NR565 Pharmacology Final questions and answers
Signs and symptoms of hypothyroidism - answersFace is pale, puffy, and expressionless.
ak ak ak ak ak ak ak ak ak ak ak
Skin is cold and dry.
ak ak ak ak ak
hair is brittle, and hair loss occurs.
ak ak ak ak ak ak ak
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Mentation may be impaired. ak ak ak
Signs and symptoms of hyperthyroidism - answersHeart Rate is Rapid; Possible arrhythmia/angina
ak ak ak ak ak ak ak ak ak ak ak
Nervousness, insomnia, rapid thought flow, and rapid speech ak ak ak ak ak ak ak
Skeletal muscles may weaken and atrophy ak ak ak ak ak
Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and sk
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
that is warm and moist
ak ak ak ak ak
Weight loss occurs if caloric intake fails to match the increase in metabolic rate
ak ak ak ak ak ak ak ak ak ak ak ak ak
Severe hypothyroidism - answersMyxedema ak ak ak
Hypothyroid Treatment - answersLevothyroxine is the drug of choice for most patients who require thyroid hormone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
replacement.
ak
Levothyroxine (Synthroid) Therapeutic Goal - answersResolution of signs and symptoms of hypothyroidism and ak ak ak ak ak ak ak ak ak ak ak ak
restoration of normal laboratory values for serum thyroid-stimulating hormone (TSH) and free thyroxine (T4).
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Major forms of hyperthyroidism - answersGraves disease and toxic nodular goiter (also known as Plummer disease).
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Graves Disease - answersMost common cause of excessive thyroid hormone secretion
ak ak ak ak ak ak ak ak ak ak
What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
medications? - answersβ-Blockers and nonradioactive iodine may be used as adjunctive therapy.
ak ak ak ak ak ak ak ak ak ak ak ak ak
β-Blockers suppress tachycardia by blocking β-receptors on the heart. ak ak ak ak ak ak ak ak ak
Nonradioactive iodine inhibits synthesis and release of thyroid hormones. ak ak ak ak ak ak ak ak
Monitoring needs and intervals for Levothyroxine - answersCheck TSH 6-8 weeks after initiating therapy and after any
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
dosage change.
ak ak ak
Check TSH at least once a year after serum TSH is stabilized.
ak ak ak ak ak ak ak ak ak ak ak
Hyperthyroid Treatment - answersthionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis ak ak ak ak ak ak ak ak ak
thyroid hormones.
ak ak
Methimazole Therapeutic Goal - answers(1) reduction of thyroid hormone production in Graves' disease, (2) control of
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
production before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
ak ak ak ak ak ak ak ak ak
Monitoring needs and intervals for Methimazole - answersCheck CBC with differential if signs or symptoms of infection
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Check LFTs if signs or symptoms of liver dysfunction.
ak ak ak ak ak ak ak ak ak
High Risk Patients for Methimazole - answersShould be avoided in the first trimester of pregnancy.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
1/18
ak ak
,Methimazole Toxicity - answersAgranulocytosis is the most dangerous toxicity. ak ak ak ak ak ak ak ak
PTU High Risk Warning - answersCarries a risk for liver toxicity. Although rare, the FDA recommends against using as a
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
first-line treatment due to potential for hepatic toxicity.
ak ak ak ak ak ak ak ak
Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment. -
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
answersCan cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
teeth, and muscles is impaired.
ak ak ak ak ak
Congenital Hypothyroidism Treatment - answersrequires replacement therapy with thyroid hormones. If treatment is ak ak ak ak ak ak ak ak ak ak ak ak
initiated within a few days of birth, physical and mental development will be normal.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
replacement therapy should continue for 3 years, after which it should be stopped for 4 weeks to determine whether ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
thyroid deficiency is permanent or transient.
ak ak ak ak ak ak
Patient Teaching for Methimazole - answersTell your healthcare providers that you are taking this drug.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Check blood work as directed. ak ak ak ak
Taking this drug may cause harm to the unborn baby if you are pregnant, especially in the first trimester.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
If you are pregnant or become pregnant while taking this drug, call your healthcare provider right away.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Tell your healthcare provider if you are breast-feeding to discuss risks to the baby.
ak ak ak ak ak ak ak ak ak ak ak ak ak
Have your baby's thyroid checked if you are using this drug and breast-feeding.
ak ak ak ak ak ak ak ak ak ak ak ak
Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare. Sore throat and fever should be ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
reported immediately.
ak ak ak
Patient Teaching for Levothyroxine - answersworks best if you take it on an empty stomach, 30 to 60 minutes before
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
breakfast.
ak
take the medicine at the same time each day.
