Exam 4: NURS 615/ NURS615 (Latest 2024/ 2025 Update) Advanced Pharmacotherapeutics Review |Qs & As| 100% Correct| Grade A (Verified Answers)- Maryville

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Exam 4: NURS 615/ NURS615 (Latest 2024/ 2025 Update) Advanced Pharmacotherapeutics Review |Qs & As| 100% Correct| Grade A (Verified Answers) Q: How does metformin work? Answer: Decreases hyperglycemia by decreasing hepatic glucose production called hepatic gluconeogenesis. The average person with type 2 diabetes has three times the rate of gluconeogenesis, metformin treatment reduces this by over 1/3rd. The molecular mechanism of metformin isn't completely understood. In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake by inducing the phosphorilization of glu4 enhancer factor, decreases insulin induced suppression of fatty acid oxidation, and decreases absorption of glucose from the GI tract. Also of note** Metformin helps reduce LDL cholesterol and triglyceride levels and is not associated with weight gain, in some people it helps promote weight loss** Q: What diagnostic testing is required before and throughout therapy with metformin? Answer: Metformin is not metabolized, it is cleared from the body by tubular secretion and is secreted unchanged in the urine. Metformin is undetectable in blood plasma within 24 hrs of a single oral dose the average elimination half-life in plasma is 6.2 hrs as it is secreted in the urine you should check a serum crt to assess renal function. Q: What is the action of gliptin? Answer: The mechanism of DDP-4 inhibitors is to increase incretin levels incretin are GLP1 and GIP which inhibit glucagon release in which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels Q: How do GLP agonists work? Answer: They bind directly to a receptor in the pancreatic beta cell. These agents work in the same pathway as the DPP-4 inhibitors as mentioned above but are generally considered more potent. Q: When should exenatide be administered? Answer: 60 minutes prior to the morning and evening meal Q: How will you assess for granulocytopenia? Answer: Signs of a Cold or flu including fever and sore throat Q: What are the adverse effects of propylthiouracil? Answer: Agranulocytosis, thrombocytopenia, and fulminant liver failure as stated above, pt's on PTU when they develop fever or sore throat, it would be important to check a CBC preferably with a smear and a diff. Q: What are the adverse effects of levothyroxine? Answer: Tachycardia and angina in the elderly Q: A patient develops a toxic goiter. What is the recommended treatment? Answer: Methimazole for one month then radioactive iodine (p. 641) Q: What are the adverse effects of PTU and methimazole? Answer: PTU- Fatal agranulocytopenia look for fever and sore throat and TEMPORARY ALOPECIA Q: What is the action of biphosphonates? Answer: Bone undergoes constant turnover and is kept in balance by osteoblasts creating bone and osteoclasts destroying bone. Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis or cell death there by slowing bone loss. Oral bisphosphonates can cause upset stomach and inflammation as well as erosion. Erosions of the esophagus which is the main problem of oral and containing preparations. This can be prevented by sitting upright for 30-60 minutes after taking the medication. If the patient does develop some type of gastric distress, give them oral 30ml of Maalox 3 hrs after taking it. IV bisphosphonates can give fever and flu like symptoms after the first infusion which is thought to occur because of their potential to activate human T cells

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ExamI4:INURSI615/INURS615I(LatestI2024
/I2025IUpdate)IAdvancedI
PharmacotherapeuticsIReviewI|QsI&IAs|I
100%ICorrect|IGradeIAI(VerifiedIAnswers)

Q:IHowIdoesImetforminIwork?

Answer:
DecreasesIhyperglycemiaIbyIdecreasingIhepaticIglucoseIproductionIcalledIhepaticIgluconeogen
esis.ITheIaverageIpersonIwithItypeI2IdiabetesIhasIthreeItimesItheIrateIofIgluconeogenesis,Imet
forminItreatmentIreducesIthisIbyIoverI1/3rd.ITheImolecularImechanismIofImetforminIisn'tIcom
pletelyIunderstood.IInIadditionItoIsuppressingIhepaticIglucoseIproduction,ImetforminIincreases
IinsulinIsensitivity,IenhancesIperipheralIglucoseIuptakeIbyIinducingItheIphosphorilizationIofIgl
u4IenhancerIfactor,IdecreasesIinsulinIinducedIsuppressionIofIfattyIacidIoxidation,IandIdecrease
sIabsorptionIofIglucoseIfromItheIGIItract.IAlsoIofInote**IMetforminIhelpsIreduceILDLIcholes
terolIandItriglycerideIlevelsIandIisInotIassociatedIwithIweightIgain,IinIsomeIpeopleIitIhelpsIpr
omoteIweightIloss**

Q:IWhatIdiagnosticItestingIisIrequiredIbeforeIandIthroughoutItherapyIwithImetformin?

