x
x
x
x
x
x
x
x
Advanced Pharmacology NSG 533
x x x
x
questions and answers latest top score.
x x x x x
x
x
x
x
x
x
x
x
EP xis xa x38-year-old xfemale xpatient xthat xcomes xin xfor xdiabetes xeducation xand
xmanagement. xShe xwas xdiagnosed x12 xyears xago xand xstates xlately xshe xis xnot xable xto
xcontrol xher xdiet xalthough xshe xcontinues xa x1600 xcalorie xdiet xwith xappropriate xdaily
xcarbohydrate xintake x(per xdietitian xprescription) xand xwalks x40 xminutes xevery xday xof
xthe xweek. xShe xstates xcompliance xwith xall xmedications. xShe xdenies xany xhistory xof
xhypoglycemia xdespite xbeing xable xto xidentify xsigns xand xsymptoms xand xdescribe
xappropriate xtreatment xstrategies. x
PMH: xT2DM, xHTN, xobesity, xdepression, xs/p xthyroidectomy xdue xto xthyroid xcancer x
FmHx: xNoncontributory x
SHx: x(−) xSmoking, xalcohol xuse, xpast xmarijuana xuse xwhile xin xhigh xschool x
Medications: xMetformin x850 xmg xtid, xglipizide x20 xmg xbid, xlisinopril x20 xmg xdaily,
xsertraline x
100 xmg xdaily, xmultivitamin xdaily x
Vitals: xBP x128/82 xmg xHg; xP x72 xbeats/min; xBMI x31 xm/kg2 x
Laboratory xtest xresults: xNa x134 xmEq/L, xK x5.4 xmEq/L, xCl x106 xmEq/L, xBU x- x xcorrect
xanswer. x xExenatide x- xExenatide x(Bydureon) xonce xweekly xhas xbeen xable xto
xdemonstrate xweight xloss xand xdecrease xA1C% xby x0.7% xto x1.2% xin xclinical xtrials;
xhowever xit xis xcontraindicated xfor xEP xdue xto xthe xself-reported xhistory xof xthyroid
xcancer. xDapagliflozin x- xDapagliflozin x(Farxiga) xis xcontraindicated xin xthis xpatient xdue
xto xhyperkalemia xwhich xcould xbe xmade xworse xby xthis xdrug. xThe xpackage xinsert
xdoes xnot xindicate xa xspecific xpotassium xconcentration xcut xoff xto xno xlonger xuse xthis
xmedication; xhowever, xthere xare xbetter xchoices xin xthis xpatient. x
Sitagliptin x- xSitagliptin x(Januvia) xis xable xto xobtain xan xA1C xgoal xof xless xthan x7%
xbased xon xclinical xtrials xand xcurrently xthe xpatient xdoes xnot xhave xany xcautionary
xobjective xmeasures xto xnot xuse xthis xmedication. xDPP-IV xinhibitors xare xweight xneutral.
xDPP-IV xinhibitors xcan xbe xused xin xpatients xtaking xsulfonylureas; xhowever, xit xmay xbe
xrecommended xto xreduce xor xstop xthe xsulfonylurea xdose. x
Acarbose x- xAcarbose x(Precose) xis xnot xrecommended xfor xinitial xmanagement xand xis
xassociated xwith xsignificant xGI xside xeffects. xMore xinformation xwould xbe xneeded
xregarding xfasting xand xpost-prandial xnumbers. xIn xaddition, xadding xacarbose xwould
xonly xlower xA1c xby x0.8% xat xbest xand xtherefore xwould xnot xachieve xthe xdesired xA1C
xgoal xof x<7% x
x
,JR xis xa x68-year-old xAfrican xAmerican xman xwith xa xnew xdiagnosis xof xT2DM. xHe xwas
xclassified xas xhaving xprediabetes x(at xrisk xfor xdeveloping xdiabetes) x5 xyears xbefore xthe
xdiagnosis xand xhas xa xstrong xfamily xhistory xof xtype x2 xdiabetes. xJR's xblood xpressure
xwas x150/92 xmm xHg. xHis xlaboratory xresults xrevealed xan xA1C xof x8.1%, xnormal
xcholesterol xpanel, xand xnormal xrenal/hepatic xfunction xwere xnoted xwith xtoday's
