NURS 5334 STUDY GUIDE 2025/2026 QUESTIONS WITH
SOLUTIONS GRADED A+
✔✔What are routes of administration? Which can be inhaled? - ✔✔SQ injection IV
infusion. Inhalation—Afrezza, meal time insulin
✔✔Typical insulin dosing for type 1? Type 2? - ✔✔Total doses may range from 0.1
unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
✔✔What are the 3 dosing schedules? - ✔✔o Twice daily dosing o Intensive basal/bolus
strategy o Continued subcutaneous insulin
✔✔How does metformin work? - ✔✔o Inhibits glucose production in the livero Reduces
glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat and
skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
✔✔Metformin What are side effects? BB warning? - ✔✔o GI effects—diarrhea
o Lactic acidosis
✔✔How does alcohol effect? - ✔✔Inhibits the breakdown of lactic acid
✔✔What are the therapeutic uses other than DM? - ✔✔o Gestational diabetes
o PCOS
✔✔Sulfonylureas - ✔✔o First generation
Chlorpropamide [Diabinese]
Tolazamide [Tolinase]
Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
✔✔MOA?
~~~~~~~~~~~~
Main side effect? - ✔✔Promote insulin release
~~~~~~~~
Hypoglycemia
Weight gain
,✔✔How does cimetidine effect? Beta blocker? - ✔✔Cimetidine—intensifies the
response
Beta blockers—diminish the benefits by suppressing the insulin release
✔✔Meglitinides (Repaglinide and Nateglinide) - ✔✔o MOA—stimulate pancreatic insulin
release
o Drug/Drug interaction—gemfibrozil
✔✔Thiazolidinediones (glitazones) - ✔✔Reduce glucose levels primarily by decreasing
insulin resistance
o Only indication is type 2 diabetes, mainly as an add-on to metformin
o Rosiglitazone [Avandia]: Restricted use
o Pioglitazone [Actos]
o Can they be used in patient with CHF?
No
✔✔Alpha-glucosidase inhibitors (Acarbose or Precose; Miglitol (glyset))
~~~~~~~~~~~~~~~~~~~~
What races are these more effective in? - ✔✔Latinos and African Americans
✔✔DPP-4 inhibitors (gliptins) - ✔✔MOA—promote glycemic control by enhancing the
actions of the incretin hormones and
they stimulate glucose dependent release of insulin
Suppress your post-prandial release of glucagon
✔✔What is the % of A1C reduction? - ✔✔0.5%
✔✔How does colesevelam work in treatment of DM? Bromocriptine? -
✔✔Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower blood
glucose
Many with diabetes also have high cholesterol so 2 birds-1 stone
o Bromocriptine—adjunct to diet and exercise (0.5% reduction)
✔✔Injectables:
o Amylin memetics? - ✔✔Pramlintide
Side effects—hypoglycemia when used with insulin
Drug/Drug—insulin
o GLP-1 receptor agonists (or incretin mimetics)
Can cause medullary thyroid cancer
✔✔What is treatment of diabetic ketoacidosis (DKA)? Hypoglycemia? - ✔✔o Insulin
replacement, reverse acidosis with bicarbonate, replace water, sodium,
potassium, normalize glucose levels
o Hypoglycemia—IV glucose, glucagon is glucose not available
, ✔✔What is hyperosmolar hyperglycemia state (HHS)?
~~~~~~~~~~
o When does this occur?
~~~~~~~~~~
o Treatment? - ✔✔o Large amount of glucose excreted in the urine and results in
dehydration and loss of
blood volume
o Increases blood concentration of electrolytes and nonelectrolytes, particularly glucose
and hematocrit
~~~~~~~~~~~~~
Most frequently with type 2 diabetics with acute infection or illness or other
stressors
~~~~~~~~~~~~~
Correcting hyperglycemia and dehydration with IV insulin, fluids, and
electrolytes
✔✔What effect does iodine have on thyroid? - ✔✔o When iodine availability is low
production of thyroid hormones decrease
✔✔Why is normal thyroid function important in first trimester of pregnancy? How much
does
requirement unusually increase in pregnant women taking thyroid supplements? - ✔✔o
Fetus is unable to produce its own hormones, without can result in permanent
neuropsychologic deficits
o Usually increases as much as 50%
✔✔When is fetal thyroid gland full functional? - ✔✔o 16 weeks
✔✔If not treated, what does hypothyroidism cause in an infant? - ✔✔o Large protruding
tongue, potbelly, and dwarfish stature
o The development of the nervous system, bones, and teeth is impaired
✔✔When should treatment be stopped? How long? - ✔✔o At 3 years of age for 4
weeks, then TSH is checked
o If rise—deficiency is permanent, thyroid replacement needed
o If normalize—transient deficiency, no further replacement required
✔✔How is Graves' Disease treated? - ✔✔o Surgical removal, destruction of the thyroid
tissue, suppression of the thyroid hormone
synthesis and/or beta blockers
o Non-radioactive iodine can be used to distract the thyroid tissue
✔✔Thyroid Storm? - ✔✔o Hyperthermia, severe tachycardia, restlessness, agitation,
tremor
SOLUTIONS GRADED A+
✔✔What are routes of administration? Which can be inhaled? - ✔✔SQ injection IV
infusion. Inhalation—Afrezza, meal time insulin
✔✔Typical insulin dosing for type 1? Type 2? - ✔✔Total doses may range from 0.1
unit/kg body weight to more than 2.5 units/kg Type1
Initial doses typically range from 0.5-0.6 units/kg per day Type2
Initial doses range from 0.2-0.6 units/kg per day
Dosage increased or decreased according to carb intake, activity
✔✔What are the 3 dosing schedules? - ✔✔o Twice daily dosing o Intensive basal/bolus
strategy o Continued subcutaneous insulin
✔✔How does metformin work? - ✔✔o Inhibits glucose production in the livero Reduces
glucose absorption in the guto Sensitizes insulin receptors in target tissues (fat and
skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
✔✔Metformin What are side effects? BB warning? - ✔✔o GI effects—diarrhea
o Lactic acidosis
✔✔How does alcohol effect? - ✔✔Inhibits the breakdown of lactic acid
✔✔What are the therapeutic uses other than DM? - ✔✔o Gestational diabetes
o PCOS
✔✔Sulfonylureas - ✔✔o First generation
Chlorpropamide [Diabinese]
Tolazamide [Tolinase]
Tolbutamine [Orinase]
o Second Generation:
Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
✔✔MOA?
