Advanced Pharmacology Nsg 533 Test 1 – Questions & Verified Answers (Rated A+ )
,EP cis ca cΣ8-year-old ctemale cpatient cthat ccomes cin ctor cdiabetes ceducation
cand cmanagement. cShe cwas cdiagnosed c12 cyears cago cand cstates clately
cshe cis cnot c able cto ccontrol cher cdiet calthough cshe ccontinues ca c1600
ccalorie cdiet cwith cappropriate cdaily ccarbohydrate cintake c(per cdietitian
cprescription) cand cwalks c40 cminutes cevery cday cot cthe cweek. cShe cstates
ccompliance cwith call cmedications. cShe cdenies cany chistory cot chypoglycemia
cdespite cbeing cable cto cidentity csigns cand csymptoms cand cdescribe
cappropriate ctreatment cstrategies. cPMH: cT2DM, cHTN, cobesity, cdepression,
cs/p cthyroidectomy cdue cto cthyroid ccancer
FmHx: c Noncontributory
SHx: c(−) cSmoking, calcohol cuse, cpast cmarijuana cuse cwhile cin chigh
cschool cMedications: cMettormin c850 cmg ctid, cglipizide c20 cmg cbid, clisinopril
c20 cmg cdaily, csertraline c100 cmg cdaily, cmultivitamin cdaily
Vitals: c BP c 128/82 c mg c Hg; c P c 72 c beats/min; c BMI c Σ1 c m/kg2
Laboratory ctest cresults: cNa c1Σ4 cmEq/L, cK c5.4 cmEq/L, cCl c106 cmEq/L, cBUN
c-- ccorrect cawswer--Exenatide c- cExenatide c(Bydureon) conce cweekly chas
cbeen cable cto cdemonstrate cweight closs cand cdecrease cA1C% cby c0.7% cto
c1.2% cin cclinical ctrials; chowever cit cis ccontraindicated ctor cEP cdue cto cthe
cselt-reported chistory cot cthyroid ccancer.
Dapaglitlozin c- cDapaglitlozin c(Farxiga) cis ccontraindicated cin cthis cpatient
cdue cto c hyperkalemia c which c could c be c made c worse c by c this c drug. c The
c package cinsert cdoes cnot cindicate ca cspecitic cpotassium cconcentration ccut
cott cto cno clonger cuse cthis cmedication; chowever, cthere care cbetter cchoices
cin cthis cpatient. cSitagliptin c - c Sitagliptin c (Januvia) c is c able c to c obtain c an
c A1C c goal c ot c less c than c7% cbased con cclinical ctrials cand ccurrently cthe
cpatient cdoes cnot chave cany
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,cautionary cobjective cmeasures cto cnot cuse cthis cmedication. cDPP-IV
cinhibitors care cweight cneutral. cDPP-IV cinhibitors ccan cbe cused cin cpatients
ctaking csultonylureas; chowever, cit cmay cbe crecommended cto creduce cor
cstop cthe csultonylurea cdose.
Acarbose c- cAcarbose c(Precose) cis cnot crecommended ctor cinitial
cmanagement cand cis cassociated cwith csigniticant cGI cside cettects. cMore
cintormation cwould c be cneeded cregarding ctasting cand cpost-prandial
cnumbers. cIn caddition, cadding cacarbose cwould conly clower cA1c cby c0.8% cat
cbest cand ctheretore cwould cnot cachieve cthe cdesired cA1C cgoal cot c<7%
JR cis ca c68-year-old cAtrican cAmerican cman cwith ca cnew cdiagnosis cot cT2DM.
cHe cwas c classitied cas c having c prediabetes c(at crisk c tor c developing
cdiabetes) c 5 cyears c betore c the c diagnosis c and c has c a c strong c tamily
c history c ot c type c 2 cdiabetes. cJR's cblood cpressure cwas c150/Q2 cmm cHg. cHis
claboratory cresults crevealed can cA1C cot c8.1%, cnormal ccholesterol cpanel,
cand cnormal c renal/hepatic ctunction cwere cnoted cwith ctoday's claboratory
ctest cresults.