xlaboratory xtest xresults. xPast xmedical xhistory: xHypertension x(diagnosed x4 xy xago)
xHyperlipidemia x(diagnosed x2 xy xago) xPancreatitis x(idiopathic) x(acute xhospitalization x3
xy xago) x
Family xhistory: xType x2 xdiabetes x
Medication: xHCTZ x25 xmg xdaily, xsimvastatin x10 xmg xdaily x
Allergies: xSMZ/TMP x
Vitals: xBP: x150/92 xmm xHg xP: x78 xbeats/min xRR: x12 xrpm xWaist xCircumference: x46 xin
xWeight: x267 xlb xHeight: x5 x′ x6 x″ xBMI: x43.1 xkg/m x2 x
x
x
Despite ximprovements xin xthe xpast xsix xweeks xdue xto xlifestyle xchanges xand xexercise,
xdrug xtherapy xis xto xbe xstarted xfor xJR's xdi x- x xcorrect xanswer. x xMetformin xis xthe xdrug
xof xchoice xrecommended xfor xmost xpatients xwith xdiabetes xin xaddition xto xlifestyle
xmodifications xassuming xno xcontraindications xor xintolerabilities xare xpresent xupon
xevaluation. xMetformin xhas xalso xshown xto xprovide xpositive xweight xneutral/loss xeffects
xin xobese xpatients. xIt xis xcrucial xto xknow xthe xrenal xstatus xof xpatients xcommencing
xmetformin xtherapy xto xlimit xthe xrisk xof xlactic xacidosis x(JR xis xwithout xcontraindication).
x
Since xhis xentry xA1C xis x>7.5%, xdual xtherapy xis xindicated. xThere xare xseveral xpotential
xchoices. xThe xsecond xstep xcan xbe xa xdipeptidyl xpeptidase-4 xinhibitor, xit xcan xbe xa
xglucagon-like xpeptide-1 x(GLP-1) xreceptor xagonist, xit xcan xbe xa xTZD, xit xcan xbe xa
xsulfonylurea xagent, xit xcan xbe xa xSGLT2 xinhibitor, xor xit xcould xbe xbasal xinsulin.
xAnything xnext xcan xbe xtried xdepending xon xwhat xsuits xthe xcircumstance x
DPP4 xinhibitors xare xweight xneutral xbet xrelatively xbenign xside xeffect xprofile. xSitagliptin
xhas xbeen xassociated xwith xcase xreports xof xpancreatitis, xso xthis xspecific xagent xshould
xbe xavoided. x$$$ x
GLP-1 xanalog xand xhas xdata xto xsupport xan xA1C xreduction xnecessary xto xgain
xglycemic xcontrol xand xmay xassist xwith xweight xloss xgoals xfor xthis xpatient. xNew
xinformation xsuggests xthese xagents xmay xprovide xbenefits xin xthose xwith xASCVD. xJR
xhas xa xpast xhistory xof xpancreatitis xand xGLP-1 xanalogs xare xnot xrecommended xdue xto
xthis xcontraindication xTZDs xhave xdata xto xsupport xan xA1C xreduction xnecessary xto
xgain xglycemic xcontrol, xbut xare xassociated xwith xweight xgain, xnegative xeffects xon
xlipids xand xincreased xrisk xof xfracture. xUntil xrecently, xTZDs xhave xalso xbeen xlinked xto
xincreased xCV xevents xand xuse xhas xfallen xout xof xfavor x
Sulfonylureas xprovide xexcellent xA1C xlowering, xbut xare xalso xassociated xwith xweight
xgain. x
They xalso xhave xthe xpotential xto xcause xhypoglycemia, xso xpatient xeducation xis xcrucial.
xBecause xof xhis xallergies xto x"sulfa", xuse xwould xbe xcontr x
x
A xpatient xwith xtype x1 xdiabetes xreports xtaking xpropranolol xfor xhypertension. xWhat
xconcern xdoes xthis xinformation xpresent xfor xthe xprovider? x- x xcorrect xanswer. x xA
, xpatient xwith xType x1 xDM xis xinsulin xdependent xfor xglucose xcontrol xand xat xhigh xrisk xfor
xhypoglycemic xepisodes. xPropanolol xcauses xprolonged xhypoglycemic xepisodes.