~~~~~~~~~~~~
Main side effect? - ✔✔Promote insulin release
~~~~~~~~
Hypoglycemia
Weight gain
,✔✔How does cimetidine effect? Beta blocker? - ✔✔Cimetidine—intensifies the
response
Beta blockers—diminish the benefits by suppressing the insulin release
✔✔Meglitinides (Repaglinide and Nateglinide) - ✔✔o MOA—stimulate pancreatic insulin
release
o Drug/Drug interaction—gemfibrozil
✔✔Thiazolidinediones (glitazones) - ✔✔Reduce glucose levels primarily by decreasing
insulin resistance
o Only indication is type 2 diabetes, mainly as an add-on to metformin
o Rosiglitazone [Avandia]: Restricted use
o Pioglitazone [Actos]
o Can they be used in patient with CHF?
No
✔✔Alpha-glucosidase inhibitors (Acarbose or Precose; Miglitol (glyset))
~~~~~~~~~~~~~~~~~~~~
What races are these more effective in? - ✔✔Latinos and African Americans
✔✔DPP-4 inhibitors (gliptins) - ✔✔MOA—promote glycemic control by enhancing the
actions of the incretin hormones and
they stimulate glucose dependent release of insulin
Suppress your post-prandial release of glucagon
✔✔What is the % of A1C reduction? - ✔✔0.5%
✔✔How does colesevelam work in treatment of DM? Bromocriptine? -
✔✔Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower blood
glucose
Many with diabetes also have high cholesterol so 2 birds-1 stone
o Bromocriptine—adjunct to diet and exercise (0.5% reduction)
✔✔Injectables:
o Amylin memetics? - ✔✔Pramlintide
Side effects—hypoglycemia when used with insulin
Drug/Drug—insulin
o GLP-1 receptor agonists (or incretin mimetics)
Can cause medullary thyroid cancer
✔✔What is treatment of diabetic ketoacidosis (DKA)? Hypoglycemia? - ✔✔o Insulin
replacement, reverse acidosis with bicarbonate, replace water, sodium,
potassium, normalize glucose levels
o Hypoglycemia—IV glucose, glucagon is glucose not available
, ✔✔What is hyperosmolar hyperglycemia state (HHS)?
~~~~~~~~~~
o When does this occur?
~~~~~~~~~~
o Treatment? - ✔✔o Large amount of glucose excreted in the urine and results in
dehydration and loss of
blood volume
o Increases blood concentration of electrolytes and nonelectrolytes, particularly glucose
and hematocrit
~~~~~~~~~~~~~
Most frequently with type 2 diabetics with acute infection or illness or other
stressors
~~~~~~~~~~~~~
Correcting hyperglycemia and dehydration with IV insulin, fluids, and
electrolytes
✔✔What effect does iodine have on thyroid? - ✔✔o When iodine availability is low
production of thyroid hormones decrease
✔✔Why is normal thyroid function important in first trimester of pregnancy? How much
does
requirement unusually increase in pregnant women taking thyroid supplements? - ✔✔o
Fetus is unable to produce its own hormones, without can result in permanent
neuropsychologic deficits
o Usually increases as much as 50%
✔✔When is fetal thyroid gland full functional? - ✔✔o 16 weeks
✔✔If not treated, what does hypothyroidism cause in an infant? - ✔✔o Large protruding
tongue, potbelly, and dwarfish stature
o The development of the nervous system, bones, and teeth is impaired
✔✔When should treatment be stopped? How long? - ✔✔o At 3 years of age for 4
weeks, then TSH is checked
o If rise—deficiency is permanent, thyroid replacement needed
o If normalize—transient deficiency, no further replacement required
✔✔How is Graves' Disease treated? - ✔✔o Surgical removal, destruction of the thyroid
tissue, suppression of the thyroid hormone
synthesis and/or beta blockers
o Non-radioactive iodine can be used to distract the thyroid tissue
✔✔Thyroid Storm? - ✔✔o Hyperthermia, severe tachycardia, restlessness, agitation,
tremor
