Advanced Pharmacology NSG 533 Test Questions and
Answers Rated A
EP is a 38-year-old female patient that comes in recommended for initial management and is
for diabetes education and management. She associated with significant GI side effects. More
was diagnosed 12 years ago and states lately information would be needed regarding fasting
she is not able to control her diet although she and post-prandial numbers. In addition, adding
continues a 1600 calorie diet with appropriate acarbose would only lower A1c by 0.8% at best
daily carbohydrate intake (per dietitian and therefore would not achieve the desired A1C
prescription) and walks 40 minutes every day of goal of <7%
the week. She states compliance with all
medications. She denies any history of
hypoglycemia despite being able to identify signs
and symptoms and describe appropriate JR is a 68-year-old African American man with a
treatment strategies. new diagnosis of T2DM. He was classified as
PMH: T2DM, HTN, obesity, depression, s/p having prediabetes (at risk for developing
thyroidectomy due to thyroid cancer diabetes) 5 years before the diagnosis and has a
FmHx: Noncontributory strong family history of type 2 diabetes. JR's
SHx: (−) Smoking, alcohol use, past marijuana blood pressure was 150/92 mm Hg. His
use while in high school laboratory results revealed an A1C of 8.1%,
Medications: Metformin 850 mg tid, glipizide 20 normal cholesterol panel, and normal
mg bid, lisinopril 20 mg daily, sertraline 100 mg renal/hepatic function were noted with today's
daily, multivitamin daily laboratory test results.
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 Past medical history: Hypertension (diagnosed 4
m/kg2 y ago) Hyperlipidemia (diagnosed 2 y ago)
Laboratory test results: Na 134 mEq/L, K 5.4 Pancreatitis (idiopathic) (acute hospitalization 3 y
mEq/L, Cl 106 mEq/L, BUN - ANSWER - ago)
Exenatide - Exenatide (Bydureon) once weekly Family history: Type 2 diabetes
has been able to demonstrate weight loss and Medication: HCTZ 25 mg daily, simvastatin 10
decrease A1C% by 0.7% to 1.2% in clinical trials; mg daily
however it is contraindicated for EP due to the Allergies: SMZ/TMP
self-reported history of thyroid cancer. Vitals: BP: 150/92 mm Hg P: 78 beats/min RR:
Dapagliflozin - Dapagliflozin (Farxiga) is 12 rpm Waist Circumference: 46 in Weight: 267
contraindicated in this patient due to lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
hyperkalemia which could be made worse by this
drug. The package insert does not indicate a
specific potassium concentration cut off to no Despite improvements in the past six weeks due
longer use this medication; however, there are to lifestyle changes and exercise, drug therapy is
better choices in this patient. to be started for JR's diabet - ANSWER -
Sitagliptin - Sitagliptin (Januvia) is able to obtain Metformin is the drug of choice recommended for
an A1C goal of less than 7% based on clinical most patients with diabetes in addition to lifestyle
trials and currently the patient does not have any modifications assuming no contraindications or
cautionary objective measures to not use this intolerabilities are present upon evaluation.
medication. DPP-IV inhibitors are weight neutral. Metformin has also shown to provide positive
DPP-IV inhibitors can be used in patients taking weight neutral/loss effects in obese patients. It is
sulfonylureas; however, it may be recommended crucial to know the renal status of patients
to reduce or stop the sulfonylurea dose. commencing metformin therapy to limit the risk of
Acarbose - Acarbose (Precose) is not lactic acidosis (JR is without contraindication).
,Advanced Pharmacology NSG 533 Test Questions and
Answers Rated A
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 A provider teaches a patient who has been
inhibitor, it can be a glucagon-like peptide-1 diagnosed with hypothyroidism about a new
(GLP-1) receptor agonist, it can be a TZD, it can prescription for levothyroxine. Which statement
be a sulfonylurea agent, it can be a SGLT2 by the patient indicates a need for further
inhibitor, or it could be basal insulin. Anything teaching?
next can be tried depending on what suits the a. "I should not take heartburn medication without
circumstance consulting my provider first."
DPP4 inhibitors are weight neutral bet relatively b. "I should report insomnia, tremors, and an
benign side effect profile. Sitagliptin has been increased heart rate to my provider."
associated with case reports of pancreatitis, so c. "If I take a multivitamin with iron, I should take
this specific agent should be avoided. $$$ it 4 hours after the levothyroxine."