xNeeds xto xswitch xto xACE xor xARB. x
x
A xprovider xteaches xa xpatient xwho xhas xbeen xdiagnosed xwith xhypothyroidism xabout xa
xnew xprescription xfor xlevothyroxine. xWhich xstatement xby xthe xpatient xindicates xa xneed
xfor xfurther xteaching? x
a. "I xshould xnot xtake xheartburn xmedication xwithout xconsulting xmy xprovider xfirst." x
b. "I xshould xreport xinsomnia, xtremors, xand xan xincreased xheart xrate xto xmy xprovider." x
c. "If xI xtake xa xmultivitamin xwith xiron, xI xshould xtake xit x4 xhours xafter xthe xlevothyroxine."
x
d. "If xI xtake xcalcium xsupplements, xI xmay xneed xto xdecrease xmy xdose xof
xlevothyroxine." x- x xcorrect xanswer. x xD. xCalcium xmay xreduce xlevothyroxine
xabsorption. xFurther xeducation xis xneeded xif xthe xpatient xfeels xshe xcan xtake xhalf xof
xa xprescribed xmedication. x
x
MC xhas xundiagnosed xmultiple xgastric xulcers. xShortly xafter xconsuming xa xlarge xmeal
xand xalcohol xhe xexperiences xsignificant xGI xdistress. xHe xtakes xan xOTC xheartburn
xremedy. xWithin xa xminute xor xtwo xhe xdevelops xwhat xhe xwill xlater xdescribe xas
x"belching, xnausea xand xa xbad xbloated xfeeling". xSeveral xof xthe xulcers xbegan xto xbleed
xand xhe xbecomes xprofoundly xhypotensive xfrom xthe xblood xloss xand xis xtaken xto xthe
xED. xEndoscopy xconfirms xmultiple xbleeds; xthe xendoscopist xremarks xthat xit xappears
xas xif xthe xlesions xhad xbeen xliterally xstretched xapart xcausing xadditional xtissue
xdamage. xWhat xdid xthe xpatient xmost xlikely xtake x(i.e. xwhat xwas xthe xOTC xremedy)? x- x
xcorrect xanswer. x xI xwould xaccept xAlka-Selzer. xI xcontains xNaHCO3 x(as xwell xas xASA).
xIn xthe xpresence xof xHCL xit xLiberates xCO2, xthat xcan xcause xgastric xdistention,
xbelching xand xnausea. xThe xreaction xis xfairly xswift xallowing xlittle xtime xfor xdissipation.
xTums, xits xprimary xingredient xcalcium xcarbonate xwhich xwhen xtaken xcause xa xreaction
xwith xthe xstomach xacid xsuch xas xproduction xof xcarbon xdioxide xgas xwhich xcan xcause
xbloating xand xthe xstomach xto xstretch xto xtear xthe xulcers xopen. x
x
On xyour xway xto xthis xexamination, xyou xexperience xthe xvulnerable xfeeling xthat xan xattack
xof xacute xdiarrhea xis ximminent! xIf xyou xstop xat xa xdrug xstore, xwhich xanti-diarrheal xdrugs
xcould xyou xbuy xwithout xa xprescription xeven xthough xit xis xchemically xrelated xto xthe
xstrong xopioid xanalgesic xmeperidine x(but xacts xonly xon xthe xperipheral xopioid xreceptor)?
x- x xcorrect xanswer. x xLoperamide x
x
JA xhas xmultiple xmedical xproblems xand xis xtaking xseveral xdrugs xincluding xtheophylline,
xwarfarin xand xphenytoin. xHis xconditions xwere xwell xcontrolled, xbut xrecently xhe xstarted
xto xexperience xsome xGI xdistress xfor xwhich xof xhis x"well xintentioned xfriends" xgave xhim
xsome xmedication. xHe xpresents xto xyou xwith xtoxic xeffects xof xall xhis xother xmedications
xand xplasma xlevels xof xthose xmedications xelevated. xWhat xwas xmost xlikely xthe
xmedication xhe xtook? x- x xcorrect xanswer. x xCimetidine x
x
What xlifestyle xmodifications xshould xbe xrecommended? x- x x correct xanswer. x x -losing
xweight x
x
x
x
x
x
x
x
Advanced Pharmacology NSG 533
x x x
x
questions and answers latest top score.
