NUR 555 Quiz 2| QUESTIONS AND ANSWERS |
2026 UPDATE | WITH COMPLETE SOLUTIONS
SGLT2-i
Second-line after metformin for pts with significant cardiovascular risk factors
Benefits of SGLT2-i
-A1c reduction - 0.4 - 1.1%
-weight reduction around 6 pounds, maintained at 2 years
-reduced risk of major adverse cardiovascular events including death or hospitalization for heart
failure
-improved renal outcome
-more effective than DPP4i's
SGLT2-i new FDA approval for
treating HFrEF without diabetes
SGLT2-i limitations
-not the best choice for pts with frequent UTIs - up to 10-15% of women
-risk of urosepsis & pyelonephritis
-candidiasis 9.5%, not good choice for incontinent pts
-necrotizing fasciitis
-phimosis can occur if uncircumcised
-risk of ketoacidosis, both hyper- and euglycemic
-relative contraindication for pts with high risk for amputation, severe neuropathy, hx foot ulcers,
,PAD, charcot joint
-fracture risk
Statin associated myalgia
-increases with higher intensity therapy
-simvastatin (most common) 80mg is no longer recommended
-usually dose dependent
-can occur with atorvastatin (40mg+) and rosuvastatin (20mg+) also
Statin associated myalgia assessment
-timing of sx relative to statin initiation (pre-existing)
-onset, duration
-bilateral? proximal?
-drug interactions (CYP inhibitors)
-comorbidities - hypothyroid, liver/renal dz
-age, sex, ethnicity
Statin associated myalgia PE
-muscle weakness (poss. other cause)
-other musculoskeletal abnormalities
Initial management of statin associated myalgia
-check CK (creatine kinase), if not significantly elevated:
-d/c statin
-monitor for sx resolution
, If resolved:
-rechallenge with same or different statin
-use lower dose or alternate day dosing
Severe statin associated myalgia
-d/c statin immediately
-investigate reversible causes
-if CK>10x upper limits of normal + renal injury - suspect rhabdomyolysis (emergency)
Labs for statin associated myalgia
-CK: distinguish between myalgia and myopathy
-TSH - r/o hypothyroidism
-vit D
-liver and renal function
-electrolytes, autoimmune markers
Patient support of statin associated myalgia
-avoid d/c unless absolutely necessary
-sx may be unrelated
-nocebo effect - may seem worse or statin-related when not
Statin associated myalgia onset
4-8 weeks after starting therapy
-resolves 2-4 weeks after stopping
Statin associated myalgia rechallenge strategy
2026 UPDATE | WITH COMPLETE SOLUTIONS
SGLT2-i
Second-line after metformin for pts with significant cardiovascular risk factors
Benefits of SGLT2-i
-A1c reduction - 0.4 - 1.1%
-weight reduction around 6 pounds, maintained at 2 years
-reduced risk of major adverse cardiovascular events including death or hospitalization for heart
failure
-improved renal outcome
-more effective than DPP4i's
SGLT2-i new FDA approval for
treating HFrEF without diabetes
SGLT2-i limitations
-not the best choice for pts with frequent UTIs - up to 10-15% of women
-risk of urosepsis & pyelonephritis
-candidiasis 9.5%, not good choice for incontinent pts
-necrotizing fasciitis
-phimosis can occur if uncircumcised
-risk of ketoacidosis, both hyper- and euglycemic
-relative contraindication for pts with high risk for amputation, severe neuropathy, hx foot ulcers,
,PAD, charcot joint
-fracture risk
Statin associated myalgia
-increases with higher intensity therapy
-simvastatin (most common) 80mg is no longer recommended
-usually dose dependent
-can occur with atorvastatin (40mg+) and rosuvastatin (20mg+) also
Statin associated myalgia assessment
-timing of sx relative to statin initiation (pre-existing)
-onset, duration
-bilateral? proximal?
-drug interactions (CYP inhibitors)
-comorbidities - hypothyroid, liver/renal dz
-age, sex, ethnicity
Statin associated myalgia PE
-muscle weakness (poss. other cause)
-other musculoskeletal abnormalities
Initial management of statin associated myalgia
-check CK (creatine kinase), if not significantly elevated:
-d/c statin
-monitor for sx resolution
, If resolved:
-rechallenge with same or different statin
-use lower dose or alternate day dosing
Severe statin associated myalgia
-d/c statin immediately
-investigate reversible causes
-if CK>10x upper limits of normal + renal injury - suspect rhabdomyolysis (emergency)
Labs for statin associated myalgia
-CK: distinguish between myalgia and myopathy
-TSH - r/o hypothyroidism
-vit D
-liver and renal function
-electrolytes, autoimmune markers
Patient support of statin associated myalgia
-avoid d/c unless absolutely necessary
-sx may be unrelated
-nocebo effect - may seem worse or statin-related when not
Statin associated myalgia onset
4-8 weeks after starting therapy
-resolves 2-4 weeks after stopping
Statin associated myalgia rechallenge strategy
