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Advanced Pharmacology NSG 533 Questions With All Correct Answers 2024/2025
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Advanced Pharmacology NSG 533 Questions With All Correct Answers 2024/2025
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Advanced Pharmacology NSG 533EP is a 38-yr-old girl patient that comes in for diabetes training and management. She become
diagnosed 12 years ago and states these days she is not capable of control her weight loss plan
even though she continues a 1600 calorie eating regimen with appropriate day by day
carbohydrate consumption (in keeping with dietitian prescription) and walks 40 mins each day of
the week. She states compliance with all medicinal drugs. She denies any history of
hypoglycemia regardless of being capable of pick out signs and signs and describe appropriate
remedy techniques.
PMH: T2DM, HTN, weight problems, despair, s/p thyroidectomy because of thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, beyond marijuana use whilst in high faculty
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, sertraline one
hundred mg every day, multivitamin each day
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory check consequences: Na 134 mEq/L, K 5.Four mEq/L, Cl 106 mEq/L, BUN -
ANSExenatide - Exenatide (Bydureon) as soon as weekly has been able to show weight
reduction and reduce A1C% through 0.7% to 1.2% in clinical trials; however it is contraindicated
for EP due to the self-suggested records of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated on this patient because of
hyperkalemia which could be made worse via this drug. The bundle insert does now not imply a
selected potassium attention reduce off to no longer use this remedy; but, there are higher picks
on this affected person.
Sitagliptin - Sitagliptin (Januvia) is able to reap an A1C aim of much less than 7% based on
scientific trials and currently the affected person does not have any cautionary objective
measures to not use this medication. DPP-IV inhibitors are weight impartial. DPP-IV inhibitors
can be utilized in sufferers taking sulfonylureas; however, it could be recommended to lessen or
prevent the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not encouraged for preliminary management and is
associated with sizable GI facet results. More records might be wanted regarding fasting and
publish-prandial numbers. In addition, adding acarbose might handiest lower A1c via zero.8% at
best and therefore could not acquire 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 - ANSMetformin 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.Five%, twin remedy is indicated. There are several capacity
alternatives. The 2nd step can be a dipeptidyl peptidase-four inhibitor, it may be a glucagon-like
peptide-1 (GLP-1) receptor agonist, it could be a TZD, it can be a sulfonylurea agent, it could be
a SGLT2 inhibitor, or it could be basal insulin. Anything subsequent may be attempted relying on
what suits the situation
DPP4 inhibitors are weight neutral bet exceedingly benign side effect profile. Sitagliptin has
been associated with case reports of pancreatitis, so this particular agent need to be avoided.
$$$
GLP-1 analog and has statistics to assist an A1C discount necessary to advantage glycemic
manage and can help with weight loss dreams for this affected person. New information shows
these retailers may also provide advantages in people with ASCVD. JR has a beyond records of
pancreatitis and GLP-1 analogs aren't endorsed because of this contraindication
TZDs have records to aid an A1C reduction important to advantage glycemic manage, but are
related to weight benefit, terrible effects on lipids and increased hazard of fracture. Until lately,
TZDs have additionally been linked to increased CV events and use has fallen out of fashion
Sulfonylureas offer exquisite A1C lowering, however also are associated with weight gain. They
additionally have the potential to motive hypoglycemia, so patient training is important. Because
of his allergies to "sulfa", use could be contr
A affected person with kind 1 diabetes reviews taking propranolol for hypertension. What
situation does this records present for the provider? - ANSA affected person with Type 1 DM is
insulin established for glucose manage and at excessive chance for hypoglycemic episodes.
Propanolol causes prolonged hypoglycemic episodes. Needs to switch to ACE or ARB.
A issuer teaches a affected person who has been recognized with hypothyroidism
approximately a new prescription for levothyroxine. Which declaration by using the affected
person indicates a want for further teaching?
A. "I ought to now not take heartburn medicine without consulting my issuer first."
b. "I must file insomnia, tremors, and an increased heart fee to my issuer."
c. "If I take a multivitamin with iron, I ought to take it 4 hours after the levothyroxine."
d. "If I take calcium supplements, I may also need to decrease my dose of levothyroxine." -
ANSD. Calcium may reduce levothyroxine absorption. Further education is needed if the patient
feels she will take half of a prescribed remedy.
, MC has undiagnosed more than one gastric ulcers. Shortly after eating a massive meal and
alcohol he stories vast GI misery. He takes an OTC heartburn treatment. Within a minute or he
develops what he'll later describe as "belching, nausea and a awful bloated feeling". Several of
the ulcers started to bleed and he turns into profoundly hypotensive from the blood loss and is
taken to the ED. Endoscopy confirms more than one bleeds; the endoscopist remarks that it
appears as if the lesions were literally stretched aside causing extra tissue damage. What did
the affected person most probable take (i.E. What turned into the OTC treatment)? - ANSI could
accept Alka-Selzer. I carries NaHCO3 (in addition to ASA). In the presence of HCL it Liberates
CO2, that can cause gastric distention, belching and nausea. The reaction within reason swift
allowing little time for dissipation. Tums, its primary ingredient calcium carbonate which when
taken purpose a response with the stomach acid such as production of carbon dioxide gasoline
that may cause bloating and the belly to stretch to tear the ulcers open.
On your manner to this exam, you revel in the prone feeling that an attack of acute diarrhea is
drawing close! If you prevent at a drug keep, which anti-diarrheal tablets should you buy without
a prescription even though it is chemically related to the robust opioid analgesic meperidine
(however acts best on the peripheral opioid receptor)? - ANSLoperamide
JA has a couple of scientific issues and is taking several pills which include theophylline,
warfarin and phenytoin. His situations have been properly controlled, but recently he
commenced to enjoy a few GI distress for which of his "well intentioned pals" gave him some
medicinal drug. He offers to you with toxic results of all his other medications and plasma levels
of those medicines increased. What was maximum in all likelihood the medication he took? -
ANSCimetidine
What lifestyle adjustments must be recommended? - ANS-dropping weight if overweight
-elevating head of bed while asleep
-eating smaller food
-avoid ingredients/meds that exacerbate gerd
-stop smoking
-stop consuming alcohol
What medications / foods can contribute to GERD? - ANS-Medications: anticholinergics,
barbituates, dopamine, estrogen, opioids, progesterone, theophylline, nitrates
-Foods: cirus fruits/juices, coffee, tomatoes, highly spiced food, carbonated liquids
Fried/fatty foods, garlic, onions, chocolate
What is the simplest PPI or H2RA inside each of those classes? - ANS-PPI- bismuth quadruple
therapy combined with proton pump inhibitors
-H2RA- Famotidine 80mg
Other products which include antacids are also available. What are a number of those and what
is their place in remedy? - ANS-Reflux symptoms <2 times a week (infrequent)
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