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Advanced Pharmacology NSG 533
Questions with 100% Correct Answers
| for Specific Exam Mail
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
:
vPretest - Stuvia US
,2
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
Ans: 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.
:
vPretest - Stuvia US
,3
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
:
vPretest - Stuvia US
, 4
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
Despite improvements in the past six weeks due to lifestyle
changes and exercise, drug therapy is to be started for
JR's diabet
:
vPretest - Stuvia US
Advanced Pharmacology NSG 533
Questions with 100% Correct Answers
| for Specific Exam Mail
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
:
vPretest - Stuvia US
,2
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
Ans: 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.
:
vPretest - Stuvia US
,3
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
:
vPretest - Stuvia US
, 4
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
Despite improvements in the past six weeks due to lifestyle
changes and exercise, drug therapy is to be started for
JR's diabet
:
vPretest - Stuvia US
