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NURS 572 Advanced Pharmacotherapeutics UofA Nursing > Endocrine: Diabetic and Thyroid Meds > Flashcards

Endocrine: Diabetic and Thyroid Meds Flashcards

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3
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What antidiabetic drug could potentially help patients lose weight?

A. glyburide
B. metformin
C. repaglinide
D. pioglitazone

A

B. Metformin

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B. Lactate accumulation.

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B.

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C. Linagliptin

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C. Pioglitazone. This may exacerbate CHF because of fluid retention.

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B. decrease storage of triglycerides.

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A. Methimazole

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C.

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D. PTU

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C. Glucocorticoids

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13
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Metformin should be discontinued and switched to a different medication for which reason?
A. GFR below 30 mL/min
B. Diarrhea
C. Abdominal pain
D. Radiological study with contrast

A

A. Metformin is contraindicated with GFR below 30 mL/min.

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14
Q

The APN is seeing a patient with a history of diabetes and hypothyroidism. The patient recently discovered that she was 8 weeks pregnant. The APN should expect to take which action?

A. Increase thyroid replacement by 25%
B. Decrease thyroid replacement by 25%
C. Decrease beta blocker by 50%
D. Increase beta blocker by 50%

A

A. Metabolic requirements are increased during pregnancy. Increasing hormone replacement by 25% results in adequate coverage during pregnancy.

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15
Q

What are the goals of treatment for hypothyroidism?

A. Increase in TSH levels
B. Decrease in T4 levels
C. Increase in Free thyroxine index (FT4I)
D. Decrease in Free T3 (FT3)

A

C. Normalization of FT4I levels within a therapeutic range are desired. As hypothyroidism leads to decreased levels, this would be a goal of treatment.

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16
Q

The APN is providing instruction to an adult patient who has been prescribed thyroid hormone replacement therapy. Which patient finding would warrant additional instruction if observed by the APN?

A. Take medication if the pulse rate is recorded at 72 bpm
B. Take medication in the morning before eating breakfast
C. Patient states that if they miss a dose, they can take the medication at dinner time
D. Patient takes the same thyroid preparation medication each day

A

C. If a dose is missed, it may be taken that same day as soon as it is remembered, 4 hours after eating. As the patient states they are going to take the medication at dinner time, the APN should provide additional instruction that an empty stomach enhances absorption.

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17
Q

Which clinical situation would signify an inappropriate use of thyroid hormone therapy?
A. Increased TSH level with clinical symptoms
B. Patient complaints of chronic depression with normal TSH levels
C. Treatment of hypothyroidism in a patient having infertility issues
D. Treating hypothyroidism in a patient who is also being treated for depression

A

B. Use of thyroid supplementation for chronic depressive states without abnormal TSH is not supported by evidence.

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18
Q

Which of these is a microvascular complication of uncontrolled diabetes?
A. Proliferative retinopathy
B. Cardiovascular disease
C. Stroke
D. Peripheral vascular disease

A

A. Uncontrolled diabetes can result in microvascular and macrovascular complications. Microvascular involvement affects the eyes, heart, kidney, and nervous system.

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19
Q

Which type of therapy is recommended for a pregnant patient who also is found to be hyperthyroid during the first trimester?
A. Synthroid
B. Propylthiouracil
C. Methimazole
D. Insulin

A

B. Propylthiouracil is the preferred ATD during pregnancy because it is 80% to 90% protein bound and less likely to cross the placenta. Methimazole is teratogenic in the first trimester.

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20
Q

The APN is evaluating an adult female patient, age 35, who presents to the emergency department with flushed skin, complaints of heat intolerance, and agitation. Patient has noticed symptoms progressing over the past few weeks and denies any stress or precipitating factors. Baseline EKG reveals tachycardia with no other abnormalities. Which disease process should the APN suspect?
A. Hyperthyroidism
B. Congestive heart failure (CHF)
C. Panic attack
D. Menopause

A

A. Hyperthyroidism. Symptoms include palpitations, tremor, anxiety, possible weight loss, heat intolerance, and heightened sensitivity to sympathetic nervous system stimulation in hyperthyroidism.

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21
Q

Which concern should the APN evaluate for adult patients who are considering taking sitagliptin (Januvia) monotherapy?

