PC707-Module 10 Exam Questions With Correct Answers

Diabetes Medication - Sulfonylureas - Answer -Action = Stimulates pancreatic insulin release. -Adverse effects = Hypoglycemia, Weight gain, Increased risk of CV mortality. -Contraindications = Impaired renal function. *Are not contraindicated in pts. with sulfa allergy due to different molecular structure (Let's talk & camtasia/text says to not use with sulfa allergy).* Diabetes Medication - Biguanides - Answer (1st line therapy) -Action = Enhances receptor sensitivity to insulin in muscle and fat. -Adverse effects = Causes nausea, cramps, and diarrhea *take with meals* -Contraindications = CHF, Renal impairment, Liver disease, >80 years of age, Severe infection, COPD, Excessive alcohol consumption. May cause megaloblastic anemia over time. *Cannot cause hypoglycemia thus are safer for patients at risk.* Diabetes Medication - Gliptins - Answer -Action = Inhibits degradation of endogenous incretins which increase insulin secretion, decreases glucagon secretion & decreases hepatic glucose production. *Considered 3rd-line therapy in patients with HbA1C >9* Diabetes Medication - Thiazolidinediones - Answer -Action = Enhances insulin sensitivity in muscle and fat by increasing glucose transporter expression. -Adverse effects = May cause weight gain & edema, increase LFT's, decrease C-reactive protien -Contraindications = Oral contraceptive use, Heart failure, Liver disease Tends to lower triglycerides and raise HDL Diabetes Medication - Alpha-Glycosidase Inhibitors - Answer -Actions = Works in the gut to prevent glucose absorption, *little risk of hypoglycemia* -Adverse effects = Diarrhea, flatulence, stomach ache, and bloating * better tolerated if client also decreases sugar intake* -Contraindications = Diseases of the bowel (inflammatory bowel, absorptive disorders, & hx of bowel obstruction) or cirrhosis. Diabetes Medication - GLP-1 agonists/incretin mimetic - Answer -Actions = Mimic hormones that regulate blood glucose -Adverse effects = Nausea, hypoglycemia, some weight loss -Contraindications = Allergy to known compounds of the drug. *Should not be taken within 1 hour of oral contraceptives* Diabetes Medication - Meglitinide - Answer -Action - Stimulates insulin release from beta cells. -Adverse effect = Hypoglycemia, Nausea *Multiple drug interactions - NSAIDS & antihypertensives & gemfibrozil* Diabetes Medication - Amylin analog - Answer -Action = Slows gastric emptying, Decreases postprandial glucagon secretion *Infrequently used because of intolerable side effects* Diabetes Medication - Combination products - Answer Advantage is that they cost less and increase adherence due to the use of one drug rather than two. Sulfonylureas & Pregnancy/Lactation - Answer Second generation - do not cross the placenta in significant amounts as opposed to first generation. Drug levels are minimal in breast milk. Biguanide & Pregnancy/Lactation - Answer Is advised to use only in special, individualized situations *is contraindicated in breastfeeding* Insulin - Answer Gold standard for treatment of gestational diabetes. Hypothyroid Medication - Thyroid Hormone - Answer -Action = Replacement of missing thyroid hormone & normalization of TSH -Adverse effects = Only seen with excessive dosing (hyperthyroidism) -Precautions = Overtreatment -Patient education = Will (most likely) need lifelong replacement, Therapeutic effect is 2-4 weeks, Frequent follow-up lab testing until stable TSH is reached then annually thereafter. Thyroid Hormone & Pregnancy/Lactation - Answer -Levothyroxin I considered first line treatment in pregnancy (category A) & safe in breastfeeding as well (Let's talk) *dosage requirements significantly increase in pregnancy and regular monitoring of serum TSH is necessary* Thyroid Hormone & Drug Interactions - Answer Calcium = decreased absorption Cholestyramine = decreased absorption Iron Preparations = decreased absorption Estrogens = decreased availability Oral hyperglycemics = have decreased effects Anticoagulant = have enhanced effects SSRI's/anticonvulsants = increased metabolism Thyroid Hormone Special Education - Answer *Patient need to know to stay with one brand of the drug* Hyperthyroid Medication - Antithyroid medications - Answer Action = Blockage of thyroid hormone synthesis. Antithyroid medications & Pregnancy/Lactation - Answer -Antithyroid medications are category D (Propylthiouracil & methimazole) -Propylthiouracil may be prescribed due to maternal and fetal risks of hyperthyroidism and is preferred due to its being highly protein bound (less drugs to the fetus) * Propylthiouracil & methimazole are both considered compatible with breastfeeding but PTU is considered safer*