NSG 533 Exam 3 Advanced Pharmacology |
(Latest 2025), Pass with Confidence, Exams
of Pharmacology WITH QUESTIONS AND
WELL VERIFIED ANSWERS 2025
EP is a 38-year-
c c c
old female patient that comes in for diabetes education and management. She
c c c c c c c c c c c c
was diagnosed 12 years ago and states lately she is not able to control her diet alt
c c c c c c c c c c c c c c c c
hough she continues a 1600 calorie diet with appropriate daily carbohydrate int
c c c c c c c c c c c
ake (per dietitian prescription) and walks 40 minutes every day of the week. Sh
c c c c c c c c c c c c c
e states compliance with all medications. She denies any history of hypoglycem
c c c c c c c c c c c
ia despite being able to identify signs and symptoms and describe appropriate t
c c c c c c c c c c c c
reatment strategies. c
,PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid canc
c c c c c c c c c c
er
FmHx: Noncontributory c
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
c c c c c c c c c c c
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
c c c c c c c c c c c c c
sertraline 100 mg daily, multivitamin daily c c c c c
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
c c c c c c c c c c
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN ......ans
c c c c c c c c c c c c cc
wer.....Exenatide - c
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss a
c c c c c c c c c c c c
nd decrease A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicate
c c c c c c c c c c c c c
d for EP due to the self-reported history of thyroid cancer.
c c c c c c c c c c
Dapagliflozin - c
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia
c c c c c c c c c c c
which could be made worse by this drug. The package insert does not indicate a
c c c c c c c c c c c c c c
c specific potassium concentration cut off to no longer use this medication; how
c c c c c c c c c c c
ever, there are better choices in this patient.
c c c c c c c
Sitagliptin - c
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinic
c c c c c c c c c c c c c c c c
al trials and currently the patient does not have any cautionary objective measu
c c c c c c c c c c c c
res to not use this medication. DPP-
c c c c c c
IV inhibitors are weight neutral. DPPIV inhibitors can be used in patients takin
c c c c c c c c c c c c
,g sulfonylureas; however, it may be re
c c c c c c
commended to reduce or stop the sulfonylurea dose. c c c c c c c
Acarbose - c
Acarbose (Precose) is not recommended for initial management and is associa
c c c c c c c c c c c
ted with significant GI side effects. More information would be needed regardi
c c c c c c c c c c c
ng fasting and post-
c c c
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% a
c c c c c c c c c c c c
t best and therefore would not achieve the desired A1C goal of <7%
c c c c c c c c c c c c
JR is a 68-year-
c c c
old African American man with a new diagnosis of T2DM. He was classified as
c c c c c c c c c c c c c c
having prediabetes (at risk for developing diabetes) 5 years before the diagnosi
c c c c c c c c c c c
s and has a strong family history of type 2 diabetes. JR's blood pressure was 150/
c c c c c c c c c c c c c c c
92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol p
c c c c c c c c c c c c c
anel, and normal renal/hepatic function were noted with today's laboratory tes
c c c c c c c c c c
t results.
c
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagn
c c c c c c c c c
osed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
c c c c c c c c c c
Family history: Type 2 diabetes c c c c
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily c c c c c c c c
Allergies: SMZ/TMP c
, Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 i
c c c c c c c c c c c c c c
n Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
c c c c c c c c c c c c
Despite improvements in the past six weeks due to lifestyle changes and exercis
c c c c c c c c c c c c
e, drug therapy is to be started for JR's diabet . -ANSWER-Metformin is the dr
c c c c c c c c c cc c c c
ug of choice recommended for most patients with diabetes in addition to lifest
c c c c c c c c c c c c
yle modifications assuming no contraindications or intolerabilities are present
c c c c c c c c c
upon evaluation. Metformin has also shown to provide positive weight neutral
c c c c c c c c c c
/loss effects in obese patients. It is crucial to know the renal status of patients c
c c c c c c c c c c c c c c c
ommencing metformin therapy to limit the risk of lactic acidosis (JR is without
c c c c c c c c c c c c c
contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potenti
c c c c c c c c c c c c c
al choices. The second step can be a dipeptidyl peptidase-
c c c c c c c c c
4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
c c c c c c c c
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SG
c c c c c c c c c c c c c c c c c c
LT2 inhibitor, or it could be basal insulin. Anything next can be tried dependin
c c c c c c c c c c c c c
g on what suits the circumstance
c c c c c
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sita
c c c c c c c c c c c
gliptin has been associated with case reports of pancreatitis, so this specific age
c c c c c c c c c c c c
nt should be avoided. $$$
c c c c
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic co
c c c c c c c c c c c c c c
ntrol and may assist with weight loss goals for this patient. New information su
c c c c c c c c c c c c c
(Latest 2025), Pass with Confidence, Exams
of Pharmacology WITH QUESTIONS AND
WELL VERIFIED ANSWERS 2025
EP is a 38-year-
c c c
old female patient that comes in for diabetes education and management. She
c c c c c c c c c c c c
was diagnosed 12 years ago and states lately she is not able to control her diet alt
c c c c c c c c c c c c c c c c
hough she continues a 1600 calorie diet with appropriate daily carbohydrate int
c c c c c c c c c c c
ake (per dietitian prescription) and walks 40 minutes every day of the week. Sh
c c c c c c c c c c c c c
e states compliance with all medications. She denies any history of hypoglycem
c c c c c c c c c c c
ia despite being able to identify signs and symptoms and describe appropriate t
c c c c c c c c c c c c
reatment strategies. c
,PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid canc
c c c c c c c c c c
er
FmHx: Noncontributory c
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
c c c c c c c c c c c
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
c c c c c c c c c c c c c
sertraline 100 mg daily, multivitamin daily c c c c c
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
c c c c c c c c c c
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN ......ans
c c c c c c c c c c c c cc
wer.....Exenatide - c
Exenatide (Bydureon) once weekly has been able to demonstrate weight loss a
c c c c c c c c c c c c
nd decrease A1C% by 0.7% to 1.2% in clinical trials; however it is contraindicate
c c c c c c c c c c c c c
d for EP due to the self-reported history of thyroid cancer.