Answer:
MetforminIisInotImetabolized,IitIisIclearedIfromItheIbodyIbyItubularIsecretionIandIisIsecretedI
unchangedIinItheIurine.IMetforminIisIundetectableIinIbloodIplasmaIwithinI24IhrsIofIaIsingleIo
ralIdoseItheIaverageIeliminationIhalf-
lifeIinIplasmaIisI6.2IhrsIasIitIisIsecretedIinItheIurineIyouIshouldIcheckIaIserumIcrtItoIassessIre
nalIfunction.

Q:IWhatIisItheIactionIofIgliptin?

Answer:

,TheImechanismIofIDDP-
4IinhibitorsIisItoIincreaseIincretinIlevelsIincretinIareIGLP1IandIGIPIwhichIinhibitIglucagonIrel
easeIinIwhichIinIturnIincreasesIinsulinIsecretion,IdecreasesIgastricIemptying,IandIdecreasesIblo
odIglucoseIlevels

Q:IHowIdoIGLPIagonistsIwork?

Answer:
TheyIbindIdirectlyItoIaIreceptorIinItheIpancreaticIbetaIcell.ITheseIagentsIworkIinItheIsameIpat
hwayIasItheIDPP-4IinhibitorsIasImentionedIaboveIbutIareIgenerallyIconsideredImoreIpotent.

Q:IWhenIshouldIexenatideIbeIadministered?

Answer:
60IminutesIpriorItoItheImorningIandIeveningImeal

Q:IHowIwillIyouIassessIforIgranulocytopenia?

Answer:
SignsIofIaIColdIorIfluIincludingIfeverIandIsoreIthroat

Q:IWhatIareItheIadverseIeffectsIofIpropylthiouracil?

Answer:
Agranulocytosis,Ithrombocytopenia,IandIfulminantIliverIfailureIasIstatedIabove,Ipt'sIonIPTUIw
henItheyIdevelopIfeverIorIsoreIthroat,IitIwouldIbeIimportantItoIcheckIaICBCIpreferablyIwithIa
IsmearIandIaIdiff.

, Q:IWhatIareItheIadverseIeffectsIofIlevothyroxine?

Answer:
TachycardiaIandIanginaIinItheIelderly

Q:IAIpatientIdevelopsIaItoxicIgoiter.IWhatIisItheIrecommendedItreatment?

Answer:
MethimazoleIforIoneImonthIthenIradioactiveIiodineI(p.I641)

Q:IWhatIareItheIadverseIeffectsIofIPTUIandImethimazole?

Answer:
PTU-IFatalIagranulocytopeniaIlookIforIfeverIandIsoreIthroatIandITEMPORARYIALOPECIA

Q:IWhatIisItheIactionIofIbiphosphonates?

Answer:
BoneIundergoesIconstantIturnoverIandIisIkeptIinIbalanceIbyIosteoblastsIcreatingIboneIandIoste
oclastsIdestroyingIbone.IBisphosphonatesIinhibitItheIdigestionIofIboneIbyIencouragingIosteocl
astsItoIundergoIapoptosisIorIcellIdeathIthereIbyIslowingIboneIloss.IOralIbisphosphonatesIcanIc
auseIupsetIstomachIandIinflammationIasIwellIasIerosion.IErosionsIofItheIesophagusIwhichIisIt
heImainIproblemIofIoralIandIcontainingIpreparations.IThisIcanIbeIpreventedIbyIsittingIuprightI
forI30-
60IminutesIafterItakingItheImedication.IIfItheIpatientIdoesIdevelopIsomeItypeIofIgastricIdistres
s,IgiveIthemIoralI30mlIofIMaaloxI3IhrsIafterItakingIit.IIVIbisphosphonatesIcanIgiveIfeverIandI
fluIlikeIsymptomsIafterItheIfirstIinfusionIwhichIisIthoughtItoIoccurIbecauseIofItheirIpotentialIt
oIactivateIhumanITIcells

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