HSC 343 Clinical Pharmacology Final Exam (NEW) Questions with Accurate Answers

Insulin - ANSWERS-is necessary for glucose uptake into cells -All are clear except for NPH which is cloudy -Observe patient closely after it is administered -Protect vials from heat and cold. DO NOT SHAKE , roll between hands and invert end- to-end -20% - 80% of dosage may adhere to glass or plastic tubing and bottle. Albumin is added to prevent this adherence. -Important aspect of control is diet therapy -causes hypokalemia -Long-acting at night is first choice. -Short-term drugs at meal-time signs and symptoms of insulin overdose/ toxicity - ANSWERS-hypoglycemia (weakness, sweating, headache, ↑ HR, anxiety, tremor, mental/visual disturbances) -All due to release of epinephrine, and hypokalemia (it drives K+ from serum into cells) insulin overdose treatment - ANSWERS-Loss on consciousness/Convulsion use Glucagon -Patient should have CHO promptly if conscious e.g. orange juice, lump of sugar, candy -Use IV glucose if in hospital insulin glargine (Toujeo, Lantus) - ANSWERS-ultra-long acting -onset: 1 hour -duration: 24 hours -cannot be given IV -Long-acting. Used for adults and children with type 1 DM, or type 2 DM patients needing a long-acting one. Injected SC once daily at bedtime—or twice daily at same times each day. Beware of hypoglycemia! Do not give IV, do not mix with others. insulin lispro (Humalog) - ANSWERS-onset: 15-30 minutes -duration: 3-6 hours -can be given IV -rapid acting -Similar to aspart - for short-term glucose management. Usually used with a long-acting or intermediate-acting prep. •Knocks down post-prandial glucose •Taken within 10-20 min of a meal absorbance from different anatomical sites - ANSWERS-greatest from abdomenarmthighhip -recent study has concluded the difference in sites is negligible -The body takes up insulin differently depending on where it is injected. Insulin is taken up fastest when injected into the subcutaneous tissue in the abdomen (stomach), and somewhat less quickly in the upper arms, thighs, and buttocks/hips. -You can use the difference in rates to plan where you're going to inject your insulin. For example, rapid-onset insulin can be injected into your abdomen just before or right after you eat a meal to take advantage of the abdomen's fast rate. NPH insulin can be injected into a different site (arms, thighs, or buttocks), to take advantage of the slower rate while you sleep. -Exercise can also affect the rate. If the diabetic plans to play basketball after injecting, for example, choose a site other than the shooting/dribbling arm, since injecting there can increase the rate. (Note: If you prefer to inject near a part of your body that you'll be using when exercising, wait at least 45 minutes after injecting before starting activity.) mixing insulins - ANSWERS-draw up short-acting, then intermediate-acting, then long-acting In the patient who has received too much insulin, the nurse would expect to see... - ANSWERS•Signs and symptoms of insulin overdose -hypoglycemia (weakness, sweating, headache, ↑ HR, anxiety, tremor, mental/visual disturbances) -All due to release of epinephrine, and hypokalemia (it drives K+ from serum into cells) A patient is given a dose of insulin glargine. This drug should control blood glucose for? - ANSWERS24 hours A patient normally doses her insulin in her abdomen. Today in the ICU she got her injection in her arm. The onset of effect would be... - ANSWERSTake longer than if it was injected into her abdomen Metformin (Glucophage) - ANSWERS- Oral/ type 2 diabetics -MOA: Reduces GI absorbance of glucose and hepatic production of glucose -SE: GI upset, acidosis -Benefits: ↑ HDL, ↓ BP, weight loss -Contraindications: Don't use in patients with renal disease, liver disease, or patients who consume lots of alcohol -is considered the DOC. Unless a patient has liver disease or other Acarbose (Precose) - ANSWERS-Delay digestion and prolong absorption of CHO, decreasing PPH -These drugs do not cause postprandial hypoglycemia; flatulence and GI upset are ADR Tolbutamide - ANSWERS-older drug -stimulates insulin release from the pancreas Exenatide (Byetta) - ANSWERS-A glucagon-like-peptide that slows gastric emptying and suppresses appetite. -Used to treat type II DM -injectable, slows gastric emptying Hyperglycemic, hyperosmolar Nonketotic syndrome (HHNKS) - ANSWERS-seen more in Type 2 DM is treated the same way as DKA, but don't have to worry about acidosis here -Treatment • IV fluids and electrolytes • IV insulin—but slowly, to reduce BG levels slowly (initial bolus, then continuous infusion to maintain BG levels) • Bicarb for acidosis, potassium for hypokalemia A patient is taking Metformin for T2DM. At his check up today, the nurse notices which of the following? - ANSWERSdecreased LDLs This sulfonylurea is a PO medication often used by patient with T2DM - ANSWERSTolbutamide The patient prescribed Exenatide must know that the drug will be given by which route? - ANSWERSinjection Thyroid Disorders - ANSWERS-thyroid synthesizes and releases 2 hormones: T3 (Triidothyronine) and T4 (Thyroxine) -TH is the main controller of how fast we burn calories -Permissive with respect to catecholamines Levothyroxine (T4) Synthroid - ANSWERS-mimics thyroid hormone -MOA: Replacement -DOC for hypothyroidism, PO/IV. Life-long therapy Methimazole (Tapazole) - ANSWERSantithyroid/hyperthyroid -MOA: Blocks iodine Incorp. into thyroid hormones -Long-term use in absence of surgery or I131 -hyperthyroidism