NSG 533 Advanced Pharmacology Exam| Complete Review
Questions and Verified Answers
Answer Exenatide - Exenatide (Bydureon) once weekly has been able to
100% Correct | Grade A+
demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials;
however it is contraindicated for EP due to the self-reported history of thyroid
cancer.
1. EP is a 38-year-old female patient that comes in for diabetes education and Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hy-
management. She was diagnosed 12 years ago and states lately she is not able to perkalemia which could be made worse by this drug.The package insert does not indicate
control her diet although she continues a 1600 calorie diet with appropriatedaily a specific potassium concentration cut off to no longer use this medication; however, there
carbohydrateintake(perdietitianprescription)andwalks40 minutes every day of are better choices in this patient.
the week. She states compliance with all medications. She denies any history of Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
hypoglycemia despite being able to identify signs and symptoms and describe clinical trials and currently the patient does not have any cautionary objectivemeasures
appropriate treatment strategies. to not use this medication.DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be
PMHT2DM,HTN,obesity,depression,s/pthyroidectomydueto thyroidcancer used in patients taking sulfonylureas; however, it may be recommended to reduce or
FmHx Noncontributory stop the sulfonylurea dose.
SHx ( ) Smoking, alcohol use, past marijuana use while in high school Acarbose - Acarbose (Precose) is not recommended for initial management and is
MedicationsMetformin 850 mg tid, glipizide 20 mg bid,lisinopril 20 mg daily, associated with significant GI side effects. More information would be needed
sertraline 100 mg daily, multivitamin daily regarding fasting and post-prandial numbers. In addition, adding acarbose would
Vitals BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2 only lower A1c by 0.8% at best and therefore would not achieve the desired A1C goal
Laboratory test results Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN- of <7%
,2. JRis a 68-year-old African American manwith a new diagnosis ofT2DM.He was
Family historyType 2 diabetes
classified as having prediabetes (at risk for developing diabetes) 5 years before
MedicationHCTZ 25 mg daily,simvastatin 10 mg daily Allergies
the diagnosis and has a strong family history of type 2 diabetes. JR's blood
SMZ/TMP
pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%,
VitalsBP150/92mmHgP78 beats/min RR12 rpmWaist Circumference46 in
normalcholesterolpanel,and normal renal/hepatic functionwere noted with
Weight 267 lb Height 5 2 6 3 BMI 43.1 kg/m 2
today's laboratory test results.
PastmedicalhistoryHypertension(diagnosed4yago)Hyperlipidemia (diag-
Despite improvements in the past six weeks due to lifestyle changes and
nosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
exercise, drug therapy is to be started for JR's diabet
Answer Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no contraindications or
intolerabilities are present upon
evaluation.Metforminhas also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin
therapy to limit the risk of lactic acidosis (JR is without contraindication). Since his entry
A1C is >7.5%, dual therapy is indicated.There are several potential choices.The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
1) receptor agonist, it can be a TZD, it can be a sulfonylureaagent, it can be a SGLT2
inhibitor, or it could be basal insulin.Anything next can be tried depending on what suits
the circumstance
,DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has
4. A provider teaches a patientwho has been diagnosed with hypothyroidism
been associated with case reports of pancreatitis, so this specific agent should be
about a new prescription for levothyroxine.Which statement by the patient
avoided. $$$
indicates a need for further teaching?
GLP-1analogandhasdatatosupportanA1Creduction necessarytogainglycemic
a. "I should not take heartburn medication without consulting my provider
control and may assist with weight loss goals for this patient.New information sug- gests
first."
theseagentsmayprovidebenefitsinthose withASCVD.JRhas apasthistory of
b. "I should report insomnia,tremors, and an increased heart rate to my
pancreatitisandGLP-1analogsarenotrecommendedduetothiscontraindication TZDs
provider."
have data to support an A1C reduction necessary to gain glycemic control, but are
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothy-
associated with weight gain, negative effects on lipids and increased risk of fracture.
roxine."
Untilrecently,TZDshavealso been linked toincreasedCVevents anduse has fallen out
d. "If I take calcium supplements,I may need to decrease my dose of levothy-
of favor
roxine."
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain.
Answer D. Calcium may reduce levothyroxine absorption. Further education is
They also have the potential to cause hypoglycemia, so patient education is crucial.
needed if the patient feels she can take half of a prescribed medication.