ak ak ak ak ak ak ak ak
Ideal HbA1C goal for diabetic, non-pregnant adults - answersless than 7%.
ak ak ak ak ak ak ak ak ak ak
HbA1C 8% - answershistory of severe hypoglycemia, limited life expectancy, or advanced microvascular or
ak ak ak ak ak ak ak ak ak ak ak ak ak
macrovascular complications
ak ak
HBA1C Value considered diagnostic of diabetes. - answersa value of 6.5% or greater
ak ak ak ak ak ak ak ak ak ak ak ak
HbA1C Measuring Interval - answersevery 3 months until value is <7%; every 6 months thereafter
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
HbA1C Goal for Older Adults - answers<7.5% [58 mmol/mol]), while those with multiple coexisting chronic illnesses,
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0-8.5% [64
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
69 mmol/mol]).
ak
Criteria for the Diagnosis of Diabetes Mellitus - answers-Fasting plasma glucose ≥126 mg/dL
ak ak ak ak ak ak ak ak ak ak ak ak
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes ak ak ak ak ak ak ak ak ak
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLcor
ak ak ak ak ak ak ak ak ak
-Hemoglobin A1c 6.5% or higher ak ak ak ak
T1DM Etiology and MOA - answersAutoimmune process; Loss of pancreatic β cells;
ak ak ak ak ak ak ak ak ak ak ak
T2DM Etiology and MOA - answersUnknown—but there is a strong familial association, suggesting that heredity is a ris
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
factor; Insulin resistance and inappropriate insulin secretion
ak ak ak ak ak ak ak
2/18
ak ak
,the total daily dose (TDD) of insulin calculation - answerstotal weight of the patient in kilograms (kg), multiplied by 0.6 un
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Basal insulin replacement - answers50% of the total daily insulin dose which replaces insulin from fasting (overnight) an
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
between meals.
ak ak
Bolus insulin replacement - answers50% of the total daily insulin dose and provides carbohydrate coverage and high
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
blood sugar correction.
ak ak ak
Biguanides Drug Class - answersMetformin ak ak ak ak
Metformin - answersDecreases glucose production by the liver (glucogenesis), increases tissue response to insulin;
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Decrease glucose absorption; Increase glucose uptake ak ak ak ak ak
drug of choice for initial therapy in most patients with type 2 diabetes
ak ak ak ak ak ak ak ak ak ak ak ak
Metformin contraindications - answersrenal disease, acidosis from hepatic disease, alcoholics, or in patients with
ak ak ak ak ak ak ak ak ak ak ak ak ak
hypoxia.
ak
Metformin Major AE - answersGastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea
ak ak ak ak ak ak ak ak ak ak
Lactic acidosis (rarely) ak ak
Sulfonylureas Prototype/MOA - answersGlyburide (Prototype Drug) ak ak ak ak ak
-Promote insulin secretion by the pancreas; may also increase tissue response to insulin;
ak ak ak ak ak ak ak ak ak ak ak ak
-stimulate beta cells of the pancreas to secrete more insulin ak ak ak ak ak ak ak ak ak
Sulfonylureas AE - answershigh risk of severe hypoglycemia; ak ak ak ak ak ak ak ak
photosensitivity; therefore, patient education is needed regarding sunscreen. ak ak ak ak ak ak ak ak
blood dyscrasias ak ak
weight gain. ak
Sulfonylureas Contraindication - answersshould be avoided in patients with impaired hepatic or renal function. ak ak ak ak ak ak ak ak ak ak ak ak ak
Meglitinides (Glinides) Prototype/MOA - answers-Repaglinide (Prototype Drug) ak ak ak ak ak ak
-stimulation of pancreatic insulin release though shorter acting then sulfonylureas and are taken with each meal
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
-Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release ak ak ak ak ak ak ak ak ak ak ak ak
Meglitinides Main AE - answersHypoglycemia ak ak ak ak
Meglitinides Contraindications - answersUse with caution in patients with liver impairment and those taking gemfibrozi
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Thiazolidinediones (Glitazones) Prototype/MOA - answers-Pioglitazone (Prototype Drug) ak ak ak ak ak ak
-enhance insulin sensitivity/decrease insulin resistance in muscle tissue and reduce glucagon production in the liver
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
-Mainly an add on to Metformin ak ak ak ak ak
Thiazolidinediones (TZDs) Main AE - answersHypoglycemia but only in the presence of excessive insulin ak ak ak ak ak ak ak ak ak ak ak ak ak
Heart failure ak
3/18
ak ak
Signs and symptoms of hypothyroidism - answersFace is pale, puffy, and expressionless.
ak ak ak ak ak ak ak ak ak ak ak
Skin is cold and dry.
ak ak ak ak ak
hair is brittle, and hair loss occurs.
