. 18. Anorexiants may cause tolerance and should only be prescribed for 6 months 19. Before prescribing phentermine a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John's wort due to: 20. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be 20. Phentoin monitoring includes 21. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now 22. Long-term monitoring of patients who are taking carbamazepine includes: -Complete blood count every 3 to 4 months 23. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of 24. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: 25. Monitoring of a patient on gabapentin to treat seizures includes: 26. Scott's seizures are well controlled on topiramate and he wants to start playing 27. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 28. Levetiracetam has known drug interactions with Few, if any, drugs 29. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and 30. How is lamotrigine (Lamictal) affected when taking oral contraceptives concurrently? Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 31. The tricyclic antidepressants should be prescribed cautiously in patients with 32. Patient teaching for phenelzine and other monoamine oxidase inhibitors (MAOIs): 1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) 3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment 4. All of the above 33. Taylor is a 10-year-old child diagnosed with major depression. The appropriate first line Fluoxetine 34. Suzanne is started on paroxetine (Paxil), SSRI for depression. Education regarding her antidepressant includes: 1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects 35. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: Duloxetine (Cymbalta) 36. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: -With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) 37. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: Insomnia 38. A 19-year-old male was started on risperidone. Monitoring for risperidone include observing for common side effects, including: Bradykinesia (slow mvmt), akathisia (restlessness), and agitation 39. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: Alprazolam (Xanax) 40. A patient with anxiety and depression may respond to: Buspirone (Buspar) and an SSRI combined 41. When prescribing temazepam (Restoril) for insomnia, patient education includes: -Temazepam should not be used more than three times a week for less than 3 months. 42. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: Zolpidem should be taken just before going to bed. 43. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: - Drowsiness and nausea 44. Tom is taking lithium for bipolar disorder. He should be taught to: Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? 45. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: Insomnia and decreased appetite 46. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: 1. ADHD symptoms 2. Routine height and weight checks 3. Amount of methylphenidate being used 4. All of the above 47. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: Blood pressure 48. What blood values should be monitored with carbamazepine? Carbamazepine may cause blood dyscrasias. Contraception 1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: - Serum potassium 2. The mechanism of action of oral combined contraceptives that prevents pregnancy is - Progestins thicken cervical mucus and slow tubal motility. 3. To improve actual effectiveness of oral contraceptives women should be educated regarding: - Use of a back-up method if they have vomiting or diarrhea during a pill packet 4. A contraindication to the use of combined contraceptives is - A history of clotting disorder 5. Obese women may have increased risk of failure with which contraceptive method? - Combined topical patch 6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully - . 7. Progesterone-only pills are recommended for women who 8. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? - Irregular vaginal bleeding for the first few months 9. Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is 10. A female patient is taking combined hormonal contraceptives to prevent pregnancy. She visits the gynecology clinic and is noted to have a blood pressure of 176/102 mm Hg. The patient is started on enalapril mesylate 10 mg. In collaboration with the primary care provider, what other patient teaching should be provided based on her current medication regimen? 11. A patient suffers from dysmenorrhea. Which oral medication will be prescribed that has the ability to provide physiological actions on the neuroendocrine control of ovarian function? 12. A patient taking hormonal contraceptives will soon turn 35 years of age. She is moderately obese and has smoked for 15 years. Which of the following is most important? 13. A patient with a complex medical history is considering the use of oral contraceptives. The nurse should be aware that many antibiotics and antiseizure medications cause what effect when combined with oral contraceptives? 14. A postmenopausal woman is administered estradiol (Estraderm). What condition will be prevented in this patient? 15. A woman is prescribed hormonal contraceptives. What aspect of this treatment places her at greatest risk for the development of blood clots? 16. A woman suffers from amenorrhea. Which of the following medications will most likely be prescribed? 