Because of his allergies to "sulfa", use would be contr
5. MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large
3. A patient with type 1 diabetes reports taking propranolol for hypertension.
meal and alcohol he experiences significant GI distress. He takes an OTC
What concern does this information present for the provider?
heartburn remedy.Within a minute or two he develops what he will later describe
Answer A patient with Type1DMisinsulindependentforglucosecontrolandathighrisk
as "belching,nauseaanda badbloatedfeeling".Several of theulcers began to
forhypoglycemic episodes.Propanololcauses prolonged hypoglycemicepisodes.
bleed and he becomes profoundly hypotensive from the blood loss and is taken
Needs to switch to ACE or ARB.
to the ED.Endoscopy confirms multiple bleeds;the endoscopist remarks that it
, appears as if the lesions had been literally stretched apart causing additional effects of all his other medications and plasma levels of those medications
tissue damage.What did the patient most likely take (i.e. what was the OTC elevated.What was most likely the medication he took?
remedy)? Answer Cimetidine
AnswerI would accept Alka-Selzer.I contains NaHCO3 (as well as ASA). In the 8. What lifestyle modifications should be recommended?
presence of HCL it Liberates CO2, that can cause gastric distention, belching and Answer -losing weight if over- weight
nausea.The reaction is fairly swift allowing little time for dissipation.Tums,itsprimary
ingredientcalciumcarbonate which whentakencause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating and the stomach to
stretch to tear the ulcers open.
6. On yourwayto this examination,you experience the vulnerable feeling that
an attack of acute diarrhea is imminent! If you stop at a drug store, which anti-
diarrheal drugs could you buy without a prescription even though it is
chemically related to the strong opioid analgesic meperidine (but acts only on
the peripheral opioid receptor)?
Answer Loperamide
7. JA has multiple medical problems and is taking several drugs including
theophylline,warfarinandphenytoin.His conditionswerewell controlled,but
recently he started to experience some GI distress for which of his "well
intentionedfriends" gave him some medication.He presentsto youwithtoxic
Questions and Verified Answers
Answer Exenatide - Exenatide (Bydureon) once weekly has been able to
100% Correct | Grade A+
demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in clinical trials;
however it is contraindicated for EP due to the self-reported history of thyroid
cancer.
1. EP is a 38-year-old female patient that comes in for diabetes education and Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hy-
management. She was diagnosed 12 years ago and states lately she is not able to perkalemia which could be made worse by this drug.The package insert does not indicate
control her diet although she continues a 1600 calorie diet with appropriatedaily a specific potassium concentration cut off to no longer use this medication; however, there
carbohydrateintake(perdietitianprescription)andwalks40 minutes every day of are better choices in this patient.
the week. She states compliance with all medications. She denies any history of Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on
hypoglycemia despite being able to identify signs and symptoms and describe clinical trials and currently the patient does not have any cautionary objectivemeasures
appropriate treatment strategies. to not use this medication.DPP-IV inhibitors are weight neutral. DPP-IV inhibitors can be
PMHT2DM,HTN,obesity,depression,s/pthyroidectomydueto thyroidcancer used in patients taking sulfonylureas; however, it may be recommended to reduce or
FmHx Noncontributory stop the sulfonylurea dose.
SHx ( ) Smoking, alcohol use, past marijuana use while in high school Acarbose - Acarbose (Precose) is not recommended for initial management and is
MedicationsMetformin 850 mg tid, glipizide 20 mg bid,lisinopril 20 mg daily, associated with significant GI side effects. More information would be needed
sertraline 100 mg daily, multivitamin daily regarding fasting and post-prandial numbers. In addition, adding acarbose would
Vitals BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2 only lower A1c by 0.8% at best and therefore would not achieve the desired A1C goal
Laboratory test results Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN- of <7%
,2. JRis a 68-year-old African American manwith a new diagnosis ofT2DM.He was
Family historyType 2 diabetes
classified as having prediabetes (at risk for developing diabetes) 5 years before
MedicationHCTZ 25 mg daily,simvastatin 10 mg daily Allergies
the diagnosis and has a strong family history of type 2 diabetes. JR's blood
SMZ/TMP
pressure was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%,
VitalsBP150/92mmHgP78 beats/min RR12 rpmWaist Circumference46 in
normalcholesterolpanel,and normal renal/hepatic functionwere noted with
Weight 267 lb Height 5 2 6 3 BMI 43.1 kg/m 2
today's laboratory test results.
