1
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Advanced Pharmacology NSG 533 Exam
2024/2025 Questions and Answers (100%
Correct Answers) Already Graded A+
EP is a 38-year-old female patient that comes in for diabetes
education and management. She was diagnosed 12 years ago
and states lately she is not able to control her diet although she
continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day
of the week. She states compliance with all medications. She
© 2025 Assignment Expert
denies any history of hypoglycemia despite being able to identify
signs and symptoms and describe appropriate treatment
strategies.
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PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high
school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20
mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L,
BUN [ ANS: ] Exenatide - Exenatide (Bydureon) once weekly has
been able to 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.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this
patient due to hyperkalemia which could be made worse by this
drug. The package insert does not indicate a specific potassium
, 2
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concentration cut off to no longer use this medication; however,
there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of
less than 7% based on clinical trials and currently the patient does
not have any cautionary objective measures to not use this
medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors
can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial
management and is associated with significant GI side effects.
© 2025 Assignment Expert
More information would be needed regarding fasting and post-
prandial numbers. In addition, adding acarbose would only lower
A1c by 0.8% at best and therefore would not achieve the desired
A1C goal of <7%
Guru01 - Stuvia
JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for
developing diabetes) 5 years before the diagnosis and has a
strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%,
normal cholesterol panel, and normal renal/hepatic function were
noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago)
Hyperlipidemia (diagnosed 2 y ago) Pancreatitis (idiopathic)
(acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
, 3
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Despite improvements in the past six weeks due to lifestyle
changes and exercise, drug therapy is to be started for JR's diabet
[ ANS: ] 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. Metformin has 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).
© 2025 Assignment Expert
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 sulfonylurea agent, it
Guru01 - Stuvia
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 been associated with case reports of
pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction
necessary to gain glycemic control and may assist with weight loss
goals for this patient. New information suggests these agents may
provide benefits in those with ASCVD. JR has a past history of
pancreatitis and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain
glycemic control, but are associated with weight gain, negative
effects on lipids and increased risk of fracture. Until recently, TZDs
have also been linked to increased CV events and use has fallen
out of favor
, 4
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Sulfonylureas provide excellent A1C lowering, but are also
associated with weight gain. They also have the potential to
cause hypoglycemia, so patient education is crucial. Because of
his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider? [ ANS: ] A patient with Type 1 DM is insulin dependent
for glucose control and at high risk for hypoglycemic episodes.
Propanolol causes prolonged hypoglycemic episodes. Needs to
switch to ACE or ARB.
© 2025 Assignment Expert
A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
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provider first."
b. "I should report insomnia, tremors, and an increased heart rate
to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my
dose of levothyroxine." [ ANS: ] D. Calcium may reduce
levothyroxine absorption. Further education is needed if the
patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after
consuming a large meal and alcohol he experiences significant
GI distress. He takes an OTC heartburn remedy. Within a minute or
two he develops what he will later describe as "belching, nausea
and a bad bloated feeling". Several of the ulcers began to bleed
and he becomes profoundly hypotensive from the blood loss and
is taken to the ED. Endoscopy confirms multiple bleeds; the
endoscopist remarks that it appears as if the lesions had been
For Expert help and assignment solutions, +254707240657
Advanced Pharmacology NSG 533 Exam
2024/2025 Questions and Answers (100%
Correct Answers) Already Graded A+
EP is a 38-year-old female patient that comes in for diabetes
education and management. She was diagnosed 12 years ago
and states lately she is not able to control her diet although she
continues a 1600 calorie diet with appropriate daily carbohydrate
intake (per dietitian prescription) and walks 40 minutes every day
of the week. She states compliance with all medications. She
© 2025 Assignment Expert
denies any history of hypoglycemia despite being able to identify
signs and symptoms and describe appropriate treatment
strategies.
Guru01 - Stuvia
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high
school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20
mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L,
BUN [ ANS: ] Exenatide - Exenatide (Bydureon) once weekly has
been able to 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.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this
patient due to hyperkalemia which could be made worse by this
drug. The package insert does not indicate a specific potassium
, 2
For Expert help and assignment solutions, +254707240657
concentration cut off to no longer use this medication; however,
there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of
less than 7% based on clinical trials and currently the patient does
not have any cautionary objective measures to not use this
medication. DPP-IV inhibitors are weight neutral. DPP-IV inhibitors
can be used in patients taking sulfonylureas; however, it may be
recommended to reduce or stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial
management and is associated with significant GI side effects.
© 2025 Assignment Expert
More information would be needed regarding fasting and post-
prandial numbers. In addition, adding acarbose would only lower
A1c by 0.8% at best and therefore would not achieve the desired
A1C goal of <7%
Guru01 - Stuvia
JR is a 68-year-old African American man with a new diagnosis of
T2DM. He was classified as having prediabetes (at risk for
developing diabetes) 5 years before the diagnosis and has a
strong family history of type 2 diabetes. JR's blood pressure was
150/92 mm Hg. His laboratory results revealed an A1C of 8.1%,
normal cholesterol panel, and normal renal/hepatic function were
noted with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago)
Hyperlipidemia (diagnosed 2 y ago) Pancreatitis (idiopathic)
(acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist
Circumference: 46 in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
, 3
For Expert help and assignment solutions, +254707240657
Despite improvements in the past six weeks due to lifestyle
changes and exercise, drug therapy is to be started for JR's diabet
[ ANS: ] 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. Metformin has 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).
© 2025 Assignment Expert
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 sulfonylurea agent, it
Guru01 - Stuvia
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 been associated with case reports of
pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction
necessary to gain glycemic control and may assist with weight loss
goals for this patient. New information suggests these agents may
provide benefits in those with ASCVD. JR has a past history of
pancreatitis and GLP-1 analogs are not recommended due to this
contraindication
TZDs have data to support an A1C reduction necessary to gain
glycemic control, but are associated with weight gain, negative
effects on lipids and increased risk of fracture. Until recently, TZDs
have also been linked to increased CV events and use has fallen
out of favor
, 4
For Expert help and assignment solutions, +254707240657
Sulfonylureas provide excellent A1C lowering, but are also
associated with weight gain. They also have the potential to
cause hypoglycemia, so patient education is crucial. Because of
his allergies to "sulfa", use would be contr
A patient with type 1 diabetes reports taking propranolol for
hypertension. What concern does this information present for the
provider? [ ANS: ] A patient with Type 1 DM is insulin dependent
for glucose control and at high risk for hypoglycemic episodes.
Propanolol causes prolonged hypoglycemic episodes. Needs to
switch to ACE or ARB.
© 2025 Assignment Expert
A provider teaches a patient who has been diagnosed with
hypothyroidism about a new prescription for levothyroxine. Which
statement by the patient indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my
Guru01 - Stuvia
provider first."
b. "I should report insomnia, tremors, and an increased heart rate
to my provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the
levothyroxine."
d. "If I take calcium supplements, I may need to decrease my
dose of levothyroxine." [ ANS: ] D. Calcium may reduce
levothyroxine absorption. Further education is needed if the
patient feels she can take half of a prescribed medication.
MC has undiagnosed multiple gastric ulcers. Shortly after
consuming a large meal and alcohol he experiences significant
GI distress. He takes an OTC heartburn remedy. Within a minute or
two he develops what he will later describe as "belching, nausea
and a bad bloated feeling". Several of the ulcers began to bleed
and he becomes profoundly hypotensive from the blood loss and
is taken to the ED. Endoscopy confirms multiple bleeds; the
endoscopist remarks that it appears as if the lesions had been