GLP-1 analog and has data to support an A1C d. "If I take calcium supplements, I may need to
reduction necessary to gain glycemic control and decrease my dose of levothyroxine." -
may assist with weight loss goals for this patient. ANSWER -D. Calcium may reduce
New information suggests these agents may levothyroxine absorption. Further education is
provide benefits in those with ASCVD. JR has a needed if the patient feels she can take half of a
past history of pancreatitis and GLP-1 analogs prescribed medication.
are not recommended due to this
contraindication
TZDs have data to support an A1C reduction
necessary to gain glycemic control, but are MC has undiagnosed multiple gastric ulcers.
associated with weight gain, negative effects on Shortly after consuming a large meal and alcohol
lipids and increased risk of fracture. Until he experiences significant GI distress. He takes
recently, TZDs have also been linked to an OTC heartburn remedy. Within a minute or
increased CV events and use has fallen out of two he develops what he will later describe as
favor "belching, nausea and a bad bloated feeling".
Sulfonylureas provide excellent A1C lowering, Several of the ulcers began to bleed and he
but are also associated with weight gain. They becomes profoundly hypotensive from the blood
also have the potential to cause hypoglycemia, loss and is taken to the ED. Endoscopy confirms
so patient education is crucial. Because of his multiple bleeds; the endoscopist remarks that it
allergies to "sulfa", use would be contr appears as if the lesions had been literally
stretched apart causing additional tissue
damage. What did the patient most likely take
(i.e. what was the OTC remedy)? -
A patient with type 1 diabetes reports taking ANSWER -I would accept Alka-Selzer. I
propranolol for hypertension. What concern does contains NaHCO3 (as well as ASA). In the
this information present for the provider? - presence of HCL it Liberates CO2, that can
ANSWER -A patient with Type 1 DM is cause gastric distention, belching and nausea.
insulin dependent for glucose control and at high The reaction is fairly swift allowing little time for
risk for hypoglycemic episodes. Propanolol dissipation. Tums, its primary ingredient calcium
causes prolonged hypoglycemic episodes. carbonate which when taken cause a reaction
Needs to switch to ACE or ARB. with the stomach acid such as production of
carbon dioxide gas which can cause bloating and
, Advanced Pharmacology NSG 533 Test Questions and
Answers Rated A
the stomach to stretch to tear the ulcers open. nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, spicy
food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
On your way to this examination, you experience
the vulnerable feeling that an attack of acute
diarrhea is imminent! If you stop at a drug store,
which anti-diarrheal drugs could you buy without What is the most effective PPI or H2RA within
a prescription even though it is chemically related each of these classes? - ANSWER --PPI-
to the strong opioid analgesic meperidine (but bismuth quadruple therapy combined with proton
acts only on the peripheral opioid receptor)? - pump inhibitors
ANSWER -Loperamide -H2RA- Famotidine 80mg
JA has multiple medical problems and is taking Other products such as antacids are also
several drugs including theophylline, warfarin available. What are some of these and what is
and phenytoin. His conditions were well their place in therapy? - ANSWER --Reflux
controlled, but recently he started to experience symptoms <2 times a week (infrequent)
some GI distress for which of his "well -Effective for immediate relief
intentioned friends" gave him some medication. -Magnesium/Aluminum Hydroxide (Maalox)- can
He presents to you with toxic effects of all his cause constipation
other medications and plasma levels of those -Alginic Acid
medications elevated. What was most likely the
medication he took? - ANSWER -
Cimetidine
Why would antibiotics be used for PUD caused
by H Pylori? What is a typical regimen and
duration of therapy? What patient specific factors
What lifestyle modifications should be should be considered and how should treatment
recommended? - ANSWER --losing weight be monitored? - ANSWER -Considerations
if overweight before regimen choice:
-elevating head of bed while asleep -penicillin allergy
-eating smaller meals -previous exposure to macroglide antibiotics
-avoid foods/meds that exacerbate gerd Strongest Reccomendation:
-stop smoking -Bismuth Quadruple Therapy 10-14 days
-stop drinking alcohol *do not drink alcohol w/ metronidazole*
-Salvage regimen should be different than first
regimen
What medications / foods can contribute to
GERD? - ANSWER --Medications:
anticholinergics, barbituates, dopamine, Who would be a candidate for prophylaxis of
estrogen, opioids, progesterone, theophylline, NSAID induced ulcer and what agents are
Answers Rated A
EP is a 38-year-old female patient that comes in recommended for initial management and is
for diabetes education and management. She associated with significant GI side effects. More
was diagnosed 12 years ago and states lately information would be needed regarding fasting
she is not able to control her diet although she and post-prandial numbers. In addition, adding
continues a 1600 calorie diet with appropriate acarbose would only lower A1c by 0.8% at best
daily carbohydrate intake (per dietitian and therefore would not achieve the desired A1C
prescription) and walks 40 minutes every day of goal of <7%
the week. She states compliance with all
medications. She denies any history of
hypoglycemia despite being able to identify signs
and symptoms and describe appropriate JR is a 68-year-old African American man with a
treatment strategies. new diagnosis of T2DM. He was classified as
PMH: T2DM, HTN, obesity, depression, s/p having prediabetes (at risk for developing
thyroidectomy due to thyroid cancer diabetes) 5 years before the diagnosis and has a
FmHx: Noncontributory strong family history of type 2 diabetes. JR's
SHx: (−) Smoking, alcohol use, past marijuana blood pressure was 150/92 mm Hg. His
use while in high school laboratory results revealed an A1C of 8.1%,
Medications: Metformin 850 mg tid, glipizide 20 normal cholesterol panel, and normal
mg bid, lisinopril 20 mg daily, sertraline 100 mg renal/hepatic function were noted with today's
daily, multivitamin daily laboratory test results.
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 Past medical history: Hypertension (diagnosed 4
m/kg2 y ago) Hyperlipidemia (diagnosed 2 y ago)
Laboratory test results: Na 134 mEq/L, K 5.4 Pancreatitis (idiopathic) (acute hospitalization 3 y
mEq/L, Cl 106 mEq/L, BUN - ANSWER - ago)
Exenatide - Exenatide (Bydureon) once weekly Family history: Type 2 diabetes
has been able to demonstrate weight loss and Medication: HCTZ 25 mg daily, simvastatin 10
decrease A1C% by 0.7% to 1.2% in clinical trials; mg daily
however it is contraindicated for EP due to the Allergies: SMZ/TMP
self-reported history of thyroid cancer. Vitals: BP: 150/92 mm Hg P: 78 beats/min RR:
Dapagliflozin - Dapagliflozin (Farxiga) is 12 rpm Waist Circumference: 46 in Weight: 267
contraindicated in this patient due to lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
hyperkalemia which could be made worse by this
drug. The package insert does not indicate a
specific potassium concentration cut off to no Despite improvements in the past six weeks due
longer use this medication; however, there are to lifestyle changes and exercise, drug therapy is
better choices in this patient. to be started for JR's diabet - ANSWER -
Sitagliptin - Sitagliptin (Januvia) is able to obtain Metformin is the drug of choice recommended for
an A1C goal of less than 7% based on clinical most patients with diabetes in addition to lifestyle
trials and currently the patient does not have any modifications assuming no contraindications or
cautionary objective measures to not use this intolerabilities are present upon evaluation.
medication. DPP-IV inhibitors are weight neutral. Metformin has also shown to provide positive
DPP-IV inhibitors can be used in patients taking weight neutral/loss effects in obese patients. It is
sulfonylureas; however, it may be recommended crucial to know the renal status of patients
to reduce or stop the sulfonylurea dose. commencing metformin therapy to limit the risk of
Acarbose - Acarbose (Precose) is not lactic acidosis (JR is without contraindication).
,Advanced Pharmacology NSG 533 Test Questions and
Answers Rated A
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 A provider teaches a patient who has been
inhibitor, it can be a glucagon-like peptide-1 diagnosed with hypothyroidism about a new
(GLP-1) receptor agonist, it can be a TZD, it can prescription for levothyroxine. Which statement
be a sulfonylurea agent, it can be a SGLT2 by the patient indicates a need for further
inhibitor, or it could be basal insulin. Anything teaching?
next can be tried depending on what suits the a. "I should not take heartburn medication without
circumstance consulting my provider first."
DPP4 inhibitors are weight neutral bet relatively b. "I should report insomnia, tremors, and an
benign side effect profile. Sitagliptin has been increased heart rate to my provider."
associated with case reports of pancreatitis, so c. "If I take a multivitamin with iron, I should take
this specific agent should be avoided. $$$ it 4 hours after the levothyroxine."