c c c c c c c c c c
Dapagliflozin - c
Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia
c c c c c c c c c c c
which could be made worse by this drug. The package insert does not indicate a
c c c c c c c c c c c c c c
c specific potassium concentration cut off to no longer use this medication; how
c c c c c c c c c c c
ever, there are better choices in this patient.
c c c c c c c
Sitagliptin - c
Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinic
c c c c c c c c c c c c c c c c
al trials and currently the patient does not have any cautionary objective measu
c c c c c c c c c c c c
res to not use this medication. DPP-
c c c c c c
IV inhibitors are weight neutral. DPPIV inhibitors can be used in patients takin
c c c c c c c c c c c c
,g sulfonylureas; however, it may be re
c c c c c c
commended to reduce or stop the sulfonylurea dose. c c c c c c c
Acarbose - c
Acarbose (Precose) is not recommended for initial management and is associa
c c c c c c c c c c c
ted with significant GI side effects. More information would be needed regardi
c c c c c c c c c c c
ng fasting and post-
c c c
prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% a
c c c c c c c c c c c c
t best and therefore would not achieve the desired A1C goal of <7%
c c c c c c c c c c c c
JR is a 68-year-
c c c
old African American man with a new diagnosis of T2DM. He was classified as
c c c c c c c c c c c c c c
having prediabetes (at risk for developing diabetes) 5 years before the diagnosi
c c c c c c c c c c c
s and has a strong family history of type 2 diabetes. JR's blood pressure was 150/
c c c c c c c c c c c c c c c
92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal cholesterol p
c c c c c c c c c c c c c
anel, and normal renal/hepatic function were noted with today's laboratory tes
c c c c c c c c c c
t results.
c
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diagn
c c c c c c c c c
osed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
c c c c c c c c c c
Family history: Type 2 diabetes c c c c
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily c c c c c c c c
Allergies: SMZ/TMP c
, Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46 i
c c c c c c c c c c c c c c
n Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
c c c c c c c c c c c c
Despite improvements in the past six weeks due to lifestyle changes and exercis
c c c c c c c c c c c c
e, drug therapy is to be started for JR's diabet . -ANSWER-Metformin is the dr
c c c c c c c c c cc c c c
ug of choice recommended for most patients with diabetes in addition to lifest
c c c c c c c c c c c c
yle modifications assuming no contraindications or intolerabilities are present
c c c c c c c c c
upon evaluation. Metformin has also shown to provide positive weight neutral
c c c c c c c c c c
/loss effects in obese patients. It is crucial to know the renal status of patients c
c c c c c c c c c c c c c c c
ommencing metformin therapy to limit the risk of lactic acidosis (JR is without
c c c c c c c c c c c c c
contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potenti
c c c c c c c c c c c c c
al choices. The second step can be a dipeptidyl peptidase-
c c c c c c c c c
4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
c c c c c c c c
1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SG
c c c c c c c c c c c c c c c c c c
LT2 inhibitor, or it could be basal insulin. Anything next can be tried dependin
c c c c c c c c c c c c c
g on what suits the circumstance
c c c c c
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sita
c c c c c c c c c c c
gliptin has been associated with case reports of pancreatitis, so this specific age
c c c c c c c c c c c c
nt should be avoided. $$$
c c c c
GLP-
1 analog and has data to support an A1C reduction necessary to gain glycemic co
c c c c c c c c c c c c c c
ntrol and may assist with weight loss goals for this patient. New information su
c c c c c c c c c c c c c
