NURS 615 Exam IV
How will you prescribe lipase, protease, and amylase components? - Answer-Patients with cystic fibrosis
are often prescribed enzyme replacement for pancreatic secretions each replacement drug has amylase,
lipase and protease components, however the drug is prescribed in units of lipase
What is the medication of choice for hypertensive crisis with pheochromocytoma? - Answer-Surgical
resection of the tumor is the first treatment of choice either my open laparotomy or laparoscopy either
surgical option requires prior treatment of nonspecific irreversible adrenergic adraonoreceptor blocker
phenoxybenzamine or a shorter acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly use
phenozibenamine in practice. Doing so promotes the surgery to proceed while minimizing the likelihood
of severe intraoperative hypertension which is likely when the tumor is manipulated.
What is the onset of action, peak of action, and duration of action of each insulin preparation? -
Answer-(Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
Peak 2-4 hrs
Duration 6-10 hrs
,(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - Answer-Hypoglycemia-
dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail polish remover or fruity breath. Also
abdominal pain, nausea, vomiting and sob.
When changing from NPH to glargine insulin, how will you adjust the patient's dose? - Answer-The
initial dose of glargine is reduced by 20% to prevent hypoglycemia.
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**
, 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.
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
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.
When should exenatide be administered? - Answer-60 minutes prior to the morning and evening meal
How will you assess for granulocytopenia? - Answer-Signs of a Cold or flu including fever and sore
throat
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.
What are the adverse effects of levothyroxine? - Answer-Tachycardia and angina in the elderly
A patient develops a toxic goiter. What is the recommended treatment? - Answer-Methimazole for one
month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? - Answer-PTU- Fatal agranulocytopenia look for
fever and sore throat and TEMPORARY ALOPECIA
How will you prescribe lipase, protease, and amylase components? - Answer-Patients with cystic fibrosis
are often prescribed enzyme replacement for pancreatic secretions each replacement drug has amylase,
lipase and protease components, however the drug is prescribed in units of lipase
What is the medication of choice for hypertensive crisis with pheochromocytoma? - Answer-Surgical
resection of the tumor is the first treatment of choice either my open laparotomy or laparoscopy either
surgical option requires prior treatment of nonspecific irreversible adrenergic adraonoreceptor blocker
phenoxybenzamine or a shorter acting alpha antagonists, prazosin, terazosin, and doxazosin. Mainly use
phenozibenamine in practice. Doing so promotes the surgery to proceed while minimizing the likelihood
of severe intraoperative hypertension which is likely when the tumor is manipulated.
What is the onset of action, peak of action, and duration of action of each insulin preparation? -
Answer-(Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
Peak 2-4 hrs
Duration 6-10 hrs
,(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - Answer-Hypoglycemia-
dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail polish remover or fruity breath. Also
abdominal pain, nausea, vomiting and sob.
When changing from NPH to glargine insulin, how will you adjust the patient's dose? - Answer-The
initial dose of glargine is reduced by 20% to prevent hypoglycemia.
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**
, 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.
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
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.
When should exenatide be administered? - Answer-60 minutes prior to the morning and evening meal
How will you assess for granulocytopenia? - Answer-Signs of a Cold or flu including fever and sore
throat
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.
What are the adverse effects of levothyroxine? - Answer-Tachycardia and angina in the elderly
A patient develops a toxic goiter. What is the recommended treatment? - Answer-Methimazole for one
month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? - Answer-PTU- Fatal agranulocytopenia look for
fever and sore throat and TEMPORARY ALOPECIA
