NSG 533 Module 2 Flashcards
Which of the following deficiencies could result from the use of metformin?
Vitamin D
Vitamin C
B12
Niacin
B12
Metformin has the potential to deplete vitamin B12 levels. B12 levels should be monitored periodically throughout treatment.
Which diabetes medication is most likely to cause hypoglycemia when used as monotherapy (by itself)?
Metformin
Empagliflozin
Semaglutide
Glipizide
Glipizide
Glipizide is a sulfonylurea that stimulates the release of insulin from the pancreas. Because of this fact, it carries the highest risk of causing hypoglycemia.
One of your patients has severe heart failure with substantial edema. He began a new diabetes medication. Which medication would be most likely to worsen edema and heart failure?
Dapagliflozin
Glyburide
Glipizide
Pioglitazone
Pioglitazone
Pioglitazone is well known to cause weight gain and edema and should be avoided in patients with heart failure.
You are meeting with a patient today and he describes significant nausea. He thinks it is his diabetes medications that are causing this. Which medication would you likely suspect is causing this?
Glipizide
Insulin glargine
Dapagliflozin
Liraglutide
Liraglutide
The most common adverse effect of GLP-1 agonists like liraglutide is nausea and other similar GI symptoms.
Which best describes the mechanism of action of metformin?
- Decreases hepatic glucose production
- Stimulates pancreatic cells to produce/release insulin
- Inhibits DPP-4 which increases incretin levels
- Glucagon-like peptide 1 agonists enhance glucose dependent insulin secretion
Decreases hepatic glucose production
Metformin decreases hepatic glucose production which ultimately lowers blood sugar. It also avoids stimulating the release of insulin-like sulfonylureas so the risk for hypoglycemia and weight gain is low.
Which medication class also has an indication for weight loss?
DPP4 Inhibitors
GLP-1 Agonists
Sulfonylureas
SGLT-2 Inhibitors
GLP-1 Agonists
GLP-1 agonists like semaglutide and liraglutide has an indication for weight loss as well as diabetes management.
JS is a 61-year-old female who is interested in trying semaglutide for weight loss and diabetes management. Her primary care provider prescribes it to her but as she is leaving the clinic she mentions that she has a history of cancer. What type of cancer would be most concerning?
Breast
Colon
Thyroid
Lung
There is a boxed warning for the entire class of GLP-1 agonists to avoid this medication in certain types of thyroid tumors.
Thyroid
There is a boxed warning for the entire class of GLP-1 agonists to avoid this medication in certain types of thyroid tumors.
Which medication would it be most important to administer with meals to reduce GI upset?
Empagliflozin
Metformin
Dulaglutide
Insulin Glargine
Metformin
Metformin is well known to cause GI upset. It would be important to give it with meals. Empagliflozin is not as critical. Dulaglutide is only administered weekly and while it can cause GI upset, giving it with food would likely not be able to help this as it is given as an injection. Insulin glargine isn’t going to typically cause GI upset.
A 2-year-old male is diagnosed with type 1 diabetes. Which of the following agents would be most appropriate to initiate to manage hyperglycemia?
Metformin
Insulin
Glipizide
Empagliflozin
Insulin
Type 1 diabetes is historically defined as an insulin deficiency and we need to give insulin. Type 2 diabetes is historically known as a disease of insulin resistance that develops as patients age.
Which of the following is true with regard to insulin glargine?
- Hypoglycemia is more problematic with glargine versus insulin aspart
- It is a rapid acting insulin
- Weight loss is a common adverse effect
- It is typically given once daily
It is typically given once daily
Insulin glargine is a long-acting (sometimes referred to as “peakless” or “basal”) insulin. It is most often given once daily. Hypoglycemia risks tend to be greater with shorter-acting insulins like insulin aspart. Weight gain is common with all insulins.
Graves disease is associated with what disorder?
Hypothyroidism
Hyperthyroidism
Diabetes
Rheumatoid Arthritis
Hyperthyroidism
Graves disease is associated with hyperthyroidism. Hashimoto’s disease is associated with hypothyroidism.
Typically, if TSH is suppressed, the levothyroxine dose should be:
- No change
- Decreased
- Increased
- Calcium should be added with Levothyroxine
Decreased
A higher level of circulating (free) T4 leads to the inhibition of TSH secretion. Patients can experience symptoms of hyperthyroidism if this happens, so decreasing the Levothyroxine dose will increase TSH secretion.
Of the following, which would be the most appropriate increase in levothyroxine dose with a TSH of 12 and mild symptoms? The patient is on 75 mcg daily.
Increase to 200 mcg daily
Decrease to 37.5 mcg daily
Increase to 100 mcg daily
Decrease to 50 mcg daily
Increase to 100 mcg daily
A high TSH is a sign of hypothyroidism. Increasing the levothyroxine dose can lower TSH levels and reduce symptoms.
A psychiatric patient with severe delusions has refused to take their thyroid supplement. What is an uncommon but potentially fatal complication of hypothyroidism that can occur if left untreated for a long time or when hypothyroidism decompensates?
Myxedema coma
Rhabdomyolysis
Huntington’s Disease
Heart Failure
Myxedema coma
Myxedema is characterized by poor circulation, hypothermia, and hypometabolism.
Which of the following medications can cause hypothyroidism?
Amiodarone
Lithium
Carbamazepine
All of the above
All of the above
All of these medications can cause hypothyroidism. Periodic TSH monitoring and symptoms of hypothyroid monitoring would be appropriate.