GLP-1 analog and has data to support an A1C d. "If I take calcium supplements, I may need to
reduction necessary to gain glycemic control and decrease my dose of levothyroxine." -
may assist with weight loss goals for this patient. ANSWER -D. Calcium may reduce
New information suggests these agents may levothyroxine absorption. Further education is
provide benefits in those with ASCVD. JR has a needed if the patient feels she can take half of a
past history of pancreatitis and GLP-1 analogs prescribed medication.
are not recommended due to this
contraindication
TZDs have data to support an A1C reduction
necessary to gain glycemic control, but are MC has undiagnosed multiple gastric ulcers.
associated with weight gain, negative effects on Shortly after consuming a large meal and alcohol
lipids and increased risk of fracture. Until he experiences significant GI distress. He takes
recently, TZDs have also been linked to an OTC heartburn remedy. Within a minute or
increased CV events and use has fallen out of two he develops what he will later describe as
favor "belching, nausea and a bad bloated feeling".
Sulfonylureas provide excellent A1C lowering, Several of the ulcers began to bleed and he
but are also associated with weight gain. They becomes profoundly hypotensive from the blood
also have the potential to cause hypoglycemia, loss and is taken to the ED. Endoscopy confirms
so patient education is crucial. Because of his multiple bleeds; the endoscopist remarks that it
allergies to "sulfa", use would be contr appears as if the lesions had been literally
stretched apart causing additional tissue
damage. What did the patient most likely take
(i.e. what was the OTC remedy)? -
A patient with type 1 diabetes reports taking ANSWER -I would accept Alka-Selzer. I
propranolol for hypertension. What concern does contains NaHCO3 (as well as ASA). In the
this information present for the provider? - presence of HCL it Liberates CO2, that can
ANSWER -A patient with Type 1 DM is cause gastric distention, belching and nausea.
insulin dependent for glucose control and at high The reaction is fairly swift allowing little time for
risk for hypoglycemic episodes. Propanolol dissipation. Tums, its primary ingredient calcium
causes prolonged hypoglycemic episodes. carbonate which when taken cause a reaction
Needs to switch to ACE or ARB. with the stomach acid such as production of
carbon dioxide gas which can cause bloating and
, Advanced Pharmacology NSG 533 Test Questions and
Answers Rated A
the stomach to stretch to tear the ulcers open. nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, spicy
food, carbonated drinks
Fried/fatty foods, garlic, onions, chocolate
On your way to this examination, you experience
the vulnerable feeling that an attack of acute
diarrhea is imminent! If you stop at a drug store,
which anti-diarrheal drugs could you buy without What is the most effective PPI or H2RA within
a prescription even though it is chemically related each of these classes? - ANSWER --PPI-
to the strong opioid analgesic meperidine (but bismuth quadruple therapy combined with proton
acts only on the peripheral opioid receptor)? - pump inhibitors
ANSWER -Loperamide -H2RA- Famotidine 80mg
JA has multiple medical problems and is taking Other products such as antacids are also
several drugs including theophylline, warfarin available. What are some of these and what is
and phenytoin. His conditions were well their place in therapy? - ANSWER --Reflux
controlled, but recently he started to experience symptoms <2 times a week (infrequent)
some GI distress for which of his "well -Effective for immediate relief
intentioned friends" gave him some medication. -Magnesium/Aluminum Hydroxide (Maalox)- can
He presents to you with toxic effects of all his cause constipation
other medications and plasma levels of those -Alginic Acid
medications elevated. What was most likely the
medication he took? - ANSWER -
Cimetidine
Why would antibiotics be used for PUD caused
by H Pylori? What is a typical regimen and
duration of therapy? What patient specific factors
What lifestyle modifications should be should be considered and how should treatment
recommended? - ANSWER --losing weight be monitored? - ANSWER -Considerations
if overweight before regimen choice:
-elevating head of bed while asleep -penicillin allergy
-eating smaller meals -previous exposure to macroglide antibiotics
-avoid foods/meds that exacerbate gerd Strongest Reccomendation:
-stop smoking -Bismuth Quadruple Therapy 10-14 days
-stop drinking alcohol *do not drink alcohol w/ metronidazole*
-Salvage regimen should be different than first
regimen
What medications / foods can contribute to
GERD? - ANSWER --Medications:
anticholinergics, barbituates, dopamine, Who would be a candidate for prophylaxis of
estrogen, opioids, progesterone, theophylline, NSAID induced ulcer and what agents are