Past cmedical chistory: cHypertension c(diagnosed c4 cy cago) cHyperlipidemia
c(diagnosed c2 cy cago) cPancreatitis c(idiopathic) c(acute chospitalization cΣ cy
cago) cFamily chistory: cType c2 cdiabetes
Medication: cHCTZ c25 cmg cdaily, csimvastatin c10 cmg cdaily
cAllergies: cSMZ/TMP
Vitals: cBP: c150/Q2 cmm cHg cP: c78 cbeats/min cRR: c12 crpm cWaist
cCircumterence: c46 cin cWeight: c267 clb cHeight: c5 c′ c6 c″ cBMI: c4Σ.1 ckg/m c2
Despite cimprovements cin cthe cpast csix cweeks cdue cto clitestyle cchanges cand
cexercise, cdrug ctherapy cis cto cbe cstarted ctor cJR's cdiabet c--correct cawswer--
cMettormin cis cthe cdrug cot cchoice crecommended ctor cmost cpatients cwith
c diabetes cin caddition cto clitestyle cmoditications cassuming cno
ccontraindications cor c intolerabilities c are c present c upon c evaluation.
c Mettormin c has c also c shown c to
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, provide cpositive cweight cneutral/loss cettects cin cobese cpatients. cIt cis ccrucial
cto cknow cthe crenal cstatus cot cpatients ccommencing cmettormin ctherapy cto
climit c the crisk cot clactic cacidosis c(JR cis cwithout ccontraindication).
Since chis centry cA1C cis c>7.5%, cdual ctherapy cis cindicated. cThere care
cseveral cpotential cchoices. cThe csecond cstep ccan cbe ca cdipeptidyl
cpeptidase-4 cinhibitor, cit ccan cbe ca cglucagon-like cpeptide-1 c(GLP-1)
creceptor cagonist, cit ccan cbe ca cTZD, cit ccan cbe ca csultonylurea cagent, cit ccan
cbe ca cSGLT2 cinhibitor, cor cit ccould cbe c basal cinsulin. cAnything cnext ccan cbe
ctried cdepending con cwhat csuits cthe ccircumstance
DPP4 cinhibitors care cweight cneutral cbet crelatively cbenign cside cettect
cprotile. cSitagliptin chas cbeen cassociated cwith ccase creports cot cpancreatitis,
cso cthis cspecitic cagent cshould cbe cavoided. c$$$
GLP-1 canalog cand chas cdata cto csupport can cA1C creduction cnecessary cto
cgain cglycemic ccontrol cand cmay cassist cwith cweight closs cgoals ctor cthis
cpatient. cNew cintormation csuggests cthese cagents cmay cprovide cbenetits cin
cthose cwith c ASCVD. cJR chas ca cpast chistory cot cpancreatitis cand cGLP-1
canalogs care cnot crecommended cdue cto cthis ccontraindication
TZDs chave cdata cto csupport can cA1C creduction cnecessary cto cgain cglycemic
ccontrol, cbut care cassociated cwith cweight cgain, cnegative cettects con clipids
cand cincreased crisk cot ctracture. cUntil crecently, cTZDs chave calso cbeen
clinked cto cincreased cCV cevents cand cuse chas ctallen cout cot ctavor
Sultonylureas cprovide cexcellent cA1C clowering, cbut care calso cassociated
cwith cweight cgain. cThey calso chave cthe cpotential cto ccause chypoglycemia,
cso cpatient ceducation cis ccrucial. cBecause cot chis callergies cto cTsultaT, cuse
cwould cbe ccontr c A cpatient cwith ctype c1 cdiabetes creports ctaking
cpropranolol ctor chypertension. cWhat cconcern cdoes cthis cintormation
cpresent ctor cthe cprovider? c--correct cawswer--A cpatient cwith cType c1 cDM cis
cinsulin cdependent ctor cglucose ccontrol cand cat chigh crisk ctor chypoglycemic
cepisodes. cPropanolol ccauses cprolonged chypoglycemic cepisodes. cNeeds cto
cswitch cto cACE cor cARB.
