NSG 533 ADVANCED
PHARMACOLOGY TEST 1
LATEST 2024-2025 ACTUAL
EXAM 100 QUESTIONS AND
CORRECT DETAILED ANSWERS
WITH RATIONALES
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 denies any history of hypoglycemia despite being able to
identify signs and symptoms and describe appropriate treatment
strategies.
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 -
answer 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 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. 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%
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
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet - answer 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).
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 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
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? - answer 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.
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 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." - answer D. Calcium may reduce levothyroxine absorption.
Further education is needed if the patient feels she can take half of a
prescribed medication.
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