x x x x x
x
x
x
x
x
x
x
x
EP xis xa x38-year-old xfemale xpatient xthat xcomes xin xfor xdiabetes xeducation xand
xmanagement. xShe xwas xdiagnosed x12 xyears xago xand xstates xlately xshe xis xnot xable xto
xcontrol xher xdiet xalthough xshe xcontinues xa x1600 xcalorie xdiet xwith xappropriate xdaily
xcarbohydrate xintake x(per xdietitian xprescription) xand xwalks x40 xminutes xevery xday xof
xthe xweek. xShe xstates xcompliance xwith xall xmedications. xShe xdenies xany xhistory xof
xhypoglycemia xdespite xbeing xable xto xidentify xsigns xand xsymptoms xand xdescribe
xappropriate xtreatment xstrategies. x
PMH: xT2DM, xHTN, xobesity, xdepression, xs/p xthyroidectomy xdue xto xthyroid xcancer x
FmHx: xNoncontributory x
SHx: x(−) xSmoking, xalcohol xuse, xpast xmarijuana xuse xwhile xin xhigh xschool x
Medications: xMetformin x850 xmg xtid, xglipizide x20 xmg xbid, xlisinopril x20 xmg xdaily,
xsertraline x
100 xmg xdaily, xmultivitamin xdaily x
Vitals: xBP x128/82 xmg xHg; xP x72 xbeats/min; xBMI x31 xm/kg2 x
Laboratory xtest xresults: xNa x134 xmEq/L, xK x5.4 xmEq/L, xCl x106 xmEq/L, xBU x- x xcorrect
xanswer. x xExenatide x- xExenatide x(Bydureon) xonce xweekly xhas xbeen xable xto
xdemonstrate xweight xloss xand xdecrease xA1C% xby x0.7% xto x1.2% xin xclinical xtrials;
xhowever xit xis xcontraindicated xfor xEP xdue xto xthe xself-reported xhistory xof xthyroid
xcancer. xDapagliflozin x- xDapagliflozin x(Farxiga) xis xcontraindicated xin xthis xpatient xdue
xto xhyperkalemia xwhich xcould xbe xmade xworse xby xthis xdrug. xThe xpackage xinsert
xdoes xnot xindicate xa xspecific xpotassium xconcentration xcut xoff xto xno xlonger xuse xthis
xmedication; xhowever, xthere xare xbetter xchoices xin xthis xpatient. x
Sitagliptin x- xSitagliptin x(Januvia) xis xable xto xobtain xan xA1C xgoal xof xless xthan x7%
xbased xon xclinical xtrials xand xcurrently xthe xpatient xdoes xnot xhave xany xcautionary
xobjective xmeasures xto xnot xuse xthis xmedication. xDPP-IV xinhibitors xare xweight xneutral.
xDPP-IV xinhibitors xcan xbe xused xin xpatients xtaking xsulfonylureas; xhowever, xit xmay xbe
xrecommended xto xreduce xor xstop xthe xsulfonylurea xdose. x
Acarbose x- xAcarbose x(Precose) xis xnot xrecommended xfor xinitial xmanagement xand xis
xassociated xwith xsignificant xGI xside xeffects. xMore xinformation xwould xbe xneeded
xregarding xfasting xand xpost-prandial xnumbers. xIn xaddition, xadding xacarbose xwould
xonly xlower xA1c xby x0.8% xat xbest xand xtherefore xwould xnot xachieve xthe xdesired xA1C
xgoal xof x<7% x
x
,JR xis xa x68-year-old xAfrican xAmerican xman xwith xa xnew xdiagnosis xof xT2DM. xHe xwas
xclassified xas xhaving xprediabetes x(at xrisk xfor xdeveloping xdiabetes) x5 xyears xbefore xthe
xdiagnosis xand xhas xa xstrong xfamily xhistory xof xtype x2 xdiabetes. xJR's xblood xpressure
xwas x150/92 xmm xHg. xHis xlaboratory xresults xrevealed xan xA1C xof x8.1%, xnormal
xcholesterol xpanel, xand xnormal xrenal/hepatic xfunction xwere xnoted xwith xtoday's
xlaboratory xtest xresults. xPast xmedical xhistory: xHypertension x(diagnosed x4 xy xago)