17. A young woman is being seen in the gynecology clinic of the local health department. She has decided to begin hormonal contraceptives. What action is specific to hormonal contraceptives and should be taught to this woman? 18. An insulin-dependent diabetic patient has begun taking an oral contraceptive. What effect will this medication regime have on her physiologically? 19. During patient teaching, a young woman asks the nurse the following question: "If I get pregnant on the 'pill,' should I continue to take it?" What is the nurse's best response? Chapter 32: Dermatologic Conditions Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be: ____ 2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for: ____ 3. Long-term treatment of moderate atopic dermatitis includes: Topical corticosteroids and emollients ____ 4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: ____ 5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for: ____ 6. Appropriate initial treatment for psoriasis would be: 7. Patient education when prescribing the Vitamin D3 derivative calcipotriene for ____ 8. Mild acne may be initially treated with: OTC benzoyl peroxide ____ 9. Tobie presents to clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include: He may see an initial worsening of his acne that will improve in 6 to 8 weeks ____ 10. Josie has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: Refer her to a dermatologist for treatment ____ 11. The most cost-effective treatment for two or three impetigo lesions on the face is: Mupirocin ointment ___ 12. Dwayne has classic tinea capitis. Treatment for tinea on the scalp is: Oral griseofulvin for 6 to 8 weeks ____ 13. Nicolas is a football player who presents to clinic with athlete’s foot. Patients with tinea pedis may be treated with: OTC miconazole cream for 4 weeks ____ 14. Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment for fungal infections of the nail includes: Oral griseofulvin ____ 15. Scabies treatment for a 4-year-old child includes a prescription for: Permethrin 5% cream applied from the neck down ____ 16. Vanessa has been diagnosed with scabies. Her education would include: All members of the household and close personal contacts should be treated ____ 17. Catherine has head lice and her mother is asking about what products are available that are not neurotoxic. The only non-neurotoxin head lice treatment is: Benzoyl alcohol (Ulesfia) ____ 18. Rick has male pattern baldness on the vertex of his head and has been using Will show results after 4 months of twice a day use 19. No contact sports with - Accutane. Liver enlargement & osteoporosis ____ 1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have: - Autoantibodies to two tyrosine phosphatases 2. Type 2 diabetes is a complex disorder involving: - A suboptimal response of insulin-sensitive tissues in the liver 3. Diagnostic criteria for diabetes include: - Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl 4. Routine screening of asymptomatic adults for diabetes is appropriate for: - Native Americans, African Americans, and Hispanics 5. Screening criteria for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter - BMI above the 85th percentile for age and sex - Family history of diabetes in first- or second-degree relative - Hypertension based on criteria for children - Any of the above 6. Insulin is used to treat both types of diabetes. It acts by: - Increasing peripheral glucose uptake by skeletal muscle and fat 7. The drug of choice for Type 2 diabetics is metformin. Metformin: - Decreases glycogenolysis by the liver 8. Before prescribing metformin, the provider shoul - Draw serum creatinine 9. Control targets for patients with diabetes include: - C. Blood pressure less than 130/80 mm Hg 10. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: - Those with no significant cardiovascular disease 11. Prevention of conversion from pre-diabetes to diabetes in young children must take highest priority and should focus on: - Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease 12. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: - Metformin and insulin 13. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: - Have a high incidence of obesity, elevated triglycerides, and hypertension - Do best with drugs that foster weight loss, such as metformin - Both 14. The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: - Glycemic targets between 7% and 7.5% 15. All diabetic patients with known cardiovascular disease should be treated with: - Ace and aspirin 16. All diabetic patients with hyperlipidemia should be treated with: - A. HMG-CoA reductase inhibitors Both ACE inhibitors and some Angiotensin-II receptor blockers have been approved in treating: 17. Both ACE inhibitors and some Angiotensin-II receptor blockers have been approved in treating: - Hypertension in diabetic patients - Diabetic nephropathy 18. Protein restriction helps slow the progression of albuminuria, GFR decline, and ESRD is some patients with diabetes. It is useful for patients who - Show progression of diabetic nephropathy despite optimal glucose and blood pressure control 19. Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include - Resting tachycardia, exercise intolerance, and orthostatic hypotension 20. Drugs used to treat diabetic peripheral neuropathy include: - Gabapentin 21. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? - A1C 22.