ak ak ak ak ak ak ak
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Mentation may be impaired. ak ak ak
Signs and symptoms of hyperthyroidism - answersHeart Rate is Rapid; Possible arrhythmia/angina
ak ak ak ak ak ak ak ak ak ak ak
Nervousness, insomnia, rapid thought flow, and rapid speech ak ak ak ak ak ak ak
Skeletal muscles may weaken and atrophy ak ak ak ak ak
Metabolic rate is raised, resulting in increased heat production, increased body temperature, intolerance to heat, and sk
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
that is warm and moist
ak ak ak ak ak
Weight loss occurs if caloric intake fails to match the increase in metabolic rate
ak ak ak ak ak ak ak ak ak ak ak ak ak
Severe hypothyroidism - answersMyxedema ak ak ak
Hypothyroid Treatment - answersLevothyroxine is the drug of choice for most patients who require thyroid hormone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
replacement.
ak
Levothyroxine (Synthroid) Therapeutic Goal - answersResolution of signs and symptoms of hypothyroidism and ak ak ak ak ak ak ak ak ak ak ak ak
restoration of normal laboratory values for serum thyroid-stimulating hormone (TSH) and free thyroxine (T4).
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Major forms of hyperthyroidism - answersGraves disease and toxic nodular goiter (also known as Plummer disease).
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Graves Disease - answersMost common cause of excessive thyroid hormone secretion
ak ak ak ak ak ak ak ak ak ak
What adjunctive therapy is good to prescribe to control symptoms of hyperthyroidism other than thyroid specific
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
medications? - answersβ-Blockers and nonradioactive iodine may be used as adjunctive therapy.
ak ak ak ak ak ak ak ak ak ak ak ak ak
β-Blockers suppress tachycardia by blocking β-receptors on the heart. ak ak ak ak ak ak ak ak ak
Nonradioactive iodine inhibits synthesis and release of thyroid hormones. ak ak ak ak ak ak ak ak
Monitoring needs and intervals for Levothyroxine - answersCheck TSH 6-8 weeks after initiating therapy and after any
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
dosage change.
ak ak ak
Check TSH at least once a year after serum TSH is stabilized.
ak ak ak ak ak ak ak ak ak ak ak
Hyperthyroid Treatment - answersthionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis ak ak ak ak ak ak ak ak ak
thyroid hormones.
ak ak
Methimazole Therapeutic Goal - answers(1) reduction of thyroid hormone production in Graves' disease, (2) control of
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
production before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
ak ak ak ak ak ak ak ak ak
Monitoring needs and intervals for Methimazole - answersCheck CBC with differential if signs or symptoms of infection
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Check LFTs if signs or symptoms of liver dysfunction.
ak ak ak ak ak ak ak ak ak
High Risk Patients for Methimazole - answersShould be avoided in the first trimester of pregnancy.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
1/18
ak ak
,Methimazole Toxicity - answersAgranulocytosis is the most dangerous toxicity. ak ak ak ak ak ak ak ak
PTU High Risk Warning - answersCarries a risk for liver toxicity. Although rare, the FDA recommends against using as a
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
first-line treatment due to potential for hepatic toxicity.
ak ak ak ak ak ak ak ak
Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment. -
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
answersCan cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bone
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
teeth, and muscles is impaired.
ak ak ak ak ak
Congenital Hypothyroidism Treatment - answersrequires replacement therapy with thyroid hormones. If treatment is ak ak ak ak ak ak ak ak ak ak ak ak
initiated within a few days of birth, physical and mental development will be normal.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
replacement therapy should continue for 3 years, after which it should be stopped for 4 weeks to determine whether ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
thyroid deficiency is permanent or transient.
ak ak ak ak ak ak
Patient Teaching for Methimazole - answersTell your healthcare providers that you are taking this drug.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Check blood work as directed. ak ak ak ak
Taking this drug may cause harm to the unborn baby if you are pregnant, especially in the first trimester.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
If you are pregnant or become pregnant while taking this drug, call your healthcare provider right away.