xHyperlipidemia x(diagnosed x2 xy xago) xPancreatitis x(idiopathic) x(acute xhospitalization x3
xy xago) x
Family xhistory: xType x2 xdiabetes x
Medication: xHCTZ x25 xmg xdaily, xsimvastatin x10 xmg xdaily x
Allergies: xSMZ/TMP x
Vitals: xBP: x150/92 xmm xHg xP: x78 xbeats/min xRR: x12 xrpm xWaist xCircumference: x46 xin
xWeight: x267 xlb xHeight: x5 x′ x6 x″ xBMI: x43.1 xkg/m x2 x
x
x
Despite ximprovements xin xthe xpast xsix xweeks xdue xto xlifestyle xchanges xand xexercise,
xdrug xtherapy xis xto xbe xstarted xfor xJR's xdi x- x xcorrect xanswer. x xMetformin xis xthe xdrug
xof xchoice xrecommended xfor xmost xpatients xwith xdiabetes xin xaddition xto xlifestyle
xmodifications xassuming xno xcontraindications xor xintolerabilities xare xpresent xupon
xevaluation. xMetformin xhas xalso xshown xto xprovide xpositive xweight xneutral/loss xeffects
xin xobese xpatients. xIt xis xcrucial xto xknow xthe xrenal xstatus xof xpatients xcommencing
xmetformin xtherapy xto xlimit xthe xrisk xof xlactic xacidosis x(JR xis xwithout xcontraindication).
x
Since xhis xentry xA1C xis x>7.5%, xdual xtherapy xis xindicated. xThere xare xseveral xpotential
xchoices. xThe xsecond xstep xcan xbe xa xdipeptidyl xpeptidase-4 xinhibitor, xit xcan xbe xa
xglucagon-like xpeptide-1 x(GLP-1) xreceptor xagonist, xit xcan xbe xa xTZD, xit xcan xbe xa
xsulfonylurea xagent, xit xcan xbe xa xSGLT2 xinhibitor, xor xit xcould xbe xbasal xinsulin.
xAnything xnext xcan xbe xtried xdepending xon xwhat xsuits xthe xcircumstance x
DPP4 xinhibitors xare xweight xneutral xbet xrelatively xbenign xside xeffect xprofile. xSitagliptin
xhas xbeen xassociated xwith xcase xreports xof xpancreatitis, xso xthis xspecific xagent xshould
xbe xavoided. x$$$ x
GLP-1 xanalog xand xhas xdata xto xsupport xan xA1C xreduction xnecessary xto xgain
xglycemic xcontrol xand xmay xassist xwith xweight xloss xgoals xfor xthis xpatient. xNew
xinformation xsuggests xthese xagents xmay xprovide xbenefits xin xthose xwith xASCVD. xJR
xhas xa xpast xhistory xof xpancreatitis xand xGLP-1 xanalogs xare xnot xrecommended xdue xto
xthis xcontraindication xTZDs xhave xdata xto xsupport xan xA1C xreduction xnecessary xto
xgain xglycemic xcontrol, xbut xare xassociated xwith xweight xgain, xnegative xeffects xon
xlipids xand xincreased xrisk xof xfracture. xUntil xrecently, xTZDs xhave xalso xbeen xlinked xto
xincreased xCV xevents xand xuse xhas xfallen xout xof xfavor x
Sulfonylureas xprovide xexcellent xA1C xlowering, xbut xare xalso xassociated xwith xweight
xgain. x
They xalso xhave xthe xpotential xto xcause xhypoglycemia, xso xpatient xeducation xis xcrucial.
xBecause xof xhis xallergies xto x"sulfa", xuse xwould xbe xcontr x
x
A xpatient xwith xtype x1 xdiabetes xreports xtaking xpropranolol xfor xhypertension. xWhat
xconcern xdoes xthis xinformation xpresent xfor xthe xprovider? x- x xcorrect xanswer. x xA
, xpatient xwith xType x1 xDM xis xinsulin xdependent xfor xglucose xcontrol xand xat xhigh xrisk xfor
xhypoglycemic xepisodes. xPropanolol xcauses xprolonged xhypoglycemic xepisodes.