A. History of congestive heart failure
B. GFR of 60 or higher
C. Nonpregnant
D. Prior cholecystectomy

A

A. Hx CHF. Heart failure continues to be a concern with the entire class of drugs.

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22
Q

Which of these is the drug of choice for treatment of hyperthyroidism in pregnancy?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil (PTU)
D. Propranolol

A

C. Propylthiouracil is the drug of choice during pregnancy because it crosses the placenta in low concentrations.

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23
Q

The APN is preparing to prescribe medication to an adult patient who is overweight and newly diagnosed with type 2 diabetes and has not had effective change in blood glucose levels using lifestyle modifications. Which medication should the APN prescribe?
A. Metformin
B. Glipizide
C. Insulin therapy
D. Janumet (sitagliptin + metformin)

A

A. Metformin is indicated as monotherapy and in multidrug therapy for patients with type 2 DM who cannot achieve adequate BG control on the typical lifestyle modifications of healthy eating, increased activity, and weight loss.

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24
Q

The APN is assessing an adult patient who presents with complaints of irritability, recent weight loss and feeling hot. Which laboratory test should the APN order?
A. Oral Glucose Tolerance Test (OGTT)
B. Lipid panel
C. TSH and T4
D. Fasting Blood Sugar (FBS)

A

C. The APN should suspect that the patient has hyperthyroidism, therefore thyroid function tests should be ordered.

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25
Q

When do the symptoms of type 1 diabetes begin?

A. After 80% to 90% of beta cell loss
B. After 40% to 50% of beta cell loss
C. After 20% to 30% of beta cell loss
D. After 60% to 70% of beta cell loss

A

A. Before hyperglycemia occurs, 80% to 90% of the function of insulin-secreting beta cells of the pancreas must be lost.

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26
Q

Which screening test is used to assess for congenital hypothyroidism in newborns?

A. Hemoglobin A1c
B. APGAR
C. Capillary blood screening
D. Blood glucose

A

C. Capillary blood screening of all infants in the U.S. and Canada before discharge from the hospital or birthing center tests for this disorder.

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27
Q

The APN diagnoses the patient with diabetes after obtaining an HbA1c of 12% in the office. The fasting blood glucose today is 135. The patient complains of a history of polyphagia, polydipsia, and polyuria. Which medication would be most appropriate to start today?

A. Insulin lispro and insulin glargine
B. Metformin
C. Glipizide
D. Metformin and sitagliptin

A

A. Oral hypoglycemic agents have limited ability to reduce hyperglycemia; therefore, for patients who initially present with blood glucose levels above 300 mg/dL, HbA1c greater than 10%, or significant hyperglycemic symptoms, insulin therapy is strongly recommended to lower PG to less than 180 mg/dL before oral agents are begun.

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28
Q

A patient with type 2 diabetes mellitus (DM) has concerns about starting insulin because of his current occupation. He states that his food intake has increased in the past 2 months, which has resulted in elevated home blood sugars. After a review of the home blood glucose readings, the APN decides on a medication to improve pre- and postprandial blood glucose levels. The addition of which medication is most appropriate?

A. Dulaglutide
B. Sitagliptin
C. Pramlintide
D. Nateglinide

A

B. Dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated efficacy in reducing pre- and postprandial blood glucose levels.

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29
Q

The APN should avoid prescribing which medication for a patient diagnosed with gestational diabetes?

A. Metformin
B. Insulin
C. Glyburide
D. Canagliflozin

A

D. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, such as canagliflozin, may affect renal development and maturation in utero. These medications should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

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30
Q

Which food selection should be avoided in patients who have hyperthyroidism?

A. Carrots
B. Highly seasoned food
C. High protein snacks
D. Potatoes

A

B. Patient who have hyperthyroidism should avoid highly seasoned foods as it can lead to facial flushing and tachycardia.

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31
Q

The APN would avoid use of saxagliptin (Onglyza) in which patient?

