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NSG6005 Test 8 – Questions With Solutions (Pass!)
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NSG6005 Test 8 – Questions With Solutions (Pass!)How will you prescribe lipase, protease, and amylase components? Right
Ans - Patients with cystic fibrosis are often prescribed enzyme replacement
for pancreatic secretions each replacement drug has amylase, lipase and
protease components, however the drug is prescribed in units of lipase
What is the medication of choice for hypertensive crisis with
pheochromocytoma? Right Ans - Surgical resection of the tumor is the first
treatment of choice either my open laparotomy or laparoscopy either surgical
option requires prior treatment of nonspecific irreversible adrenergic
adraonoreceptor blocker phenoxybenzamine or a shorter acting alpha
antagonists, prazosin, terazosin, and doxazosin. Mainly use phenozibenamine
in practice. Doing so promotes the surgery to proceed while minimizing the
likelihood of severe intraoperative hypertension which is likely when the
tumor is manipulated.
What is the onset of action, peak of action, and duration of action of each
insulin preparation? Right Ans - (Intermediate Acting) NPH
Onset-60-90 min after administration,
Peak 48 hrs
Duration 10-18 hrs.
(Short Acting) Regular Onset 30-60 min
Peak 2-4 hrs
Duration 6-10 hrs
(Long Acting) Aspart, Lispro, Glulisine
Onset less than 15 min
Peak 1-2 hrs
Duration 3-6 hrs
(Long Acting) Glargine, Detemir
Onset 1-2 hrs
Peak NO PEAK
Duration 24 hrs
,Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis.
Right Ans - Hypoglycemia- dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia- polyphagia, polydipsia, polyuria, blurred vision, and fatigue
Ketoacidosis- hallmark symptoms include acetone breath like nail polish
remover or fruity breath. Also abdominal pain, nausea, vomiting and sob.
When changing from NPH to glargine insulin, how will you adjust the patient's
dose? Right Ans - The initial dose of glargine is reduced by 20% to prevent
hypoglycemia.
How does metformin work? Right Ans - Decreases hyperglycemia by
decreasing hepatic glucose production called hepatic gluconeogenesis. The
average person with type 2 diabetes has three times the rate of
gluconeogenesis, metformin treatment reduces this by over 1/3rd. The
molecular mechanism of metformin isn't completely understood. In addition
to suppressing hepatic glucose production, metformin increases insulin
sensitivity, enhances peripheral glucose uptake by inducing the
phosphorilization of glu4 enhancer factor, decreases insulin induced
suppression of fatty acid oxidation, and decreases absorption of glucose from
the GI tract. Also of note** Metformin helps reduce LDL cholesterol and
triglyceride levels and is not associated with weight gain, in some people it
helps promote weight loss**
What diagnostic testing is required before and throughout therapy with
metformin? Right Ans - Metformin is not metabolized, it is cleared from the
body by tubular secretion and is secreted unchanged in the urine. Metformin
is undetectable in blood plasma within 24 hrs of a single oral dose the average
elimination half-life in plasma is 6.2 hrs as it is secreted in the urine you
should check a serum crt to assess renal function.
What is the action of gliptin? Right Ans - The mechanism of DDP-4
inhibitors is to increase incretin levels incretin are GLP1 and GIP which inhibit
glucagon release in which in turn increases insulin secretion, decreases
gastric emptying, and decreases blood glucose levels
How do GLP agonists work? Right Ans - They bind directly to a receptor in
the pancreatic beta cell. These agents work in the same pathway as the DPP-4
inhibitors as mentioned above but are generally considered more potent.
, When should exenatide be administered? Right Ans - 60 minutes prior to
the morning and evening meal
How will you assess for granulocytopenia? Right Ans - Signs of a Cold or flu
including fever and sore throat
What are the adverse effects of propylthiouracil? Right Ans -
Agranulocytosis, thrombocytopenia, and fulminant liver failure as stated
above, pt's on PTU when they develop fever or sore throat, it would be
important to check a CBC preferably with a smear and a diff.
What are the adverse effects of levothyroxine? Right Ans - Tachycardia and
angina in the elderly
A patient develops a toxic goiter. What is the recommended treatment?
Right Ans - Methimazole for one month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? Right Ans - PTU-
Fatal agranulocytopenia look for fever and sore throat and TEMPORARY
ALOPECIA
What is the action of biphosphonates? Right Ans - Bone undergoes
constant turnover and is kept in balance by osteoblasts creating bone and
osteoclasts destroying bone. Bisphosphonates inhibit the digestion of bone by
encouraging osteoclasts to undergo apoptosis or cell death there by slowing
bone loss. Oral bisphosphonates can cause upset stomach and inflammation as
well as erosion. Erosions of the esophagus which is the main problem of oral
and containing preparations. This can be prevented by sitting upright for 30-
60 minutes after taking the medication. If the patient does develop some type
of gastric distress, give them oral 30ml of Maalox 3 hrs after taking it. IV
bisphosphonates can give fever and flu like symptoms after the first infusion
which is thought to occur because of their potential to activate human T cells
Which infant formula is linked to impairment of thyroxine absorption?
Right Ans - Prosobee
What are the drug interactions when prescribing poglitazone? Right Ans -
Metabolized by the CYP 2C8 which induces just like oral contraceptives. Oral
contraceptives will be less effective, which leads to more unintended
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