xNeeds xto xswitch xto xACE xor xARB. x
x
A xprovider xteaches xa xpatient xwho xhas xbeen xdiagnosed xwith xhypothyroidism xabout xa
xnew xprescription xfor xlevothyroxine. xWhich xstatement xby xthe xpatient xindicates xa xneed
xfor xfurther xteaching? x
a. "I xshould xnot xtake xheartburn xmedication xwithout xconsulting xmy xprovider xfirst." x
b. "I xshould xreport xinsomnia, xtremors, xand xan xincreased xheart xrate xto xmy xprovider." x
c. "If xI xtake xa xmultivitamin xwith xiron, xI xshould xtake xit x4 xhours xafter xthe xlevothyroxine."
x
d. "If xI xtake xcalcium xsupplements, xI xmay xneed xto xdecrease xmy xdose xof
xlevothyroxine." x- x xcorrect xanswer. x xD. xCalcium xmay xreduce xlevothyroxine
xabsorption. xFurther xeducation xis xneeded xif xthe xpatient xfeels xshe xcan xtake xhalf xof
xa xprescribed xmedication. x
x
MC xhas xundiagnosed xmultiple xgastric xulcers. xShortly xafter xconsuming xa xlarge xmeal
xand xalcohol xhe xexperiences xsignificant xGI xdistress. xHe xtakes xan xOTC xheartburn
xremedy. xWithin xa xminute xor xtwo xhe xdevelops xwhat xhe xwill xlater xdescribe xas
x"belching, xnausea xand xa xbad xbloated xfeeling". xSeveral xof xthe xulcers xbegan xto xbleed
xand xhe xbecomes xprofoundly xhypotensive xfrom xthe xblood xloss xand xis xtaken xto xthe
xED. xEndoscopy xconfirms xmultiple xbleeds; xthe xendoscopist xremarks xthat xit xappears
xas xif xthe xlesions xhad xbeen xliterally xstretched xapart xcausing xadditional xtissue
xdamage. xWhat xdid xthe xpatient xmost xlikely xtake x(i.e. xwhat xwas xthe xOTC xremedy)? x- x
xcorrect xanswer. x xI xwould xaccept xAlka-Selzer. xI xcontains xNaHCO3 x(as xwell xas xASA).
xIn xthe xpresence xof xHCL xit xLiberates xCO2, xthat xcan xcause xgastric xdistention,
xbelching xand xnausea. xThe xreaction xis xfairly xswift xallowing xlittle xtime xfor xdissipation.
xTums, xits xprimary xingredient xcalcium xcarbonate xwhich xwhen xtaken xcause xa xreaction
xwith xthe xstomach xacid xsuch xas xproduction xof xcarbon xdioxide xgas xwhich xcan xcause
xbloating xand xthe xstomach xto xstretch xto xtear xthe xulcers xopen. x
x
On xyour xway xto xthis xexamination, xyou xexperience xthe xvulnerable xfeeling xthat xan xattack
xof xacute xdiarrhea xis ximminent! xIf xyou xstop xat xa xdrug xstore, xwhich xanti-diarrheal xdrugs
xcould xyou xbuy xwithout xa xprescription xeven xthough xit xis xchemically xrelated xto xthe
xstrong xopioid xanalgesic xmeperidine x(but xacts xonly xon xthe xperipheral xopioid xreceptor)?
x- x xcorrect xanswer. x xLoperamide x
x
JA xhas xmultiple xmedical xproblems xand xis xtaking xseveral xdrugs xincluding xtheophylline,
xwarfarin xand xphenytoin. xHis xconditions xwere xwell xcontrolled, xbut xrecently xhe xstarted
xto xexperience xsome xGI xdistress xfor xwhich xof xhis x"well xintentioned xfriends" xgave xhim
xsome xmedication. xHe xpresents xto xyou xwith xtoxic xeffects xof xall xhis xother xmedications
xand xplasma xlevels xof xthose xmedications xelevated. xWhat xwas xmost xlikely xthe
xmedication xhe xtook? x- x xcorrect xanswer. x xCimetidine x
x
What xlifestyle xmodifications xshould xbe xrecommended? x- x x correct xanswer. x x -losing
xweight x