A. A 63-year-old patient with body mass index (BMI) of 40 who is currently using insulin glargine
B. A 52-year-old patient with history of pancreatitis
C. A 50-year-old patient with creatinine of 1.6 and glomerular filtration rate of 75 mL/min
D. A 38-year-old patient who was newly diagnosed with type 2 diabetes mellitus with occasional mild nausea

A

B. Cases of acute pancreatitis have been reported with dipeptidyl peptidase-4 inhibitors (DPP-4) inhibitors such as saxagliptin. It should be avoided in a patient with history of pancreatitis.

32
Q

Patients who require exogenous insulin should be cautioned to drink alcohol in moderation, because alcohol can have which effect?

A. Increases the risk of cardiovascular disease
B. Results in 25% weight increase
C. Masks the symptoms of diabetes
D. Increases blood glucose levels

A

C. Alcohol can induce hypoglycemia, but it also masks the signs and symptoms of the disorder.

33
Q

The patient is scheduled for a cardiac catheter this morning and has been NPO since midnight. He has a 10-year history of latent autoimmune diabetes in adults (LADA) and is currently on a basal/bolus regimen with good control. The blood glucose this morning is 170 mg/dL. The APN is writing orders for the procedure when the RN asks about the insulin dose this morning. Which action is most appropriate for the APN to instruct the RN to take?

A. Hold the morning dose of insulin because the patient administered insulin detemir the previous night.
B. Administer the usual dose of 15 units of Humulin Lispro.
C. Give an oral antidiabetic medication with a sip of water.
D. Reduce the Humulin Lispro insulin dose to 5 units.

A

A. For patients that are on bedtime glargine or detemir, the usual dose is given at night before the procedure. The blood glucose is less than 200 mg/dL; therefore, rapid-acting insulin (RAI) is not required. Insulin detemir has a half-life of 5 to 7 hours and peaks within 4 to 6 hours with duration of more than 12.

34
Q

A 32-year-old male patient with type 2 diabetes mellitus (DM) reports a recent episode of hypoglycemia in the morning. The APN is reviewing the medications and decides that adjustment of which medication would be most appropriate?

A. Insulin detemir
B. Sitagliptin
C. Glyburide
D. Insulin lispro

A

A. The use of basal insulin affects fasting blood glucose (FBG) and should be monitored with hypoglycemic episodes in the morning. Gliptins have a low risk for hypoglycemia. All sulfonylureas may produce severe hypoglycemia, but it is not specific to the fasting blood glucose (FBG). Insulin lispro has the greatest effect on postprandial blood glucose (BG).

35
Q

According to the American Diabetic Association (ADA) standards of medical care in diabetes, which of these is a diagnostic criterion for diabetes?

A. HbA1c 6.5%
B. Random glucose less than 200 mg/dL
C. Fasting glucose of 100 mg/dL
D. Fasting glucose less than 92 mg/dL

A

A. According to ADA guidelines, the diagnostic criteria for diabetes includes HbA1c 6.5%.

36
Q

For the diabetic patient with hypothyroidism, the APN should expect to take which action?

A. Add a 3 a.m. blood glucose
B. Increase insulin doses
C. Decrease basal insulin
D. Increase doses of thyroid hormone

A

C. Hypothyroidism may delay insulin turnover, requiring less insulin to treat diabetes mellitus.

37
Q

A patient requires 224 units of Humulin R per day. How can the APN help decrease the number of injections that this patient will require per day?

A. Increase the needle size.
B. Change the syringe size.
C. Increase metformin to decrease insulin resistance.
D. Change from Humulin U R 100 to Humulin R 500 U.

A

D. In the rare cases when individual injections of rapid-acting insulin (RAI), long-acting insulin (LAI), or ultra long-acting insulin (ULAI) are more than 200 units, the prescriber should consider a consultation with an endocrinologist to initiate use of concentrated insulin.

38
Q

The APN is teaching the mother of a 6-month-old infant with a diagnosis of congenital hypothyroidism. Which information would the APN include regarding levothyroxine (Synthroid)?

A. It should not be crushed.
B. It is given as a suspension from the pharmacy.
C. It should be crushed and added to infant formula.
D. It will not begin until the child is 1 year old.

A

C. There are no liquid levothyroxine products; tablets are crushed and added to infant formula with water or breast milk.

39
Q

Which lab results would the APN expect to see in an adult patient who is being evaluated for hypothyroidism?

