Advanced Pharmacology Fundamentals Endocrine system Exam with answers

I understand the value of doing my own work and learning this skill to support my future independent practice as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning. I do not. I do. Use the John Jones case study to answer the following question. Which glucose level equates with a Hgb A1C of 8.1%? ~204 mg/dl ~160 mg/dl ~175 mg/dl ~183 mg/dl The correct answer is ~183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding eAG levels for complete information. Use the John Jones case study to answer the following question. John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen? Don’t take the metformin the day of the procedure and for 48 hours afterward. No special instructions are needed. Take the metformin the morning of the procedure but don’t take it for 48 hours afterward. Don’t take the metformin the day of the procedure but resume the following day. Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels should be normal before resuming metformin. Use the John Jones case study to answer the following question. Which of the following lab test should be evaluated before prescribing metformin? Complete blood count (CBC) Complete metabolic profile (CMP) Lipid Panel Urinalysis CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout treatment with metformin. Use the John Jones case study to answer the following question. Which behavior in John’s social history poses a potential concern with initiating metformin? His diet largely consists of fast-food meals. He drinks sweet tea with every meal. He reports drinking “a few beers on the weekend during football season”. No answer text provided. He drinks 3-4 cups of coffee per day. Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis. Use the John Jones case study to answer the following question. Metformin works by decreasing and . glucogenesis; incretin secretion incretin secretion; insulin production Correct Answer glucogenesis; insulin resistance insulin resistance; incretin secretion Metformin decreases glucogenesis and insulin resistance. Use the John Jones case study to answer the following question. Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John? Canagliflozin Glyburide Dulaglutide Metformin According to the ADA Standards of Medical Care in Diabetes-2020, Metformin is the first-line medication to prescribe for patients with a HgbA1C >6.5%. American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. Use the John Jones case study to answer the following question. Which of the following statements best describes John’s status? He has diabetes and requires pharmacological intervention. He does not have diabetes. He has diabetes but does not require pharmacological intervention. He has pre-diabetes. DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to pharmacological intervention. These criteria include: • Fasting plasma glucose ≥126 mg/dLa Or • Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or • Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc Or • Hemoglobin A1c 6.5% or higher; Use the John Jones case study to answer the following question. John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time? Increase John’s atorvastatin to 20mg per day. Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked. Increase John’s atorvastatin to 40 mg per day. Stop John’s atorvastatin since he is now being treated for diabetes. According to the ADA Standards of Medical Care in Diabetes-2020, the correct action is to intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women). John's treatment includes lifestyle changes as well as metformin which aligns with practice guidelines. John’s atorvastatin should remain as currently prescribed with monitoring of lipid profile and A1C. Use the John Jones case study to answer the following question. What is the recommended interval for monitoring John’s HgbA1C? 1-month 6-weeks 3-months 6-months The HgbA1C is a 3-month average of glucose; therefore, it should be re-checked in 3 months after starting treatment. Checking this lab value beforehand will provide a mixed result of glucose before and after treatment. Monitoring blood sugar between the beginning of treatment with metformin and a 3 month follow up, fasting finger stick blood sugars should be done. Use the John Jones case study to answer the following question. Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply. He drinks 3-4 cups of coffee per day. Sits at a desk several hours a day. Weight 235lbs His diet largely consists of fast-food meals. He drinks sweet tea with every meal. Family history is significant for diabetes. Correct Answer BP 130/90 The combination of moderate exercise and weight loss reduces the risk for the development of type 2 diabetes and improves outcomes for patients with type 2 diabetes (Rosenthal & Burchum, 2021). Use the Alfonso Giuliani case study to answer the following question. Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)? CBC LFTs HgbA1C CMP A complete metabolic profile (CMP) is needed to evaluate GFR before prescribing a SGLT2i. Use the Alfonso Giuliani case study to answer the following question. Alfonso should be started on statin therapy to address his high total cholesterol and low HDL. True False Statin therapy is recommended because of his known diabetes and 10-year risk ≥7.5%. If Alfonso’s LDL is <70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk-benefits may be considered before starting statins. Identify SGLT2i agents in the list below. Select all that apply. linagliptin dapagliflozin alogliptin sitagliptin saxagliptin canagliflozin empagliflozin The Food and Drug Administration (FDA has approved three SGLT2 selective inhibitors for mono, dual, and triple therapy: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®)