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,EP cis ca cΣ8-year-old ctemale cpatient cthat ccomes cin ctor cdiabetes ceducation
cand cmanagement. cShe cwas cdiagnosed c12 cyears cago cand cstates clately
cshe cis cnot c able cto ccontrol cher cdiet calthough cshe ccontinues ca c1600
ccalorie cdiet cwith cappropriate cdaily ccarbohydrate cintake c(per cdietitian
cprescription) cand cwalks c40 cminutes cevery cday cot cthe cweek. cShe cstates
ccompliance cwith call cmedications. cShe cdenies cany chistory cot chypoglycemia
cdespite cbeing cable cto cidentity csigns cand csymptoms cand cdescribe
cappropriate ctreatment cstrategies. cPMH: cT2DM, cHTN, cobesity, cdepression,
cs/p cthyroidectomy cdue cto cthyroid ccancer
FmHx: c Noncontributory
SHx: c(−) cSmoking, calcohol cuse, cpast cmarijuana cuse cwhile cin chigh
cschool cMedications: cMettormin c850 cmg ctid, cglipizide c20 cmg cbid, clisinopril
c20 cmg cdaily, csertraline c100 cmg cdaily, cmultivitamin cdaily
Vitals: c BP c 128/82 c mg c Hg; c P c 72 c beats/min; c BMI c Σ1 c m/kg2
Laboratory ctest cresults: cNa c1Σ4 cmEq/L, cK c5.4 cmEq/L, cCl c106 cmEq/L, cBUN
c-- ccorrect cawswer--Exenatide c- cExenatide c(Bydureon) conce cweekly chas
cbeen cable cto cdemonstrate cweight closs cand cdecrease cA1C% cby c0.7% cto
c1.2% cin cclinical ctrials; chowever cit cis ccontraindicated ctor cEP cdue cto cthe
cselt-reported chistory cot cthyroid ccancer.
Dapaglitlozin c- cDapaglitlozin c(Farxiga) cis ccontraindicated cin cthis cpatient
cdue cto c hyperkalemia c which c could c be c made c worse c by c this c drug. c The
c package cinsert cdoes cnot cindicate ca cspecitic cpotassium cconcentration ccut
cott cto cno clonger cuse cthis cmedication; chowever, cthere care cbetter cchoices
cin cthis cpatient. cSitagliptin c - c Sitagliptin c (Januvia) c is c able c to c obtain c an
c A1C c goal c ot c less c than c7% cbased con cclinical ctrials cand ccurrently cthe
cpatient cdoes cnot chave cany
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,cautionary cobjective cmeasures cto cnot cuse cthis cmedication. cDPP-IV
cinhibitors care cweight cneutral. cDPP-IV cinhibitors ccan cbe cused cin cpatients
ctaking csultonylureas; chowever, cit cmay cbe crecommended cto creduce cor
cstop cthe csultonylurea cdose.
Acarbose c- cAcarbose c(Precose) cis cnot crecommended ctor cinitial
cmanagement cand cis cassociated cwith csigniticant cGI cside cettects. cMore
cintormation cwould c be cneeded cregarding ctasting cand cpost-prandial
cnumbers. cIn caddition, cadding cacarbose cwould conly clower cA1c cby c0.8% cat
cbest cand ctheretore cwould cnot cachieve cthe cdesired cA1C cgoal cot c<7%
JR cis ca c68-year-old cAtrican cAmerican cman cwith ca cnew cdiagnosis cot cT2DM.
cHe cwas c classitied cas c having c prediabetes c(at crisk c tor c developing
cdiabetes) c 5 cyears c betore c the c diagnosis c and c has c a c strong c tamily
c history c ot c type c 2 cdiabetes. cJR's cblood cpressure cwas c150/Q2 cmm cHg. cHis
claboratory cresults crevealed can cA1C cot c8.1%, cnormal ccholesterol cpanel,
cand cnormal c renal/hepatic ctunction cwere cnoted cwith ctoday's claboratory
ctest cresults.