A. Decreased TSH
B. TRH normal range
C. Decreased T4 and T3
D. Increased free triiodothyronine index (FT3I)

A

C. Decreased T4 and T3 levels would be seen in hypothyroidism due to insufficient conversion. TSH levels would be increased in hypothyroidism due to the feedback mechanism to stimulate thyroid hormone production. FT31 would be normal or decreased. TRH would have a low exaggerated rise in hypothyroidism.

40
Q

The APN is discussing the prognosis for a patient who was diagnosed with postpartum thyroiditis following the birth 2 weeks ago. What information should the APN share with the patient?

A. Most patients will achieve normal function without treatment
B. Symptoms are likely to continue for at least 9 months following the delivery
C. Postpartum thyroiditis is a common complication following delivery
D. The patient needs to be placed on replacement therapy during the post-partum period

A

A. Symptoms resolve spontaneously in 95% of patients and most return to euthyroid states without therapy. Antibody production in this disorder peaks three to four months after delivery and then declines. Postpartum thyroiditis with hypothyroid characteristics affects up to 7% of postpartum women. Symptoms resolve spontaneously in 95% of patients and most return to euthyroid states without therapy.

41
Q

Which adverse effect of metformin is most common?

A. Weight loss
B. Lactic acidosis
C. Flatulence
D. Reduction of LDL levels

A

C. The most common adverse reaction of metformin is gastrointestinal (GI) disturbances. Metformin can provide some benefit for lipids, but this is not the most common effect.

42
Q

Which statement is accurate as it relates to physiological active T3 and T4 levels in the body?

A. Large amounts of T4 and T3 are active in the body.
B. Active T4 and T3 are not bound to protein.
C. T3 and T4 levels are physiologically active at all times when in the body.
D. T4 and T3 levels are minimally affected by environmental changes; thus, they remain active.

A

B. T4 and T3 are clinically active only when they are free (not bound to protein). In the body, only small amounts of T4 (0.02%) and T3 (0.03%) are active. Their production and release occur in response to a feedback loop mechanism. T3 and T4 levels are affected by environmental changers such as stress, cold, acute and chronic illness, starvation, and some medications.

43
Q

Which body system is most affected by thyroid dysfunction?

A. Cardiovascular
B. Respiratory
C. Musculoskeletal
D. Integumentary

A

A. Cardiovascular. Thyroid disease affects all functions of the body, but the most prominent impact is on the cardiovascular system.

44
Q

The APN prescribed exenatide for a 56-year-old female patient with a history of type 2 diabetes mellitus (DM) on her last visit. The APN should be concerned if the patient reports which symptom?

A. Abdominal pain and nausea
B. Nausea
C. Diarrhea
D. Reduced appetite

A

A. Persistent, severe abdominal pain that may be accompanied by vomiting are hallmark symptoms of pancreatitis and would be a cause for concern.

45
Q

Testing of which levels best monitors the effectiveness of thyroid replacement?

A. Thyroid-stimulating hormone (TSH)
B. Serum triiodothyronine (T3)
C. Levothyroxine
D. Serum thyroxine (T4)

A

A. Thyroid function in hypothyroidism is monitored with TSH and free T4. Serum T4 measurements are unreliable for monitoring levothyroxine dosing.

46
Q

Which ORAL medication has the most potential for hypoglycemia?

A. Selective sodium-glucose cotransporter 2 (SGLT-2) inhibitor
B. Dipeptidyl peptidase-4 (DPP-4) inhibitor
C. Short-acting rapid insulin
D. Sulfonylurea

A

D. All sulfonylureas may produce severe hypoglycemia. DDP-4 inhibitors have a low risk for hypoglycemia.

47
Q

Which of these can increase HbA1c?

A. Chronic renal failure
B. Blood loss
C. Alcohol use
D. Pregnancy

A

C. Alcohol. HbA1c can be increased by alcohol use.. Renal failure decreases HbA1c due to loss of erythrocyte production. HbA1c can be decreased by blood loss and pregnancy due to erythrocyte turnover.

48
Q

A postmenopausal patient being treated for hypothyroidism with levothyroxine for several years returns for a follow-up office visit. Thyroid labs have been stable. Vital signs: BP 138/68; pulse 72, regular; respirations 20 nonlabored; afebrile. Which diagnostic test should the APN order to assess for concomitant disease?