PastmedicalhistoryHypertension(diagnosed4yago)Hyperlipidemia (diag-
Despite improvements in the past six weeks due to lifestyle changes and
nosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
exercise, drug therapy is to be started for JR's diabet
Answer Metformin is the drug of choice recommended for most patients with
diabetes in addition to lifestyle modifications assuming no contraindications or
intolerabilities are present upon
evaluation.Metforminhas also shown to provide positive weight neutral/loss effects in
obese patients. It is crucial to know the renal status of patients commencing metformin
therapy to limit the risk of lactic acidosis (JR is without contraindication). Since his entry
A1C is >7.5%, dual therapy is indicated.There are several potential choices.The second
step can be a dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
1) receptor agonist, it can be a TZD, it can be a sulfonylureaagent, it can be a SGLT2
inhibitor, or it could be basal insulin.Anything next can be tried depending on what suits
the circumstance
,DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has
4. A provider teaches a patientwho has been diagnosed with hypothyroidism
been associated with case reports of pancreatitis, so this specific agent should be
about a new prescription for levothyroxine.Which statement by the patient
avoided. $$$
indicates a need for further teaching?
GLP-1analogandhasdatatosupportanA1Creduction necessarytogainglycemic
a. "I should not take heartburn medication without consulting my provider
control and may assist with weight loss goals for this patient.New information sug- gests
first."
theseagentsmayprovidebenefitsinthose withASCVD.JRhas apasthistory of
b. "I should report insomnia,tremors, and an increased heart rate to my
pancreatitisandGLP-1analogsarenotrecommendedduetothiscontraindication TZDs
provider."
have data to support an A1C reduction necessary to gain glycemic control, but are
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothy-
associated with weight gain, negative effects on lipids and increased risk of fracture.
roxine."
Untilrecently,TZDshavealso been linked toincreasedCVevents anduse has fallen out
d. "If I take calcium supplements,I may need to decrease my dose of levothy-
of favor
roxine."
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain.
Answer D. Calcium may reduce levothyroxine absorption. Further education is
They also have the potential to cause hypoglycemia, so patient education is crucial.
needed if the patient feels she can take half of a prescribed medication.
Because of his allergies to "sulfa", use would be contr
5. MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large
3. A patient with type 1 diabetes reports taking propranolol for hypertension.
meal and alcohol he experiences significant GI distress. He takes an OTC
What concern does this information present for the provider?
heartburn remedy.Within a minute or two he develops what he will later describe
Answer A patient with Type1DMisinsulindependentforglucosecontrolandathighrisk
as "belching,nauseaanda badbloatedfeeling".Several of theulcers began to
forhypoglycemic episodes.Propanololcauses prolonged hypoglycemicepisodes.
bleed and he becomes profoundly hypotensive from the blood loss and is taken
Needs to switch to ACE or ARB.
to the ED.Endoscopy confirms multiple bleeds;the endoscopist remarks that it
, appears as if the lesions had been literally stretched apart causing additional effects of all his other medications and plasma levels of those medications
tissue damage.What did the patient most likely take (i.e. what was the OTC elevated.What was most likely the medication he took?
remedy)? Answer Cimetidine
AnswerI would accept Alka-Selzer.I contains NaHCO3 (as well as ASA). In the 8. What lifestyle modifications should be recommended?
presence of HCL it Liberates CO2, that can cause gastric distention, belching and Answer -losing weight if over- weight
nausea.The reaction is fairly swift allowing little time for dissipation.Tums,itsprimary
ingredientcalciumcarbonate which whentakencause a reaction with the stomach acid
such as production of carbon dioxide gas which can cause bloating and the stomach to
stretch to tear the ulcers open.
6. On yourwayto this examination,you experience the vulnerable feeling that
an attack of acute diarrhea is imminent! If you stop at a drug store, which anti-
diarrheal drugs could you buy without a prescription even though it is
chemically related to the strong opioid analgesic meperidine (but acts only on
the peripheral opioid receptor)?
Answer Loperamide
7. JA has multiple medical problems and is taking several drugs including
theophylline,warfarinandphenytoin.His conditionswerewell controlled,but
recently he started to experience some GI distress for which of his "well
intentionedfriends" gave him some medication.He presentsto youwithtoxic
