ADVANCED PHARMACOLOGY NSG 533
ADVANCED PHARMACOLOGY NSG 533 EXAM QUESTIONS AND
ANSWERS GRADED A+ LATEST UPDATE.
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
hypoglycaemia 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
FAMVX: Non-contributory
TX: (−) Smoking, alcohol use, past marijuana uses while in high school
Medications: Metformin 850 mg tad, 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 me/L, K 5.4 me/L, Cl 106 me/L, BUN ANS >> Exenatide - Exenatide
(Biedron) 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 (Farmiga) is contraindicated in this patient due to hyperkalaemia 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-
,ADVANCED PHARMACOLOGY NSG 533
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 (Precise) 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) Hyperlipidaemia (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 diabetes ANS >> Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no contraindications or intolerabilities are
present upon evaluation. Metformin has also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin therapy to limit
the risk of lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor
agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal
insulin. Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been
associated with case reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analogy and has data to support an A1C reduction necessary to gain glycaemic control and may
assist with weight loss goals for this patient. New information suggests these agents may provide
, ADVANCED PHARMACOLOGY NSG 533
benefits in those with ASCVD. JR has a past history of pancreatitis and GLP-1 analogy are not
recommended due to this contraindication
Tad’s have data to support an A1C reduction necessary to gain glycaemic control, but are associated with
weight gain, negative effects on lipids and increased risk of fracture. Until recently, Tad’s have also been
linked to increased CV events and use has fallen out of Favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have
the potential to cause hypoglycaemia, so patient education is crucial. Because of his allergies to "sulpha",
use would be contra
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this
information present for the provider? ANS >> A patient with Type 1 DM is insulin dependent for glucose
control and at high risk for hypoglycemics episodes. Propranolol causes prolonged hypoglycemics
episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription for
levothyroxine. Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." ANS >> D. Calcium
may reduce levothyroxine absorption. Further education is needed if the patient feels she can take half
of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he
experiences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he
develops what he will later describe as "belching, nausea and a bad bloated feeling". Several of the
ulcers began to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had
been literally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
what was the OTC remedy)? ANS >> I would accept Alka-Selzer. I contain NaHCO3 (as well as ASA). In
the presence of HCL, it Liberates CO2, that can cause gastric distention, belching and nausea. The
reaction is fairly swift allowing little time for dissipation. Tums, its primary ingredient calcium carbonate
which when taken cause a reaction with the stomach acid such as production of carbon dioxide gas
which can cause bloating and the stomach to stretch to tear the ulcers open.
ADVANCED PHARMACOLOGY NSG 533 EXAM QUESTIONS AND
ANSWERS GRADED A+ LATEST UPDATE.
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
hypoglycaemia 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
FAMVX: Non-contributory
TX: (−) Smoking, alcohol use, past marijuana uses while in high school
Medications: Metformin 850 mg tad, 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 me/L, K 5.4 me/L, Cl 106 me/L, BUN ANS >> Exenatide - Exenatide
(Biedron) 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 (Farmiga) is contraindicated in this patient due to hyperkalaemia 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-
,ADVANCED PHARMACOLOGY NSG 533
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 (Precise) 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) Hyperlipidaemia (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 diabetes ANS >> Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no contraindications or intolerabilities are
present upon evaluation. Metformin has also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin therapy to limit
the risk of lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor
agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal
insulin. Anything next can be tried depending on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been
associated with case reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analogy and has data to support an A1C reduction necessary to gain glycaemic control and may
assist with weight loss goals for this patient. New information suggests these agents may provide
, ADVANCED PHARMACOLOGY NSG 533
benefits in those with ASCVD. JR has a past history of pancreatitis and GLP-1 analogy are not
recommended due to this contraindication
Tad’s have data to support an A1C reduction necessary to gain glycaemic control, but are associated with
weight gain, negative effects on lipids and increased risk of fracture. Until recently, Tad’s have also been
linked to increased CV events and use has fallen out of Favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have
the potential to cause hypoglycaemia, so patient education is crucial. Because of his allergies to "sulpha",
use would be contra
A patient with type 1 diabetes reports taking propranolol for hypertension. What concern does this
information present for the provider? ANS >> A patient with Type 1 DM is insulin dependent for glucose
control and at high risk for hypoglycemics episodes. Propranolol causes prolonged hypoglycemics
episodes. Needs to switch to ACE or ARB.
A provider teaches a patient who has been diagnosed with hypothyroidism about a new prescription for
levothyroxine. Which statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider first."
b. "I should report insomnia, tremors, and an increased heart rate to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothyroxine." ANS >> D. Calcium
may reduce levothyroxine absorption. Further education is needed if the patient feels she can take half
of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large meal and alcohol he
experiences significant GI distress. He takes an OTC heartburn remedy. Within a minute or two he
develops what he will later describe as "belching, nausea and a bad bloated feeling". Several of the
ulcers began to bleed and he becomes profoundly hypotensive from the blood loss and is taken to the
ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that it appears as if the lesions had
been literally stretched apart causing additional tissue damage. What did the patient most likely take (i.e.
what was the OTC remedy)? ANS >> I would accept Alka-Selzer. I contain NaHCO3 (as well as ASA). In
the presence of HCL, it Liberates CO2, that can cause gastric distention, belching and nausea. The
reaction is fairly swift allowing little time for dissipation. Tums, its primary ingredient calcium carbonate
which when taken cause a reaction with the stomach acid such as production of carbon dioxide gas
which can cause bloating and the stomach to stretch to tear the ulcers open.