A. Oral glucose tolerance test (OGTT)
B. Ultrasound of the neck
C. DEXA scan
D. Chest x-ray

A

C. DEXA scan. Long-term use of levothyroxine therapy in women has been associated with decreased bone density in the hip and spine.

49
Q

Which symptom should be reported to the health-care provider and may be a reason to discontinue an antithyroid medication?

A. Weight gain
B. Agranulocytosis
C. Weakness
D. Headache

A

B. The most common potential adverse reaction is agranulocytosis. Patients are taught to report sore throat, fever, chills, rash, and unusual bleeding or bruising. HA, weakness and weight loss are all sx on untreated hyperthyroidism.

50
Q

A 72-year-old male patient is taking a sodium-glucose cotransporter 2 (SGLT-2) inhibitor for type 2 diabetes mellitus. The APN should be concerned if the patient reports which symptom?

A. Falls
B. Glycosuria
C. Increased hemoglobin
D. Weight loss

A

A. Falls. A history of falls may suggest hypotension as a result of hypovolemia. Glycosuria, increased hemoglobin and weight loss are all expected symptoms of a SGLT-2 inhibitor.

51
Q

Which lab results would the APN expect to see in an adult patient who is being evaluated for hypothyroidism?

A. Decreased TSH
B. TRH normal range
C. Decreased T4 and T3
D. Increased free triiodothyronine index

A

C. Decreased T4 and T3 levels would be seen in hypothyroidism due to insufficient conversion.

52
Q

Which body system is most likely to be impacted by thyroid dysfunction leading to increased morbidity and mortality?

A. Musculoskeletal
B. Integument
C. Gastrointestinal
D. Cardiovascular

A

D. Thyroid dysfunction (hypo or hyper) can lead to significant cardiac complications due to alterations in lipid metabolism, thus leading to increased morbidity and mortality.

53
Q

A patient is being treated with methimazole. How long will it take for the drug to be effective?

A. 1 week
B. 2 weeks
C. 6 months
D. 4 to 8 weeks

A

D. Methimazole takes about 4 to 8 weeks to achieve effects.

54
Q

A 29-year-old male patient with a history of type 2 diabetes mellitus presents to the office for a routine health maintenance visit. His HbA1C has increased by 2% within the past 4 months. The APN discusses the option of adding an additional medication. The patient informs the APN that he is concerned about his weight but is unable to start a weight loss program at this time due to the complexity of his schedule. Which medication change should be considered?

A. Decrease linagliptin (DPP-4 inhibitor)
B. Increase glipizide
C. Decrease canagliflozin (SGLT-2 inhibitor)
D. Increase metformin

A

D. Metformin is the oral agent most associated with fostering weight loss and is the drug of choice in the treatment algorithm for patients with central obesity. Weight gain is common following the initiation of sulfonylurea therapy. The increased insulin secretion generated by sulfonylureas has been associated with weight gain and hyperinsulinemia. Dipeptidyl peptidase-4 inhibitors (DPP-4) medications, and sodium-glucose cotransporter 2 (SGLT-2) medications have also been shown to promote weight loss so you would not want to decrease these.

55
Q

A 48-year-old new patient admission has been added to the APN’s schedule. She has a history of latent autoimmune diabetes in adults (LADA). She is currently utilizing a mixed insulin twice a day and a rapid-acting insulin (RAI) with meals according to her sliding scale. Her fasting blood glucose is 95 mg/L and the HbA1C is 6.5%. Which action taken by the APN today would be most appropriate?
correct
A. The APN would indicate that no adjustments are needed.
B. The APN would change to basal bolus method.
C. The APN would request additional information before making changes at this appointment.
D. The APN would instruct the patient to include RAI before meals.

A

A. No adjustments. Her current medication regimen is therapeutic. ADA guidelines say the HbA1c goal for most patients is generally less than 7% so it is not necessary to change medications or need more information.

