Nurs 615 Exam IV
How will you prescribe lipase, protease, and amylase components? - correct answer 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? - correct
answer 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? -
correct answer (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
,Nurs 615 Exam IV
Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis. - correct answer
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? - correct
answer The initial dose of glargine is reduced by 20% to prevent hypoglycemia.
How does metformin work? - correct answer 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? - correct
answer 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? - correct answer 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? - correct answer 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? - correct answer 60 minutes prior to the morning
and evening meal
How will you assess for granulocytopenia? - correct answer Signs of a Cold or flu including
fever and sore throat
What are the adverse effects of propylthiouracil? - correct answer 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.
, Nurs 615 Exam IV
What are the adverse effects of levothyroxine? - correct answer Tachycardia and angina in the
elderly
A patient develops a toxic goiter. What is the recommended treatment? - correct answer
Methimazole for one month then radioactive iodine (p. 641)
What are the adverse effects of PTU and methimazole? - correct answer PTU- Fatal
agranulocytopenia look for fever and sore throat and TEMPORARY ALOPECIA
What is the action of biphosphonates? - correct answer 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? - correct answer
Prosobee
What are the drug interactions when prescribing poglitazone? - correct answer Metabolized by
the CYP 2C8 which induces just like oral contraceptives. Oral contraceptives will be less
effective, which leads to more unintended pregnancies. Council patients to change to a more
reliable method of birth control that is not metabolized by the liver such as depropravera, long
acting reversible contraceptives such as the IED or implantable contraceptives such as
nexplanon
What is the drug of choice to treat neurogenic diabetes insipidus? - correct answer
Clorapropramide
What is the dosage schedule for alpha-glucosidase inhibitors? - correct answer Take within the
first bite of each meal
Describe the pharmacodynamics of meglitinides. - correct answer Citagliptan works to
compatibly inhibit the enzyme dipeptidyl, dipeptide, or called DDP 4 as mentioned before, this
enzyme breaks down the incretins GLP1 and GIP gastrointestinal hormone released in response
to a meal. By preventing GLP1 and GIP inactivation, they are able to increase secretion of
insulin and suppress the release of glucagon by the alpha cells of the pancreas, this process
ultimately drives calcium into the cell, this drives blood glucose levels towards normal as the
blood glucose level approaches normal, the amount of insulin release in glucagon suppression