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Tell your healthcare provider if you are breast-feeding to discuss risks to the baby.
ak ak ak ak ak ak ak ak ak ak ak ak ak
Have your baby's thyroid checked if you are using this drug and breast-feeding.
ak ak ak ak ak ak ak ak ak ak ak ak
Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare. Sore throat and fever should be ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
reported immediately.
ak ak ak
Patient Teaching for Levothyroxine - answersworks best if you take it on an empty stomach, 30 to 60 minutes before
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
breakfast.
ak
take the medicine at the same time each day.
ak ak ak ak ak ak ak ak
Ideal HbA1C goal for diabetic, non-pregnant adults - answersless than 7%.
ak ak ak ak ak ak ak ak ak ak
HbA1C 8% - answershistory of severe hypoglycemia, limited life expectancy, or advanced microvascular or
ak ak ak ak ak ak ak ak ak ak ak ak ak
macrovascular complications
ak ak
HBA1C Value considered diagnostic of diabetes. - answersa value of 6.5% or greater
ak ak ak ak ak ak ak ak ak ak ak ak
HbA1C Measuring Interval - answersevery 3 months until value is <7%; every 6 months thereafter
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
HbA1C Goal for Older Adults - answers<7.5% [58 mmol/mol]), while those with multiple coexisting chronic illnesses,
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0-8.5% [64
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
69 mmol/mol]).
ak
Criteria for the Diagnosis of Diabetes Mellitus - answers-Fasting plasma glucose ≥126 mg/dL
ak ak ak ak ak ak ak ak ak ak ak ak
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes ak ak ak ak ak ak ak ak ak
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLcor
ak ak ak ak ak ak ak ak ak
-Hemoglobin A1c 6.5% or higher ak ak ak ak
T1DM Etiology and MOA - answersAutoimmune process; Loss of pancreatic β cells;
ak ak ak ak ak ak ak ak ak ak ak
T2DM Etiology and MOA - answersUnknown—but there is a strong familial association, suggesting that heredity is a ris
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
factor; Insulin resistance and inappropriate insulin secretion
ak ak ak ak ak ak ak
2/18
ak ak
,the total daily dose (TDD) of insulin calculation - answerstotal weight of the patient in kilograms (kg), multiplied by 0.6 un
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Basal insulin replacement - answers50% of the total daily insulin dose which replaces insulin from fasting (overnight) an
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
between meals.
ak ak
Bolus insulin replacement - answers50% of the total daily insulin dose and provides carbohydrate coverage and high
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
blood sugar correction.
ak ak ak
Biguanides Drug Class - answersMetformin ak ak ak ak
Metformin - answersDecreases glucose production by the liver (glucogenesis), increases tissue response to insulin;
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Decrease glucose absorption; Increase glucose uptake ak ak ak ak ak
drug of choice for initial therapy in most patients with type 2 diabetes
ak ak ak ak ak ak ak ak ak ak ak ak
Metformin contraindications - answersrenal disease, acidosis from hepatic disease, alcoholics, or in patients with
ak ak ak ak ak ak ak ak ak ak ak ak ak
hypoxia.
ak
Metformin Major AE - answersGastrointestinal (GI) symptoms: decreased appetite, nausea, diarrhea
ak ak ak ak ak ak ak ak ak ak
Lactic acidosis (rarely) ak ak
Sulfonylureas Prototype/MOA - answersGlyburide (Prototype Drug) ak ak ak ak ak
-Promote insulin secretion by the pancreas; may also increase tissue response to insulin;
ak ak ak ak ak ak ak ak ak ak ak ak
-stimulate beta cells of the pancreas to secrete more insulin ak ak ak ak ak ak ak ak ak
Sulfonylureas AE - answershigh risk of severe hypoglycemia; ak ak ak ak ak ak ak ak
photosensitivity; therefore, patient education is needed regarding sunscreen. ak ak ak ak ak ak ak ak
blood dyscrasias ak ak
weight gain. ak
Sulfonylureas Contraindication - answersshould be avoided in patients with impaired hepatic or renal function. ak ak ak ak ak ak ak ak ak ak ak ak ak
Meglitinides (Glinides) Prototype/MOA - answers-Repaglinide (Prototype Drug) ak ak ak ak ak ak
-stimulation of pancreatic insulin release though shorter acting then sulfonylureas and are taken with each meal
ak ak ak ak ak ak ak ak ak ak ak ak ak ak ak
-Facilitates calcium influx in pancreatic β cells, which leads to increased insulin release ak ak ak ak ak ak ak ak ak ak ak ak
Meglitinides Main AE - answersHypoglycemia ak ak ak ak
Meglitinides Contraindications - answersUse with caution in patients with liver impairment and those taking gemfibrozi
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
Thiazolidinediones (Glitazones) Prototype/MOA - answers-Pioglitazone (Prototype Drug) ak ak ak ak ak ak
-enhance insulin sensitivity/decrease insulin resistance in muscle tissue and reduce glucagon production in the liver
ak ak ak ak ak ak ak ak ak ak ak ak ak ak
-Mainly an add on to Metformin ak ak ak ak ak
Thiazolidinediones (TZDs) Main AE - answersHypoglycemia but only in the presence of excessive insulin ak ak ak ak ak ak ak ak ak ak ak ak ak
Heart failure ak
3/18
ak ak