Past cmedical chistory: cHypertension c(diagnosed c4 cy cago) cHyperlipidemia
c(diagnosed c2 cy cago) cPancreatitis c(idiopathic) c(acute chospitalization cΣ cy
cago) cFamily chistory: cType c2 cdiabetes
Medication: cHCTZ c25 cmg cdaily, csimvastatin c10 cmg cdaily
cAllergies: cSMZ/TMP
Vitals: cBP: c150/Q2 cmm cHg cP: c78 cbeats/min cRR: c12 crpm cWaist
cCircumterence: c46 cin cWeight: c267 clb cHeight: c5 c′ c6 c″ cBMI: c4Σ.1 ckg/m c2
Despite cimprovements cin cthe cpast csix cweeks cdue cto clitestyle cchanges cand
cexercise, cdrug ctherapy cis cto cbe cstarted ctor cJR's cdiabet c--correct cawswer--
cMettormin cis cthe cdrug cot cchoice crecommended ctor cmost cpatients cwith
c diabetes cin caddition cto clitestyle cmoditications cassuming cno
ccontraindications cor c intolerabilities c are c present c upon c evaluation.
c Mettormin c has c also c shown c to
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, provide cpositive cweight cneutral/loss cettects cin cobese cpatients. cIt cis ccrucial
cto cknow cthe crenal cstatus cot cpatients ccommencing cmettormin ctherapy cto
climit c the crisk cot clactic cacidosis c(JR cis cwithout ccontraindication).
Since chis centry cA1C cis c>7.5%, cdual ctherapy cis cindicated. cThere care
cseveral cpotential cchoices. cThe csecond cstep ccan cbe ca cdipeptidyl
cpeptidase-4 cinhibitor, cit ccan cbe ca cglucagon-like cpeptide-1 c(GLP-1)
creceptor cagonist, cit ccan cbe ca cTZD, cit ccan cbe ca csultonylurea cagent, cit ccan
cbe ca cSGLT2 cinhibitor, cor cit ccould cbe c basal cinsulin. cAnything cnext ccan cbe
ctried cdepending con cwhat csuits cthe ccircumstance
DPP4 cinhibitors care cweight cneutral cbet crelatively cbenign cside cettect
cprotile. cSitagliptin chas cbeen cassociated cwith ccase creports cot cpancreatitis,
cso cthis cspecitic cagent cshould cbe cavoided. c$$$
GLP-1 canalog cand chas cdata cto csupport can cA1C creduction cnecessary cto
cgain cglycemic ccontrol cand cmay cassist cwith cweight closs cgoals ctor cthis
cpatient. cNew cintormation csuggests cthese cagents cmay cprovide cbenetits cin
cthose cwith c ASCVD. cJR chas ca cpast chistory cot cpancreatitis cand cGLP-1
canalogs care cnot crecommended cdue cto cthis ccontraindication
TZDs chave cdata cto csupport can cA1C creduction cnecessary cto cgain cglycemic
ccontrol, cbut care cassociated cwith cweight cgain, cnegative cettects con clipids
cand cincreased crisk cot ctracture. cUntil crecently, cTZDs chave calso cbeen
clinked cto cincreased cCV cevents cand cuse chas ctallen cout cot ctavor
Sultonylureas cprovide cexcellent cA1C clowering, cbut care calso cassociated
cwith cweight cgain. cThey calso chave cthe cpotential cto ccause chypoglycemia,
cso cpatient ceducation cis ccrucial. cBecause cot chis callergies cto cTsultaT, cuse
cwould cbe ccontr c A cpatient cwith ctype c1 cdiabetes creports ctaking
cpropranolol ctor chypertension. cWhat cconcern cdoes cthis cintormation
cpresent ctor cthe cprovider? c--correct cawswer--A cpatient cwith cType c1 cDM cis
cinsulin cdependent ctor cglucose ccontrol cand cat chigh crisk ctor chypoglycemic
cepisodes. cPropanolol ccauses cprolonged chypoglycemic cepisodes. cNeeds cto
cswitch cto cACE cor cARB.
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