56
Q

A frail, 78-year-old female patient with a history of type 2 diabetes mellitus (DM), obesity, chronic obstructive pulmonary disease, and coronary artery disease is returning for a follow-up evaluation. She has a previous history of hypoglycemia. Her current medication regimen includes max dose of biguanide and a dipeptidyl peptidase-4 (DPP-4) inhibitor. Her HbA1c is 7.8%. Which action is most appropriate for the APN to take?
correct
A. Prescribe no additional medication.
B. Prescribe rapid-acting insulin (RAI) before meals.
C. Prescribe nasally inhaled human insulin.
D. Prescribe a sulfonylurea.

A

A. No additional meds. According to the American Diabetic Association (ADA) guidelines, a less stringent A1c goal of less than 8% may be appropriate for a patient with extensive comorbid conditions. The patient has a previous history of hypoglycemic episodes, so RAI and sulfonylureas would not be a good choice for this patient.

57
Q

The goal of thyroid replacement in congenital hypothyroidism is to achieve normal IQ and neurological function. Close monitoring is needed when the infant diet consists of which of these?

A. Breast milk
B. Cooked cereal
C. Milk-based formula
D. Soy-based formula

A

D. There is evidence that soy may impair thyroxine absorption from the gut.

58
Q

The lowest dose possible of levothyroxine (Synthroid) should be given to the patient with which condition?

A. Pregnancy
B. Diabetes
C. Osteoporosis
D. Simple nontoxic goiter

A

C. Osteoporosis. Long-term levothyroxine therapy has been associated with decreased bone density in the hip and spine in both pre- and postmenopausal women. Use the lowest dose possible for the osteoporosis patient. Metabolic requirements are increased during pregnancy. Increasing hormone replacement by 25% results in adequate coverage during pregnancy.

59
Q

Which treatment plan should the APN initiate when starting hormone replacement therapy for hypothyroidism in a newly diagnosed adult patient?

A. Starting levothyroxine at 100 mcg daily and increasing every week by 25 mcg until TSH goal is reached
B. Starting levothyroxine at 75 mcg daily and increasing at 4-week intervals to 150 mcg/d to establish TSH goals
C. Initial dose of 25 mcg daily with increasing at 6 to 8 weeks intervals to establish TSH goals
D. Starting levothyroxine at 50 mcg daily and increased at 2 to 4 weeks intervals by 25 mcg to establish TSH goals

A

D. Levothyroxine is started at 50 mcg in the adult patient and is increased in increments of 25 mcg/d at 2- to 4-week intervals to 100 to 150 mcg/d. The target dose is based on TSH levels and is approximately 1.6-1.7 mcg/kg/d.

60
Q

The APN is testing for gestational diabetes and instructs the patient who is 24 weeks pregnant how the oral glucose tolerance test is conducted. The patient states that her mother has diabetes and has a blood test called an HbA1c, which is tested three times a year. The APN informs the patient that the HbA1c would NOT be an adequate measurement for diagnosis of gestational diabetes for which reason?

A. HbA1c is unreliable in early pregnancy.
B. HbA1c test is more expensive.
incorrect
C. Oral glucose tolerance test (OGTT) is more effective.
D. HbA1c is unreliable in disorders with hepatic gluconeogenesis.

A

A. HbA1c would not be an accurate measurement of blood glucose for a patient without a history of diabetes. The OGTT is more effective in gestational diabetes because it determines how well the body uses glucose; however, the question is why HbA1c is not used in pregnancy. The cost of HbA1c is less expensive than the oral glucose tolerance test (OGTT).

61
Q

Which physiological event leads to a clinical diagnosis of hyperthyroidism?

A. Activation of feedback leading to suppression of TSH and TRH.
B. Decrease in release of thyroid hormones leading to increased metabolism
C. Suppression of autoimmune response leading to hypometabolism
D. Resumption of normal pathway mechanisms leading to increased thyroid hormones

A

A. The hyperfunction of the thyroid gland leads to suppression of TSH and TRH.

62
Q

The APN is reviewing thyroid replacement therapy for a pregnant patient. Which plan of action should the APN take?

A. Recheck TSH levels in 6 to 8 weeks
B. APN can manage the patient independently
C. Dose adjustments of 10% typically are needed during pregnancy
D. Typically, no dose adjustments are needed during pregnancy if TSH levels have been within range pre-pregnancy

A

A. TSH levels should be checked every 6 to 8 weeks during pregnancy to determine whether any dose adjustment is needed. Increasing the dose by 25% usually results in adequate coverage during pregnancy.

63
Q

Intensive insulin regimens have proven their effectiveness with the greatest impact on lowering blood glucose. Which of these is an intensive insulin regimen?

A. Humalog 70/30 subcutaneously twice a day
B. Metformin bid and Novolin 75/25 daily at bedtime
C. Insulin glargine 10 daily at bedtime and insulin lispro 5 units before each meal
D. NPH subcutaneously every evening

A

C. An intensive insulin therapy would include a basal/bolus insulin combination. When using the intensive insulin therapy approach, two to four injections are administered per day. This regimen involves 1:1 basal bolus dosing with long-acting insulin (LAI) or the new ultra long-acting insulin (ULAI) administered either at breakfast or bedtime with either rapid-acting insulin (RAI) or short-acting insulin (SAI) bolus doses before each meal. Humalog 70/30 is a premixed insulin that is a combination between short and intermediate insulin, not basal/bolus insulin.

64
Q

Pioglitazone should not be used in patients with which condition?

A. Class III heart failure
B. Peripheral arterial disease
C. Obesity
D. Angina

A
  1. Class III HF
65
Q
A
66
Q

Levothyroxine (Synthroid) is contraindicated in the patient with which comorbidity?

A. Diabetes
B. Osteoporosis
C. Myocardial infarction (MI)
D. Peripheral vascular disease

A

C. Cardiovascular disease may worsen when thyroid hormones are given. Thyroid hormone replacement is contraindicated after recent MI. The increased thyroid hormone increases oxygen demand by the heart muscle and decreases oxygen supply by reducing diastolic filling time.

67
Q

Prior to prescribing metformin, the provider should:

a) Order an eGFR to assess renal function
b) Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions
c) Try the patient on insulin
d) Tell the patient to increase iodine

A

A.

68
Q

Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:
a) Easy bruising, palpitations, and cardiac dysrhythmias
b) Diarrhea, abdominal pain, and weight loss
c) “Fruity” breath odor and rapid respiration
d) Dizziness, confusion, diaphoresis, and tachycardia

A

D.

69
Q

The decision may be made to switch from twice daily NPH insulin to insulin glargine to improve glycemia control throughout the day. If this is done:

A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
B. The initial dose of glargine is 2 to 10 units per day.
C. Patients who have been on high doses of NPH will need tests for insulin antibodies.
D. Obese patients may require more than 100 units per day.

A

A.

70
Q

Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to step 2 therapy because they:

a) Increase the risk for hypoglycemia
b) Increase endogenous insulin secretion
c) Improve insulin binding to receptors
d) Address the insulin resistance found in type 2 diabetics

A

A.

71
Q

When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:

a) They should feel symptomatic improvement in 1 to 2 weeks.
b) Because of its short half-life, levothyroxine doses should not be missed.
c) Drug adverse effects such as lethargy and dry skin may occur.
d) It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.

A

D

72
Q

Diagnostic criteria for diabetes include:

A. Fasting blood glucose greater than 140 mg/dL on two occasions
B. Postprandial blood glucose greater than 140 mg/dL
C. Fasting blood glucose 100 to 125 mg/dL on two occasions
D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dL

A

D.

73
Q

Which characteristic of metformin makes it a popular selection for diabetes care?

a) No gastrointestinal (GI) side effects
b) Only rarely causes hypoglycemia
c) Once-weekly dosing
d) Pain-free injections due to the micro needle

A

B

74
Q

Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:

a) Substitutes for insulin usually secreted by the pancreas
b) Increases the release of insulin from beta cells
c) Decreases peripheral glucose utilization
d) Decreases hepatic glucose production

A

D

75
Q

The action of gliptins is different from other antidiabetic agents because they:

a) Act on the incretin system to indirectly increase insulin production
b) Close ATP-dependent potassium channels in the beta cell
c) Have a low risk for hypoglycemia
d) Are not associated with weight gain

A

A

76
Q

Elderly patients who are on levothyroxine for thyroid replacement should be monitored for:

a) Weight gain
b) Excessive sedation
c) Cold intolerance
d) Tachycardia and angina

A

D

NURS 572 Advanced Pharmacotherapeutics UofA Nursing (19 decks)

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